Outline
The Michigan 4106 form is a crucial application designed for small businesses seeking to participate in the Michigan Department of Transportation's (MDOT) Small Business Program. This form specifically assesses the eligibility of non-Disadvantaged Business Enterprises (non-DBEs) to bid on MDOT projects. To maintain compliance, businesses must submit this application annually, ensuring it is filed at least 30 days before any bidding process. Notably, certified Disadvantaged Business Enterprises (DBEs) are exempt from completing this form, as their certification includes an annual verification of small business size. The form requires detailed information about the applicant business, including its name, address, and major products or services offered. It also collects data on ownership, partnerships, and the business's financial performance over the past three years. Additionally, the form addresses the business's affiliates and subsidiaries, requiring disclosure of any shared ownership or interests. Understanding the requirements and accurately completing the Michigan 4106 form is essential for small businesses aiming to engage with state projects and contribute to the local economy.
Sample - Michigan 4106 Form
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) |
Page 2 of 9 |
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.
YEAR |
DOLLARS |
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YEAR |
DOLLARS |
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YEAR |
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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TOTAL NUMBER OF ALL |
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TOTAL NUMBER OF ALL |
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TOTAL NUMBER OF ALL |
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TOTAL NUMBER OF ALL |
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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) |
Page 3 of 9 |
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
$
YEAR |
DOLLARS |
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$ |
YEAR |
DOLLARS |
20 |
$ |
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
YEAR |
DOLLARS |
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YEAR |
DOLLARS |
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YEAR |
DOLLARS |
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Total |
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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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TOTAL NUMBER OF ALL |
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TOTAL NUMBER OF ALL |
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TOTAL NUMBER OF ALL |
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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
YEAR |
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TOTAL NUMBER OF ALL |
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YEAR |
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TOTAL NUMBER OF ALL |
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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) |
Page 4 of 9 |
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
a.
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) |
Page 5 of 9 |
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) |
Page 6 of 9 |
(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 $500,000 or both. It can also result in certain administrative penalties, such as suspension or debarment from further contracting with the US Government.
MDOT 4106 (10/12) |
Page 7 of 9 |
PERSONAL FINANCIAL STATEMENT
As of |
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Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stockholder owning or (4) any person or entity providing a guaranty loan.
Name |
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Business Phone |
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Residence Address |
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Residence Phone |
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City, State, & Zip Code |
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Business Name of Applicant/Borrower |
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ASSETS |
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(Omit Cents) |
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LIABILITIES |
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Cash on hand & in Banks |
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Accounts Payable |
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$ |
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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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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: |
Date: |
Social Security Number: |
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Signature: |
Date: |
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 Information
| Fact Name | Description |
|---|---|
| Purpose | The Michigan 4106 form is designed to assess the eligibility of non-Disadvantaged Business Enterprises (non-DBEs) to participate in the Michigan Department of Transportation's Small Business Program projects. |
| Submission Frequency | This application must be submitted annually, at least 30 days prior to bidding on any relevant projects. |
| Certification Exemption | Certified Disadvantaged Business Enterprises (DBEs) are exempt from completing this form, as they must only verify their small business size annually. |
| Governing Law | The form is governed by the regulations outlined in 13 Code of Federal Regulations (CFR) Part 121, which details the size standards for small businesses. |
| Size Standards | To qualify, businesses must meet the SBA's size standards, which are based on either gross receipts or the number of employees, depending on the industry. |
Detailed Guide for Filling Out Michigan 4106
Completing the Michigan 4106 form is an essential step for non-Disadvantaged Business Enterprises (non-DBEs) seeking to participate in the Michigan Department of Transportation's Small Business Program. This application must be submitted annually, at least 30 days before bidding on projects. Below are the steps to fill out the form accurately.
- Gather Necessary Information: Collect all relevant business documents, including tax forms, to support your application.
- Fill Out Business Information: In Part 1, provide the name, address, and contact information for your business, including the name and title of the authorized signer.
- Federal Tax Year End: Indicate the federal year-end tax date for your business.
- Describe Products or Services: Detail the major products or services your business provides, along with the corresponding NAICS code.
- List Owners and Partners: Include names and addresses of owners, partners, principal stockholders, and their respective interests in the business.
- Document Officers: Provide the names and addresses of all officers associated with your business.
- Board of Directors: If applicable, list the names and addresses of the Board of Directors.
- Affiliates Information: If any listed individuals are involved in other businesses, provide their names, positions, and percentage of interest in those businesses.
- Gross Receipts: Complete the small business size determination section by providing gross receipts for the last three fiscal years, along with supporting tax documents.
- Employee Count: If applicable, document the total number of employees for the last three years, including full-time, part-time, and temporary workers.
- Affiliates and Subsidiaries: For each affiliate or subsidiary, provide their names, addresses, gross sales or receipts for the past three years, and employee counts if necessary.
- Certification: The authorized signer must certify that all information provided is true and correct. Include the name, title, and date of signing.
After completing the form, review all entries for accuracy and completeness. Submit the application to the Michigan Department of Transportation's Office of Business Development, ensuring that all necessary attachments are included. This process will help facilitate your eligibility for bidding on Small Business Program projects.
