Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

New York City Business Directory

VIEWS: 33 PAGES: 24

New York City Business Directory document sample

More Info
									                                                                                                       M/WBE Re-Certification




                                           THE CITY OF NEW YORK
                                    DEPARTMENT OF SMALL BUSINESS SERVICES
ROBERT W. WALSH
  COMMISSIONER

Dear Applicant,

Thank you for your interest in re-certifying in the Minority and Woman-Owned Business Enterprise (M/WBE) Program.

The Minority- and Women-Owned Business Enterprise Program seeks to ensure the greater participation of minority and
women-owned businesses in New York City’s procurement. To be eligible, businesses must 1) be at least 51% owned,
operated and controlled by a minority and/or woman (and be able to provide considerable proof to that effect), 2) have
been in business for at least one year, and 3) be located in New York City or have a significant tie to the City’s business
community (i.e., have conducted business in the city, have derived 25% or more of gross receipts from business
conducted in the city, possess a license issued by the city, etc.).

In order for us to completely process your application please take the following steps:

Step 1:           Obtain an “FMS Vendor Number,” which is required for all companies doing business with New York
                  City. To do so, complete a Vendor Application Form, which is available online at
                  www.nyc.gov/html/moc/html/bidderform.html. You may also obtain the form and an FMS Vendor
                  Number by calling 212-857-1680. Please be advised that it normally takes several weeks after registering
                  to receive your FMS Vendor Number.
                  * Please be advised when completing the Vendor Application Form you must select NIGP Codes
                  describing your company. Without NIGP codes your company will not appear in SBS Directory. *

Step 2:           Complete the two enclosed applications, entitled “Uniform Re-Certification Application” and “SBS
                  Supplemental Application”. The Department of Small Business Services (SBS) uses the “Uniform Re-
                  Certification Application” and you can use the same application to apply for certification at many other
                  governmental agencies, as listed on page IV, eliminating duplicate work. The “SBS Supplemental
                  Application” consists of those questions specific to SBS’ online Directory, which lists certified
                  companies on our website. This is an excellent way for you to gain exposure to the hundreds of public
                  and private purchasing officers who are looking to do business with New York’s M/WBEs.

Step 3:           Check that you have answered all questions and have signed and notarized both applications and the re-
                  certification affidavit.

Step 4:           Provide all of the requested supporting documents, as listed on page 10.

Step 5:           Submit the two applications and all supporting documents to the following address:
                                   New York City Department of Small Business Services
                                     Division of Economic and Financial Opportunity
                                 Minority and Woman-Owned Business Enterprise Program
                                          110 William Street, New York, NY 10038
It is extremely important that you answer all questions and provide all requested documentation. Without all of this
information, we cannot process your application and will return it to you for completion. Please call 311 and ask for the
M/WBE program or email us at mwbe@sbs.nyc.gov if you have any questions or if we can be of any further assistance.
                                                       Guidelines

Why Should I Certify My Business as a Minority or Woman-owned Business Enterprise?

The New York City Department of Small Business Services’ M/WBE program is designed to assist businesses owned and
controlled by minorities and women. It is of high importance to the program to help increase the participation of M/WBE
Certified Businesses in the procurement activities of New York City.

The NYC Department of Small Business Services M/WBE Certification gives the participating businesses an opportunity
to be listed in a city-wide Directory, used by different city agencies, contractors and businesses.


Who Is Eligible for M/WBE Certification?

Any ongoing independent business owned, operated and controlled by a U.S. Citizen/s or Permanent Resident Alien/s
who are minority group members or women. The ownership of the business must be real and continuing and the business
must be active for a period of at least one year. Ownership must show the authority to control the business decisions
independently.

Definitions:

Woman-owned Business Enterprise (WBE)

The Business Enterprise must show ownership by a woman/women owning fifty-one (51%) of the business. In the case
of a publicly owned business at least fifty-one (51%) must be owned by citizens or permanent aliens who are women.

Minority Business Enterprise (MBE)

A MBE business enterprise is at least fifty-one percent (51%) owned by or in the case of a publicly owned business at
least fifty-one (51%) percent of the stock is owned by citizens or permanent resident aliens who are:

           •   Black persons having origins in any of the Black African racial groups;

           •   Hispanic persons of Mexican, Puerto Rican, Dominican, Cuban, Central or South American descent of either
               Indian or Hispanic origin, regardless of race.

           •   Asian and Pacific Islander persons having origins in any of the Far East countries, Southeast Asia, the Indian
               subcontinent or the Pacific Islands; or

           •   Native American or Alaskan Native persons having origins in any of the original peoples of North America.




RMJ 7/03                                                       II
The Certification Process

           Contact the Mayor’s Office of Contracts either by the internet or by phone, to fill out or obtain an application for
           a FMS Vendor Number. You must obtain this number if you wish to do work with the city and get certified as a
           Minority and Woman-owned Business Enterprise. You will not be able to apply to the M/WBE Program with out
           this (FMS Vendor) number. If you have already obtained this number in the past, you may want to apply again if
           any of your original information has changed including commodity codes, address or contact person. To obtain
           the FMS Vendor Number, complete a Vendor Application Form, which is available online at
           www.nyc.gov/html/moc/html/bidderform.html.

           If you prefer, you may obtain the form by calling (212) 857 – 1680.

    •      Upon receiving a FMS Vendor Number, proceed in completing the M/WBE Certification Application and
           Supplemental Application. Fill out both the applications completely and in detail.

