Fitzgerald Murraine. Enclosures. RE: Certification as SDBE, MBE, FBE and DLSB in the New PEP. Dear Business Owner:

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1 Robert C. Walker Chairperson Thomas J. Wahlrab Executive Director C I T Y o f D A Y T O N, O H I O HUMAN RE L AT IO NS CO UNCIL 371 West Second Street, Suite 100, Dayton, OH (937) / / / FAX RE: Certification as SDBE, MBE, FBE and DLSB in the New PEP Dear Business Owner: As you may be aware, the City of Dayton has enacted a new Procurement Enhancement Program (PEP) which becomes effective on July 1, The City of Dayton spends over $200 million annually on construction, supplies and services. We invite your company to become certified in the City s new PEP and to maximize the business opportunities that flow from having such certifications. We are excited about the business and contracting opportunities under the new PEP. The new PEP has certification and contracting opportunities for Small Business Enterprise (SBE), Minority Business Enterprise (MBE), Female Business Enterprise (FBE), and Dayton Small and Local Business Enterprise (DSLB) in the areas of construction, supplies, and services including professional services. SBE, MBE and FBE certifications are limited to companies located within the State of Ohio. Under the special DSLB program, certification is limited to companies located within the corporate limits of the City of Dayton. All four certification programs under the new PEP require that you and other disadvantaged owners meet the Personal Net Worth (PNW) criteria of $750, (excluding the value of your primary residence and your investment in the business). In order become certified in the new PEP, you must complete and notarize the enclosed PEP Certification Affidavit and the PEP Personal Net Worth Form. We have also included the PEP Certification Instructions Form listing the required supporting documents. Please review the certification criteria and instructions for each certification program and provide the necessary documentation to ensure the timely processing of your application. Generally, your company must meet the annual gross sales criteria and the disadvantaged owners must also meet the Personal Net Worth (PNW) criteria. We also encourage Joint Venture and Strategic Partnerships to become certified in the PEP. We urge you to complete and promptly return your Certification Application and supporting documentation to ensure your company s certification and participation in the new PEP on July 1, I may be reached at (937) Sincerely, Fitzgerald Murraine Fitzgerald Murraine, Supervisor Compliance and Special Programs cc: Thomas Wahlrab Catherine Crosby Enclosures

2 City of Dayton Procurement Enhancement Program (PEP) Certification Application Instructions Thank you for your interest in becoming a certified SBE, MBE, FBE, Dayton Local Small Business or HUD Section 3 company with the City of Dayton PEP. Mail or deliver original (notarized) application to: City of Dayton Procurement Enhancement Program (PEP) Human Relations Council (HRC) 371 West Second Street, Suite 100 Dayton, Ohio To speak with a Certification Specialist, please call or fax: (937) /1439 Voice * FAX (937) INSTRUCTIONS TO ALL SBE, MBE, FBE and DLSB APPLICANTS: 1. CERTIFICATION UNDER THE CITY OF DAYTON PEP IS GENERALLY LIMITED TO COMPANIES LOCATED IN THE STATE OF OHIO. 2. PLEASE READ THE CERTIFICATION APPLICATION AND CERTIFICATION CRITERIA COMPLETELY BEFORE SUBMITTING THE APPLICATION. 3. YOU MUST SUBMIT ALL REQUIRED DOCUMENTS - SEE CHECKLIST. 4. NO FAXED APPLICATIONS ACCEPTED. 5. APPLICATION MUST BE NOTARIZED AND MUST INCLUDE THE REQUIRED SUPPORTING DOCUMENTATION. 6. ALL INCOMPLETE APPLICATIONS WILL BE RETURNED. 7. PLEASE ALLOW 30 DAYS FOR PROCESSING. The HRC will certify the applicant or provide the applicant with written justification of denial, within thirty (30) days after the date that the HRC receives a satisfactorily completed application and documentation from the applicant. CHECKLIST OF DOCUMENTS NEEDED: Complete This Checklist To Ensure All Required Documents Are Included Please review the checklist below and use it as a guide to complete your application and organize the appropriate submission documents. Please make sure to include all supplemental documentation (as applicable) with your application. Failure to submit a complete and accurate application could result in your application being returned to you with no action taken. Please mail or deliver a complete application with required documents to the address listed above. Faxed applications will not be accepted. ALL SBE, MBE, FBE, and DAYTON SMALL AND LOCAL CERTIFICATION APPLICANTS MUST SUBMIT THESE DOCUMENTS: 1. Resume and background: Work experience and resume(s) that include places of ownership/employment and corresponding dates. 2. Equipment: List of equipment (leased or owned) along with signed lease agreements, vehicle titles/proof of ownership of equipment needed to operate your business. 3. Location: Signed lease for office/warehouse/storage space, deed, mortgage, payroll tax records, etc. 4. Tax returns: for the past 3 years (or life of firm if less than 3 years old). If no tax returns have been filed, a current Balance Sheet is acceptable. A new business must provide a current Balance Sheet. All financial documents will be kept Confidential to the extent permitted by law (tax returns and PNW). 5. Contracts: Copies of three largest contracts or purchase orders. 6. Other Certifications: MBE/DBE//FBE/HUB/SBA 8(a) or SBE letters, certifications held, or denials and decertifications. 7. Proof of citizenship or permanent residence (birth certificate, passport, voter registration card, green card or military ID). 8. Licenses: Architectural, Engineering, Surveyors, Attorney s, CPA s and other restricted professions must include a copy of the professional license for certification.

