Document Sample
					Dear Applicant for GMSDC 2007-08 Reciprocal Services:
Thank you for your interest in Reciprocal Services from the Georgia Minority Supplier Development
Council (GMSDC), Inc. The GMSDC is the preeminent organization in the Georgia Region dedicated to
increasing procurement opportunities for Minority Business Enterprises (MBE). GMSDC is a regional
affiliate of the National Minority Supplier Development Council (NMSDC), which has more than 3,500
corporations among its members; more than 130 corporate members are in the Georgia region.

Enclosed is a copy of the GMSDC Minority Business Enterprise (MBE) Reciprocal Services Application.
This reciprocal services application is universally accepted within the NMSDC network. Please complete
the application in its entirety. If the requested information is not applicable to your company, please
state so on the application.

Criteria for a certified MBE to receive “Reciprocal Services” from the GMSDC requires: that a MBE
must be “certified and in good standing” with a regional affiliate (home council) of the NMSDC.
PLEASE NOTE: In Georgia, your enterprise shall have a local occupational license (the county where
your firm is located) and if incorporated or LLC, your enterprise shall be ”certified” by the Office
of Georgia Secretary of State (see for specific details or call
404.656.2817). Please see attached “Check List.”

The process for reciprocal services is as follows:
1. Complete attached Reciprocal Services Application; reciprocal services is an annual process. Firms
     shall apply each year for Reciprocal Services. A certified MBE receiving “reciprocal services” is
     “not” receiving a re-certification” from the GMSDC. Only your home council can recertify your
     firm and change your NAICS codes. Application shall be signed by the appropriate and authorize
     company official. The payment instrument (i.e., business credit card or business check) must be
     in the name of the reciprocal services firm (i.e., home council certificate). Please do not use a
     3rd party checks or credit cards.
2.   Submit “home council certificate” and Georgia support business documentation (if appropriate, visit
     our website for details). PLEASE NOTE: A Reciprocal Services’ Certificate will expire on the same
     date as your home council certification. If you are within 120 days of your home council certificate
     expiring, please complete your home council recertification first. With current certificate in hand,
     submit your GMSDC Reciprocal Services’ request along with your $350.00 fee.
3.   Upon approval by the GMSDC Board of Directors, applicants will be notified.
4.   Reciprocal Services certificate is faxed; original is placed in the US mail.

If you have questions about reciprocal services, contact your home council. If you have specific question
about the GMSDC Reciprocal Services process, please contact a GMSDC Certification staff at (404) 589-
1823 or visit our website: (applications). Thank you for your interest in GMSDC.


George Lottier, President and CEO


Section I
Name of Firm:
Mailing Address:
City:                                               State:                              Zip:
Contact Person:                            Owner’s Name:
Business Phone: (         )                         Fax Number: (         )
E-mail:                                              Web Address:
Federal Tax ID#:                                     Year Firm Started:
Date of Acquisition:
Method of Acquisition (check one):
Bought existing business                   Started a new business
Secured a franchise
Other (specify)
8(A) certified:                    Sinking Fund #:           Contract termination date:
Full-time employees:               Part-time employees:                # of minority employees:

List home council(s) you are currently certified with and certification date:
Council (Certified/Home)                                                  Date:                         ________
         (Recip Svcs)                                                     Date:                                _
         (Recip Svcs)                                                     Date:                                _
         (Recip Svcs)                                                     Date:                                _

Section II
Geographical Market: (circle one & list as appropriate).
Local:                                                   ____ ________
National:                                    International:_____
Type of Business Structure: (circle one)
C Corporation                I Individual      P Partnership     S Sole Proprietorship  L LLC
Type of Business: (circle primary function)
DS Distributor                      CC Construction Contractor           MF Manufacturer      MR Manuf. Rep.

CP Consultants/Professionals            SC Service Contractor             BA Brokers/Agents

Nature of Business: (provide full descriptive information and relevant NAIC CODES – codes must be the same as
those on home council certificate/MBISYS form) – use six digit code numbers only
a. NAICS Code (1): ______________________________________________________________________
NAICS Description: ______________________________________________________________________
b. NAICS Code (2): _______________________________________________________________________
NAICS Description: ______________________________________________________________________
c. NAICS Code (3): _______________________________________________________________________
NAICS Description: ______________________________________________________________________
d. NAICS Code (4): _______________________________________________________________________
NAICS Description: ______________________________________________________________________
e. NAICS Code (5): _______________________________________________________________________
NAICS Description: ______________________________________________________________________
f. NAICS Code (6): ________________________________________________________________________
NAICS Description: ______________________________________________________________________

Minority Ownership: (Specify the ethnic origin and % of ownership of the person(s) who own & control the firm)
BLM Black American Male                     %                BLF Black American Female                  %
HIM Hispanic American Male                  %                HIF Hispanic American Female___            %
NAM Native American Male                    %                NAF Native American Female                 %
APM Asian-Pacific Amer. Male___             %                APF Asian-Pacific Amer. Female _______%
AIM Asian-Indian Amer. Male                 %                AIF Asian-Indian Amer. Female _______%

The undersigned swears or affirms that the foregoing statements are true and correct and include all material
information necessary to identify and explain the operations of,                     as well as the ownership

I am executing this affidavit, and state that I am properly authorized by (name of firm)
                            to execute the affidavit and am doing so as a free act and deed.

