Article Guide
The Michigan 4106 form is a critical document for businesses seeking to participate in the Michigan Department of Transportation's (MDOT) Small Business Program. This form is specifically designed to assess the eligibility of non-Disadvantaged Business Enterprises (non-DBEs) to bid on various MDOT projects. It is essential for applicants to submit this application annually, ensuring it reaches MDOT at least 30 days before any bidding process. Notably, certified DBEs are exempt from completing this form, as their small business size is verified through a different certification process. The application collects vital information about the applicant business, including its name, address, and details regarding ownership and management. Additionally, it requires financial data such as gross receipts and employee counts, which help determine whether the business meets the Small Business Administration's (SBA) size standards. Understanding the requirements and deadlines associated with the Michigan 4106 form is crucial for businesses aiming to successfully navigate the bidding landscape and secure opportunities within the state's infrastructure projects.
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Michigan Department
Of Transportation
4106 (10/12)
SMALL BUSINESS PROGRAM APPLICATION
Page 1 of 9
This form is used to determine eligibility of
Certified DBEs do not need to complete this form - annual verification of small business size is a requirement of certification.
Part 1. Information relating to applicant business only
NAME OF BUSINESS
ADDRESS OF BUSINESS |
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NAME AND TITLE OF AUTHORZIED SIGNER FOR THIS BUSINESS |
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TELEPHONE NO. |
FAX NO. |
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WHAT IS THE FEDERAL YEAR END TAX DATE FOR THE APPLICANT BUSINESS (Month/Date) |
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DESCRIBE THE MAJOR PRODUCTS OR SERVICES YOUR BUSINESS PROVIDES |
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1A. Business Major Products or Services – see FHVVJRYHRVZZZDLFV
Products/Services
NAICS Code
1B. Name and address of owner, partners, principal stockholders, or members of business
organization. Please denote the type of partners
Percent of voting stock or
kinds of interest
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1C. Name of all officers |
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Address for each officer |
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1D. Name of the Board of Directors of this |
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Address of each member of the Board of Directors |
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business, if a corporation |
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MDOT 4106 (10/12) |
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1E. If any person listed in 1B, 1C, or 1D is an owner, partner, director, officer, member, employee or principal stockholder in
another business, please provide the following information (add extra pages if needed).
Name of Person
Business Name and Address
Position Held
%Interest in
Business
1F. Small Business Size Determination – Business Gross Receipts per tax form
Please complete this section if the NAICS codes identified is section 1A. base business size on gross receipts. The small business size table is available at http://www.sba.gov/sites/default/files/files/Size_Standards_Table.xls Under “Table of Size Standards.” You must provide copies of U.S. business tax forms showing gross receipts earned for the three consecutive fiscal years reported below for this business.
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YEAR |
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DOLLARS |
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Total |
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1G. Total number of employees of the applicant business
Please complete this section if the NAICS codes identified in 1A determine business size using total number of employees. See http://www.sba.gov/sites/default/files/files/Size_Standards_Table.xls “Table of Size Standards.” You must provide copies of U.S. business tax forms showing total number of employees.
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Part 2. Affiliates and Subsidiaries, including those identified in Part 1E.
13 CFR 121 – Stock ownership has to be 50% or more in another company – including when ownership is shared among several people.
BUSINESS NAME
PRODUCTS/SERVICES
NAICS CODE
MDOT 4106 (10/12) |
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2A. Gross sales or receipts of 1st affiliate business for the past three fiscal years
You must provide copies of U.S. business tax forms for the fiscal years reported below which show gross receipts of all subsidiaries or affiliates.
NAME AND ADDRESS OF AFFILIATE OR SUBSIDIARY
YEAR
20
DOLLARS
$
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DOLLARS |
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DOLLARS |
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Total |
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2B. Gross sales or receipts of 2nd affiliate business for the past three fiscal years
You must provide copies of U.S. business tax forms for the fiscal years reported below which show gross receipts of all subsidiaries or affiliates. If you have more than two affiliates or subsidiaries, please attach additional pages for those affiliates.
