Laserfiche WebLink
Docusign Envelope ID: E74COCFE-CO64-4OD2-A75B-E107999569F8 <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: <br />Certification expires 12 months after date of signature <br />Signature: Date: <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 />Page 37 of 43 <br />