Attachment K MWBE Certification Form – This form must be completed with Response. Indicate all that apply within each section. Supplier’s Business Class Large Business Concern Women Owned Business Small Business Concern Small Disadvantage Business Disabled Owned Business Disabled Veteran Owned Business Veteran Owned Business HUB Zone Business Minority Business Status Business Ownership MBE African American 51% owned, operated and controlled MBE Asian Pacific MBE Hispanic American MBE Native American MBE Asian Indian American Caucasian/Non-Minority Other Not Disadvantage Third Party Certification Certifying Organization Certification Number To promote your company within the E&I Membership, E&I requests third-party certification for all diverse business classes and ownerships. If your company has been certified by one or more organizations, including the Federal, State or Municipal Government, the SBA, or the NMSDC, please provide the respective organization's name and certification number here, and include a copy of the certification with your response. Supplier Name Signature Officer’s Printed Name Date
Attachment K – MWBE Certification Form This form must be completed with Supplier’s Response. Indicate all that apply within each section. Business Class Large Business Concern Women Owned Business Small Business Concern Small Disadvantage Business Disabled Owned Business Disabled Veteran Owned Business Veteran Owned Business HUB Zone Business Minority Business Status Business Ownership 51% owned, operated and controlled MBE African American MBE Asian Pacific MBE Hispanic American MBE Native American MBE Asian Indian American Caucasian/Non-Minority Other Not Disadvantage Third Party Certification To promote your company within the E&I Membership, E&I requests third-party certification for all diverse business classes and ownerships. If your company has been certified by one or more organizations, including the Federal, State or Municipal Government, the SBA, or the NMSDC, please provide the respective organization's name and certification number here, and include a copy of the certification with your response. Certifying Organization Certification Number Supplier Name Officer’s Signature Printed Name Date