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Docusign Envelope ID: E74COCFE-CO64-4OD2-A75B-E107999569F8 <br />idderl espondent will submit <br />this completed document with <br />Bid/Proposal. <br />EXHIBIT 5C <br />MBE/WBE/Section 3 <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. I �� CER"TIFICA"TION AS A MINORFTY OWNED, WOMEN OWNED OR SECTION3 BUSINESS <br />I, certify that ( ) is / () is not <br />a Minority Owned, Women Owned or Section 3 Business. <br />Business Registered Name <br />Business Registered Address 1 <br />State of Registration: <br />Certificate or Registration Number: <br />Certifying Agency: <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 />Signature and Date: <br />Printed Name: <br />Position: <br />Page 1 of 2 <br />Page 31 of 43 <br />