CITY OF OAKLAND APPLICATION FOR LOCAL CERTIFICATION

To complete the Certification/Recertification process for the City of Oakland please submit to our office an original copy of the Supplemental Questionnaire "C" and the notorized Affidavit of Certification, a copy Business Tax License, 3 years of Tax returns(only for SLBE certification) a copy of your business current lease agreement.

If your firm is requesting certification with Alameda County, Alameda County Transportation Improvement Authority/ACTIA, and Port of Oakland an original copy of each Supplemental Questionnaires, Notorized Affidavit of Certifications and any other documentation requested by the Supplemental Questionnaire must be submitted to our office. There is no affidavit required for certification with Alameda County.

You may forward the completed Common Application and supporting documents to the:

City of Oakland, Department of Contracting & Purchasing,
Attn: Social Equity Division
250 Frank H. Ogawa Plaza Suite 3341
Oakland, CA 94612.

See our website at "http://cces.oaklandnet.com/cceshome/FormsSchedules.asp" for the list of supplementals and Affidavit of Certification. For any additional questions please, email Vivian Inman at vinman@oaklandnet.com

To check for your NAICS code cut and paste this link "http://www.census.gov/epcd/naics02/naico602.htm" to your web browser.

THE COMMON APPLICATION IS A SHARING OF INFORMATION BETWEEN AGENCIES AND NOT A RECIPROCAL CERTIFICATION.

* Required

Cert or Recert * I would like to get my business

Certified
Recertified

I am applying for: * SLBE=Small Local Business Enterprise, LBE=Local Business Enterprise, NPLBE=Non-Profit Local Business Enterpise, NPSLBE=Non-Profit Small Local Business Enterprise Certification

SLBE
LBE
NPLBE
NPSLBE

Business Category * My business is a, CS=Construction Services, PS=Professional Services, CSPS=Both

CS
PS
CSPS

Business Name * Legal Name of your Business

Contact Person First Name *

Contact Person Last Name *

Contact Person Job Title *

Street Address (No P.O.Box) *

City *

State *

Zip Code *

County

Telephone Number *

Fax Number

Cell Number

Email Address *

Website Address

Business Primary Service: *

Business Specialty Service:

Business Profile * Please submit a summary of your services and specialization(s)

Business Date Established * The date your business was estbalished

Oakland Established Date * The date your Oakland Office was established

Other Offices * Does your business have offices outside the City of Oakland

Yes
No

Other Locations If yes, list other locations

Different Business Name Has this business operated under a different name in the past 5 years. If yes, please enter other name below.

Gender *

Male
Female

Employees FT * Number of full time employees at the local office. Permanent, Temporary and Seasonal Employees

Employees PT Number of part time employees at the local office. Permanent, Temporary and Seasonal Employees

Total Employees Total number of employees in all locations. Business with offices outside of Oakland

Certification Certification from other Agencies. Please list in order and separate by comma the name of agency, type of certification, certification number and certification expiration date.

Non-Profit Business If you are a non-profit business please fax (510-238-3363) or mail your IRS letter of determination.

I am a Non-Profit Business

Licenses Contractor/Professional Licenses, Permits or Certificates. Choose from the list and type in your answer in the next 3 questions.

State of CA Contractor's License Board
State of CA Professional License
State of CA Service License or Permit
Other:

Professional License Type of Professional Licenses, Permits or Certificates. Please enter your Professional Licenses, Permits or Certificates number here.

License Number Please enter your Contractor/Professional Licenses, Permits or Certificates number here.

License Expiration Date Please enter your Contractor/Professional Licenses, Permits or Certificate expiration date here.

1. NAICS Codes: * To review the NAICS codes click on the link above this page

2. NAICS Codes: Please review the NAICS listing of work codes

3. NAICS Codes: Please review the NAICS listing of work codes

4. NAICS Codes: Please review the NAICS listing of work codes

5. NAICS Codes: Please review the NAICS listing of work codes

6. NAICS Codes: Please review the NAICS listing of work codes

Trucking Firm * Are you a Trucking Firm

Yes
No

Truck Broker Are you a Truck Broker?

Yes
No

Supplier * Are you a Supplier?

Yes
No

Consent * When submitting this application to any of the listed Certification Taskforce members, I consent to the sharing of information contained herein and declare under penalty of perjury that all statements made in this Application are true and correct

Yes
No