Blank Tennessee Uniform Certification Template

Blank Tennessee Uniform Certification Template

The Tennessee Uniform Certification Form serves as an essential document for businesses seeking to participate in the Tennessee Uniform Certification Program (TNUCP) as Disadvantaged Business Enterprises (DBEs) or Airport Concession Disadvantaged Business Enterprises (ACDBEs). This form is designed to streamline the certification process, ensuring that eligible firms can access opportunities within contracts supported by the U.S. Department of Transportation. By completing this form accurately, businesses can enhance their chances of being certified and included in the TNUCP database.

Modify Tennessee Uniform Certification

The Tennessee Uniform Certification Program (TNUCP) plays a crucial role in supporting disadvantaged business enterprises (DBEs) across the state. This program aims to enhance opportunities for these businesses to participate in contracts funded by the U.S. Department of Transportation (DOT). It is essential for firms seeking certification to understand the requirements outlined in the Tennessee Uniform Certification form. This form serves as an application for DBE or Airport Concession Disadvantaged Business Enterprise (ACDBE) status and is a key component in the certification process. The TNUCP is responsible for maintaining a comprehensive database of certified DBEs, ensuring that only eligible firms can participate in DOT-assisted projects. The application process requires careful attention to detail, as incomplete submissions can lead to delays or denials. Applicants must provide thorough documentation, including notarized affidavits and personal financial statements, to demonstrate their eligibility. Furthermore, the program streamlines the certification process by allowing businesses to apply through one member agency rather than multiple ones, thereby simplifying the experience for applicants. Ultimately, the TNUCP aims to foster a more inclusive business environment, helping disadvantaged firms thrive in Tennessee's economic landscape.

Dos and Don'ts

When filling out the Tennessee Uniform Certification form, it is important to follow specific guidelines to ensure a smooth application process. Below is a list of things to do and avoid:

  • Do answer all questions completely. If a question does not apply, mark it as “N/A.”
  • Do provide all documents requested in the Certification Checklist.
  • Do fill out the Personal Financial Statement completely. Leave no line blank.
  • Do have the Affidavit of Certification signed in front of a Notary Public.
  • Do keep a copy of all submitted documents for your records.
  • Don't submit an incomplete application. All requested documents must be included.
  • Don't ignore changes in ownership or control. Report them within 30 days.

Similar forms

The Small Business Administration (SBA) 8(a) Certification is a program designed to assist small businesses that are socially and economically disadvantaged. Similar to the Tennessee Uniform Certification form, this application requires detailed information about the business and its owners. Both processes aim to ensure that disadvantaged businesses receive fair opportunities in government contracting. The SBA 8(a) Certification also necessitates the submission of financial statements, ownership details, and proof of social disadvantage, making it a parallel process for those seeking federal assistance.

The Disadvantaged Business Enterprise (DBE) Program Certification is another document that shares similarities with the Tennessee Uniform Certification form. This program, overseen by the U.S. Department of Transportation, aims to ensure that disadvantaged businesses can compete for federally funded transportation projects. Like the TNUCP, the DBE Certification process requires thorough documentation regarding ownership, control, and personal financial status. Both certifications emphasize the importance of supporting disadvantaged businesses in accessing government contracts.

The Airport Concession Disadvantaged Business Enterprise (ACDBE) Certification operates under similar principles as the TNUCP. This certification focuses specifically on businesses that provide services at airports. Both the ACDBE and TNUCP require applicants to demonstrate their disadvantaged status and provide extensive financial documentation. The goal is to ensure that these businesses can participate in airport concessions and benefit from federal funding opportunities.

The Minority Business Enterprise (MBE) Certification is another relevant document. This certification focuses on businesses owned by minorities and aims to promote equal opportunities in public contracting. Like the Tennessee Uniform Certification form, the MBE Certification requires applicants to provide proof of ownership, control, and financial status. Both processes help ensure that minority-owned businesses can compete effectively in government contracts.

The Women-Owned Small Business (WOSB) Certification is similar in that it specifically targets businesses owned and controlled by women. This certification process also requires comprehensive documentation regarding ownership and financial standing, akin to the requirements outlined in the TNUCP. Both certifications aim to promote diversity and inclusion in federal contracting, ensuring that women-owned businesses have access to the same opportunities as their counterparts.