NAME AND ADDRESS OF 2nd AFFILIATE
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2C. Total number of employees of 1st affiliate |
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Please complete this section if the NAICS codes identified in section 1A. base business size on number of employees. The small business size table is available at http://www.sba.gov/sites/default/files/files/Size_Standards_Table.xls under “Table of Size Standards.” You must provide copies of U.S. business tax forms showing total numbers of
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2D. Total number of employees of 2nd affiliate
Please complete this section if the NAICS codes identified in section 1A. base business size on number of employees.
The small business size table is available at http://www.sba.gov/sites/default/files/files/Size_Standards_Table.xls under “Table of
Size Standards.” You must provide copies of U.S. business tax forms showing total numbers of
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TOTAL NUMBER OF ALL |
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CERTIFICATION
I hereby certify that all information provided on this form and in attachments are true and correct to the best of my knowledge and belief. This information is submitted for the purpose of assisting the MDOT in making a size determination in order that my business may participate in the
NAME OF SOLE PROPRIETORSHIP, PARTNERSHIP, LIMITED LIABILITY COMPANY, OR CORPORATION
SIGNATURE
NAME AND TITLE
DATE OF SIGNING
MDOT 4106 (10/12) |
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Instructions FOR SMALL BUSINESS Program application
For participation in the Michigan Department of Transportation (MDOT)
SMALL BUSINESS PROGRAM
Carefully read these instructions and the United States Small Business Administration (SBA) size regulations found at 13 Code of Federal Regulations Part 121 before completing this form.
To qualify for the Small Business Program, applicants must meet SBA small business size standards for the industry in which the applicant will be bidding.
No business, including affiliates and subsidiaries, will qualify for this program if gross receipts as averaged over the previous three years exceed $22.41 million.
General Instructions
1.Information provided will be used by the MDOT to determine small business size of non- disadvantaged business enterprises
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b.
2.Select North American Industry Classification System (NAICS) codes that best describe your business and then determine if the business meets size standards for the selected codes. SBA size standards are usually stated either in number of employees over the past 12 months, or average annual receipts over the past three years – whichever number represents the largest size of your business right now (including subsidiaries and affiliates). Size standards are available for every private sector industry in the U.S. economy, with the NAICS used to identify the industries. The steps are simple to determine your size:
a.Identify the NAICS code(s) that best describe(s) your business activities. http://www.census.gov/eos/www/naics/
See Identifying Industry Codes at
b.Determine your Industry's size standard using the Table of Small Business Size Standards at
3.One copy of MDOT SBP Application, with additional sheets attached as needed, must be returned to the MDOT Office of Business Development.
4.The person signing this form must be authorized to do so.
5.All affiliates of the business, whether acknowledged or not, and whether foreign or domestic, must be disclosed. SBA's criteria for defining affiliates should be carefully reviewed. In 13 CFR §121.103, SBA identifies various forms of affiliation.
MDOT 4106 (10/12) |
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6.Where the applicable size standard involves "number of employees", a business' average number of employees on payroll before for the 12 months preceding the application or offers is examined, including all individuals who are fulltime,
7.Where applicable size standards involve "average annual receipts", a business' annual receipts mean total income (or gross income in the case of a sole proprietorship) plus cost of goods sold as these terms are defined and reported on the business' Federal Income Tax Return, which must be attached to this eligibility request determination. See 13 CFR § 121.104 of SBA's regulations.
8.MDOT must determine the primary industry activity or the NAICS code of a business as part of its size determination for the Small Business Program. In making this size determination, consideration is given to various criteria, such as the distribution of a business' revenues, employment and costs associated with doing business. See 13 CFR 121.107.
9.For purposes of this form, MDOT considers a principal of the business as those persons or affiliated businesses that own 10 percent or more of its ownership. In cases where no individual or affiliated business owns at least 10 percent interest, the five largest interest holders and their percentages of interest must be listed. Additionally, the principal officers and their interest in the business must be listed.
10.Affiliation is defined in the Small Business Administration (SBA) regulations, 13 CFR part 121.