3 9. Personal Net Worth (PNW) Form: the eligible owner(s) must complete the enclosed PNW Form or provide a notarized personal net worth statement to verify that the owner does not exceed the $750,000 personal net worth limitation. All Information will be kept confidential. 10. Proof of Ethnicity (passport, green card, birth certificate). If any of these documents do not prove ethnicity, you will need to complete an Ethnicity Affidavit. 11. Employees. List of employees and their home zip codes for HUD Section Bonding and Insurance: provide copies of insurance and bonding. SUBMIT THIS ADDITIONAL INFORMATION ACCORDING TO YOUR BUSINESS STRUCTURE: SOLE PROPRIETORSHIP: 1. Business license (or professional license where business license is required Montgomery County Business License Office, Vendors license). PARTNERSHIP OR JOINT VENTURE: 1. Copy of Partnership or Joint Venture Agreement. 2. Business License (or professional license where business license is required). CORPORATION OR LLC: 1. Official Articles of Incorporation (from Secretary of State). 2. Both sides of all Corporate Stock Certificates and Stock. 3. Stock Transfer Ledger. 4. Shareholders Agreement. 5. Minutes of First Stockholder and Board of Directors meetings. 6. Corporate by-laws and any amendments. 7. Business License (or professional license where business license is required). CERTIFICATION CRITERIA FOR SBE, MBE and FBE: For the City of Dayton PEP Program To qualify for SBE, MBE or FBE Certification, a firm must meet the City of Dayton definition of an SBE, MBE or FBE and complete all sections of the certification application. 1. Geographic Restriction: The business enterprise must have its principal place of business within the State of Ohio. 2. Ownership Requirements: At least fifty-one percent (51%) of the interest in the Business Enterprise must be owned by one or more disadvantaged owner(s). A person shall be deemed a disadvantaged owner of all or a portion of a Business Enterprise if such person: a. Owns in his or her own name the legal and equitable interest in the Business Enterprise; b. Acquired the interest in a real and substantial arms-length transaction utilizing real and substantial consideration; c. The Personal Net Worth of the disadvantaged owner(s) should not exceed $750,000, excluding: (i) their combined equity in their primary residence; and (ii) the combined investment or interest in the applicant(s) Business Enterprise (value of the business); and 3. Ownership and control: The daily business operations of the Business Enterprise shall be owned, managed and controlled by one or more disadvantaged owner(s). We will make determinations regarding ownership and control by relying on some of the following factors: a. The disadvantaged owner(s) management and control is specifically demonstrated to be real, substantial and continuing and goes beyond the pro-forma ownership of the Business Enterprise as reflected in its ownership documents; b. The disadvantaged owner(s) possess the power to, and actually, direct the management and policies of the Business Enterprise; c. The disadvantaged owner(s) make both routine and major decisions on matters of management, policy and operations; and d. The disadvantaged owner(s) are not subject to formal or informal restrictions that are inconsistent with the customary discretion of majority owners.

