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SMALL BUSINESS ENTERPRISE (SBE) CERTIFICATION APPLICATION

Application Information

Return completed application to the address below:
Texas Department of Transportation, Civil Right Division
125 E. 11th Street, Austin, TX 78701-5539
(512) 416-4700 Fax (512) 486-5539

The Texas Department of Transportation's Small Buisness Enterprise (SBE) Program offers small businesses another avenue of maximizing their opportunities of doing business with TxDOT.  The program applies only to highway construction and maintenance projects that are funded entirely by state and/or local funds.

Businesses interested in pursuing an SBE certification must meet the U.S. SMall Business Administration (SBA) size standards and submit a completed application.  The SBE Program is a TxDOT program authorized by law, 43 TAC §9.305.  Certified Disadvantaged Business Enterprise firms are recognized as SBEs without having to submit an SBE application.

INSTRUCTIONS:

  • All questions must be answered and all information requested must be submitted.
  • DO NOT LEAVE ANY SPACE BLANK;  ENTER "N/A" FOR NOT APPLICABLE.
  • If your application is not legible, completed, signed, dated, notarized and accompanied by all required documentation, your certification will be delayed.
  • For assistance, call the above number.

Primary Information

NAME AND ADDRESS

PRIMARY OWNER

CITIZENSHIP

Select the appropriate box to indicate whether the primary owner is a U.S. Citizen or a lawfully admitted permanent resident.  If the primary owner is not a U.S. Citizen or a lawfullly admitted permanent resident then this firm is NOT eligible for SBE Certification.

ETHNICITY

Identify the owner's ethnicity.  If you checked other, specify the owner's ethnic group/identify not otherwise listed.

GENDER

    BUSINESS STRUCTURE

      Other Information

      OWNERSHIP

      (Provide information for all owners) For additional space, attach a continuation sheet in the format below:

      Name (First, Ml, Last)

      Title

      % of Ownership

      GROSS RECEIPTS AND EMPLOYMENT LEVELS

      Beginning with the most recent year in which the business filed a federal income tax return with the Internal Revenue Service (IRS) and going back three previous years, provide the gross receipts figures as they were reported on the federal income tax returns. Also, provide the total number of employees that were reported at least once on the business federal and state employer's quarterly reports for each of the respective tax filing reporting periods

      Gross Receipts

      # Employees

      Tax Filing Year

      Business size will be determined by the Business Activity and Service listed on your firm’s tax return, Schedule C or Schedule K

        EQUIPMENT

            List owned/leased equipment

            Equipment Type  

            Description

            Quantity

            CERTIFICATIONS

            CONTRACTS

            List the three (3) largest contracts that this firm has received:

            Contract

            Amount

            Contact Person

            Phone Number

            Type of Work

            Date

            About the Company

            DESCRIPTION

            Describe what your company does

            Applicable NAICS Codes for this line of work include:

            NATURE OF BUSINESS

            Check the type of highway construction and/or maintenance work that your business does. Should your firm’s type not be listed below, indicate service provided and percent of dollar value.

            Locations

            Check the District(s) in which this business is capable of working. Please be advised, should you select a statewide listing, the directory accessible on the TxDOT webpage will only list your firm as statewide and will not list it in the individual districts.

            Affidavit of Eligibility

            I/we agree to provide all materials and information necessary to identify and explain the operation of the above named business and hereby permit, if required the audit and examination of its books, records, and files. I/we understand that any material misrepresentation of data for Small Business Enterprise Certification may result in immediate removal from certification. I/we the undersigned furthermore certify under penalty of law, that the above and foregoing information, including all requested documentation, is a full true and correct statement of the facts that substantiate the business' Small Business eligibility. I/we also understand that a person/business entity who intentionally applies as a Small Business for an award of a public works contract and who knowingly does not meet the definition of a Small Business commits a felony of the third degree.If there are any changes regarding the information contained or incorporated in this application, I/we will notify the TxDOT within 30 days of such changes. I/we agree to faithfully abide by the laws and rules of the State of Texas now in effect and any subsequent revisions thereof.The text will appear here

            Subscribed and sworn to me the undersigned notary public on this

            day of

            ,

            at

            /s/

            My commission expires:

            Seal (if required)

            (NOTARY)

            The Texas Department of Transportation maintains the information collected through this form. With few exceptions, you are entitled on request, to be informed about the information that is collected about you. Under §552.021 and §552.023 of the Texas Government Code, you also are entitled to receive and review the information. Under §559.004 of the Government Code, you are also entitled to have us correct information about you that is incorrect.

            Required Documentation

            The applicant must provide any and all materials and information necessary to demonstrate active participation in the operation and management of the small business.

            I. ALL APPLICANTS MUST SUBMIT THE FOLLOWING WITH THE COMPLETED APPLICATION:

            • Either of the following, whichever applies, (also see II, III, IV, V, VI);
            • Provide proof of U.S. Citizenship (i.e. U.S. Passport, Birth Certificate or Resident Alien Card).

            II.FOR A SOLE PROPRIETORSHIP, ADD:

            • Signed copy of the three most current federal income tax returns Schedule C (Form 1040)
              • If your business has not filed a federal income tax return with the Internal Revenue Service (IRS), please see “For New Businesses” below
            • Assumed Name Certificate/Certificate of Unincorporated Business (obtained at County Courthouse)

            III. FOR A PARTNERSHIP, ADD:

            • Signed copy of the three most current federal income tax returns Form 1065 and all Schedules
              • If your business has not filed a federal income tax return with the Internal Revenue Service (IRS), please see “For New Businesses” below
            • Assumed Name Certificate/Certificate of Unincorporated Business
            • Partnership Agreement

            IV. FOR A CORPORATION, ADD:

            • Signed copy of the three most current federal income tax returns Form 1120, 1120A, or 1120S and all Schedules
              • If your business has not filed a federal income tax return with the Internal Revenue Service (IRS), please see “For New Businesses” below
            • Certificate of Incorporation verifying Secretary of State registration (including Articles of Incorporation, Shareholders Agreement, etc.) 
            • All stock certificates currently issued to all owners (NOT A SPECIMEN COPY)
            • Stock Transfer Ledger
            • Companies “Doing Business As (DBA)”, please submit your Assumed Name Certificate verifying county registration

            V. FOR A LIMITED LIABILITY CORPORATION (LLC)/LIMITED LIABILITY PARTNERSHIP (LLP), ADD:

            • Signed copy of the three most current federal income tax returns Form 1065 and all Schedules
              • If your business has not filed a federal income tax return with the Internal Revenue Service (IRS), please see “For New Businesses” below
            • Certificate of Organization and Articles of Organization verifying Secretary of State registration of business name
            • All Membership Certificates currently issued to all owners (NOT A SPECIMEN COPY) (if applicable)
            • Membership Transfer Ledger (LLC)/Ownership Interest Ledger (LLP)

            VI. FOR NEW BUSINESSES:

            • Businesses seeking certification that have not filed the business’s federal income tax return with the IRS must comply with the following requirements to be certified as a Small Business Enterprise: 
            • Submit copies of documents applicable to your business structure listed in items I-V
            • Submit a notarized balance sheet 
            • Verification of Vendor Identification Number [i.e., IRS Taxpayer Identification Forms, W-2's of the business, Sales Reports]