In the realm of business agreements, establishing trust and confidentiality is essential, particularly when sensitive information is involved. A well-crafted Ohio PDF Forms Non-disclosure Agreement (NDA) serves as a vital tool for protecting proprietary information and ensuring that all parties understand their obligations. This not only fosters a secure business environment but also clarifies the terms of engagement, enabling effective collaboration while minimizing the risk of information breaches.

The 8(a) Business Development Program is another document that parallels the Tennessee Uniform Certification form. This program is designed to assist small businesses in gaining access to federal contracts. Similar to the TNUCP, the 8(a) application process requires businesses to demonstrate their disadvantaged status and submit detailed financial information. Both aim to create a level playing field for small businesses in competitive markets.

The Veteran-Owned Small Business (VOSB) Certification focuses on businesses owned by veterans. This certification shares similarities with the TNUCP in that it requires proof of ownership and control, as well as financial disclosures. Both certifications are part of broader efforts to ensure that historically marginalized groups have access to government contracts and resources.

The Service-Disabled Veteran-Owned Small Business (SDVOSB) Certification is closely related to the VOSB Certification. It specifically targets businesses owned by service-disabled veterans and requires similar documentation regarding ownership and financial status. Both certifications aim to promote opportunities for veteran-owned businesses in federal contracting, aligning with the objectives of the TNUCP.

The Historically Underutilized Business Zone (HUBZone) Certification is another document that aligns with the principles of the Tennessee Uniform Certification form. This program aims to encourage economic development in historically underutilized business zones. The HUBZone application process requires businesses to demonstrate their location, ownership, and financial standing, similar to the requirements of the TNUCP. Both certifications help ensure that businesses in underserved areas can access government contracting opportunities.

Finally, the Small Business Innovation Research (SBIR) Program application shares similarities with the TNUCP. This program provides funding to small businesses for research and development. The application process requires detailed information about the business, its owners, and financial status, similar to the documentation required for the TNUCP. Both processes aim to support small businesses in accessing federal funding and contracting opportunities.

Tennessee Uniform Certification: Usage Guidelines

Filling out the Tennessee Uniform Certification form is an essential step for businesses seeking to become certified as Disadvantaged Business Enterprises (DBEs) or Airport Concession Disadvantaged Business Enterprises (ACDBEs). Once the form is completed and submitted, it will be reviewed to determine eligibility. The process may involve additional documentation and an on-site interview.

  1. Begin by reading the instructions thoroughly to ensure you understand all requirements.
  2. Fill out all sections of the application, answering each question. If a question does not apply to your firm, mark it as “N/A.”
  3. Gather and attach all documents listed on the Certification Checklist. Mark “N/A” for any items that do not pertain to your company.
  4. Complete the Personal Financial Statement, ensuring every line is filled out. This form must be signed and notarized by each DBE applicant.
  5. Sign the Affidavit of Certification in the presence of a Notary Public. Ensure that the principal owner(s) sign this document.
  6. Submit your completed application and all supporting documents to the appropriate member agency based on your firm’s principal place of business.
  7. Keep a copy of all submitted documents for your records.
  8. Be prepared for an on-site interview if your firm is based in Tennessee. This will typically occur within 90 business days after your application is received.

Common mistakes

Filling out the Tennessee Uniform Certification form is a critical step for businesses seeking Disadvantaged Business Enterprise (DBE) certification. However, applicants often make common mistakes that can delay their application or lead to denial. One frequent error is failing to answer all questions completely. Every section of the application must be addressed. If a question does not apply, marking it as “N/A” is essential. Omitting this detail can result in the application being deemed incomplete, leading to unnecessary delays.

Another mistake involves the Personal Financial Statement. This form must be filled out thoroughly, with no lines left blank. Each applicant must sign this document in the presence of a Notary Public. Neglecting to complete this statement accurately can hinder the certification process. Additionally, some applicants forget to include required supporting documents, such as recent tax returns. The application checklist specifies which documents are necessary, and failing to provide these can stall the review process.

Applicants may also overlook the importance of timely communication regarding changes in ownership or management. If any changes occur within a year prior to submitting the application, they must be reported. This requirement ensures that the agency has the most current information about the business. Failing to disclose such changes can raise red flags during the evaluation process, potentially jeopardizing certification.

Finally, many applicants do not keep copies of their submitted documents. Retaining a copy of all application materials is vital for reference and record-keeping. This practice can be especially helpful if questions arise during the review process or if there is a need to appeal a denial. By avoiding these common pitfalls, applicants can enhance their chances of a successful certification process.