Obtain Answers on Michigan 4106
-
What is the Michigan 4106 form?
The Michigan 4106 form is an application used by the Michigan Department of Transportation (MDOT) to determine the eligibility of non-Disadvantaged Business Enterprises (non-DBEs) to participate in the Small Business Program. This form must be submitted annually, at least 30 days before bidding on MDOT projects.
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Who needs to fill out the Michigan 4106 form?
Only non-DBEs need to complete this form. Certified DBEs do not have to fill it out, as they are required to verify their small business size annually as part of their certification process.
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What information is required on the form?
The form requires detailed information about the business, including:
- Name and address of the business
- Contact information for the authorized signer
- Major products or services provided
- Details about owners, partners, and key stakeholders
- Gross receipts and employee counts for the past three fiscal years
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What are the size standards for small businesses?
To qualify as a small business under the program, a business's gross receipts must not exceed $22.41 million averaged over the last three years. Additionally, the business must meet the size standards defined by the North American Industry Classification System (NAICS) codes.
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How do I determine my business's size?
To determine your business size, you will need to identify the appropriate NAICS code that describes your business activities. Then, refer to the Small Business Administration's (SBA) size standards to see if your business meets the criteria based on either gross receipts or the number of employees.
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What happens if I do not submit the form on time?
Failure to submit the Michigan 4106 form at least 30 days before bidding may result in ineligibility to participate in the Small Business Program. Timely submission is crucial to ensure your business can bid on MDOT projects.
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Can I submit additional information if needed?
Yes, if there are additional details that need to be included, you can attach extra pages to the application. MDOT may also request further information at their discretion to complete their size determination.
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Who can sign the form?
The form must be signed by an authorized representative of the business. If the signer is not an employee, they must provide a letter authorizing them to represent the business.
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What if my business has affiliates or subsidiaries?
All affiliates and subsidiaries must be disclosed on the form. The SBA defines affiliates as businesses that are controlled by or have common ownership with the applicant. This includes any business relationships that may impact the size determination.
Common mistakes
When filling out the Michigan 4106 form, individuals often encounter several common mistakes that can hinder their application process. One significant error is failing to provide complete and accurate information. Each section of the form requires specific details about the business, including its name, address, and ownership structure. Incomplete entries can lead to delays in processing or even rejection of the application. It's essential to double-check all entries before submission to ensure that every required field is filled out correctly.
Another frequent oversight is neglecting to submit the necessary documentation to support the information provided. For example, applicants must include copies of U.S. business tax forms that show gross receipts and employee counts for the past three years. Without these documents, the Michigan Department of Transportation (MDOT) cannot verify the information, which may result in an unfavorable determination. Therefore, gathering all required paperwork ahead of time can streamline the application process.
Additionally, applicants often misinterpret the size standards set by the Small Business Administration (SBA). Each business must determine whether it qualifies based on either the number of employees or average annual receipts, depending on its industry. Some may mistakenly believe they qualify without thoroughly checking the relevant NAICS codes and their corresponding size standards. Understanding these criteria is crucial, as exceeding the established limits can disqualify a business from participating in the Small Business Program.
Lastly, individuals sometimes overlook the importance of proper authorization when signing the form. The person who signs the application must be an authorized representative of the business. If someone who is not authorized signs the form, it may lead to complications or invalidate the application altogether. Ensuring that the correct individual is designated to sign and that they have the necessary authority is vital for a successful submission.
Documents used along the form
The Michigan Department of Transportation (MDOT) 4106 form plays a crucial role in the Small Business Program, as it helps determine the eligibility of businesses to participate in MDOT projects. However, several other forms and documents are often used in conjunction with the 4106 form to provide a comprehensive view of a business's qualifications and operations. Understanding these additional documents can help streamline the application process and ensure that all necessary information is accurately submitted.
- Michigan DBE Certification Application: This form is used by businesses seeking certification as a Disadvantaged Business Enterprise (DBE). It includes detailed information about the business's ownership, control, and financial status. Certification as a DBE can provide access to various federal and state contracting opportunities.
- Business Tax Forms: Businesses must provide copies of their federal tax returns for the past three years to demonstrate their gross receipts. These forms are essential for assessing the business's size and eligibility under the SBA size standards.
- Affiliation Disclosure Form: This document outlines any relationships with affiliated businesses or subsidiaries. It is necessary to disclose any entities that may impact the business's size determination, ensuring transparency in ownership and control.
- Employee Count Documentation: To verify the total number of employees, businesses may need to submit payroll records or other documentation that reflects their workforce size over the past three years. This information is crucial for meeting the employee-based size standards.
- NAICS Code Selection Form: This form assists businesses in identifying the appropriate North American Industry Classification System (NAICS) codes that best describe their operations. Accurate NAICS code selection is vital for determining eligibility under specific industry size standards.
By gathering and submitting these additional forms alongside the Michigan 4106 form, businesses can present a well-rounded application. This comprehensive approach not only enhances the chances of approval but also helps MDOT assess eligibility more effectively. Understanding the importance of each document in the application process is key to navigating the requirements successfully.
