E. Affidavit Form. The Small Business Affidavit shall be in the following form: SMALL BUSINESS AFFIDAVIT
I,_________________________(type or print your name legibly), affirm to the State of Maryland that:
1. I am the _____________________________(type or print legibly your title, office, or capacity) of ________________(type or print legibly the correct and complete company name) hereinafter referred to as the "Business."2. The Business is: (a) a for-profit enterprise;(b) not a broker, as defined in COMAR 21.01.02.01B(13-1);(c) independently owned and operated;(d) not a subsidiary of another business;(e) not dominant in its field of operation;(f) With respect to employees, either:(i) The wholesale operations of the Business did not employ more than 50 persons in its most recently completed 3 fiscal years;(ii) The retail operations of the Business did not employ more than 25 persons in its most recently completed 3 fiscal years;(iii) The manufacturing operations of the Business did not employ more than 100 persons in its most recently completed 3 fiscal years;(iv) The service operations of the Business did not employ more than 100 persons in its most recently completed 3 fiscal years;(v) The construction operations of the Business did not employ more than 50 persons in its most recently completed 3 fiscal years; or(vi) The architect and engineering services of the Business did not employ more than 100 persons in its most recently completed 3 fiscal years; and(g) With respect to gross sales: (i) The gross sales of its wholesale operations did not exceed an average of $4,000,000 in its most recently completed 3 fiscal years;(ii) The gross sales of its retail operations did not exceed an average of $3,000,000 in its most recently completed 3 fiscal years;(iii) The gross sales of its manufacturing operations did not exceed an average of $2,000,000 in its most recently completed 3 fiscal years;(iv) The gross sales of its service operations did not exceed an average of $10,000,000 in its most recently completed 3 fiscal years;(v) The gross sales of its construction operations did not exceed an average of $7,000,000 in its most recently completed 3 fiscal years; and(vi) The gross sales of its architectural and engineering operations did not exceed an average of $4,500,000 in its most recently completed 3 fiscal years. Note: If a business has not existed for 3 years, the employment and gross sales shall be the average(s) for each year or part of year during which the business has been in existence.
3. For the exclusive purpose of pursuing out-of-State contracts, the business has: (a) 250 or fewer employees; or(b) Average annual gross receipts of $10,000,000 or less averaged over its most recently completed three fiscal years. 4. For small businesses claiming an additional percentage preference for being veteran-owned (2%) or disabled-veteran-owned (3%), initial next to the applicable statement: The business is at least 51% owned and controlled by one or more individuals who are veterans as defined in 38 U.S.C. § 101(2) and who are domiciled in Maryland.
Or
The business is at least 51% owned and controlled by one or more individuals who are disabled veterans domiciled in Maryland and who have been certified by the U.S. Department of Veterans Affairs as having a service-connected disability regardless of the disability rating.
5. I am fully authorized by the Business to provide this Affidavit.6. Upon request of the State of Maryland, the Business promises to provide the State promptly with copies of the complete federal and state (all states in which the Business filed returns) income tax returns for the most recently completed 3 fiscal years of the Business.7. I understand that the State of Maryland may rely upon this affidavit and that if the information provided by me in this certification is false I may be subject to criminal prosecution for perjury, procurement fraud, and other crimes and any contract awarded to the Business in reliance upon this Affidavit may be void or subject to termination for default. UNDER PENALTIES OF PERJURY, I hereby swear that the matters stated in this Affidavit are true.
_________________________(Date)
____________________________________________Signature
Type or print name legibly