4 In addition, one or more Disadvantaged Owners must: a. Hold the professional license or contractor license necessary for operation of each type of business for which the Business Enterprise seeks certification; b. Have substantial experience in the trade or industry which would be necessary to make routine and major decisions for the Business Enterprise; and c. Regularly hold themselves out to the public and sign important documents and financial instruments in a manner that is indicative of primary management and control of daily business operations and responsibility for routine and major decisions. 4. Citizenship Requirements: Owner(s) must be U.S. citizen(s) or permanent residents. 5. Actively in business: The Business Enterprise must be actively engaged in commerce and satisfy all of the following requirements: a. Formation of the Business Enterprise completed; b. Commencement of sustained business activity in the trade or profession described on the certification application; and c. Commencement of ownership, management and control of daily business operations by the identified disadvantaged owner(s). 6. Perform a commercially useful function: The Business Enterprise must be a for-profit business that performs a commercially useful function. A Business Enterprise does not perform a commercially useful function if it merely acts as a conduit by passing the scope of work for which it is scheduled to perform or supply on the contract to a non-certified firm. 7. Personal Net Worth Statement: The applicant business must provide sufficient financial statement documentation to verify that the disadvantaged owner(s) meets personal net worth criteria. 8. Copies of three largest contracts or other purchase order. 9. Threshold size: The annual sales volume of the Business Enterprise and the number of employees of the Business Enterprise cannot exceed the size standards set forth in the PEP Ordinance which shall be adjusted from time to time to mirror the SBA Size Standard Table below: For details on SBA size standards, please visit the SBA website at For purposes of the above standards, the annual receipts and number of employees of an applicant shall be determined in accordance with the definitions and methodology established by the Small Business Administration at 13 C.F. R et. seq., as amended, or successor regulation or classification system (the SBA Size Regulations ). CERTIFICATION CRITERIA FOR DAYTON SMALL AND LOCAL BUSINESS (DSLB): To qualify for DSLB Certification, a firm must meet the definition of a PEP SBE, MBE or FBE and be located within the City of Dayton corporate limits. DSLB must also complete the relevant section the PEP Certification application: 1. Geographic Restriction: Eligible SBE, MBE or FBE and must be located within the City of Dayton corporate limits. HUD SECTION 3 CERTIFICATION CRITERIA: (See attached HUD Section 3 Application)

5 CITY OF DAYTON HUMAN RELATIONS COUNCIL PROCUREMENT ENHANCEMENT PROGRAM (PEP) CERTIFICATION APPLICATION (All information will be kept confidential to the extent permitted by law) 1. Name of Firm: 2. Firm Address: (number & street, no P.O. boxes) 3. City: 4. State: 5. Zip Code: 6. Telephone Number: 7. Cell Number: 8. Fax: 9. Address: 10. Company Web site: 11. Business Type: Sole Proprietorship Franchise Partnership Corporation Joint Venture LLC Other (Specify) 12. Date Established: 13. Nature of Business: 14. Federal I.D. or Social Security Number: 15. NAICS Code(s): 16. List Name(s) and Attributes of Owner(s) Ethnic Group Gender % of Ownership M M M M F F F F Date of Obtaining Ownership 17. If owner(s) and/or family members of owner(s) have ownership in any other business, please list: Owner s Name Name of Company

