Fillable The State of New Jersey State of New

Fill Online, Printable, Fillable, Blank The State of New Jersey State of New Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

The State of New Jersey State of New

On average this form takes 20 minutes to complete

The The State of New Jersey State of New form is 4 pages long and contains:

  • 0 signatures
  • 10 check-boxes
  • 76 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
The State of New Jersey
Department of the Treasury
Division of Revenue
State of New Jersey MBE/WBE Certification Application
Dear Business Owner:
Enclosed please find the State of New Jersey MBE/WBE Certification Application. If you wish to become certified as a Minority
and/or Women Business Enterprise, complete and submit the enclosed application with a non-refundable check or money order in
the amount of $100.00 made payable to “NJ Division of Revenue”. DO NOT SEND CASH.
Be advised that the average processing time is four weeks after your check has been cashed.
Your M/WBE certification is valid for 3 years. Annually, the business must submit, not more than 20 days prior the anniversary
of the certification, an annual verification statement, in which it shall attest that there is no change in the ownership, control or
any other factor of the business affecting eligibility for the certification as a minority or women- owned business.
If the certified business fails to submit the annual verification statement by the anniversary date, the certification will be revoked
and the business will be removed from the SAVI1 database that registers certified minority and women-owned businesses. If the
business seeks to be certified, it will have to reapply and pay the $100 application fee.
If the business submits the annual verification statement by the anniversary date, but either the verification statement or the
information received by the Division indicates that the business is no longer eligible for certification as a minority or women-
owned business, the Division shall revoke the certification pursuant to this chapter and following revocation, the business shall be
removed from the SAVI database. The business may appeal this revocation pursuant to the procedures set forth at N.J.A.C.
17:46-1.8.
Please pay particular attention to the supporting documents required. For each question on the application, a response must be
indicated, even if it is “Not Applicable.” Incomplete applications will not be processed. Any applicant, who knowingly supplies
false information shall, upon conviction, be guilty of a crime of the fourth degree.
NOTE: The State currently works with other certifying groups to accept alternative certifications. If you have a currently valid
certificate with a national or statewide certifying group, you may submit a copy of their certification approval and the initial
application from that group for consideration to satisfy requirements of certification under N.J.A.C. 17:46-1.10. You must also
submit a non-refundable check or money order in the amount of $100.00 and a Fast Track NJ Certification Application found at
www.nj.gov/njbusiness/contracting/. Please send your completed application to:
Division of Revenue
Business Support Services Bureau
P.O. Box 455
Trenton, NJ 08646
If you require further information, please call the Division's Business Registration and Certification Office at (609) 292-2146.
Also, for free business counseling, you may contact the Small Business Development Center's general information office at
(973) 353-1927.
1
NJSAVI (New Jersey Selective Assistance Vendor Information) is a database that identifies businesses that are registered as a
SBE and/or certified as a M/WBE with the State of New Jersey, through the Division of Revenue. The NJSAVI database
identifies businesses eligible for mandated state programs such as the NJ Small Business Set Aside program, and aids in
matching buyers and vendors for private contracting opportunities
Print Form
Type
The State of New Jersey
Department of the Treasury
Division of Revenue
State of New Jersey MBE/WBE Certification Application
Provide full address of principal place of business
ANSWER ALL QUESTIONS OR APPLICATION WILL NOT BE PROCESSED
1. Name of Firm President/Chief Executive Officer/Managing Member/Owner
President and/or CEO Managing Member Owner
M
Minority Business Enterprise (MBE)
Start New Business
Bought Existing Business Merger or Consolidation Other
Inherited BusinessSecured Franchise/Concession
Women Business Enterprise (WBE)
F
1a. Name & tile of officer of the firm who can be contacted during the application review process.
2. This firm is applying for certification as: (one or designation may be chosen.)
3. Method of acquisition (check all that apply): Date of acquisition:
Firm Name:
D/B/A or T/A:
Mailing Address:
City State: Zip:
County:
DO NOT WRITE IN THIS SPACE
For Agency Use Only
Revenue Receipt Date:
__________________________________
Check #:___________________________
Referring Agency:
SBA______NJDOT_______ NJT_______
NY/NJ PA_____SBDC______OTHER______
AI Letter Sent Date________ Int.______
Approved____Date________ Int.______
Dissapproved___Date_______ int.______
Phone: Fax:
E-Mail
Contact Person:
