New York City School Construction Authority APPLICATION FOR. Minority/Woman Business Enterprise (M/WBE) CERTIFICATION

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1 New York City School Construction Authority APPLICATION FOR Minority/Woman Business Enterprise (M/WBE) CERTIFICATION APPENDI E(4) DOCUMENT CHECKLIST AND INSTRUCTIONS Supplier Only M/WBE Certification is a review process designed to ensure that a business is actually owned, controlled, and operated by the applicant(s). The requested documents are required for determining eligibility for certification. Applications will not be processed without required documentation or a written explanation. To make the certification process as smooth and easy as possible, you should gather together and have with you the following information when you fill out the application (online or handwritten): CATEGORY EPLANATION REQUIRED DOCUMENTATION/INFORMATION Financial Statements and Tax Returns All Applicant Firms, regardless of type and/or dollar amount. If the Applicant Firm conducted business within the City of New York, a copy of the firm's most recent New York City General Corporation tax return or New York City Unincorporated Business tax return must be provided. The tax return must be signed and dated by both the preparer and the Firm's designated officer. If not applicable, attach a statement from the Applicant Firm s CPA or tax preparer stating the reason(s) why a NYC business tax return is not required. Copy of the Applicant Firm's two most recent "audited" financial statements including the Certified Public Accountant's signed report, balance sheet, statements of income and retained earnings, statement of cash flow and footnotes. OR Copy of the Applicant Firm's two most recent "reviewed" or "compiled" financial statements and the two most recent Federal tax returns (including all supporting schedules), which must be signed and dated by both the preparer and the Firm's designated officer. If the returns were filed electronically, a copy of IRS Form 8879 (IRS e-file Signature Authorization) signed by both an officer of the Applicant Firm and the preparer will be valid evidence of signature; however, a copy of the entire Federal tax return must still be provided. If the Applicant Firm is a Sole Proprietorship or Single Member LLC treated as a disregarded entity for federal tax purposes, submit two (2) years of the Federal Schedule C from the owner s personal tax return. Supporting Documents For any questions to which you answer yes, including all satisfied suits, tax liens or warrants, repayment plans, judgments, litigation or court actions detailed in the Application. If the Applicant Firm does not have audited, reviewed or compiled financial statements, provide full Federal tax returns with signatures. Supporting documentation. Rev 7/2013 M/WBE Certification (Supplier Only)-- Appendix E(4) Page 1 of 5

2 CATEGORY EPLANATION REQUIRED DOCUMENTATION/INFORMATION Matters Under Appeal Information regarding any pending suits, liens, judgments, litigation, violations, investigations, criminal or administrative/court actions, and civil investigative demands. Supporting documentation. Investigation Includes (a) an appearance before a grand jury by any representative of the Applicant Firm or its affiliate firm(s) or any Key Person; (b) the issuance of a subpoena to the Applicant Firm or its affiliate firm(s) or any Key Person for the giving of testimony or the production of documents in a criminal proceeding or before a government or public agency, permanent or temporary commission or an investigative body; (c) the execution of a search warrant at any location occupied by the Applicant Firm or affiliate firm(s) or any Key Person; (d) the questioning of an employee by a government or public agency, permanent or temporary commission or an investigative body, including a court appointed monitor concerning the business conduct of the Applicant Firm or the affiliate firm(s); (e) receipt of any discovery demand in a civil or regulatory matter in connection with an inquiry by or in which any government or public agency, permanent or temporary commission or an investigative body is a party. Affiliate Firms At present or during the past five (5) years: - Firms the Applicant Firm has owned 5% or more of, - Firms that own 5% or more of the applicant firm. - Firms that are a subsidiary of the Applicant Firm. - Firms where the Key People of Applicant Firm have served as Key People or owned 5% or more of any other firm, including firms that are inactive, have been dissolved or are non-construction related. - Firms that share offices, warehouses, space, equipment, staff or telephone exchanges. Affiliate firm information; includes firms listed in the Business Organization & History section, and Key People in the Key People & Personnel section, within the timeframes indicated. Include tax identification number of all affiliate firms and name of key person associated with that particular affiliate. Include ownership timeframe. References For trades in which the Applicant Firm seeks qualification. - For qualification >$1,000,000 per contract, the Applicant Firm must provide a minimum of 4 commercial references per trade for which the firm wishes to be qualified, completed within the past 3 years, averaging at least $1,000,000 and proof of apprenticeship program participation, if applicable. - For qualification < $1,000,000 per contract, the Applicant Firm must provide a minimum of 4 commercial references per trade for which the firm wishes to be qualified, completed within the past 3 years; each reference must be $25,000. Corporate Status Your firm must be deemed active by the New York State Division of Corporations. Visit and click on Search the Corporations/Business Entities Database. Rev 7/2013 M/WBE Certification (Supplier Only)-- Appendix E(4) Page 2 of 5