(1)Except as otherwise provided in 13 CFR part 121, concerns are affiliates of each other when, either directly or indirectly:
(i)One concern controls or has the power to control the other; or
(ii)A third party or parties controls or has the power to control both; or
(iii)An identity of interest between or among parties exists such that affiliation may be found.
(2)In determining whether affiliation exists, it is necessary to consider all appropriate factors, including common ownership, common management, and contractual relationships. Affiliates must be considered together in determining whether a concern meets small business size criteria and the statutory cap on the participation of firms in the DBE program.
(6)In determining the concern's size, SBA counts the receipts, employees, or other measure of size of the concern whose size is at issue and all of its domestic and foreign affiliates, regardless of whether the affiliates are organized for profit.
(b)Exceptions to affiliation coverage. (1) Business concerns owned in whole or substantial part by investment companies licensed, or development companies qualifying, under the Small Business Investment Act of 1958, as amended, are not considered affiliates of such investment companies or development companies.
(7)(c) Affiliation based on stock ownership. (1) A person (including any individual, concern or other entity) that owns, or has the power to control, 50 percent or more of a concern's voting stock, or a block of voting stock which is large compared to other outstanding blocks of voting stock, controls or has the power to control the concern.
(7)(4)(e) Affiliation based on common management. Affiliation arises where one or more officers, directors, managing members, or partners who control the board of directors and/or management of one concern also control the board of directors or management of one or more other concerns.
MDOT 4106 (10/12) |
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(f)Affiliation based on identity of interest. Affiliation may arise among two or more persons with an identity of interest. Individuals or firms that have identical or substantially identical business or economic interests (such as family members, individuals or firms with common investments, or firms that are economically dependent through contractual or other relationships) may be treated as one party with such interests aggregated. Where SBA determines that such interests should be aggregated, an individual or firm may rebut that determination with evidence showing that the interests deemed to be one are in fact separate.
PENALTIES FOR CRIMINAL VIOLATIONS
It is a criminal offense to misrepresent in writing the status of a concern as a small business in order to obtain a prime or subcontract contract awarded pursuant to Section 9 or 15 of the Act (15 U.S.C. § 638 and § 644) and Section 8(a) of the Act ( 15 U.S.C. § 637(a)) or subcontract included as part or all of a goal contained in a subcontracting plan required according to the Section 8(d) of the Act (15 U.S.C. § 637 (d)), or prime or subcontract awarded under Federal Law that references Section 8(d) of the Act (15 U.S.C. § 637 (d)) that defines eligibility for such programs as the Small and Disadvantaged Business contracting program. Under Section 16(d) of the Act (15 U.S.C. 645(d)), the punishment for this offense is imprisonment of not more than 10 years or a fine of not more than $500,000 or both. It can also result in certain administrative penalties, such as suspension or debarment from further contracting with the US Government.
MDOT 4106 (10/12) |
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PERSONAL FINANCIAL STATEMENT
As of |
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Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning or (4) any person or entity providing a guaranty loan.
Name |
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Business Phone |
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Residence Address |
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Residence Phone |
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City, State, & Zip Code |
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Business Name of Applicant/Borrower |
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ASSETS |
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(Omit Cents) |
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LIABILITIES |
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Cash on hand & in Banks |
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Accounts Payable |
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$ |
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Savings Accounts |
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Notes Payable to Banks and Others |
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IRA or Other Retirement Account |
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(Describe in Section 2) |
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Accounts & Notes Receivable |
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Installment Account (Auto) |
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Life |
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Mo. Payments |
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(Complete Section 8) |
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Installment Account (Other) |
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Stocks and Bonds |
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Mo. Payments |
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(Describe in Section 3) |
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Loan on Life Insurance |
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Real Estate |
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Mortgages on Real Estate |
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(Describe in Section 4) |
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(Describe in Section 4) |
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Unpaid Taxes |
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Other Personal Property |
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(Describe in Section 6) |
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(Describe in Section 5) |
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Other Liabilities |
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Other Assets |
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(Describe in Section 7) |
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(Describe in Section 5) |
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Total Liabilities |
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Net Worth |
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Total |
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Section 1. |
Source of Income |
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Contingent Liabilities |
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Salary |
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As Endorser or |
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Net Investment Income |
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Legal Claims & Judgments |
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Real Estate Income |
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Provision for Federal Income Tax |
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Other Income (Describe below)* |
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Other Special Debt |
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Description of Other Income in Section 1.
