Small Business Self-Classification Form

The small business registry is a database used by County officials to solicit quotes from small local business in Broome County.  The registry acts as the primary source for County Officials to seek quotations for goods and services below competitive bidding thresholds.

For the purposes of the Procurement Policy of the County of Broome, a "small business" shall refer to any commercial entity located physically within the geographic borders of the County of Broome that employes from zero up to and including nine employees, including sole proprietorships, with a gross annual revenue of less than $1,000,000.

No PO Boxes - Physical address only
Street Address Line 2
City
Name & Title
Company website address
Description of Goods and/or services available from the company
Other Government Business Classifications Held Weight
NYS-MWBE - New York State Certified Minority or Woman Owned Business
MWBE - Certified Minority or Woman Owned Business (other states)
FTA Disadvantaged Business Enterprise
Small Business Concern
Small Disadvantage Business Concern
Woman-Owned Business Concern
Veteran-Owned Business Concern
Service Disabled Veteran-Owned Business Concern
Other
To obtain small business size standards, go to the Small Business Administration's website at http://www.sba.gov/size/
Additional documentation required to be submitted with this form:

Please scan and attach required documents to this form.

If you are unable to submit the required documentation with this form please check the box below.  You must hand deliver the necessary documentation with 10 days of submitting this form.

1.  Completed IRS Form 940 for prior year or other documentation to validate the total employees meet the stated requirement.
One file only.
2 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
2.  Valid Certificate of Incorporation as issued by NYS Department of State, Division of Corporations, State Records and Uniform Commercial Code or other documentation to validate the proposed firm has a commercial business office operating within the geographic borders of the County of Broome.
One file only.
2 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
3.  The last fiscal year Financial Statement or other financial report within the last fiscal year showing the firm's Annual Gross Revenue does not exceed $1,000,000.00
One file only.
2 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
I hereby certify that the information provided to quality as a Broome Small Business is true and correct.
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