I ___________________________________ , hereby declare there have been no changes in
dpw.vi.gov I ___________________________________ , hereby declare there have been no changes in ________________________________________ (Business Name) circumstances affecting its ability to meet the size, disadvantaged status, ownership, or control requirements of 49 CFR Part 26 and 13 CFR Part 121. I further declare there have been no material changes in the information provided with the most recent DBE application submitted by this business, except for any changes about which I have provided written notice to the Virgin Islands Department of Public Works, Office of Civil Rights pursuant to 49 CFR § 26.83(i). I further declare that I am socially disadvantaged because I have been subjected to racial or ethnic prejudice or cultural bias, or have been suffered the effects of discrimination, because of my identity as a member of the groups identified in 49 CFR § 26.5, without regard to my individual qualities. …
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dpw.vi.gov I ___________________________________ , hereby declare there have been no changes in ________________________________________ (Business Name) circumstances affecting its ability to meet the size, disadvantaged status, ownership, or control requirements of 49 CFR Part 26 and 13 CFR Part 121. I further declare there have been no material changes in the information provided with the most recent DBE application submitted by this business, except for any changes about which I have provided written notice to the Virgin Islands Department of Public Works, Office of Civil Rights pursuant to 49 CFR § 26.83(i). I further declare that I am socially disadvantaged because I have been subjected to racial or ethnic prejudice or cultural bias, or have been suffered the effects of discrimination, because of my identity as a member of the groups identified in 49 CFR § 26.5, without regard to my individual qualities. I further declare that my personal net worth does not exceed $1.32 million, and that I am economically disadvantaged because of my ability to compete in the free-market enterprise system has been impaired due to diminished capital and credit opportunities as compared to others in the same or similar line of business who are not socially and economically disadvantaged. In addition, I specifically declare that this business continues to meet the Small Business Administration (SBA) size criteria and the overall gross receipts cap of 49 CFR Part 26. I specifically declare that this business’ average gross receipts over the previous three (3) fiscal years is $________________. I included the business tax return(s) for this and any affiliate businesses in support of this declaration. I declare under penalty of perjury, that the forgoing is true and correct.1 Executed on ____________________ Signature/Title: (Printed Name/Title) 1Knowingly and willfully providing false or misleading information to State and Federal government is a violation of 18 U.S.C. Section 1001 (False Statements) and F.S 337.135, and could subject you to fines, imprisonment or both. NO CHANGE DECLARATION