Similar forms
The Michigan 4106 form is a crucial document for businesses seeking to participate in the Michigan Department of Transportation's Small Business Program. Several other forms share similarities with the Michigan 4106 in terms of purpose, structure, and required information. Here are eight such documents:
- SBA Form 2413 - Small Business Certification Application: This form is used to certify small businesses for federal contracting opportunities. Like the Michigan 4106, it requires detailed information about the business's ownership, size, and financial data.
- DBE Certification Application: This application is for businesses seeking Disadvantaged Business Enterprise (DBE) status. It shares the requirement for financial disclosures and ownership details, similar to the Michigan 4106.
- Small Business Self-Certification Form: This form allows businesses to self-certify their status as small businesses. It also requests financial information and business size metrics, much like the Michigan 4106.
- Federal Form 1040 - U.S. Individual Income Tax Return: While primarily a tax document, it includes financial information that businesses may need to provide in forms like the Michigan 4106 to demonstrate gross receipts.
- SBA Form 3300 - 8(a) Application: This application is used for businesses seeking entry into the SBA's 8(a) Business Development Program. It requires comprehensive business information, including financials and ownership structure, similar to the Michigan 4106.
- Form 990 - Return of Organization Exempt from Income Tax: Nonprofit organizations use this form to provide financial information. Like the Michigan 4106, it requires detailed financial disclosures and can indicate business size.
- State of Michigan Business Entity Registration: This form registers a business with the state and includes information about ownership and structure, aligning with the data requested in the Michigan 4106.
- IRS Form 941 - Employer's Quarterly Federal Tax Return: This form reports income taxes, social security tax, and Medicare tax withheld from employee paychecks. It provides data on employee counts, which is relevant for size determinations in the Michigan 4106.
Dos and Don'ts
When filling out the Michigan 4106 form, it's essential to approach the task with care and attention to detail. Here’s a helpful list of dos and don’ts to ensure your application is completed correctly and efficiently.
- Do read the instructions thoroughly before starting the form.
- Do provide accurate and complete information about your business.
- Do submit the application at least 30 days before bidding on projects.
- Do attach required documentation, such as tax forms, to support your application.
- Do ensure the person signing the form is authorized to do so.
- Don't leave any sections of the form blank; all information is crucial.
- Don't forget to disclose all affiliates and subsidiaries, as required.
- Don't submit outdated financial information; ensure it's current.
- Don't overlook the specific NAICS codes that apply to your business.
- Don't assume that certified DBEs need to fill out this form; they do not.
By following these guidelines, you can streamline the application process and increase the likelihood of a successful submission. Good luck!
Misconceptions
Misconceptions about the Michigan 4106 form can lead to confusion for applicants. Here are ten common misunderstandings along with clarifications:
- Only Disadvantaged Business Enterprises (DBEs) need to fill out this form. This is incorrect. The Michigan 4106 form is specifically for non-DBEs to determine eligibility for the Small Business Program.
- Once submitted, the form does not need to be updated. In reality, this form must be submitted annually, and any changes in business structure or ownership should be reported.
- There is no deadline for submission. The application must be submitted at least 30 days prior to bidding on projects.
- All businesses qualify for the Small Business Program. Not all businesses qualify. Applicants must meet specific size standards set by the Small Business Administration (SBA).
- DBEs do not need to verify their size. While certified DBEs do not need to fill out the 4106 form, they still must verify their small business size annually.
- Only revenue is considered for size determination. Both gross receipts and the number of employees are used to determine eligibility based on the relevant NAICS codes.
- Affiliates do not need to be disclosed. All affiliates must be disclosed, as they can affect the size determination of the applicant business.
- Tax documents are not necessary. Applicants must provide copies of U.S. business tax forms showing gross receipts and employee numbers for the past three years.
- The form can be signed by anyone. The person signing the form must be authorized to do so, and non-employee representatives must provide a letter of authorization.
- Failure to provide complete information will not impact the application. Incomplete information can lead to delays or adverse conclusions about the business's eligibility.
Key takeaways
- Purpose: The Michigan 4106 form is designed to assess the eligibility of non-Disadvantaged Business Enterprises (non-DBEs) for bidding on MDOT Small Business Program projects.
- Annual Submission: Businesses must submit this form once a year, at least 30 days before bidding on projects.
- DBE Exemption: Certified Disadvantaged Business Enterprises (DBEs) do not need to complete this form; they must verify their small business size annually instead.
- Business Information: The form requires detailed information about the business, including its name, address, and major products or services.
- Ownership Disclosure: Applicants must disclose information about owners, partners, and stockholders, including their ownership percentages.
- Size Determination: Businesses must determine their size based on gross receipts or the total number of employees, using the appropriate NAICS codes.
- Affiliate Reporting: All affiliates and subsidiaries must be disclosed, along with their financial data, to assess overall business size accurately.
- Completeness is Key: Providing complete and accurate information is crucial, as incomplete submissions may delay the eligibility determination.
- Authorized Signatures: The form must be signed by an authorized representative of the business, ensuring that the information is valid and reliable.