FDOT_Small_Business_Affidavit

Small Business Affidavit

Please Note:
Completion of this form and listing on the Small Business site does not constitute Prequalification with FDOT.
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Florida Law (Chapter 337.14 F.S.) And Rules of the State of Florida, Department of Transportation, (Chapter 14-22, F.A.C.) require contractors to be prequalified with the Department in order to bid for the performance of road, bridge, or public transportation construction contracts greater than $250,000.00. If you are not prequalified, information can be found here: Contracts Administration Prequalification Information

Professional Service Consultants must be prequalified to bid on projects. If your firm is not prequalified, information can be found here: Prequalification Information

Small Business Affidavit

Small Business Affidavit

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Small Business Affidavit

The undersigned hereby authorize(s) and request(s) any person, firm or corporation to furnish any pertinent information requested by the State of Florida Department of Transportation deemed necessary to verify the statements made in this affidavit or regarding the ability, standing and general reputation of the Proposer. I declare, under penalty of perjury, that the information provided above and any supporting documents are true and accurate to the best of my knowledge. By submittal of the Affidavit certification, you are affirming that your firm meets the definition for a small business, pursuant to s. 337.027, F.S. It is the responsibility of the owner/authorized representative to inform the Department within 30 days of any change that would affect your small business eligibility, including average gross revenues over the prior three years exceeding the small business size threshold. Changes that would affect eligibility should be communicated to smallbusiness@dot.state.fl.us. This certification is good for one year or until your firm exceeds the small business threshold, whichever is earlier. To ensure regulatory compliance and accountability for the Small Business Program, firms agree to furnish any pertinent information to verify the statements in this Small Business Affidavit Certification, upon request by the Department. If financial documents are not timely provided within 10 business days, or financial documents do not confirm small business eligibility, the Department reserves the right to revoke this small business certification.

Pursuant to Section 337.027, F.S., a small business means a business with yearly average gross receipts of less than $25 million for road and bridge contracts and less than $10 million for professional and non-professional services contracts. A business’ average gross receipts isdetermined by averaging its annual gross receipts over the last three years, including the receipts ofany affiliates as defined in Section 337.165, F.S.

Gross Receipts

In the next section, enter your gross revenues for the previous three years. The system will automatically calculate the average to complete the required form field.

Warning: Your business does not meet the qualifications for a small business as your average receipts are over $25,000,000.00

Warning: Your business does not meet the qualifications for a small business as your average receipts are over $10,000,000.00