6 18. Please indicate the PEP Certification(s) for which you are applying: SBE PROGRAMS Construction: (Average Annual Receipts of not more than $33.5 Million) MBE and FBE PROGRAMS Construction: (Average Annual Receipts of not more than $33.5 Million) Services: Average Annual Receipts not more than Services: Annual Receipts not more than $15.0 Million $15.0 Million Supplies: 100 or less employees Supplies: 100 or less employees Net Worth: $750,000 (Excludes ownership equity in the business and individual s primary residence) Net Worth: $750,000 (Excludes ownership equity in the business and individual s primary residence) DAYTON LOCAL SMALL BUSINESS CERTIFICATION Construction: (Average Annual Receipts not more than $15.0 Million) Specialty Trades: (Average Annual Receipts not more than $5.0 Million) Services Supplies: Net Worth: $750,000 (Excludes ownership equity in the business and individual s primary residence) HUD SECTION 3 Construction Supplies: Basis for Section 3 Application: Location of business Location of employees 19. Annual Gross Sales History for Three Years, Preceding the Year of Application: Year 1: Year 2: Year 3: Annual Sales: Annual Sales: Annual Sales: 20. Company s Contract Capacity: 21. Company s Bonding Capacity: 22. Disadvantaged Owner s Personal Net Worth (PNW) 23. (Please attach PNW Worksheets for each owner) Owner No1. Owner No See Certification Instructions Sheet for the list of supporting documents that must be submitted with this Certification Affidavit, as well as the criteria for the each PEP Program. 25. This firm is an independent business. The SBE/FBE/MBE/DLSB owners possess the power to control and direct the daily operations, management, finances and policies of this business enterprise. AFFIANT/OFFICER/OWNER Signature Sworn to before me and subscribed in my presence this TITLE IN COMPANY of NOTARY PUBLIC

7 HRC 1/2010 City of Dayton Human Relations Council Procurement Enhancement Program (PEP) Personal Net Worth Form (All information will be kept confidential to the extent permitted by Law) Complete this form for: (1) each proprietor, or (2) each limited partner and each general partner, or (3) each stockholder or (4) any person or entity with ownership in this MBE/SBE/FBE/DSLB. Name Business Phone ( ) Residence Address Residence Phone ( ) City, State, & Zip Code Business Name of Applicant/Borrower ASSETS (Do not include Personal Residence or Investment in the Business) (omit cents) Cash on hands & in Banks $ Savings Accounts $ IRA or Other Retirement Account $ Accounts & Notes Receivable $ Life Insurance-Cash Surrender Value Only $ (Complete Section 8) Stocks and Bonds $ (Describe in Section 3) Real Estate $ (Describe in Section 4) Automobile-Present Value $ Other Personal Property $ (Describe in Section 5) Other Assets $ (Describe in Section 5) Total.....$ (Omit Cents) LIABILITIES Accounts Payable $ Notes Payable to Banks and Others $ (Describe in Section 2) Installment Account (Auto) $ Mo. Payments $ Installment Account (other) $ Mo. Payments $ Loan on Life Insurance $ Mortgages on Real Estate $ (Describe in Section 4) Unpaid Taxes $ (Describe in Section 6) Other Liabilities $ (Describe in Section 7) Total Liabilities $ Net Worth = (Total Assets Total Liabilities) $ Total..... $ Section 1. Source of Income Contingent Liabilities Salary $ Net Investment Income $ Real Estate Income $ Other Income (Describe below)* $ As Endorser or Co-Maker $ Legal Claims & Judgments $ Provision for Federal Income Tax $ Other Special Debt $ Description of Other Income in Section 1. Section 2 Notes Payable to Bank and Others. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.) Name and Address of Note holder (s) Original Balance Current Balance Payment Amount Frequency (monthly, etc.) How Secured or Endorsed Type of Collateral

8 Section 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed). Number of Shares Name of Securities Cost Market Value Quotation/Exchange Date of Quotation/Exchange Total Value Section 4. Type of Property Real Estate Owned. Exclude Primary Residence (List each parcel separately. Use attachments if necessary. Each attachment must be identified as a part of this statement and signed). Property A Property B Property C Address Date Purchased Original Cost Present Market Value Name & Address of Mortgage Holder Mortgage Account Number Mortgage Balance Amount of Payment per Month/Year Status of Mortgage Section 5. Other Personal Property and Other Assets. Exclude Investment in the Business (Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms of payment, and if delinquent, describe delinquency). Section 6. Other Liabilities. (Describe in detail). I authorize the HRC to make inquiries as necessary to verify the accuracy of the statements made and to determine my eligibility for the PEP. I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining certification with the City of Dayton PEP. I understand FALSE statements may result in denial/removal of eligibility for certification and possible prosecution for fraud. Signature: Date: Social Security Number: Sworn to before me and subscribed in my presence this day of, 20. Seal Notary Public PLEASE NOTE: If you have questions, please contact Human Relations Council at (937) or fitzgerald.murraine@cityofdayton.org.

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