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JSEB Re-Certification Application

This application is intended for the renewal your certification with the City of Jacksonville Small and Emerging Business. If you have not been through the certification process, you may do so by completing the full JSEB application. If you don't know your company's certification status with the City, please contact our office at (904) 255-8840 or e-mail jseb@coj.net. A renewal must be completed 60 days prior to the JSEB expiration date. Failure to complete this application prior, will result in deactivation of JSEB status.

Fields marked with an asterisk are required.

Complete Name of Business

Address of Business

Owner's Name

Phone Number

Number of Employees

Number of contracts with the city in the past year: Prime or Sub-Contractor

Owner's E-mail Address

As a recertification requirement, the business owner must engage in continuing education. Have you completed continuing education workshops, certification updates, or courses within the past 2 years?

Yes No

Identify All Owners of the Business

If more than four owners, please include Name, Years of Ownership & % of Ownership

Supporting Documents Needed

This information is for internal data collection purposes only. Copies of the following documents are required when submitting your application.

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

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A complete copy of the last three years of Business Taxes

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Part 1

A complete copy of the last three years of Business Taxes

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Part 2

A complete copy of the last three years of Business Taxes

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Part 3

Proof of Course Completion

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Current Business Tax Receipt

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

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By checking the box, you consent to the following statement

I understand that any material misrepresentation will be grounds for de-certification and for initiation of actions under State law(s) regarding the making of false statements. I certify that there has been no material changes in the information provided with this firm’s most recent complete application for JSEB certification, except those heretofore conveyed, in writing to the City of Jacksonville.

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