Furthermore, I understand that I may not:
a) fraudulently obtain, retain, attempt to obtain nor aid another in fraudulently obtaining or retaining or
    attempting to obtain minority business enterprise certification:
b) willfully make a false statement, whether by affidavit, report, or other representation, to state official or
    employee for the purpose of influencing the certification or denial of certification of any entity as a
    minority business enterprise; or
c) willfully obstruct, impede, or attempt to obstruct or impede any state official or employee who is
    investigating the qualifications of a business entity which had requested certification as a minority business
d) any material misrepresentation will be grounds for initiating action under Federal or State laws concerning
    false statements.

(Appropriate Company officer)




CORPORATE SEAL (attest, where appropriate)




On this               , Day of                              , 200
Before me appeared (name)



Please include a copy of “current” your home council certificate and $350.00 non-refundable processing
fee/annual dues. Remit payment (please include all documents and fees together) to:
                                                GMSDC - Certifications
                                             58 Edgewood Avenue, 5 Floor
                                                  Atlanta, GA 30303


      Present your enterprise’s current RMSDC certificate (if your home council
       certificate expires over the next 120 days, get recertified first, then apply with
       the GMSDC).

      Present a completed Reciprocal Services application.

      Present payment of Reciprocal Service fee. Please pay with a business check
       or business credit card (i.e., name of enterprise must be embossed or printed
       on financial instrument). For credit cards payments please call 404.589.4929
       ext 2111 and speak with Rose.

      Please present a local occupational (business) license permit (from the Georgia
       county or city-- where your business will reside or operates). If applicable,
       please call the local county or city for specific details.

      Please present a Certification from the Office of the Georgia Secretary of State
       -- if your enterprise is a chartered entity (i.e., limited partnership, corporation
       or LLC). This certification will allow your enterprise to do business as a
       “foreign” entity in Georgia. Please speak with your legal advisor or call the
       Office of the Georgia Secretary of State at 404.656.2817 for specifics.

      Please have your enterprise’s documents signed by the appropriate company

      Please use the appropriate 6 digit NAICS codes (i.e., xxxxxx) and
       descriptions. Also note, if your enterprise plans to increase (i.e., change) the
       number of NAICS codes relative to the codes currently appearing on your
       “home council” certificate, please make the code change with your home
       council first. The GMSDC will only place the NAICS codes on your
       Reciprocal Services’ certificate that appear on your home council certificate.

      The 2007 – Certification Committee Meeting Dates (i.e., the committee will
       meet the 2nd Thursday of each month). All Reciprocal services applicants
       must be on the Certification Committee agenda:
       Jan 11, 2007                   Feb 8*
       Mar 8                          Apr 12
       May 10                         Jun 14
       Jul 12                         Aug 9**
       Sep 13                         Oct 11
       Nov 8                          Dec 13
          * If you want to exhibit at the GMSDC’s Business Opportunity Expo at the
          GA International Convention Center in College Park, GA on Wednesday,
          April 11, 2007, your certification materials must be turned in on this date.
          ** If you want to exhibit at the NMSDC’s Business Opportunity Expo at the
          Miami Beach Convention Center in Miami Beach, FL on Monday, October 29,
          2007, your certification materials must be turned in on this date.

      The Tentative 2007 – Board of Director Meeting Dates
       (All Reciprocal services applicants must be on the Certification Committee
       Agenda prior to being placed on the Board of Director’s Agenda.)

          Only the Board of Directors can certify a MBE enterprise. Thus, Certification
          Committee’s Chairwoman presents each enterprise before the Board of
          Directors. The Board of Director’s meetings are normally scheduled the 3rd
          Wednesday (usually, every other month).

          During the Board of Director’s meeting, the chairwoman of the Certification
          Committee recommends the Board of Directors to either approve or not
          approve each applicant for MBE certification. The Board of Director’s
          normally precede the GMSDC Business Opportunity Luncheon. Please verify
          all dates on our website.

          Anticipated 2007 Board Meetings (11:00am, GMSDC Headquarters)
          February 22, 2007            (Thursday)*
          April 18, 2007               (Wednesday)
          June 20, 2007                (Wednesday)
          August 23, 2007              (Thursday)
          October 3-4, 2007            (Wednesday-Thursday) GMSDC Board
                                       Retreat **

          * If you want to exhibit at the GMSDC’s Business Opportunity Expo at the
          GA International Convention Center in College Park, GA on Wednesday,
          April 11, 2007, your certification materials must be turned in on this date.
          ** If you want to exhibit at the NMSDC’s Business Opportunity Expo at the
          Miami Beach Convention Center in Miami Beach, FL on Monday, October 29,
          2007, your certification materials must be turned in on this date.

      Additional Questions? Please call – 404.589.4929, ext. 2104 (Certifications).

          GMSDC Certification Committee
          Dwan Armstrong
          Chairwoman and 2007 Member of the GMSDC Board of Directors.


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