Form Attributes

Fact Name Description
Program Purpose The Tennessee Uniform Certification Program (TNUCP) aims to certify Disadvantaged Business Enterprises (DBEs) and Airport Concession Disadvantaged Business Enterprises (ACDBEs) to enhance their participation in DOT-assisted contracts.
Governing Law The program operates under the Final Rule 49 Code of Federal Regulations (CFR) Part 26, which mandates a uniform certification process for U.S. DOT recipients.
Application Requirement Applicants must complete the Uniform Certification Application in full, including notarized documents like the Affidavit of Certification and Personal Financial Statement.
Member Agencies The TNUCP includes several member agencies, such as the Tennessee Department of Transportation and various airport authorities across the state.
Database Inclusion Only firms certified as eligible DBEs will be included in the TNUCP database, allowing them to participate in the DBE program of U.S. DOT grantees.
Out-of-State Firms Firms based outside Tennessee must be certified in their home state to apply for TNUCP certification.
Application Processing Time For in-state applicants, an on-site interview is required, and the application should be processed within 90 business days after receipt of the complete certification package.

Tennessee Uniform Certification Example

Tennessee

Uniform

Certification

Program

Member Agencies

Tennessee Department of Transportation

Metropolitan Knoxville Airport Authority

Chattanooga

Metropolitan

Airport Authority

Memphis Shelby County Airport Authority

Metropolitan Nashville Airport Authority

Chattanooga Area

Regional

Transportation Authority

Memphis Area

Transit Authority

Nashville Metropolitan Transit Authority

Jackson Transit

Authority

Smyrna Airport

Authority

Tri-Cities Airport

Commission

Clarksville Transit

System

Regional Transportation Authority [Middle TN]

Knoxville Area Transit

Jackson Airport

TENNESSEE UNIFORM CERTIFICATION PROGRAM

(TNUCP)

Thank you for your interest in participating in the Tennessee Uniform Certification Program (TNUCP) to become a Disadvantaged Business Enterprise (DBE)/Airport Concession Disadvantaged Business Enterprise (ACDBE). Our DBE objective is to ensure that disadvantaged business firms have the maximum opportunity to participate in DOT assisted contracts.

The TNUCP is charged with the responsibility of certifying firms for the purpose of maintaining a database of certified DBEs for the United States Department of Transportation (U.S. DOT) grantees in the state of Tennessee. This is pursuant to the Final Rule 49 Code of Federal Regulations (CFR) Part 26 that requires U.S. DOT recipients to take part in a statewide uniform certification process.

Please complete the attached application if you wish to be considered for DBE certification. In order to avoid unnecessary delays, please complete all portions of the Uniform Certification Application and include all copies of documents requested on the application. In addition, the Affidavit of Certification and the Personal Financial Statement must both be notarized.

Additional documentation may be requested if it is considered necessary to make a certification determination. Incomplete applications will not be evaluated until all requested documentation has been submitted for review. We highly recommend that you keep a copy of all submitted documents for your records.

It is no longer necessary to apply for DBE certification at more than one of the member agencies. If your firm meets the criteria for certification, it will be entered in the TNUCP database. Only firms currently certified as eligible DBEs for the TNUCP may participate in the DBE program of U.S.

DOT grantees within the state of Tennessee. The TNUCP is not required to process an application for certification from a firm having its principal place of business outside the state of Tennessee if the firm is not certified in its home state. If the firm has its principal place of business in another state and is currently certified in that state, please contact the Tennessee Department of Transportation.

To participate in the TNUCP DBE/ACDBE program, please send the completed application and all supporting documentation to the appropriate member agency listed on the following page.

Page 1 of 18

Rev. 12-2008

The following member agency processes ACDBE/ DBE applications. Please forward your completed certification packet to MMBC Uniform Certification Agency serving the area where your firm has its principal place of business:

Uniform Certification Agency P.O. Box 3060

158 Madison Avenue, Suite 300 Memphis, TN 38173 (901)525-6512(T) (901)525-5204(Fax) www.mmbc-memphis.org

Tennessee Uniform Certification Program (TNUCP)

Application for Certification as a Disadvantaged Business Enterprise

(DBE)

INSTRUCTIONS AND INFORMATION

Please read these instructions completely and thoroughly!!!

1.All questions must be answered. Questions that do not apply to your firm should be marked “N/A.”