Title:
Social Security#:
Name: Title:
Website:
Federal ID#:
4. Name, position & ethnicity of all principals with ownership interest. (Check all that are applicable. If no positions are held
write "None".)
Name Position Group Code*
%
Owned
Sex
US Citizen or
Permanent
Resident Alien
*Group Code Key (Please refer to regulations for definitions)
5. Gross Receipts (Sales). Please provide total gross sales for the last 3 years.
(You must have some revenue to apply for and receive MBE/WBE status, even if it is for less than one year- cannot be zero income)
Current year: $ Last year: $ Previous year: $
Year: Year: Year:
6. Construction-related industry list construction craft codes (http://www.nj.gov/njbusiness/documents/constcodes.pdf) 5-digit
codes (12 codes maximum)
7. For all other non-construction related industries, select from the NIGP Commodity/Services codes and enter the 5-digit codes
that most accurately describe the goods and services your firm provides. (www.state.nj.us/treasury/purchase/commcode.shtml)
(12 codes maximum)
8. Annual Verification Requirements (as applicable):
All certified Firms must complete the annual verification form at the end of years 1 & 2. Be advised that you may be asked for
supporting document(s).
9. Application: Provide all required information and documentation as follows:
a. Briefly describe the firm's major field(s) of operation;
b. Articles of incorporation, corporation by-laws, certificate of formation, partnership agreements, and joint venture agreements;
c. Names and addresses of members and officers of the business and board of directors in the case of corporations;
d. Names and addresses of capital investors and the amount of capital contributed. Gifted ownership shall not be considered;
e. Firm federal and state tax returns for the past three consecutive years;
f. Most current income statements and balance sheets;
g. Resumes of all principals, partners, officers and/or key employees of the firm. Show home address, telephone number, education,
training and employment dates;
h. Number of shares of all classes of stock issued, and stock outstanding in the case of a corporation;
i. Proof of ethnicity and gender (i.e. Photo ID, driver's license, birth certificate, passport and /or green card);
j. The affiliation of the firm or any of its owners, officers or directors with any other business entity;
k. A complete list of major and real personal property holding of the firm;
l. A complete listing and copy of signature cards for all banking institutions with which the firm is affiliated;
m. A complete listing of previously attained certifications and listing of all legal entities which denied certifications;
n. Copies of office lease/rental agreements or deeds, and mortgages when home based.
An Applicant who fails to comply with requested additional information or documentation within 30 days
shall be considered in non-compliance and subject to rejection
The State of New Jersey
Department of the Treasury
Division of Revenue
State of New Jersey MBE/WBE
VERIFICATION
MUST BE SIGNED, DATED AND NOTARIZED
STATE OF
COUNTY OF
(A)
(B)
ss
)
)
being duly sworn, states that I am the owner
being duly sworn, state that I am the
,
(Or a partner/member in) of the enterprise making the foregoing Application and that the statements
and representations made in the Application are true to his or her own knowledge.
of the firm making the foregoing Application, that I have read the Application and know its contents,
that the statements and representations made in the Application are true to my knowledge, and that
the Application is fully authorized by the firm (if corporation, fully authorized by the Board of directors).
Title
Printed NameSignature of President, Owner or Managing Partner
Name of Business
Title Phone:
Date
Notary Seal
Sworn to before me this the day of 20
Notary Public
Person assisting in completing the application:
NOTE: Applicant must also sign Fraud Statement
Name Telephone Number
Fraud Statement: I attest that the information contained in this application has been completed as directed and that the information is
accurate to the best of my knowledge. I understand that any information willfully falsified or omitted may result in penalties outlined in
N.J..A.C. 17:46-1.10 and/or in prosecution under New Jersey's fraud statutes and liability to attendant civil or criminal penalties.
I have read and acknowledge the forgoing
Signature of Applicant
Mail completed form to:
NJ Division of Revenue, Business Support Services
PO Box 455, Trenton, NJ 08646
2
2 Only the signature of the owner or president of a corporation is acceptable. (For a partnership, only a general Partner may sign, the signature of a
Limited Partner is not acceptable. For an LLC, the managing member must sign.)
Name of President or Owner
Frequently Asked Questions on the New Jersey Small Business Registration &
Minority and Women Certification Programs
1. Where can I send my small business registration or minority/women certification application payment?
a. Make your check payable to Division of Revenue and send it to the NJ Division of Revenue, Business Support Services
Bureau, PO Box 455, Trenton, NJ 08646