    •      Provide all the requested supporting documents listed on pages 10 - 13 of the certification application.

    •      Your application and documents are then assigned to an analyst who reviews all of the documentation. After
           reviewing the documents the analyst makes a determination whether to schedule an interview (audit) with the
           business owner or forward the file to the unit supervisor for final review and approval.

    •      Your firm will be notified after the final review of one of the following decisions: Certified, Denied or Rejected.

    •      If you business is denied certification, you are offered the opportunity to appeal the decision.

    •      If your firm is rejected, it generally means that your application was not able to be processed, due to missing
           information.


Geographic Requirements:

Only the following counties are recognized for the NYC M/WBE Certification:

New York State:            Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, Westchester.

New Jersey:                Bergen, Essex, Hudson, Middlesex, Monmouth, Morris, Passaic, Somerset, Union.

Connecticut:               Fairfield.


Out of state sole proprietorships and partnerships must provide a New York State Vendor Tax Number which can be
obtained by contacting NYS Department of Taxation and Finance (800) 972 – 1233.

If the business is an out of state corporation, then you must obtain a New York State Certificate of Authority. This
certificate may be obtained from the New York State Corporation Division (518) 473 – 2492.


Certifying Agencies

Attached is a listing of other certifying agencies to which you can apply to be certified. You may use the Uniform
M/WBE application but will probably have to get the certifying agency’s signature pages.




RMJ 7/03                                                        III
                                                                 CERTIFICATION AGENCIES
                          You may use copies of the same application and documents to apply to all of the agencies marked with (*) below


                                                                                                TIME
               AGENCY                          CONTACT               PHONE           FEE                        AREAS COVERED               GROUPS ELIGIBLE
                                                                                               TABLE
        *Empire State Development
                                                                                                             All 5 boroughs, New Jersey
       633 Third Avenue, 32nd Floor           Veena Bathija       (212) 803-2414      None      90 days                                      AA, AI, AP, H, NA
                                                                                                                   and Connecticut
           New York, NY 10017
 *Department of Small Business Services                                                                      All 5 boroughs, New Jersey
                   DEFO                                                                                      Nassau, Suffolk, Richmond,
                                              Alfred Milton       (212) 513-6311      None     10-30 days                                    AA, AI, AP, H, NA
       110 William Street, 2nd Floor                                                                          Rockland and Westchester
           New York, NY 10038                                                                                 Counties and Fairfield, CT
  *NYC School Construction Authority
          30-30 Thomson Avenue                 Lloyd Mair         (718) 472-8325      None     30-60 days     No geographic limitations       AA, AI, AP, H, NA
       Long Island City, NY 11101
     *The Port Authority of NY & NJ
                                                                                                                                             Minorities, woman-
  Office of Business and Job Opportunity                          (973) 565-5531                              All of New York and New
                                             Shanda Johnson                           None     30-60 days                                  owned, disadvantaged and
        1 Riverfront Plaza, 9th Floor                                                                                   Jersey
                                                                                                                                               small businesses
            Newark, NJ 07102
 Department of Administrative Services in
                                                                                                                                             AA, H, A Amer, AI,
   Connecticut Supplier Diversity Unit                            (860) 713-5047                 2 to 3        Only Connecticut-based
                                              Mark Carroza                            None                                                  women and individuals
            165 Capital Avenue                                                                   weeks                businesses
                                                                                                                                              with a disability
            Hartford, CT 06106
*AA – African American *AI - Asian Indian, * AP - Asian Pacific, *H - Hispanic, * NA - Native American, * A Amer - Asian American




RMJ 7/03                                                                           IV
                                              CITY OF NEW YORK
                                     DEPARTMENT OF SMALL BUSINESS SERVICES

                                     Division of Economic and Financial Opportunity
                                 Minority and Woman-Owned Business Enterprise Certification


                    UNIFORM RE-CERTIFICATION APPLICATION
                                                          General Instructions:
      (PLEASE TYPE OR PRINT CLEARLY. DO NOT LEAVE ANY SPACES BLANK ON THE APPLICATION.)

             If a question is not applicable to your business insert “N/A” in the space provided for your answer.
         You may make photocopies of the completed application as necessary. Whenever the space is insufficient to
      answer the questions completely, attach additional sheets as necessary. Use the question number to identify any
        answer continued on an additional sheet. Once you have completed the application, please return it and the
         required documentation to: NYC Department of Small Business Services, Division of Economic and
                 Financial Opportunity, Certification Unit, 110 William Street, New York, NY 10038

1a.        Name and Street Address of the Applicant Firm; (Enter the full legal name of the enterprise. For example, a corporation
           named ABC Construction, Inc. should be identified as “ABC Construction, Inc.” not as “ABC Construction”)

           (Company Name

           (Street Address)_________________________________________(City)

           (State)___________________(Zip Code)_____________________(County)

1b.        “Doing Business As” (D/B/A) Name;
           (Complete if firm does business under an assumed or trade name that is different from it legal name.)
           ___________________________________________________________________________________________

1c.        Mailing Address (Complete if different from the street address );
           ___________________________________________________________________________________________

           ___________________________________________________________________________________________

2.         Business Phone Number: (                ) _________________                  FAX: (         ) ____________________________

3a.        Federal Employer Identification Number OR Social Security Number (A Federal Employer Identification Number is
           required for most business activities. For an application and/or additional information, contact the U.S. Internal Revenue Service at
           (516) 447-4952. Sole proprietorships may submit social security number of the owner in lieu of the federal identification number):

