Small Business Self Certification Statement PDF Details

For small businesses aiming to collaborate or contract with larger companies and government agencies, understanding and completing the Small Business Self-Certification Statement form is a critical step. This document serves as a verification of a business's size and ownership status, enabling it to qualify for various designations that can significantly impact its opportunities for growth and partnership. Such classifications include Small Business, Women Owned Small Business, Veteran Owned Small Business, and several others, all of which unlock specific benefits and considerations in the competitive market. Additionally, the form requires businesses to provide essential information like the company name, contact details, and identifiers such as the DUNS number and Primary NAICS code, crucial for their identification in federal and commercial databases. It’s also worth noting the legal implications highlighted within the form; any misrepresentation regarding the company's size or ownership status could lead to severe penalties, including fines and imprisonment. As such, companies are advised to accurately assess their eligibility by consulting the definitions in the Federal Acquisition Regulation or reaching out to the Small Business Administration (SBA) directly. This self-certification, valid for one year, necessitates businesses to maintain accuracy in their status and report any changes, ensuring they remain in compliance and eligible for the advantages being certified brings.

QuestionAnswer
Form NameSmall Business Self Certification Statement
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namessmall business self certification, form for self certification of business insurance, small business self certification statement, business certification form

Form Preview Example

Small Business Self-Certiication Form

SMITH SECKMAN REID, INC. / SSRCx

Company Name:

 

 

Street:

 

 

City:

State:

Zip:

Phone Number:

Fax Number:

 

Cage Code:

Primary NAICS Code:

 

DUNS Number:

Number of Employees:

 

Business Size: (Please check all that apply)

 

 

Small Business

Certiied by SBA as Small Disadvantaged Business

Certiied by SBA as HUBZone Small Business

Women Owned Small Business

Veteran Owned Small Business

Service Disabled Veteran Owned Small Business

 

Minority Owned Small Business (Please specify Minority

)

 

 

 

Large Business

You may wish to review the deinitions for the above categories in the Federal Acquisition Regulation 19.7 or 52.219- 8 (https://www.acquisition.gov/far/). If you have dificulty ascertaining your size status, please call 1-800-U-ASK-SBA or refer to the SBA’s website at www.sba.gov.

Under 15 U.S.C. 645(d), any person who misrepresents company size status shall (1) be punished by a ine, imprisonment, or both; (2) be subject to administrative remedies; and (3) be ineligible for participation in programs conducted under the authority of the Small Business Act.

Signature

Title

Date

This self-certiication is good for one year. It is your responsibility to notify us if your size or ownership status changes during that period. After one year, you are required to re-certify with us. Please e-mail this completed document to workwithus@ssr-inc.com.

2995 Sidco Drive, Nashville, Tennessee 37204 P: 615.383.1113 F: 615.386.8469

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