2.All documents requested on the Certification Checklist must be provided. Mark “N/A” for any items that do not pertain to your company.

3.The Personal Financial Statement enclosed must be filled out in its entirety leaving no line blank. This form

must be completed for each DBE applicant and this form must be signed by each DBE applicant in the presence of a Notary Public.

4.The Affidavit of Certification must be signed by the principal owner(s) in the presence of a Notary Public.

Please note that failure to complete the application as instructed above will delay processing and may result in a denial of certification as a Disadvantaged Business Enterprise.

For Your Information

1.An on-site interview will be required for all in-state applicants, as part of the certification process. Once the application is complete, this should occur within 90 business days of receipt of the certification package.

2.Additional information may be required during the processing period. Delays in submitting requested information will cause a delay in processing the application.

3.Changes in ownership, control, or operation of the business should be reported within 30 days of the occurrence. Any changes in ownership or transfer of ownership two (2) years prior to submission of an application with the Tennessee Uniform Certification Program will not be acceptable and will be seriously scrutinized for timing and reasons for ownership change.

4.An applicant has the right to protest a Denial of Certification by filing an appeal with the U.S. Department of Transportation.

5.All certified businesses will be listed in the Directory of Disadvantaged Business Enterprises for the Tennessee Uniform Certification Program.

Page 2 of 18

Rev. 12-2008

Tennessee Uniform Certification Program

(TNUCP)

Disadvantaged Business Enterprise

(DBE)

Renewal Application

→This document and its attachment must be completed in their entirety for each DBE owner←

PRINT NAME AND TITLE OF MAJORITY DISADVANTAGED OWNER(S):

___________________________________________________________________________________________________

BUSINESS NAME: ___________________________________________________________________________________________

MAILING ADDRESS: ________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

BUSINESS PHONE NUMBER: ___________________________

FAX NUMBER: ______________________________

EMAIL ADDRESS: _____________________________________

 

DBE FIRM’S GROSS RECEIPTS (attach a copy of the firm’s most recent corporate tax return and all attachments, if applicable)

DBE OWNER’S PERSONAL TAX RETURN (attach a copy of the most recent personal tax return and all attachments for each individual applying for disadvantaged status)

PERSONAL FINANCIAL STATEMENT (This attached document must be filled out in its entirety, signed, dated and notarized by the applicant)

HAS THERE BEEN A CHANGE IN OWNERSHIP/MANAGEMENT THIS PAST YEAR? YES____ NO ____

(If “YES,” you must submit all pertinent information to show changes in ownership)

I agree that the TNUCP will be notified in writing within 30 days of any changes in ownership and/or control, personal net worth and/or size standard that would impact the firm’s eligibility to remain in the program.

I, _____________________________________(NAME OF DBE FIRM OWNER{S}), swear (or affirm) that there have been no changes in

____________________________(NAME OF DBE FIRM) circumstances affecting its ability to meet the size, disadvantaged status, ownership

or control requirements of 49 CFR Part 26 and 13 CFR Part 121. I swear (or affirm) there have been no material changes in the information provided with __________________________________(NAME OF DBE FIRM) application for certification, except for any

changes about which I have provided written notice to_____________________________________(name of DOT recipient) pursuant to

49 CFR 26.83(i).

I swear (or affirm) that I am socially disadvantaged because I have been subjected to racial or ethnic prejudice or cultural bias, or have suffered the effects of discrimination, because of my identity as a member of one or more of the groups identified in 49 CFR 26.5, without regard to my individual qualities. I further swear (or affirm) that my personal net worth does not exceed $750,000, and that I am economically disadvantaged because my ability to compete in the free enterprise system has been impaired due to diminished capital and credit opportunities as compared to others in the same or similar line of business who are not socially and economically disadvantaged.

I specifically swear (or affirm) _____________________________(NAME OF DBE FIRM) continues to meet the Small Business

Administration (SBA) business size criteria and the overall gross receipts cap of 49 CFR Part 26 and _________________________(NAME

OF DBE FIRM) average annual gross receipts (as defined by SBA rules) over the previous three fiscal years do not exceed

_______________(dollar amount). I provide the attached size and gross receipts documentation to support this affidavit.

I certify that the above information is true and complete to the best of my knowledge and understand that knowingly and willfully providing false information to the Federal government is a violation of 18 U.S.C. 1001 (False Statements) which could result in fines, imprisonment or both.

