JSEB - JSEB For-Profit Application

Driver’s License (preferred) or state issued photo ID for Primary Owner

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Proof of citizenship for Primary Owner: Birth Certificate, Voter’s Registration Card, Permanent Resident Alien Status, Passport, or Naturalization Papers

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Proof of residency for Non-Homeowners

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Rental agreement and Declaration of Domicile obtained at the court House

Last three years of complete Business Federal Tax Returns

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Part 1

Last three years of complete Business Federal Tax Returns

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Part 2

Last three years of complete Business Federal Tax Returns

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Part 3

Current Business Tax Receipt

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Capabilities Statement

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Visit https://jseb.jacksonville.gov/jseb-application to retrieve the Capabilities Statement template.

Current Professional and Special License(s) as REQUIRED

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Current Florida Department of Revenue Forms DR-11 and DR-13 (for Suppliers)

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Current Resume of Primary Owner

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Three executed contracts, purchase orders or relevant invoices

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Part 1

Three executed contracts, purchase orders or relevant invoices

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Part 2

Three executed contracts, purchase orders or relevant invoices

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Part 3

Building / office lease / rental agreement for business site (if applicable)

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List of equipment, assets, inventory with the approximate value, owned by the firm.

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List other relevant documents

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By checking the box, you consent to the following statement: The applicant swears that the initial and any supplemental information, statements and documents provided are: (i) provided in an effort to induce the grant of JSEB certification with the City of Jacksonville; and (i) true and correct and include all material information necessary to identify and explain the operations of the undersigned’s business, as well as the ownership thereof. Subsequent to receiving certification as a JSEB, the applicant agrees to abide by all applicable federal, state and local laws, statutes, ordinances, rules and regulations, to abide by the requirements contained herein and to provide to the City of Jacksonville current, complete and accurate information regarding actual work performed on any City of Jacksonville project, the payment therefore and any proposed changes, if any, and to permit the audit and examination of books, records and files of the undersigned business upon the City of Jacksonville’s reasonable notice and/or request for the same. The undersigned hereby authorize(s) and request(s) any person, business or corporation to furnish any pertinent information requested by the City of Jacksonville deemed necessary to verify the statement made in this application or regarding the ability, standing and general reputation of the applicant. I understand according to § 337.135, F.S., as may be amended from time to time, it is unlawful for any individual to fraudulently represent an entity as a small or socially and economically disadvantaged business enterprise for the purposes of qualifying for certification designed to assist small or socially and economically disadvantaged business enterprises in the receipt of contracts for the provision of goods and services. Any person who violated this section is guilty of a felony of the second degree, punishable in §§ 775.082, 775.083, or 775.084, F.S., as may be amended from time to time. Furthermore, I understand that I may not: (a) Fraudulently obtain, retain, attempt to obtain or aid another in fraudulently obtaining or retaining or attempting to obtain small or socially disadvantaged business enterprise certification. (b) Violate the requirements of the City of Jacksonville Ordinance Code, particularly Chapter 126, or willfully make a false statement, whether by affidavit, report, or other representation for any purpose, particularly for the purpose of securing a contract for the provision of goods and services, or of influencing the certification or denial of certification of any entity as a small or socially disadvantaged business enterprise; or (c) Willfully obstruct, impede, or attempt to obstruct or impede the investigation of the qualifications of a business entity that has requested certification as a small or socially disadvantaged business enterprise. Any material misrepresentation will be grounds for immediate de-certification, debarment, and initiation of action under Federal, state or local laws concerning false statements.

JSEB For-Profit Application

IMPORTANT INFORMATION

INSTRUCTIONS FOR COMPLETING

Please have all your documents ready before attempting to complete the application.