*Alimony or child support payments need not be disclosed in "Other Income" unless it is desired to have such payments counted toward total income.
Section 2. Notes Payable to Banks and Others. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed.)
Name and Address of Noteholder(s)
Original Balance
Current Balance
Payment
Amount
Frequency
(monthly,etc.)
How Secured or Endorsed
Type of Collateral
(tumble)
MDOT 4106 (10/12)
Section 3. Stocks and Bonds. (Use attachments if necessary. Each attachment must be identified as a part of this statement and signed).
Number of Shares
Name of Securities
Cost
Market Value
Quotation/Exchange
Date of
Quotation/Exchange
Total Value
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Section 4. Real Estate Owned. |
(List each parcel separately. Use attachment if necessary. Each attachment must be identified as a part |
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of this statement and signed.) |
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Type of Property |
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Address |
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Date Purchased |
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Original Cost |
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Present Market Value |
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Name & |
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Address of Mortgage Holder |
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Mortgage Account Number |
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Mortgage Balance |
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Amount of Payment per Month/Year |
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Status of Mortgage |
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Section 5. Other Personal Property and Other Assets. |
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(Describe, and if any is pledged as security, state name and address of lien holder, amount of lien, terms |
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payment and if delinquent, describe delinquency) |
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Section 6. |
Unpaid Taxes. |
(Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a tax lien attaches.) |
Section 7. Other Liabilities. (Describe in detail.)
Section 8. |
Life Insurance Held. |
(Give face amount and cash surrender value of policies - name of insurance company and beneficiaries) |
I authorize SBA/Lender to make inquiries as necessary to verify the accuracy of the statements made and to determine my creditworthiness. I certify the above and the statements contained in the attachments are true and accurate as of the stated date(s). These statements are made for the purpose of either obtaining a loan or guaranteeing a loan. I understand FALSE statements may result in forfeiture of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001).
Signature: |
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Social Security Number: |
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Signature: |
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Social Security Number: |
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MDOT 4106 (10/12) |
Page 9 of 9 |
Small Business Program (SBP) Application Checklist and
required attachments:
Legal business name: ______________________________
PERSONAL NET WORTH (PNW)
All owners of businesses applying for the SBP must have a pnw less than $1.32 million. This figure excludes each owner’s primary residence, and the value of the business applying for participation in the SBP.
SMALL BUSINESS PROGAM SIZE
Businesses, including affiliates, qualifying for the SBP must not exceed the U.S. Small Business Administration size standard(s) for the North American Industry Classification (NAICS) code for the type(s) of work performed. In no case shall any eligible business, including affiliate businesses, have gross receipts over $22.41 million as averaged over the three most recent tax years.
The following documents must be provided in order for MDOT to determine eligibility to participate in the SBP:
A completed copy of the entire SBP application, signed and notarized with last 4 digits of SS #.
All assets listed as joint on PNW must provide a break down for each individual.
The personal financial statement must include the value of ownership in all other companies owned by the applicant.
United States 1040 Personal Income Tax Returns for the most recent three (3) consecutive years (i.e., 2009, 2010, 2011)
O Include all schedules and
Federal business tax returns for the most recent three (3) consecutive years for the applicant business and all affiliate businesses:
O Include all business tax schedules and required attachments and
Please DO NOT bind or staple the application
Mail completed application to the following address:
MDOT Office of Business Development,
P.O. Box 30050,
Lansing, Michigan 48909
Note: Incomplete application packages will be returned.
