Small Business Certification

Please complete the SMALL BUSINESS CERTIFICATION form in its entirety, as all fields are required. This includes any applicable Government Small Business certifications and/or Ownership and Self-certifications, identified by applicable NAICS code.

It is your firm’s responsibility to submit updated information whenever there are changes related to your small business status. You will need to confirm your self-certification information with LEO A DALY on an annual basis.

All Fields Are Required

Company Name:
   
Address:
   
City, State, Zip:
   
Contact Person:
   
Email Address:
   
Phone Number:
   

FIRM SIZE:

- Primary NAICS Code (as applicable):
Large Business
Small Business
• Government Certifications
8(a)
Small Disadvantaged Business
HubZone certified by SBA
Service Disabled Veteran Owned with CVE Verification
• Ownership and Self-Certifications
Small Business (SB)
Self-Certified Small Disadvantaged Business (SDB)
Service Disabled Veteran Owned (SDVOSB)
Veteran Owned (VOSB)
Woman-Owned Small Business (WOSB)
Economically Disadvantaged WOSB (EDWOSB)
Tribally Owned
Alaska Native Corp (ANC) Owned
Native Hawaiian Org (NHO) Owned
Other:

If your firm has a different size category under a different NAICS code other than the primary NAICS Code indicated above, please complete the following:
Add Another NAICS

Definitions for the above categories in the Federal Acquisition Regulation 19.7 or 52.219-8 (www.arnet.gov/far).
Size standards by NAICS code can be found at www.sba.gov/content/small-business-size-standars. If you have difficulty ascertaining your size status, please contact your local SBA office.

Under 15 U.S.C 645(d), any person who misrepresents its size status shall
(1) be punished by a fine, 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
   
Name and Title
   
Date*
   

* Note: certifications by your firm must be renewed on an annual basis to be considered for
  sub-contracting with LEO A DALY.

Required Firm attachments/uploads:

Firm capabilities statement    
Firm Profile    
Firm Logo    
Current and Signed SF330 Part II