           ___________________________________________

4a.        Name of the Company President/Chief Executive Officer/Owner:

           _________________________                  _________________________                     _________________________
           President                                  Chief Executive Officer                       Owner




RMJ 7/03                                                               -1-
4b.        Name & title of the officer of the firm who can be contacted during the application review process:

           _________________________________                     _________________________________
           Name                                                  Title


5.         This firm is applying for certification as (Please refer to page 12 of this application to determine the appropriate designation
           for your company. Please select: MBE, WBE or both, and DBE if you qualify.)
               Minority Business Enterprise (MBE)                   Disadvantaged Business Enterprise (DBE)
               Women-Owned Business Enterprise (WBE)

6.         Does this firm have current Small Business Administration (SBA) 8(a) status?
              Yes     No      If Yes, please attach a copy of the SBA letter of approval.

7.         Are you currently involved in the bidding process or other contract/purchase order negotiations with any
           governmental agency, department or authority?

             Yes      No      If Yes, Please identify agency, department or authority.

8a. Type of ownership (Please specify current ownership)

       Sole Proprietorship_______________ Certificate of Trade Name on file in ______________________________________
                                 Date Established                                                           County

       Partnership_______________ Business Certificate for Partners on file in_______________________________________
                         Date Established                                                                    County

       Corporation_______________ Certificate of Incorporation on file in ___________________________________________
                           Date Established                                                                 State


8b.Did the business exist under a different type of ownership prior to the date indicated in question 8a?

       Yes            No      If Yes, Explain_________________________________________________________________________

___________________________________________________________________________________________________________

8c. Has your Certificate of Incorporation or business certificate been amended?
      Yes             No      If Yes, Explain _________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

8d. Method of Acquisition ( check all applicable)
      Started New Business                                                            Secured Franchise

      Bought Existing Business                                                        Secured Concession

      Inherited Business                                                              Merger or Consolidation

      Other ______________________________________________________

      Date of Acquisition _______________________________________________


RMJ 7/03                                                            -2-
8e. Name & Position of all Person(s) with ownership interest
    (Check all that are applicable. If no positions are held state none)
                                                                                                                  U.S. Citizen or
                                                                           Group                                  Permanent
Name                                         Position                      Code        % Owned    Gender          Resident Alien

___________________________________ _____________________ __________ __________ Male Female                       Yes       No

___________________________________ _____________________ __________ __________ Male Female                       Yes       No

___________________________________ _____________________ __________ __________ Male Female                       Yes       No
     *Group Code Key
     01-Black         02a-Hispanic         03a-Asian-Pacific     04-Native American
                      02b-Portuguese       03b-Asian-Indian      05-Non-Minority
                      02c-Spanish                                06-Other

9. Please identify the cash and capital contributions to the firm by those identified in 8e, including gifts,
   equipment, loans, and expertise.

Contributor/Source                                      Amount/Value                       Type/Date of Contribution

__________________________________                      __________________________         ____________________________________

__________________________________                      __________________________         ____________________________________

__________________________________                      __________________________         ____________________________________

__________________________________                      __________________________         ____________________________________

10a. If the firm is a partnership, please complete for all the partners.

                                                        Total
                                                        Amount/Value                              Date of
Name                                                    of Contributions                          Ownership

__________________________________________ ____________________________________ ____________________________

__________________________________________ ____________________________________ ____________________________

__________________________________________ ____________________________________ ____________________________

__________________________________________ ____________________________________ ____________________________

__________________________________________ ____________________________________ ____________________________

10b. If the firm is a corporation, please complete for all the shareholders.
                                                                                   Common         Amount
                                                                     No. of            or         Paid When     Date of
Name                                                                Shares         Preferred      Purchased     Ownership

__________________________________________________ _____________ ______________ _____________ ______________

__________________________________________________ _____________ ______________ ______________ _____________

__________________________________________________ _____________ ______________ ______________ _____________


RMJ 7/03                                                           -3-
10c. If a corporation, the number of shares

Common Authorized________________________________________                Common Issued________________________________

Preferred Authorized________________________________________              Preferred Issued_______________________________


11. Gross Receipts (Sales) please provide gross receipts for the last 3 years.
    ( If in business for less than 3 years complete as applicable.)


    $_________________________________            $_____________________________           $__________________________
    Current Year ( 20______ )                      Last Year ( 20______ )                   Previous Year (200______ )



12. Number of Employees (Please average over the past year.)

                 Permanent                                           Temporary

    Full-Time _______________                             Full-Time _______________

    Part-Time _______________                             Part-Time _______________


13. If licensing, Permit or accreditation is required to conduct the business, please identify:


  Type of License/Permit          Issued by Issued Date Exp. Date                       Holder/Registrant

________________________________ ____________ ____________ _____________ _______________________________________________

________________________________ ____________ ____________ _____________ _______________________________________________

________________________________ ____________ ____________ _____________ _______________________________________________

________________________________ ____________ ____________ _____________ _______________________________________________

14a. Check the one(s), which best describe(s) the business operation.
           Construction-Related                    Consumer Service
           Professional Service                    Manufacture/Supplier
           Technical Service                       Retail

           Other (explain)_________________________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________


14b. Describe principal products/commodities sold/specialties/or services offered (Please explain)
________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________