2. How long does it take before I get a decision on my application?
a. You will receive a response generally within 4 weeks of your check being cashed.
3. What happens when my application is approved?
a. You will receive a letter and a certificate in the mail.
4. What happens if my application is incomplete?
a. We will send you a request for additional information. You will be asked to respond within 30 days to prevent a
non-compliance closure of your application.
5. What happens if my application is denied?
a. You will receive a letter explaining why your application was denied. The letter will also explain that we need to receive a
letter from you on your company letterhead within 10 days if you wish to appeal the denial.
6. Where can I get help in filling out my application?
a. For one-on-one assistance, visit your local Small Business Development Center. For a complete listing, go to
http://www.njsbdc.com
7. Is a business registration with the State of New Jersey, Division of Revenue the same as a small business registration with
your Division?
a. No, these are two different types of registrations. A business registration with the Division of Revenue will ensure that
the business is registered for applicable taxes and related liabilities. Businesses must submit to the Division of Revenue
the Business Registration form (NJ-REG) and if applicable, the Public Records Filing for New Jersey Business Entity form.
After registering, businesses will receive the forms, returns, instructions and other information required for on-going
compliance with New Jersey State taxes. For more information on the Business Registration Form please see
http://www.state.nj.us/treasury/revenue/busregcert.shtml
8. What is a Small Business Enterprise (SBE) registration?
a. The SBE registration is required to compete for contracts under the Small Business Set Aside Act. The small business set-aside
program was established with the goal of awarding 25 percent of state and purchase order dollars to small businesses.
Go to http://www.nj.gov/njbusiness/contracting/ for a listing of the standards for eligibility and to obtain an application form.
9. How long will my SBE registration or M/WBE certification last?
a. The cost for both the SBE registration and M/WBE certification is $100 for three years. Please note that you will have to submit
an annual verification form or your registration or certification will be revoked.
10. Can I compete for a Small Business Set Aside contract if I get my SBE registration after the bid opening date?
a. You must have a current SBE registration on the bid opening date to be eligible to compete.
11. My company was considered ineligible to be a SBE under the old rules and regulations. Do the new rules and regulations
take into consideration new industries or sizes?
a. The new rules and regulations have changed the size of the categories so that the size of your industry is taken into account.
As a result, your company may now qualify as a SBE and be eligible to participate in the Small Business Set Aside Program.
To view Small Business size standard by NAICS industry see: 13_CFR 121.201 at http://www.gpoaccess.gov/cfr/index.html
12. What if I have a bid due before the four week response time?
a. You must attach a request to expedite your application and accompany this request with a copy of the bid page that contains
the bid due date. Please note that the application must be properly completed and all required support documentation must
be received by our office before we are able to begin processing your request.
In cases where a prime is requiring a sub-contractor to obtain a registration or certification, you must submit a letter from
the prime, on their letterhead, stating that there is a commitment to award the sub-contract if in fact registration/
certification is provided. A copy of the bid page that contains the bid due date must be attached to the letter from the prime.
Where/When feasible we will issue an expedite certificate five days before the bid due date.
Note: Submitting an application does not mean that you will automatically receive an approval. You need to submit your
application and the front page of the bid for review to the Division at least 48 hours before the bid opening date. If you
submit your application with less than 48 hours before the bid opening, there may not be enough time to process your
application or answer any questions.
13. What is a Minority and/or women Owned Business Enterprise (MWBE) certification?
a. MWBE's are encouraged to become certified with the State so that we can accurately and timely assess the share of procurement
activity recorded by this group compared to the share of business registered by non MWBE vendors. In addition, private firms
and municipal (not State) governments may require proof of an MWBE certificate.
Go to http://www.nj.gov/njbusiness/contracting/ for a listing of the standards for eligibility and to obtain an application form.
The WMBE certification cost is $100 for three years. Please note that you will have to send in annual verification forms or
your certification will be revoked.
14. My MWBE certification is going to expire. Do I have to recertify my business?
