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 __________________
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