Registered / Certified Business: Has your company been classified as a Certified Business in any of categories or from any of these agencies? (Minority, Woman Owned, Veteran, Small Business, Disadvantaged Yes No Business, Federal, County, or City) If yes, please answer the following questions below. If NO, continue on to next page. Is your Company Minority Registered / Certified? Yes No If yes, fill in shaded area. If no, continue to next question. NMSDC (National Minority Supplier Development Council) City Other (Please list state) (Please List) (Please list) Is your Company Registered / Certified as Woman Owned Business? Yes No If yes, fill in shaded area. If no, continue to next question. (Women's Business Enterprise National Council) City Other Federal Which Council? (Please list). (Please list) (Please list) Yes No Is your Company a Certified Veteran or Registered Federal Business (excluding Woman-Owned)? If yes, fill in shaded area below. If No, continue to Next Question. VOB (Veteran Owned DB (Disadvantaged Business) SDVOB (Service Disabled VOB) HZB (HUB Zone) Business) 8 (a) CERT (Certified Self Certified Business (SB) Other (please list) Business) Yes No Is your Company State or County Registered / Certified (excluding Women Owned or Minority)? If No, continue to Next Question. If yes, fill in shaded area below. Which U.S. State does your State / County certification come from? If County, which were you certified in: DBE (Disadvantage Business enterprise) Choose certifying agency below DDOT (Detroit Department of DOT(Department of Transportation) WCC (Wayne County Certified) Transportation) Other please list: Yes No Is your Company City Registered / Certified (excluding Women Owned or Minority)? If yes, fill in shaded area below. If No, continue to Next Question. U.S. State does your city certification come from? City does your certification come from? Please check all that applies below: (City Based (City Headquartered Business) (City Small Business Enterprise) Other (please list) Business) Other Registrations / Certifications If checked, fill in shaded area below. Please list any other Registered or Certified Business Certifications not listed above: Quality: Do you have a Registered Quality Management System? Yes No If yes, fill in shaded area and continue to Design Software. If no, then continue to next question. Agency Name Date Certified
Registered / Certified Business: Has your company been classified as a Certified Business in any of categories or from any of these agencies? (Minority, Woman Owned, Veteran, Small Business, Disadvantaged Business, Federal, County, or City) Yes No If yes, please answer the following questions below. If NO, continue on to next page. Is your Company Minority Registered / Certified? Yes No If yes, fill in shaded area. If no, continue to next question. NMSDC (National Minority Supplier Development Council) (Please list state) City (Please List) Other (Please list) Is your Company Registered / Certified as Woman Owned Business? Yes No If yes, fill in shaded area. If no, continue to next question. (Women's Business Enterprise National Council) Which Council? (Please list). City (Please list) Other (Please list) Federal Is your Company a Certified Veteran or Registered Federal Business (excluding Woman-Owned)? Yes No If yes, fill in shaded area below. If No, continue to Next Question. DB (Disadvantaged Business) VOB (Veteran Owned Business) SDVOB (Service Disabled VOB) HZB (HUB Zone) Self Certified Business (SB) 8 (a) CERT (Certified Business) Other (please list) Is your Company State or County Registered / Certified (excluding Women Owned or Minority)? Yes No If yes, fill in shaded area below. If No, continue to Next Question. Which U.S. State does your State / County certification come from? If County, which were you certified in: DBE (Disadvantage Business enterprise) Choose certifying agency below DOT(Department of Transportation) DDOT (Detroit Department of Transportation) WCC (Wayne County Certified) Other please list: Is your Company City Registered / Certified (excluding Women Owned or Minority)? Yes No If yes, fill in shaded area below. If No, continue to Next Question. U.S. State does your city certification come from? City does your certification come from? Please check all that applies below: (City Based Business) (City Headquartered Business) (City Small Business Enterprise) Other (please list) Other Registrations / Certifications If checked, fill in shaded area below. Please list any other Registered or Certified Business Certifications not listed above: Quality: Do you have a Registered Quality Management System? Yes No If yes, fill in shaded area and continue to Design Software. If no, then continue to next question. Agency Name Date Certified
2018-Dig-Sub-PreQual-Form.docx