URA MWBE Self-Certification Form

MWBE Self-Certification Application
The Urban Redevelopment Authority offers a limited self-certification option for diverse companies not yet certified by a third party entity to work on a URA project for MWBE credit. All applicants are encouraged to pursue third party certification.

IMPORTANT: URA self-certification is for acceptance on URA projects only and will not meet the third party certification requirements of non-URA projects. Please visit this link for more information on applying for third party certification.

All requests for self-certification must be accompanied by a notarized affidavit and a copy of a current driver's license for consideration. Questions can be emailed to mwbe@ura.org.

The Affidavit Form (notarization required) can be downloaded here.

Disclaimer: The URA reserves the right to deny any request for self-certification at its discretion.
Applicant's Name *

First NameLast Name
Company*
Phone *
Applicant's E-mail*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
M/WBE Status (select all that apply):*

My company is a Minority-Owned Business Enterprise (MBE)My company is a Women-Owned Business Enterprise (WBE)Other
Provide a short summary of your scope of abilities?*
Supporting Documentation
Applicants must upload a notarized affidavit and a copy of the driver's license.

A fillable PDF version of the Affidavit can be downloaded HERE.

A print-and-fill version of the Affidavit can be downloaded HERE.
AFFIDAVIT UPLOAD*

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Photo ID*

Browse Files
Documentation can include a driver's license or other valid forms of state or U.S. government issued photo ID. Cancelof
Acknowledgements & Signature
I hereby certify that I am eligible for self-certification status and have attached a notarized affidavit with a copy of my driver's license attesting to this claim. I understand that the URA can deny a request for self-certification at its discretion*

Check Box to Agree
Typed Signature *

First NameLast Name
Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

MWBE Self-Certification Application

Supporting Documentation

Acknowledgements & Signature