Affidavit For Claiming Status As A Disadvantaged Business Form printable pdf download

Affidavit For Claiming Status As A Disadvantaged Business Form

STATE OF

COUNTY OF

AFFIDAVIT FOR CLAIMING STATUS AS A DISADVANTAGED

BUSINESS

BIDDER, AFTER BEING FIRST DULY SWORN, AFFIRMS THAT IT IS A DISADVANTAGED BUSINESS

AS DEFINED BY THE CODE OF LAWS OF THE METROPOLITAN GOVERNMENT OF NASHVILLE

AND DAVIDSON COUNTY TENNESSEE AND THE REGULATIONS THERETO.

AS DEFINED IN SECTION 4.44.010 OF THE METROPOLITAN CODE OF LAWS;

“Disadvantaged Business” means a small business which is owned or controlled by a majority of persons,

not limited to members of minority groups, who have been deprived of the opportunity to develop and

maintain a competitive position in the economy because of social disadvantage or disability.

BIDDER CLAIMS STATUS AS:

MINORITY-OWNED SMALL BUSINESS

__________

WOMEN-OWNED SMALL BUSINESS

__________

DISABLED-OWNED SMALL BUSINESS

__________

BIDDER CLAIMS STATUS AS A MINORITY-OWNED SMALL BUSINESS AS BEING:

AFRICAN AMERICAN-OWNED SMALL BUSINESS

__________

HISPANIC AMERICAN-OWNED SMALL BUSINESS

__________

ASIAN AMERICAN-OWNED SMALL BUSINESS

__________

NATIVE AMERICAN-OWNED SMALL BUSINESS

__________

________________________________

BIDDER

SWORN TO AND SUBSCRIBED BEFORE ME, A NOTARY PUBLIC, FOR THE ABOVE STATE AND

COUNTY, ON THIS ________________ DAY OF __________________________, 19_____.

________________________________

NOTARY PUBLIC

MY COMMISSION EXPIRES ______________________________________

Note:

If status above has been certified by one or more other Government Entities, please attach

copy(s) of said certification(s) to this affidavit.

Affidavit For Claiming Status As A Disadvantaged Business Form