Signature_____________________________________________ Date____________________________________________________

NOTARY CERTIFICATE:

 

PERSONAL FINANCIAL STATEMENT

 

As of _________________ ,__________________

Name

Business Phone

 

 

Residence Address

Residence Phone

 

 

City, State, & Zip Code

Business Name of Applicant

 

ASSETS

(Omit Cents)

 

LIABILITIES

(Omit Cents)

 

 

Cash on hand & in Banks…………

$_______________

 

Accounts Payable…………………………...

$________________

 

 

Savings Accounts…………………..

$_______________

 

Notes Payable to Banks and Others………

$________________

 

 

 

 

 

 

 

IRA or Other Retirement Account...

$_______________

 

(Describe in Section 2)

 

 

 

 

 

 

Installment Account (Auto)…………………

$________________

 

 

Accounts & Notes Receivable…….

$_______________

 

Mo. Payments $_______

 

 

 

Life Insurance-Cash Surrender

 

 

Installment Account (Other)………………..

$________________

 

 

 

 

Mo. Payments $_______

 

 

 

Value Only ………………………….

 

 

 

 

 

$_______________

 

Loan on Life Insurance……………………..

$________________

 

 

(Complete Section 8)

 

 

 

 

 

 

 

 

 

Stocks and Bonds…………………..

$_______________

 

Mortgages on Real Estate………………….

$________________

 

 

(Describe in Section 3)

 

(Describe in Section 4)

 

 

 

 

 

 

 

 

Real Estate………………………….

$_______________

 

Unpaid Taxes………………………………..

$________________

 

 

(Describe in Section 4)

 

(Describe in Section 6)

 

 

 

 

 

 

 

 

Automobile-Present Value…………

$_______________

 

Other Liabilities………………………………

$________________

 

 

 

 

 

 

Personal Property…………………..

 

 

(Describe in Section 7)

 

 

 

$_______________

 

 

 

 

 

(Describe in Section 5)

 

 

 

 

 

 

 

Total Liabilities

$________________

 

 

Other Assets……………………...

 

 

 

 

$_______________

 

 

 

 

 

(Describe in Section 5)

 

 

 

 

 

 

 

 

 

 

 

Total Assets

$_______________

 

Total Assets – Total Liabilities=

 

 

 

 

 

Net Worth

$________________

 

 

 

 

 

 

 

Section 1.

Source of Income

 

 

Contingent Liabilities

 

 

 

Salary………………………………

$_______________

 

 

As Endorser or Co-Maker…………………..

$_______________

 

 

Net Investment Income…………….

$_______________

 

 

Legal Claims & Judgments…………………

$_______________

 

 

Real Estate Income………………...

$_______________

 

 

Provision for Federal Income Tax………….

$_______________

 

 

Other Income………………………..

$_______________

 

 

Other Special Debt…………………………..

$_______________

 

 

(Describe in section 1 below)

 

 

 

 

 

 

Description of Other Income in Section 1.

*Alimony or child support payments need not be disclosed in “Other Income” unless it is desired to have such payments counted toward total income.

Section 2. Notes Payable to Banks and Other. (Use attachments if necessary. Each attachment must be identified as part of this statement and signed.)

 

 

 

 

Original

 

 

Current

 

Payment

 

 

Frequency

 

 

How Secured or Endorsed Type of

 

 

Name and Address of Noteholder(s)

 

 

 

 

Balance

 

 

Balance

 

Amount

 

 

(monthly, etc.)

 

 

Collateral

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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. Real Estate Owned

(List each parcel separately. Use attachment if necessary. Each attachment must be identified as a

 

part of this statement and signed.)

 

 

 

Primary Residence

Property B

Property C

Type of Property

 

 

 

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. Personal Property and Other Assets. (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.

Unpaid Taxes (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.)

Section 7. Other Liabilities (Describe in detail.)

Section 8. Life Insurance Held. (Give face amount and cash surrender value of policies – name of insurance company and beneficiaries.)

I authorize the Tennessee Uniform Certification Program to make inquiries as necessary to verify the accuracy of the statements made and to determine my eligibility. 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 determining Disadvantaged Business Enterprise eligibility. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001)

Signature:

Date: Social Security Number

 

 

Signature:

Date: Social Security Number

NOTARY

Subscribed and sworn to before me this ____day of _________20__

Signed_____________________________, Notary Public in and for the

County of __________________, State_________________

My Commission Expires____________________________