a. You no longer recertify your business under the new rules and regulations. You must submit a new application with the
required information.
15. Can I use my MWBE to compete for bids under the Small Business Set Aside law?
a. The New Jersey State Government contracting process is race and gender free so you don't need a MWBE designation. You need
an SBE designation to compete under the Set Aside Act (Refer to response to Question #8).
16. How do I go about ensuring that information in my record is updated?
Change in general contact information or description of services fields (refer to listing below *) must be accompanied by;
1. Written request signed by the owner, president or managing partner.
*Listing of fields:
* Phone number
* Fax number
* Email address
* Business location or mailing address
* Correct any spelling on the company's name or owner's name
* Add or Delete construction or Commodity codes ( NOT categories)
Change of the Company Name must be accompanies by;
1. Written request signed by the owner, president or managing partner
2. Copy of the certificate of Incorporation, formation or business registration that shows the amendment/change
for the name.
Change of the Company Federal ID# must be accompanied by;
1. Written request signed by the owner, president or managing partner to close the record that is currently approved/
certified.
2. Copy of certificate of dissolution or other legally binding documentation that shows that the company is no longer
in business.
3. Provide IRS form assigning FEIN number to the designated business. If a sole proprietor, proof that this is the
applicant's social security number.
4. Submission of a new application meeting all the requirements and fee.
Change in Owners or Ownership Breakdown (Percentages of ownership) must be accompanies by;
1. Written request signed by the new/revised owner(s).
2. Agreement/contract of sale transferring ownership (proof of payment, cancelled check)
3. Resume for the new owner (s)
4. When applicable proof of ethnicity (MBE) or gender (WBE)
5. If new owner is not MBE or WBE, a new application will need to be submitted.
Change in Category
Changes in category are authorized only when upon review by an auditor, she/he confirms that the original designation was
incorrect when initially approved OR that upon receipt of documentation that accompanies the annual verification form,
there is proof of a significant change that requires change in category. In both cases, the owner, president or managing
partner must provide copies of page 1 of the business tax returns for the last 3 years.
NOTE: The Division of Revenue reserves the right to request additional documentation from your business and to
contact you to schedule a site visit to confirm validity of change(s) requested.
17. Where do I get information on new bids from State agencies, universities and authorities?
a. The Division offers a centralized database that post all statewide bids which you can access anytime by keyword, agency
or commodity code. Go to http://www.nj.gov/njbusiness/contracting Refer to the right hand side banner Online Services,
Click on Statewide Bid Opportunities.
For guidance on how to navigate and maximize the potential of the State's procurement process, small businesses are
encouraged to contact the New jersey Small Business Development Center at www.njsbdc.com
18. Can I get automatic notification of new bid opportunities?
a. You can sign up to get customized email notifications for opportunities within the goods, service, or construction field you
identify as being of interest. The identification of goods, services or construction field will be based on the National Institute
of Governmental Purchasing, Inc. NIGP code, which you must provide. Go to
https://wwwnet1.state.nj.us/treasury/dpp/ebid/NotificationUser/NotificationUserEnrollment.aspx
For those of you familiar with the North American Industry Classification System (NAICS) and need to find an equivalent NiGP
code you can do so by searching for similar wording or description. Treasury has an NIGP lookup tool located at:
http://www.state.nj.us/treasury/purchase/commcode.shtml
19. Where can I find the commodity and construction codes?
a. Commodity and construction codes consist of expense account codes that provide information and/or descriptions of nature of
the purchases (goods,services, construction field) made by state agencies. Constitutes a system of identifying a commodity by
an assigned number. Go to: http://www.state.nj.us/treasury/purchase/commcode.shtml
20. What happens if I lose my registration/certificate?
a. You may ask for a replacement by sending your request to us on your company letterhead. You may send your request to us by
mail or fax (609-984-6679).
21. Do you give out grants?
a. While the Division does not give grants, you may explore other funding sources by calling the Economic Development
Authority Customer Care line at 609 777-4898 or your local Small Business Development Center www.njsbdc.com
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

The State of New Jersey State of New

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 30 October 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document