1.5 Is the Legal Business Entity a certified Minority-Owned Business Enterprise (MBE), Women-Owned Yes No Business Enterprise (WBE), New York State Small Business (SB) or a federally certified Disadvantaged Business Enterprise (DBE)? If check all that apply: “Yes,” certified Minority-Owned Business Enterprise (MBE) certified Women-Owned Business Enterprise (WBE) Small Business (SB) Federally certified Disadvantaged Business Enterprise (DBE) 1.6 Identify Officials and Principal Owners, if applicable. For each person, include name, title and percentage of ownership. Attach additional pages if necessary. If applicable, reference to relevant SEC filing(s) containing the required information is optional. Name Title Percentage Ownership (Enter 0% if not applicable) II. REPORTING ENTITY INFORMATION 2.0 The Reporting Entity for this questionnaire is: Note: Select only one. Legal Business Entity Note: If selecting this option, to the entire Legal Business Entity for the remainder of the “Reporting Entity” refers questionnaire. (SKIP THE REMAINDER OF SECTION II AND PROCEED WITH SECTION III.) Organizational Unit within and operating under the authority of the Legal Business Entity See definitions of and for additional information on criteria to qualify for this “Reporting Entity” “Organizational Unit” selection. Note: If selecting this option, refers to the Organizational Unit within the Legal Business Entity for the “Reporting Entity” remainder of the questionnaire. (COMPLETE THE REMAINDER OF SECTION II AND ALL REMAINING SECTIONS OF THIS QUESTIONNAIRE.) IDENTIFYING INFORMATION a) Reporting Entity Name Telephone Address of the Primary Place of Business (street, city, state, zip code) ext. b) Describe the relationship of the Reporting Entity to the Legal Business Entity c) Attach an organizational chart Yes No d) Does the Reporting Entity have a DUNS Number? If enter DUNS Number “Yes,”
1.5 Is the Legal Business Entity a certified Minority-Owned Business Enterprise (MBE), Women-Owned Business Enterprise (WBE), New York State Small Business (SB) or a federally certified Disadvantaged Business Enterprise (DBE)? If “Yes,” check all that apply: certified Minority-Owned Business Enterprise (MBE) certified Women-Owned Business Enterprise (WBE) Small Business (SB) Federally certified Disadvantaged Business Enterprise (DBE) Yes No 1.6 Identify Officials and Principal Owners, if applicable. For each person, include name, title and percentage of ownership. Attach additional pages if necessary. If applicable, reference to relevant SEC filing(s) containing the required information is optional. Name Title Percentage Ownership (Enter 0% if not applicable) II. REPORTING ENTITY INFORMATION 2.0 The Reporting Entity for this questionnaire is: Note: Select only one. Legal Business Entity Note: If selecting this option, “Reporting Entity” refers to the entire Legal Business Entity for the remainder of the questionnaire. (SKIP THE REMAINDER OF SECTION II AND PROCEED WITH SECTION III.) Organizational Unit within and operating under the authority of the Legal Business Entity See definitions of “Reporting Entity” and “Organizational Unit” for additional information on criteria to qualify for this selection. Note: If selecting this option, “Reporting Entity” refers to the Organizational Unit within the Legal Business Entity for the remainder of the questionnaire. (COMPLETE THE REMAINDER OF SECTION II AND ALL REMAINING SECTIONS OF THIS QUESTIONNAIRE.) IDENTIFYING INFORMATION a) Reporting Entity Name Address of the Primary Place of Business (street, city, state, zip code) Telephone ext. b) Describe the relationship of the Reporting Entity to the Legal Business Entity c) Attach an organizational chart d) Does the Reporting Entity have a DUNS Number? Yes No If “Yes,” enter DUNS Number
94951.docx