RMJ 7/03                                                       -4-
15a. Identify those individuals responsible for the managerial operations (State if owner or non-owner.)
           *For Group Codes, see Page 13

Name & Title                               Gender             Group Code*           Owner or Non-Owner
1.   Financial Decisions

___________________________________         Male    Female   __________________      Owner     Non-Owner

___________________________________         Male    Female   __________________      Owner     Non-Owner
2.   Estimating

___________________________________         Male    Female    _________________      Owner     Non-Owner

_____________________________               Male    Female    _________________      Owner     Non-Owner
3.   Preparing Bids

____________________________________        Male    Female    _________________      Owner     Non-Owner

_____________________________               Male    Female    _________________      Owner     Non-Owner
4.   Negotiating Bonding

____________________________________        Male    Female   __________________      Owner     Non-Owner

____________________________________        Male    Female   __________________       Owner    Non-Owner
5.   Negotiating Insurance

____________________________________        Male    Female   __________________      Owner     Non-Owner

____________________________________        Male    Female   __________________      Owner     Non-Owner
6.   Marketing & Sales

____________________________________        Male    Female   ___________________     Owner     Non-Owner

____________________________________        Male    Female   ___________________     Owner     Non-Owner
7.   Hiring & Firing

____________________________________        Male    Female   ___________________     Owner     Non-Owner

____________________________________        Male    Female   ___________________     Owner     Non-Owner
8.   Supervising Field Operations

____________________________________        Male    Female   ___________________     Owner     Non-Owner

____________________________________        Male    Female   ___________________     Owner     Non-Owner
9.   Purchasing Equipment/Supplies

____________________________________        Male    Female   ____________________    Owner     Non-Owner

____________________________________        Male    Female   ____________________    Owner     Non-Owner
10. Managing & Signing Payroll

____________________________________        Male    Female   ____________________    Owner     Non-Owner

____________________________________        Male    Female   ____________________    Owner     Non-Owner
11. Negotiating Contracts

____________________________________        Male    Female   ____________________    Owner     Non-Owner

____________________________________        Male    Female   ____________________    Owner     Non-Owner
12. Signatures for Business Accounts

____________________________________        Male    Female   ____________________    Owner     Non-Owner

____________________________________        Male    Female   ____________________    Owner     Non-Owner

RMJ 7/03                                                      -5-
15b. Do any of the following also work for another firm? If yes, please provide the person’s name, his/her positions, the other
firm’s name, address and telephone number.

                                 Name & Position                     Other Firm Name, Address             Phone

1.     Office staff

     Yes      No _________________________________________ _______________________________________ ________________________

     Yes      No _________________________________________ _______________________________________ ________________________


2.     Field/Supervisory staff

     Yes      No _________________________________________ _______________________________________ ________________________

     Yes      No _________________________________________ _______________________________________ ________________________


3.     Estimator

     Yes      No _________________________________________ _______________________________________ ________________________

     Yes      No _________________________________________ _______________________________________ ________________________


4.     Controller

     Yes      No _________________________________________ _______________________________________ ________________________

     Yes      No _________________________________________ _______________________________________ ________________________


5.     Consultants (for firms involved in providing consultants/technical service or advisory service:)

     Yes      No _________________________________________ _______________________________________ ________________________

     Yes      No _________________________________________ _______________________________________ ________________________


15c. Does this firm share the following with any other firm? If Yes, please provide the other firm’s name, address & telephone
number.

                                 Other Firm Name                              Address                     Phone

1.     Office space

     Yes      No      _______________________________________________ ________________________________ _______________________

     Yes      No      _______________________________________________ ________________________________ _______________________


2.     Yard space

     Yes      No      _______________________________________________ ________________________________ _______________________

     Yes      No      _______________________________________________ ________________________________ _______________________


3.     Equipment (include rentals)

     Yes      No      _______________________________________________ ________________________________ _______________________

     Yes      No      _______________________________________________ ________________________________ _______________________



RMJ 7/03                                                               -6-
16a. List rented, leased, or owned warehouse, plant and office facilities.

Facility type                                Lesser and/or rental agent                             Amount or yearly rent payment

______________________________________ ________________________________________ ________________________________________

______________________________________ ________________________________________ ________________________________________

______________________________________ ________________________________________ ________________________________________

______________________________________ ________________________________________ ________________________________________


16b. List major equipment or machinery, which is owned or leased by the firm.

                                             Depreciated                          Acquisition                Payment
Type                                         dollar value                         date                       terms

______________________________________ _______________________________ ________________________ ________________________

______________________________________ _______________________________ ________________________ ________________________

______________________________________ _______________________________ ________________________ ________________________

______________________________________ _______________________________ ________________________ ________________________

______________________________________ _______________________________ ________________________ ________________________

______________________________________ _______________________________ ________________________ ________________________

______________________________________ _______________________________ ________________________ ________________________


17. Do any principals, officers and/or owners of the firm have an affiliation (i.e. business interest or employment) with any
    other firm? If Yes, please complete.

 Yes       No

Name of                                   Firm name                 Phone                   Nature of                  Nature of
Person                                    & address                 number                  business                   affiliation

____________________________________ ______________________ ____________________ ______________________ ________________

____________________________________ ______________________ ____________________ ______________________ ________________

____________________________________ ______________________ ____________________ ______________________ ________________

____________________________________ ______________________ ____________________ ______________________ ________________

____________________________________ ______________________ ____________________ ______________________ ________________


18. Attorney for the firm

________________________________________________________________________________________________________________________
Name

_______________________________________________________________________________________________________________________________________
Street Address

_______________________________________      _________________            ______________________    _________________________________
City                                         State                        Zip Code                  Phone Number


RMJ 7/03                                                         -7-
19. C.P.A. or Accountant for the firm.

