SF Green Business - componentoption,com

Annual Self Certification Form

Business Name	Invalid Input - Must be alphanumeric. Please reenter.
Business Address	Invalid Input - Business Address Must be Alpha Numeric.
Date of Green Business Recognition (Listed on your Green Business Award Certificate) (*)	Invalid Input

	Please provide the name and contact information of the staff person responsible for implementation of Green Business practices. (This may be you, but doesn’t have to be.)
Contact name (*)	Invalid Input
Email address (*)	Invalid Input

Phone number (*)	Invalid Input
	To the best of my knowledge, this business is in compliance with all Federal, State and City laws, permits and regulations.
	Yes No Invalid Input
	This business continues to implement all the measures checked on our original SF Green Business Program checklist
	Yes No Invalid Input
	There has been no change in ownership or location since our original SF Green Business recognition.
	Yes No Invalid Input
	I also understand that the Green Business recognition may be revoked at anytime if we are not meeting SF Green Business standards. Furthermore, we may be subject to a fine of $500 if found to be deliberately providing false or incorrect information.
	Yes No Invalid Input
	Please provide the details of the person completing this form:
Your Name (*)	Invalid Input
Your Title (*)	Invalid Input
Today’s Date (*)	Invalid Input