Fillable City of Richmond Minority Business Development Emerging Small (Port of Richmond)

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City of Richmond Minority Business Development Emerging Small (Port of Richmond)

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City of Richmond
Minority Business Development
Emerging Small Business (ESB)
Registration Checklist
□ Completed ESB Registration Application
□ Copy of Government Issued Photo Identification of the business owner(s);
(e.g. DMV License, Passport, Non-Drivers License)
□ Copy of Richmond City Business License
□ Copy of Leasing Agreement (Business must be located in City of Richmond Enterprise Zone)
□ Copy of Contractors Business Class License (If Applicable)
□ Proof of Ownership (Copy)
□ Copy of company’s federal income tax filings for last three years
□ Affidavit stating business is not operating/headquartered outside of Richmond, Virginia
□ Work History in Related Business Field (Brochure, Typed Document)
Additional Requirements:
Company has fewer than 10 full-time permanent employees.
Pays personal property, real estate and business taxes as applicable to the City of Richmond.
Not a subsidariary of another business and/or does not belong to a group of businesses owned
and controlled by the same individuals.
Annual gross receipts of $500,000 or less for each of its three fiscal years preceding
application for such certification if engaged primarily in the construction business or of
$250,000 or less if engaged primarily in a non-construction business.
Required site visit.
Contact Minority Business Development should you have questions about the registration process.
(804) 646-5947 or Minority.Business.Development@richmondgov.com
Please remember to completely fill out the ESB application.
Failure to do so will delay the processing of your application.
Minority Business Development
900 E. Broad Street, 16t h Floor, Room 1603 Richmond, VA 23219
Phone: (804)646‐5947 Fax: (804)646‐0136
Minority Business Development
900 East Broad Street
City Hall, 16
th
Floor, Room 1603
Richmond, VA 23219
Office: (804) 646-5947
Fax: (804) 646-0136
www.richmondgov.com/MBD
c
Emerging Small Business Certification Application
Revised 03/28/2015
Emer ging Small Business means a b usiness that has b een certified by t he Mino rity
Business Deve lop men t for a perio d of up to seven years, has an nual gros s receipt of
$500,0 00 o r less for each o f its t hree fiscal years preced ing application for such
cert ificat ion it enga ged p rim ari ly in th e co nst ructio n busin ess o r of $ 250, 000 o r less if
engaged primarily in a no n -co nst ructio n busine ss, has fewer than 10 full - time ,
perm anen t employ ees, is no t a subs idiary o f an other business and does n ot belon g t o
a group of b usine sses owned an d co n trolled by th e sam e individuals, has its princ ipa l
place of bu sines s entirely \w ithin th e b oundaries of the City o f R ichmond Enterprise
Zone, p ossesse s a City license , and pay s p ersonal property, real estate, and business
taxes to th e City of Richmon d.
Contact Person
Prefix:
First Name:
Last Name:
Company Name:
Primary Company Address:
City:
State:
Phone:
Fax:
E-Mail:
Website:
Principal Owner(s)
NAME
GENDER
RACE/ETHNICITY
MALE FEMALE
BLACK/
AFRICAN
AMERICAN
HISPANIC /
LATINO
AMERICAN
ASIAN
AMERICAN
NATIVE
INDIAN
ANGLO
AMERICAN
MALE FEMALE
BLACK/
AFRICAN
AMERICAN
HISPANIC /
LATINO
AMERICAN
ASIAN
AMERICAN
NATIVE
INDIAN
ANGLO
AMERICAN
MALE FEMALE
BLACK/
AFRICAN
AMERICAN
HISPANIC
/LATINO
AMERICAN
ASIAN
AMERICAN
NATIVE
INDIAN
ANGLO
AMERICAN
FIRM TYPE:
SOLE PROPRIERTORSHIP
PARTNERSHIP
CORPORATION
(State of INC.)
OTHER (SPECIFY)
BUSINESS TYPE:
DATE BUSINESS COMMENCED:
Fed ID/SSN No.
City:
State:
DESCRIBE
SERVICES
HAS YOUR COMPANY PREVIOUSLY
BEEN DEBARRED FROM DOING BUSINESS WITH
ANY GOVERNMENT ENTITY? IF YES, EXPLAIN
GROSS RECEIPTS FOR PRIOR THREE FISCAL YEARS
YEAR
GROSS
RECEIPTS
Permanent
Employee
Full-Time Part-Time
YEAR
GROSS
RECEIPTS
Permanent
Employee
Full-Time Part-Time
YEAR
GROSS
RECEIPTS
Permanent
Employee
Full-Time Part-Time
YEARS IN BUSINESS:
BUSINESS LICENSE JURISDICTION : N/A
POSSES ALL STATE/CITY LICENSES TO LEGALLY
CONDUCT BUSINESS IN VA
YES NO
WORK
FORCE
SIZE
CONTRACTOR’S LICENSE :
A B C N/A
CURRENTLY INSURED
IF YES TO WHAT AMOUNT?
YES NO $
CURRENTLY BONDED
IF YES, TO WHAT AMOUNT?
YES NO $
TYPE OF CERTIFICATION (EXAMPLE: MBE, DBE, WBE, ETC.)
All f irm s listed in MBD dir ect ory have regist ered w ith the City of
Richm ond as a minor ity owned busin es s (MBE) or cert ified as an
Emerging Small Bu siness (ESB) . It sho uld be noted, that there
are M BE bu sinesses listed in this direct ory t hat are not
certifi ed. Ther efore, an y prime contra ctor/vend or des iring to
use a regi ster ed MBE firm that is not certified , must be aware,
that the register ed MBE firm ha s 180 days to get certif ied or
before the completion of the contract , which ever is less, or the
prime contract or/vendor r isk s not rec eiving credit t oward t he
minor ity part icip ation goal f or the said project.
CERTIFICATION SOURCE (EXAMPLE: VA DEPT. OF TRANSPORTATION, VA
DEPT. OF MINORITY BUSINESS ENTERPRISE, US SMALL BUSINESS
ADMINISTRATION)
YOUR SIGNATURE INDICATES THAT THE ABOVE INFORMATION IS ACCURATE TO THE BEST OF YOUR KNOWLEDGE.
SIGNATURE: TITLE: DATE:
Registration can be faxed, mailed or emailed to
Minority.Business.Development@richmondgov.com
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City of Richmond Minority Business Development Emerging Small (Port of Richmond)

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Completed 29 July 2020

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