Form Specifications
| Fact Name | Details |
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| Purpose | The Michigan 4106 form is used to determine the eligibility of non-Disadvantaged Business Enterprises (non-DBEs) for MDOT Small Business Program projects. |
| Submission Frequency | This application must be submitted annually, at least 30 days before bidding on projects. |
| DBE Exemption | Certified DBEs are not required to complete this form but must verify their small business size annually. |
| Governing Law | The form operates under the regulations set forth in 13 CFR Part 121. |
| NAICS Codes | Applicants must select appropriate NAICS codes that best describe their business activities. |
| Gross Receipts Limit | Businesses with average gross receipts exceeding $22.41 million over the past three years do not qualify. |
| Employee Count | Eligibility can also be determined based on the total number of employees over the past 12 months. |
| Information Requirement | Complete and accurate information is essential for MDOT to make a size determination. |
| Affiliates Disclosure | All affiliates must be disclosed, regardless of whether they are domestic or foreign. |
| Principal Owners | Individuals or businesses owning 10% or more must be identified in the application. |
Michigan 4106: Usage Guidelines
Completing the Michigan 4106 form is an essential step for businesses looking to participate in the Michigan Department of Transportation's Small Business Program. This application needs to be submitted at least 30 days before bidding, and it is crucial to ensure that all information is accurate and complete. Here’s a straightforward guide to help you through the process.
- Gather Necessary Information: Before you start filling out the form, collect all relevant documents, including your business tax forms for the past three years and details about your business structure.
- Fill in Business Information: Start with the business name, address, and contact details. Include the name and title of the authorized signer.
- Provide Federal Tax Year End Date: Enter the month and date for your business's federal year-end tax date.
- Describe Major Products or Services: Clearly outline the main products or services your business provides and include the corresponding NAICS code.
- List Ownership and Management: In section 1B, provide the names and addresses of owners, partners, and principal stockholders, along with their respective interests.
- Detail Officers and Directors: Fill in the names and addresses of all officers and members of the board of directors in sections 1C and 1D.
- Report Affiliations: If any individuals listed in previous sections are involved in other businesses, provide their names, positions, and ownership percentages in section 1E.
- Complete Size Determination: Depending on the chosen NAICS code, report gross receipts or total number of employees for the past three years in sections 1F and 1G.
- Affiliates and Subsidiaries: For each affiliate or subsidiary, fill out sections 2A and 2B with their gross sales or receipts, and sections 2C and 2D with employee counts.
- Certification: Finally, the authorized signer must certify that all information is true and accurate. Include the name, title, and date of signing.
After completing the form, review it carefully for any errors or missing information. Once you are confident that everything is accurate, submit the form along with any required attachments to the MDOT Office of Business Development. This submission is a critical step in ensuring your eligibility for the program.
Your Questions, Answered
What is the Michigan 4106 form used for?
The Michigan 4106 form is an application used to determine the eligibility of non-Disadvantaged Business Enterprises (non-DBEs) to bid on projects under the Michigan Department of Transportation's Small Business Program. This form must be submitted annually, at least 30 days before bidding on projects.
Who needs to fill out the Michigan 4106 form?
Only non-Disadvantaged Business Enterprises (non-DBEs) are required to complete this form. Certified DBEs do not need to fill it out, as they must verify their small business size annually as part of their certification process.
What information is required on the form?
The form requires basic information about the applicant business, including its name, address, and contact details. Additionally, it asks for details about the business's major products or services, ownership structure, and gross receipts or number of employees for the past three fiscal years.
How often must the form be submitted?
The Michigan 4106 form must be submitted once a year. It is important to ensure that it is filed at least 30 days before the intended bidding date to allow for processing.
What are the size standards for small businesses?
To qualify as a small business under the program, the applicant must meet the Small Business Administration (SBA) size standards. These standards are based on either the average annual receipts over the past three years or the average number of employees over the past 12 months, whichever is larger. For most industries, the gross receipts limit is $22.41 million.
What documents must accompany the form?
Applicants must provide copies of U.S. business tax forms that show gross receipts and the total number of employees for the last three fiscal years. This documentation is essential for verifying the business's eligibility based on size standards.
What happens if the information provided is incomplete?
If the information on the form is incomplete, it may cause delays in the size determination process. Additionally, it could lead to negative inferences regarding the business's status as a small business.
Are affiliates and subsidiaries required to be disclosed?
Yes, all affiliates and subsidiaries of the applicant business must be disclosed on the form. The SBA has specific criteria for defining affiliates, and failure to disclose them could impact the eligibility determination.