3 Document(s) Required MWBE Sole Proprietor Partnership LLP Joint Venture Corporation LLC Resumes for all principals, partners, officers and/or Key People. Must include home address, telephone number, education, training and employment with dates. Licenses and/or accreditations required to conduct business Bank signature card, bank resolution, or letter from the bank identifying persons authorized to conduct transactions, level of authority and limitations, if any Current financial statement Please submit prior three (3) years of your business Federal, State and City tax returns including all schedules and w-2s where applicable. For businesses that are less than three years old, substitute three (3) years of personal federal income tax returns including all schedules for each owner with an interest of 10% or more. Proof of sources of capitalization/investments Proof of ethnicity (e.g., birth certificate, U.S. passport, etc.) Proof of U.S. citizenship (e.g., birth certificate, U.S. passport, naturalization certificate, etc.) Proof of permanent resident alien status i.e., permanent resident ("green") card Copy of Lease Agreement All third-party agreements including equipment rentals, purchase agreements, management service agreements, etc. Any employment agreements Vehicle registration(s) Any certification, decertification or denial of certification documentation Written request for exemption from disclosure regarding trade secrets Business Trade Name or Certification Trade Name filed with County Clerk (if doing business under an assumed name) Business Certificate Certificate of Registration Partnership Agreement Buy-Out Rights Articles of incorporation/organization, including date approved by NY State Corporate by-laws/operating agreements Minutes of first corporate organizational meeting and amendments Rev 7/2013 M/WBE Certification (Supplier Only)-- Appendix E(4) Page 3 of 5

4 All issued stock certificates (front and back) and next unissued certificate Stock ledger If applicable, copies of agreements relating to: Stock options Shareholder agreements Shareholder voting rights Restriction on the disposal of stock loan agreements Facts pertaining to the value of shares Restriction on control of the corporation Notarized certification (Appendix A); certifications must be signed before a notary public and notarized when signed. Stamped signatures for either the notary public or key person are not acceptable. "Key People" include: President, Chief Executive Officer, proprietor(s), principal(s), partners, directors, officers, members. Partners, including general, limited and limited liability. Members Admitted as members of a limited liability company (LLC), with a membership interest in the LLC. Membership interest is a member's aggregate rights in an LLC, including, without limitation, the member's right to a share of the profits and losses of the LLC and the right to vote and participate in the management of the LLC. Corporations Publicly held corporations should list the President, Treasurer, Chief Financial Officer, shareholders of 5% or more of the firm's issued stock, and only those officers and managers who will have direct responsibility for SCA contracts. Shareholders are owners of 5% or more of issued stock or other securities (stock options, secured or unsecured bonds, warrants rights) that can be converted to stock that, if exercised, would constitute 5% or more of the firm's issued stock. Non-publicly held corporations should list all Corporate Officers and all Shareholders (owners of 5% or more of authorized shares). Any person in a position to control and direct the firm's overall operations and financial decisions, including "hiring and firing." Signatories to bank accounts and collective bargaining agreements, whether or not considered "Key People." Holders of licenses necessary for the Applicant Firm to perform SCA work for which it is seeking Certification.. GENERAL INFORMATION The SCA MWBE (Minority, Women-Owned Based Enterprise) program provides opportunities for minority-owned, women-owned enterprises to participate in the SCA's procurement process and gain valuable experience. To be eligible for the business development opportunities that the SCA provides, a supplier must become M/WBE-certified. For each certification category, ownership must be real, substantial and continuing. The applicant must have and exercise the authority to independently control the business decisions of the enterprise. Rev 7/2013 M/WBE Certification (Supplier Only)-- Appendix E(4) Page 4 of 5

5 M/WBE INFORMATION Minority Business Enterprise (MBE) A business enterprise which is at least 51% owned by, and controlled or, in the case of a publicly owned business, at least 51% of the stock of which is owned by citizens or permanent resident aliens; and whose management and daily business operations are controlled by one or more such individuals meeting the ethnic definitions of black, Hispanic, Asian-Pacific, Asian-Indian or Native American. Women-Owned Business Enterprise (WBE) A business enterprise which is at least 51% owned by, and controlled or, in the case of a publicly owned business, at least 51% of the stock of which is owned by citizens or permanent resident aliens who are women and whose management and daily business operations are controlled by women. ETHNICITY DEFINITIONS NAME Black Hispanic Asian-Pacific Asian-Indian Native American Non-Minority DEFINITION Persons having origins in any of the black African racial groups. All persons of Mexican, Puerto Rican, Dominican, Cuban, Central or South American descent of either Indian or Hispanic origin, regardless of race. *Please note: Portuguese and Spanish ethnicities are not considered Hispanic for M/WBE certification with the SCA. Persons having origins in the Far East, Southeast Asia or the Pacific Islands. Persons having origins in the Indian subcontinent. Persons having origins in any of the original peoples of North America. Persons whose culture or origin is other than those defined above. APPENDI A Once you have submitted your application, be sure to follow the on-screen instructions to print out the bar coded Appendix A (certification) and the bar coded fax cover sheet. All current Key People of the Applicant Firm must file a bar coded, signed and notarized Appendix A. The Appendix A document must be notarized when signed. You may upload or fax a signed/notarized Appendix A. After uploading or faxing the signed/notarized Appendix A document(s), mail the originals to: New York City School Construction Authority Thomson Avenue Long Island City, NY ATTN: Certification Unit RECERTIFICATION Firms are certified for a period of three (3) years, after which they are required to verify that there were no changes to the ownership (by uploading or mailing a notarized affidavit) and provide tax returns for the last two years (online or by mail) Firms are strongly encouraged to submit for recertification at least six (6) months before their certification status expires. GETTING HELP Questions regarding M/WBE certification should be directed to the Certification Hot Line at You may visit the Business Development Division Monday through Friday, between 9:00 a.m. and 4:00 p.m., for personal assistance with the certification process. Rev 7/2013 M/WBE Certification (Supplier Only)-- Appendix E(4) Page 5 of 5

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