Section 3 Application for doing business with the APHA

Lakeside I IMG_0158-resizedBelow is an application for certification as a Section 3 company. 

You may copy and paste the application, email or mail it to us:

 

 

 

AVON PARK HOUSING AUTHORITY
SECTION 3 BUSINESS CERTIFICATION

Name of Business _______________________________________________________________
Address of Business _____________________________________________________________
Contact Person___________________________________________ Title __________________
Telephone______________________________________________

The bidder certifies that it is a Section 3 Business Concern based on:
____Status as a Section 3 resident-owned enterprise (at least 51% owned by Section 3 residents:
• Provide copy of resident lease, evidence of participation in a public assistance program, or
signed certification of Section 3 resident.
• Provide documentation of business ownership, such as copy of articles of incorporation,
partnership agreement, list of owners/stockholders and percentage ownership of each,
organization chart with names and titles.

____At least 30% of permanent, full-time employees are currently Section 3 Residents or were Section 3 residents within the past 3 years:
• Provide complete list of all permanent, full-time employees
• Provide list of employees claiming Section 3 status
• Provide documentation of Section 3 status for all applicable employees such as PHA residential lease or signed certification of Section 3 resident.

____Commitment to subcontract 25% of the dollar awarded to qualified Section 3 business (only applicable to prime contractors:
• Provide list of subcontracted Section 3 business(es) and subcontract amount
• Provide documentation of Section 3 status for applicable businesses.

I hereby certify that the information provided here is true and correct and understand that any falsification of any information provided could subject me to disqualification and punishment under the law.

__________________________________________ ______________________
Authorized Name and Signature Date

___________________________________________ ______________________
Witness Name and Signature Date

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