________________________________________________________________________________________________________________________
Name

_______________________________________________________________________________________________________________________________________
Street Address

_______________________________________     _________________           ______________________    _________________________________
City                                        State                       Zip Code                  Phone Number

20a. Has the firm applied for certification as an M/WBE, or DBE with another governmental agency,
     department or authority? Yes          No      If Yes, complete the following:

Agency                        Date                     Contact Person                     Phone                    Specify M/W/DBE
1. Pending with

__________________________ _____________________ ______________________________ ______________________ _________________

__________________________ _____________________ ______________________________ ______________________ _________________

__________________________ _____________________ ______________________________ ______________________ _________________

2.   Certified by

__________________________ _____________________ ______________________________ ______________________ _________________

__________________________ _____________________ ______________________________ ______________________ _________________

__________________________ _____________________ ______________________________ ______________________ _________________

__________________________ _____________________ ______________________________ ______________________ _________________

3.   Registered by

__________________________ _____________________ ______________________________ ______________________ _________________

__________________________ _____________________ ______________________________ ______________________ _________________

4.   Withdrawn/Closed out

__________________________ _____________________ ______________________________ ______________________ _________________

5.   Rejected by

__________________________ _____________________ ______________________________ ______________________ _________________

6.   Denied by

__________________________ _____________________ ______________________________ ______________________ _________________

7.   Decertified by

__________________________ _____________________ ______________________________ ______________________ _________________

20b. Are there appeals pending on any of the above applications or certifications?
           Yes        No
Agency                                Date of Appeal         Agency                    Contact Person             Phone

_________________________________ ___________________ ______________________ ________________________ _________________

_________________________________ ___________________ ______________________ ________________________ _________________

_________________________________ ___________________ ______________________ ________________________ _________________
RMJ 7/03                                                          -8-
21. List the three (3) largest accounts for which the applicant has provided goods or services within the last two years:

                                Account                 Location of
Firm Name & Phone               Dollar Amount           Performance             Duration
_______________________________ ___________________ __________________ ___________________________

_______________________________ ___________________ __________________ ___________________________

_______________________________ ___________________ __________________ ___________________________

_______________________________ ___________________ __________________ ___________________________

22. Identify Bank(s) where firm’s accounts are maintained.

Bank Name                         Address                     Contact                 Type of Account            Account No.
_________________________         ___________________         ___________________     __________________         _____________

_________________________         ___________________         ___________________        __________________      _____________

_________________________         ___________________         ___________________        __________________      _____________

23. Do you have a line of Credit? If yes, Identify.
          Yes     No
Source                                  Limit                           Name of Guarantor(s)
_______________________________ _________________________ _______________________________________

_______________________________ _________________________ _______________________________________

_______________________________ _________________________ _______________________________________

24. List major current creditors and/or lenders and types of investments and/or loans in the firm.

Name of                         Type of investment              Dollar value of investment/
Creditor/lender                 credit/loan                              terms/credit/loan
_______________________________ ________________________________ _________________________________

_______________________________ ________________________________ _________________________________

_______________________________ ________________________________ _________________________________

_______________________________ ________________________________ _________________________________

25. If your company is owned in full or in part by another firm, please identify the firm and the percentage of ownership
    interest. Include venture capitalists and other similar investors.

Firm Name                                             Address                                   Percentage Ownership
______________________________________                _________________________________         _________________________

______________________________________                _________________________________          _________________________

______________________________________                ________________________________           _________________________

26. Is the firm bonded? If yes, specify type and limit.
      Yes          No

Bonding Company ____________________________________________________________________

Address _____________________________________________________________________________

Telephone(     )_____________________________ Contact Person__________________________________________

Type ______________________________________                   Amount _______________________________________________

RMJ 7/03                                                        -9-
                                          SUPPORTING DOCUMENTS
A. REQUIRED FOR ALL APPLICANTS
(Attach copies of the following documents. Please indicate documents submitted by checking the appropriate
boxes. All documents must be submitted for certification.)

NOTE: If appropriate documents are not submitted AND no written explanation is given, the application will be
returned to you. The following certifying agencies; New York State (NYS), School Construction Authority (SCA),
New York City (NYC), listed in ( ), require those specific document(s) for certification.

  1.    Resumes of all principals, partners, officers and/or key employees of the firm.
        Show home address and telephone number, education, training and employment with dates.
                                         (Required by: NYS, SCA and NYC)

  2.    Bank signature card, bank resolution, or letter from the bank identifying persons authorized to conduct
        transactions, level of authority and limitations, if any.
                                           (Required by: NYS, SCA and NYC)

   3.   Current financial statement.
        (Required by: NYS, SCA and NYC)

   4.   Prior three years Federal, State and City tax returns including all schedules, where applicable.
                                          (Required by: NYS, SCA and NYC)

   5.   Prior two (2) years Personal Tax Returns (1040s) and all applicable W-2 forms for all the owners/partners.
                                               (Required by: NYC)

   6.   Proof of sources of capitalization/ investments. (a copy of three (3) receipts with their cancelled checks
        showing items that were purchased for the business to help improve it within the last two (2) years)
                                            (Required by: NYS, SCA and NYC)