Who is authorized to sign the Michigan 4106 form?
The form must be signed by an authorized representative of the business. If a non-employee, such as an attorney or accountant, is signing, they must provide a letter authorizing them to represent the firm.
Common mistakes
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Incomplete Information: Many applicants fail to provide all required details, such as the complete address of the business or the names of all officers. This omission can lead to delays or even rejection of the application.
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Incorrect NAICS Codes: Selecting the wrong North American Industry Classification System (NAICS) codes can disqualify a business from eligibility. Ensure that the codes accurately represent your business activities.
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Failure to Include Financial Documents: Applicants often neglect to attach necessary financial documents, such as U.S. business tax forms showing gross receipts for the past three years. This information is crucial for determining size eligibility.
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Missing Authorized Signature: The form must be signed by an authorized individual. Applications submitted without a proper signature may be considered invalid, leading to further complications.
Documents used along the form
The Michigan 4106 form is essential for businesses seeking to participate in the Michigan Department of Transportation's Small Business Program. However, several other forms and documents are often required to accompany this application, ensuring a comprehensive review of the business's qualifications. Below are five commonly used forms that may be necessary.
- IRS Form 1040 or 1120: These forms are used to report individual or corporate income tax returns. They provide evidence of gross receipts and overall financial performance, which are critical for determining eligibility for the Small Business Program.
- Business Tax Returns: Businesses must submit tax returns for the last three years. These documents help verify gross receipts and employee counts, ensuring compliance with size standards set by the SBA.
- Affidavit of Eligibility: This document is a sworn statement affirming that the business meets all eligibility criteria for the Small Business Program. It may include details about ownership and operational control.
- NAICS Code Documentation: Businesses must provide documentation identifying their North American Industry Classification System (NAICS) codes. This classification is vital for assessing whether the business meets the size standards for its industry.
- Owner Information Form: This form collects detailed information about business owners, partners, and principal stockholders. It is crucial for evaluating ownership structure and potential affiliations with other businesses.
In summary, submitting the Michigan 4106 form alongside these additional documents is crucial for a successful application. Each form plays a specific role in demonstrating the business's eligibility and compliance with program requirements.
Similar forms
- Small Business Administration (SBA) 8(a) Application - Like the Michigan 4106 form, this application determines eligibility for federal assistance programs aimed at small businesses. Both require detailed financial information and business structure disclosures.
- DBE Certification Application - This form is used for businesses seeking certification as Disadvantaged Business Enterprises. It shares the same goal of establishing eligibility to participate in certain government contracts, requiring similar financial documentation.
- Minority Business Enterprise (MBE) Application - This application certifies minority-owned businesses. Like the Michigan 4106, it assesses business size and ownership structure, ensuring compliance with specific eligibility criteria.
- Women-Owned Business Enterprise (WBE) Application - Similar to the MBE application, this form is for women-owned businesses seeking certification. It also requires proof of ownership and financial documentation, paralleling the requirements of the Michigan 4106 form.
- Small Business Size Certification (SBA Form 355) - This form certifies small businesses based on size standards. Both forms require businesses to provide financial data and ownership information to establish eligibility.
- Federal Acquisition Regulation (FAR) 52.219-1 - This clause requires federal contractors to demonstrate their small business status. Like the Michigan 4106, it necessitates the submission of financial records and business size information.
- State Certification for Small Business Programs - Many states have their own forms for small business certification, similar to the Michigan 4106. These forms typically require proof of business size and ownership, aligning with the information requested in the Michigan form.
Dos and Don'ts
Filling out the Michigan 4106 form can be a crucial step for businesses looking to participate in the Small Business Program. Here are five important things to do and avoid when completing this form:
- Do read the instructions carefully before you begin. Understanding the requirements will help ensure you provide all necessary information.
- Do gather all required documents, such as tax forms and employee records, before starting the application. This will streamline the process and reduce the likelihood of errors.
- Do ensure that the person signing the form is authorized to do so. This is essential for the validity of your application.
- Do disclose all affiliates and subsidiaries. Transparency is key to meeting eligibility requirements.
