NOTICE OF VOLUNTARY REMOVAL 
 FROM THE 
 VIDPW DISADVANTAGED BUSINESS ENTERPRISE (DBE) PROGRAM                                  
 
 
Name of the Company: 
 
Address: 
 
City, State, Zip code: 
 
 
After careful consideration, I, the undersigned DBE / ACDBE owner or authorized designee, have elected 
not to apply or continue the firm's participation as a DBE / ACDBE at this time. This notice serves to inform 
the Virgin Islands Department of Public Works Unified Certification Program, of this decision.  
 
I understand that the firm is subject to decertification proceedings pursuant to Title 49, Code of Federal 
Regulations, Section 26.87, unless the reason for this decision is because the disadvantaged individual's 
Personal Net worth (PNW) exceeds the threshold of $1.32 million.  
 
Please mark which explanation best describes the reason(s) for voluntarily removing the firm from the DBE / 
ACDBE program: 
 
 
Personal Net Worth Exceeds 1.32 million     
Change in Ownership                                 
 
Sale of Business 
 
 
 
        
No benefit in being certified as a  
 
 
 
 
 
 
   
VIDPW DBE / ACDBE 
 
Not interested in continuing participation in    
Other: ________________________ 
VIDPW DBE / ACDBE program 
 
 
 
 
 
 
Authorization: _________________________________________________________________________________ 
                                                      (Print Name & Title) 
 
 
___________________________________________________  
 
_____________________ 
                                     Signature                                                                   Date 
 
 
 
 
Notary:    _______________________________________ 
 
 
SEAL: 
                     Signature & Date 
 
 
 
 
 
 
 
 
         
         
 
 
 
SIGN
SIGN