   7.   Copies of permits or licenses granted by government agencies
                                         (Required by: NYS, SCA and NYC)

   8. Lease Agreements or Deed for location from where the business operates, and/or stores equipment.
                                      (Required by: NYS, SCA and NYC)

   9. All third party agreements including equipment rental, purchased agreements, management service
       agreements, utility bills for three (3) months, etc.
                                           (Required by: NYS, SCA and NYC)
   10. Copy of two (2) completed contracts within the last two (2) years within the five (5) boroughs
       of New York City.
                                                  (Required by: NYC)
   11. Vehicle registration(s)
        (Required by: NYS, SCA and NYC)

   12. Any certification, de-certification or denial of certification documentation.
                                          (Required by: NYS, SCA and NYC)

NOTE: if appropriate documents are not submitted AND no written explanation is given, application will not be processed.
                                            (Required by: NYS, SCA and NYC)

RMJ 7/03                                                     - 10 -
                                       DEFINITIONS OF MBE, WBE AND DBE
                                            (To be used to answer Question 5, Page 1)



MINORITY BUSINESS ENTERPRISES (MBE)-A business enterprise, which is at least fifty-one percent (51%)
owned by, or in case of a publicly owned business at least fifty-one percent (51%) of the stock of which is owned by citizens
or permanent resident aliens meeting the ethnic definitions of:

           01      Black
           02a     Hispanic
           03a     Asian-Pacific
           03b     Asian-Indian
           04      Native American



WOMEN-OWNED BUSINESS ENTERPRISE (WBE)-A business enterprise which is at least fifty-one percent
(51%) owned by, or in the case of a publicly owned business at least fifty-one percent (51%) of the stock of which is owned by
citizens or permanent resident aliens who are women.


DISADVANTAGE BUSINESS ENTERPRISE (DBE)-A small business concern, which is at least fifty-one percent
(51%) owned and controlled by one or more socially and economically disadvantaged individuals or, in the case of a publicly
owned business, at least fifty-one (51%) of the stock of which is owned by one or more socially and economically
disadvantaged individuals; and whose management and daily business operations are controlled by one or more such
individuals.

“Socially and economically disadvantaged individuals” are individuals who are citizens or lawful permanent residents of the
United States and who are:


           01      Black
           02a     Hispanic
           02b     Portuguese
           02c     Spanish
           03a     Asian-Pacific
           03b     Asian-Indian
           04      Native American
           05      Non-Minority

           Women, regardless of race or ethnicity

        Members of other groups or other individuals found, on case-by-case basis, to be economically and socially
disadvantage by the U.S. Department of Transportation grant recipients or by the Small Business Administration under
Section 8 (a) of the Small Business Act, as amended (15 U.S.C. 637(a) ).



UNDER EACH CERTIFICATION CATEGORY, OWNERSHIP MUST BE REAL, SUBSTANTIAL AND
CONTINUING.   THE APPLICANT MUST HAVE AND EXERCISE THE AUTHORITY TO
INDEPENDENTLY CONTROL THE BUSINESS DECISIONS OF THE ENTERPRISE.




RMJ 7/03                                                      - 11 -
                                    DEFINITIONS OF GROUP CODES
                           (To be used to answer Question 8e, Page 2; and Question 15a,
                               Pages 4 & 5; and Supporting Documents D7, page11)




Group                        Group                        Group
Code                         Name                         Definition
___________________________ _____________________________ ______________________________________________


01                          Black                              Persons having origins from any of the Black African
                                                               racial groups


02a                         Hispanic                           Persons of Mexican, Puerto Rican, Dominican, Cuban,
                                                               Central or South America descent of either Indian or
                                                               Hispanic origin, regardless of race


02b                         Portuguese                         Persons whose culture or origin is rooted on Portugal


02c                         Spanish                            Persons whose culture or origin is rooted in Spain.


03a                         Asian-Pacific                      Persons having origins from the Far East, Southern Asia
                                                               or the Pacific Islands


03b                         Asian-Indian                       Persons having origins from the Indian subcontinent


04                          Native American                    Persons having origins in any of the original peoples of
                                                               North America


05                          Non-Minority                       Persons whose culture or origin is other than those defined
                                                               above


06                          Other                              Persons other than defined above who believe they are
                                                               socially and economically disadvantaged




RMJ 7/03                                              - 12 -
                THIS APPLICATION MUST BE VERIFIED UNDER OATH BY AN AUTHORIZED
                                 REPRESENTATION OF APPLICANT




                   The undersigned, ____________________________________________________, being the

_________________________________ of ___________________________________________, does hereby apply for
              (title)                                (firm name)



Certification as a Minority Owned Business Enterprise (“MBE”) or Woman Owned Business Enterprise
(“WBE”) and for that purpose does hereby certify and set forth:

           1.      The Application form, the supporting documents, and any other information provided in support of the
                   Application are considered part of the Application. It is recognized and acknowledged that the information
                   contained in the Application is given under oath, that this Application is being submitted as an inducement to
                   the New York City Department of Small Business Service (“SBS”) to certify the Applicant as a MBE or a
                   WBE and that the DBS will rely on the information supplied therein, in order to determine the eligibility of
                   the Applicant for such certification.

           2.      The Applicant agrees to provide notice to the SBS of any material change in the information contained in this
                   Application within 30 days of such change.

