Laserfiche WebLink
Docusign Envelope ID:3EDD0960-FFF6-43E2-8E49-1A7B2008A238 <br /> ATTACHMENT F-SECTION 3 BUSINESS CONCERN CERTIFICATION FORM FOR CONTRACTING <br /> To certify your business' Section 3 status, enter the following information and select applicable criteria: <br /> Business Information <br /> Name of Business: <br /> Address of Business: <br /> Name of Business Owner: <br /> Phone Number of Business Owner: <br /> Email Address of Business Owner: <br /> Preferred Contact Information <br /> ❑ Same as above, or: <br /> Name of Preferred Contact: <br /> Phone Number of Preferred Contact: <br /> Email Address of Preferred Contact: <br /> Type of Business(select from the following options): <br /> ❑Corporation ❑Partnership ❑Sole Proprietorship ❑Joint Venture <br /> Select from ONE of the following three options below that applies: <br /> ❑ At least 51 percent of the business is owned and controlled by low-or very low-income persons (Refer to income <br /> guidelines below). <br /> ❑ At least 51 percent of the business is owned and controlled by current public housing residents or residents who <br /> currently live in Section 8-assisted housing. <br /> ❑ Over 75 percent of the labor hours performed for the business over the prior three-month period are performed by <br /> Section 3 Workers (Refer to definition below). <br /> Business Concern Affirmation <br /> I affirm that the above statements are true, complete, and correct to the best of my knowledge and belief. I understand <br /> that businesses who misrepresent themselves as Section 3 Business Concerns and report false information to the City of <br /> San Marcos,Texas, may have their contracts terminated as default and be barred from ongoing and future considerations <br /> for contracting opportunities. I hereby certify, under penalty of law, that this information is correct to the best of my <br /> knowledge. <br /> Printed Name: Signature: Date: <br /> Certification expires 12 months after date of signature <br /> Information regarding Section 3 Business Concerns can be found at 24 CFR 75.5 <br /> FOR ADMINISTRATIVE USE ONLY <br /> Is the business a Section 3 business concern based upon their certification? ❑YES ❑NO <br /> EMPLOYERS MUST RETAIN THIS FORM IN THEIR SECTION 3 COMPLIANCE FILE FOR FIVE YEARS. <br /> Last Updated: 12/20/21 Certification Form Four Page 1 of 2 <br />