REQUEST FOR GOAL ASSIGNMENT-
SURTAX PROJECTS AND SERVICES
1
Contact the Office of Economic and Small Business Development (OESBD) at 954-357-6400 for assistance or
clarification regarding this form. If additional space is required to complete your response than this form allows, please
attach additional sheets as needed. Please submit the completed form to sbsurtax@broward.org
.
IMPORTANT NOTE: This form is intended for the review of ONLY the Surtax-funded portions of projects that are approved
by the Surtax Oversight Board and the Broward County Board of County Commissioners.
Date: _______________
___________
City/M
unicipality Name: ____________________________________________________________________
Projec
t Title: _____________________________________________________________________________
Surtax Project ID #: ________________________________________________________________________
Projec
t Location Zip Code(s) (if applicable): _____________________________________________________
Project Location City(ies) (if applicable): ________________________________________________________
Projec
t Manager Contact Information:
Name: __________________________________________________________________
Title: ____________________________________________________________________
Phone: __________________________________________________________________
Email:___________________________________________________________________
Webpage where solicitation will be posted: _________________________________________
1. Estimated Project Value for Initial Term: $ _______________________________________
(a) Length of initial contract term: _________________________________________
(b) Total estimated value of Optional Services: $_________________________
(c) Total amount reimbursable to prime (e.g. permit fees): $________________________
2. Detail
ed Project Description: (Be as specific as possible as to the activities, participants, materials used
and other information relevant to understanding the project.)