           3.      The Applicant understands that the SBS may require proof of minority or woman status in addition to the
                   information disclosed in this Application. By making this Application, the Applicant agrees to submit
                   additional proof if it is requested and acknowledges that the DBS may decide not to certify the Applicant as a
                   MBE or a WBE if the additional proof is not submitted within 20 days after the date that is requested by the
                   SBS.

           4.      The Applicant understands that a material false statement or omission made in connection with the
                   Application is sufficient cause for the denial of certification or revocation or revocation of prior certification
                   and may subject the person and/or entity making the false statement to any and all civil and criminal
                   penalties available pursuant to applicable law.

           5.      By filing the Application with the SBS, the Applicant consents to inquiries by the SBS of the Applicant’s
                   bonding companies, banking institutions, credit agencies, contractors, affiliates, clients, other certifying
                   agencies, and any entity named in the Application to ascertain the Applicant’s eligibility for certification.
                   The Applicant also consents to the inspection by the SBS of its place of business, books and records, and to
                   permit interviews of its principals and employees. The Applicant acknowledges that refusal to permit such
                   inquiries shall be grounds for denial of certification.



(Name of Applicant) _______________________________________________________


                        By _______________________________________________________
(Name of Capacity)



RMJ 7/03                                                         - 13 -
                                                                     VERIFICATION


STATE OF                                               )
                                                       )          SS.:
COUNTY OF                                              )


(A) ___________________________________________________________, being duly sworn, states he or she is the owner of
                                 (Print Name)
(or partner in) the enterprise making the foregoing Application and that the statements and representations made in the
Application are true to his or her own knowledge.



(B)_______________________________________________________________, being duly sworn, states that he or she is the
                      (Print Name of Corporate Officer)



________________________________________________of _________________________________________________________
                      (Print Title of Corporate Officer)                                           (Print Name of Corporation)



Federal Employer Identification Number OR Social Security Number: _______________________________________________


New York City FMS Vendor Number: ______________________________________________________


the enterprise making the foregoing application, that he or she read the Application and knows its contents, that the statements
and representations made in the Application are true to his or her knowledge, and that the Application is made at the direction
of the Board of the Board of Directors of the Corporation.




           _______________________________________________                                         _______________________________
                                 Signature                                                                       Date




Sworn before me this _____________________

day of _____________________, 20___

                      __________________________________________
                                      (Notary Public)



Person assisting in completion of the Application:                                      ______________________________________________
                                                                                                              Print Name

____________________________________________________                                    ______________________________________________
                      Signature                                                                       Telephone No.

Included with this application is a voter registration form in compliance with Local Law 29 of 2000, Government services/benefits are not conditioned on the
completion or submission of this voter registration form.
RMJ 7/03                                                                       - 14 -
                                     DEPARTMENT OF SMALL BUSINESS SERVICES
                                        M/WBE RECERTIFICATION AFFIDAVIT

STATE OF_______________________)                                   COMPANY TAXPAYER I.D.#____________
                                ) SS:
COUNTY OF_____________________)                                    S.S.#_______ _____ _______



I, ____________________________________, being duly sworn, deposes and says:
              (full name)


           1.   I am an owner of (or a partner in) ________________________________________(the “Applicant”) and do hereby
                apply for recertification as a Minority Owned Business Enterprise (“MBE”) and/or a
                Woman Owned Business Enterprise (“WBE”) and for that purpose do hereby certify and set forth:

           2.   The application form, the supporting documents and any other information provided in support of the
                application are considered part of the application (the “Application”). I recognize and acknowledge that the information
                contained in the application is given under oath, that this application is being submitted as an inducement to the New
                York City Department of Small Business Services (“SBS”) to certify the Applicant as a MBE or WBE and that the SBS
                will rely on the information supplied therein, in order to determine the eligibility of the Applicant for such certification.

           3.   The Applicant agrees to provide written notice to SBS, within forty-two (42) business days, of any material change in the
                content of the MBE and/or WBE Certification Application or other documentation submitted to SBS on behalf of the
                Applicant. The Applicant understands that a material change includes, but is not limited to, any change in: corporate
                structure, ownership interest, managerial operations, officers and primary employees, capital funding, affiliations, or
                sources of equipment and facilities;

           4.   The Applicant agrees to submit additional documentation of eligibility to SBS upon request. The Application
                acknowledges that SBS may decide not to continue to certify the Company as a MBE or a WBE if such additional
                documentation is not submitted within twenty-eight (28) business days after the date that information is requested by
                SBS;

           5.   The Applicant consents to inquiries by SBS of the Applicant’s bonding companies, banking institutions, credit agencies,
                contractors, affiliates, clients, other certifying entities and any entity named in the Application to ascertain the
                Applicant’s eligibility for certification. The Applicant consents to the inspection by SBS of its place of business, books
                and records, and to permit interviews of principals and employees. The Applicant acknowledges that refusal to promptly
                permit such inquiries to take place shall be grounds for revocation of certification; and

           6.   I understand that a material false statement or omission made in connection with this document, the Application or any
                other documentation relating to the Company’s certified MBE or WBE status is sufficient cause for revocation of
                certification and may subject the person and/or entity making the false statement to any and all civil and criminal
                penalties available pursuant to applicable law.


