BUSINESS LOCATION
ADDITIONAL SATELLITE LOCATION(S) MUST BE RECORDED ON AN ADDITIONAL SHEET OF PAPER
License/Certification Revocation *
Has the owner or any party to this application had any certification or license revoked or had any other disciplinary actions levied from any state or federal agency?
*If yes, attach documentation explaining the circumstances.
Felony Status *
Has the owner or any party to this application ever been convicted of a felony by this or any other state or federal court?
*If yes, attach documentation explaining the circumstances.
Pending Matters *
Is the owner, or any party to this application currently in any pending matter referred to in the preceding two items?
*If yes, attach documentation explaining the circumstances.
OPERATIONAL INFORMATION
CERTIFICATION
The undersigned certifies that the information contained in this application and all attached documentation is true and correct to the best of my knowledge and belief and that I will comply with Southeastrans, Inc. Rules and Policies, as amended, governing Independent Provider’s contract. Provider shall operate as an independent Provider in providing services under this Contract, and not as an agent, representative or employee of Southeastrans.
SERVICE AREA
What states and counties are you servicing?
ADDITIONAL INFORMATION
SMALL BUSINESS ENTERPRISE (SBE)
A SMALL BUSINESS ENTERPRISE (SBE) is any corporation, partnership, sole proprietorship, individual, or other business enterprise operating for profit with 100 employees or fewer, including employees employed in any subsidiary or affiliated corporation which otherwise meets the requirements of the federal small business innovation research program, except for the limitation regarding a maximum number of company employees.
WOMAN BUSINESS ENTERPRISE (WBE)
A WOMAN BUSINESS ENTERPRISE (WBE) is at least 51% owned by a woman, or in the case of a publicly owned enterprise, a business enterprise in which at least 51% of the voting stock is owned by minority group members; or any enterprise that is approved or certified as such for purposes of participation in the contracts subject to minority business enterprise requirements involving federal programs and federal funds.
MINORITY BUSINESS ENTERPRISE (MBE)
A MINORITY BUSINESS ENTERPRISE (MBE) is at least 51% owned by minority group members, or in the case of a publicly owned enterprise, a business enterprise that is approved or certified as such for purposes of participation in the contracts subject to women owned business enterprise requirements involving federal programs and federal funds.
DISABLED VETERAN BUSINESS ENTERPRISE (DVBE)
A
DISABLED VETERAN BUSINESS ENTERPRISE (DVBE) meets all of the following:
- The business is at least, 51 percent owned by one or more disabled veterans or in the case of a publicly owned business, at least 51 percent of its stock is owned by one or more disabled veterans; a subsidiary which is wholly owned by a parent corporation but only if at least 51 percent of the voting stock of the parent corporation is owned by one or more disabled veterans; or a joint venture in which at least 51 percent of the joint venture’s management and control and earnings are held by one or more disabled veterans.
- One or more disabled veterans manage and control the daily business operations. The disabled veterans who exercise management and control are not required to be the same disabled veterans as the owners of the business concern.
- A sole proprietorship, corporation, or partnership with its home office located in the United States, which is not a branch or subsidiary of a foreign corporation, foreign firm or other foreign-based business.
Veteran Business Enterprise (VBE)
A VETERAN BUSINESS ENTERPRISE (VBE) is at least 51% owned by a veteran, or in the case of a publicly owned enterprise, a business enterprise in which at least 51% of the voting stock is owned by veterans; or any enterprise that is approved or certified as such for purposes of participation in the contracts subject to minority business enterprise requirements involving federal programs and federal funds.
Disabled Business Enterprise (DBE)
A DISABLED BUSINESS ENTERPRISE (DBE) is at least 51% owned by a disabled person, or in the case of a publicly owned enterprise, a business enterprise in which at least 51% of the voting stock is owned by disabled persons ; or any enterprise that is approved or certified as such for purposes of participation in the contracts subject to minority business enterprise requirements involving federal programs and federal funds.
