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Bidder/Respondentwill submit <br /> <br />this completed document with <br />Bid/Proposal. <br />EXHIBIT 5C <br />-"%ȝ7"%ȝ3¤¢³¨®­ Β <br />Instructions: If the Respondent/Bidder is a Minority Owned Business (MOB) or Women Owned Business (WOB) <br />or qualifies as a Section 3 business, the Respondent completes Form F.1., and if the Respondent/Bidder intends <br />to utilize a MOB/WOB or Section 3 business in the performance of the proposed contract, the respondent <br />/bidder completes Form F.2 <br />F.1: CERTIFICATION AS A MINORITY OWNED, WOMEN OWNED OR SECTION 3 BUSINESS <br /> <br />I,________________________certifythat______________________________________()is / ( )is not <br />a Minority Owned, Women Owned or Section 3 Business. <br /> <br />Business Registered Name <br />Business Registered Address 1 <br />State ofRegistration: <br />Certificate or RegistrationNumber: <br />CertifyingAgency: <br /> <br />This certification is a material representation of fact upon which reliance was placed when this transaction was <br />made or entered into. The City reserves the right to withdraw or terminate the proposed contract should the <br />representation of fact be false. <br /> <br />Signature and Date: _____________________________________________________________ <br />Printed Name: _________________________________________________________________ <br />Position: ______________________________________________________________________ <br /> <br />Page 1 of 2 <br /> <br />Page 32 of 44 <br /> <br />