           _______________________________                                    Sworn to before me this ________
           Owner/Partner Signature
                                                                              Day of ________________, 200___

           _______________________________                                    _____________________________
                              Date                                                    (Notary Public)


RMJ 7/03                                                             - 15 -
                                        SBS Supplemental Application
                                                      General Instructions:

    (PLEASE TYPE OR PRINT CLEARLY. DO NOT LEAVE ANY SPACES BLANK ON THE APPLICATION.)

                                                -IMPORTANT-
 Before filling out this certification application you must obtain a FMS Vendor Number. To do so, complete a Vendor
              Application Form, which is available online at www.nyc.gov/html/moc/html/bidderform.html.
                              If you prefer, you may obtain a form by calling (212) 857 – 1680.

                   Your application will not be processed without the FMS Vendor Number.
            If you already have an FMS Vendor Number please call (212) 857 -1680 or go online at
www.nyc.gov/html/moc/html/bidderform.html to check that your business information and NIGP Commodity Codes
                                          are correct and up to date.

     Once you obtain a number you may complete the questions in this Supplemental Application. Completion of this
                      application will help us better market your goods and services to purchasers.
                                      Thank you for taking the time to complete it.

          If a question is not applicable to your business insert “N/A” in the space provided for your answer.
 You may make photocopies of the completed application as necessary. Whenever the space is insufficient to answer
  the questions completely, attach additional sheets as necessary. Use the question number to identify any answer
    continued on an additional sheet. Once you have completed the application, please return it and the required
documentation to: NYC Department of Small Business Services, Division of Economic and Financial Opportunity, 110 William
                                                    Street, New York, NY 10038
(Please Type or Print Clearly)

    1)      Company Name: ____________________________________________________

    2)      Doing Business As, Name: _____________________________________________

    3)      FMS Vendor Number: ________________________________________________
                (You must obtain an FMS Vendor ID Number; your application will not be processed without it)

    4)      Email Address: ______________________________________________________

    5)      Company Description: ________________________________________________


            _____________________________________________________________________

RMJ 7/03                                                         - 16 -
    6)         Highest Level of Bonding ($): __________________________________________

    7)         Targeted Geographic Market: (Please Check the Appropriate Box or Boxes)
                                      □       New York City
                                      □       New York City Metropolitan Area
                                      □       New York State
                                      □       Northeast/Mid-Atlantic Region
                                      □       National
                                      □       Other
                                              (Please specify): _________________________________


    8)         Company Work Experience:
           (Please provide a listing of one (1) to three (3) contracts/jobs performed within the last two years that you would like
           to have listed in the SBS Directory. These contracts/jobs will represent your company in the SBS Directory as to the
           experience and type of work your company performs)



                                                    Company Experience #1

o   Name of Organization for Whom Work Was Performed: _____________________________________

o   Date of Work (Month/Year): ____________________________________________________________

o   Value of Job: __________________________________________________________________________

o   Brief description of the work that was performed:


      ______________________________________________________________________________________


     ______________________________________________________________________________________


o   Organization Contact - Last Name, First Name, Title:

     _______________________________________________________________________________________


o   Telephone Number of Organization: _____________________________________________________




RMJ 7/03                                                            - 17 -
                                         Company Experience #2

o   Name of Organization for Whom Work Was Performed: _____________________________________

o   Date of Work (Month/Year): ____________________________________________________________

o   Value of Job: __________________________________________________________________________

o   Brief description of the work that was performed:

    ______________________________________________________________________________________

     ______________________________________________________________________________________


o   Organization Contact - Last Name, First Name, Title:

     ______________________________________________________________________________________


o   Telephone Number of Organization: _____________________________________________________




                                         Company Experience #3

o   Name of Organization for Whom Work Was Performed: _____________________________________

o   Date of Work (Month/Year): ____________________________________________________________

o   Value of Job: __________________________________________________________________________

o   Brief description of the work that was performed:

    ______________________________________________________________________________________

    ______________________________________________________________________________________

o   Organization Contact - Last Name, First Name, Title:

     ______________________________________________________________________________________


o   Telephone Number of Organization: _____________________________________________________




RMJ 7/03                                                - 18 -
Please fill out the following so we can better focus our resources (optional):

How did you find out about our program?


Letter __________          Telephone __________      Event __________

(If Event was checked please answer the following)



Name of the Event _____________________________________________________________________________


Name of the SBS Representative: _________________________________________________________________


Other (Please explain) _________________________________________________________________________


______________________________________________________________________________________________




RMJ 7/03                                              - 19 -
                                   VERIFICATION

STATE OF                                  )
                                          )          SS.:
COUNTY OF                                 )


(A) ___________________________________________________________, being duly sworn, states he or she is the owner of
    (or partner in) the enterprise making the foregoing Application and that the statements and representations made in the
    Application are true to his or her own knowledge.

(B) ______________________________________________________________, being duly sworn, states that he or she is the

Name of Corporate Officer

________________________________of __________________________________________
Title of Corporate Officer                                                     Name of Corporation

the enterprise making the foregoing application, that he or she read the Application and knows its contents, that the
statements and representations made in the Application are true to his or her knowledge, and that the Application is made at
the direction of the Board of the Board of Directors of the Corporation.



                     _____________________________                    _______________________________
                            Signature                                               Date




Sworn before me this _____________________

Day of _____________________, 20___


           __________________________________________
                         (Notary Public)




Person assisting in completion of the Application:           ______________________________
                                                     Print Name

__________________________________________                            ________________________________
              Signature                                                      Telephone No.




RMJ 7/03                                                     - 20 -

								
To top