- Do double-check your calculations for gross receipts and employee numbers. Accurate figures are critical for determining your business size.
- Don't leave any sections blank. Incomplete information can lead to delays or rejection of your application.
- Don't submit the form without reviewing it for accuracy. Mistakes can be costly and time-consuming to correct.
- Don't overlook the deadline. Ensure that your application is submitted at least 30 days before bidding.
- Don't provide outdated financial information. Use the most recent tax forms to reflect your current business status.
- Don't assume that previous submissions are still valid. Each year, the application must be completed anew.
By following these guidelines, you can navigate the Michigan 4106 form with confidence and improve your chances of success in the Small Business Program.
Misconceptions
Misconceptions about the Michigan 4106 form can lead to confusion and potential errors in the application process. Here are ten common misconceptions, along with clarifications to help demystify the form.
- Misconception 1: Only Disadvantaged Business Enterprises (DBEs) need to fill out the Michigan 4106 form.
- Misconception 2: The form must be submitted every time a business wants to bid on a project.
- Misconception 3: There are no specific deadlines for submitting the form.
- Misconception 4: Businesses can provide any financial documents to demonstrate size.
- Misconception 5: Affiliates and subsidiaries do not need to be disclosed.
- Misconception 6: Only full-time employees count towards the total employee count.
- Misconception 7: The Michigan 4106 form can be completed without understanding NAICS codes.
- Misconception 8: A business can qualify for the program regardless of its gross receipts.
- Misconception 9: The person signing the form does not need to be authorized.
- Misconception 10: The information provided on the form is not subject to verification.
This is incorrect. The form is specifically designed for non-Disadvantaged Business Enterprises (non-DBEs) to determine eligibility for the MDOT Small Business Program. Certified DBEs do not need to complete this form.
In reality, the Michigan 4106 form must be submitted only once a year, at least 30 days before bidding on a project. This annual submission is sufficient for ongoing eligibility.
On the contrary, the form must be submitted at least 30 days prior to bidding. Missing this deadline can result in disqualification from bidding on projects.
This is misleading. Businesses must provide copies of U.S. tax forms that show gross receipts or the number of employees for the last three consecutive fiscal years. Specific documentation is required.
This is a critical error. All affiliates and subsidiaries must be disclosed, as they can impact the size determination of the business. Failing to disclose this information may lead to disqualification.
In fact, the total number of employees includes full-time, part-time, temporary, and seasonal employees. All individuals working for the business must be accounted for in the employee count.
This is not advisable. Applicants must identify the North American Industry Classification System (NAICS) codes that best describe their business activities, as these codes determine the applicable size standards.
This is incorrect. A business will not qualify if its gross receipts, averaged over the previous three years, exceed $22.41 million. This cap is strictly enforced.
This is a misunderstanding. The individual signing the form must be authorized to do so. If a non-employee representative is signing, a letter of authorization must be provided.
This is false. The Michigan Department of Transportation (MDOT) may request additional information to verify the accuracy of the details provided on the form. Incomplete or inaccurate information can lead to delays or disqualification.
Key takeaways
The Michigan 4106 form is essential for businesses seeking to participate in the Michigan Department of Transportation (MDOT) Small Business Program. Below are key takeaways regarding the completion and use of this form:
- Eligibility Determination: The form assesses the eligibility of non-Disadvantaged Business Enterprises (non-DBEs) to bid on MDOT projects.
- Annual Submission: Businesses must submit the form once a year, at least 30 days before bidding on projects.
- DBE Exemption: Certified Disadvantaged Business Enterprises (DBEs) are not required to complete this form, as they undergo annual verification of their small business size.
- Complete Information: All sections of the form must be filled out completely. Incomplete submissions may lead to delays or negative assumptions regarding the business's size.
- Affiliates Disclosure: All affiliates, whether domestic or foreign, must be disclosed. This includes any business relationships that could affect size determinations.
- Size Standards: Applicants must meet the Small Business Administration (SBA) size standards, which are based on either gross receipts or the number of employees.
- Authorized Signatory: The individual signing the form must be authorized to do so. Non-employee representatives must provide a letter of authorization.