WMBE PLEASE COMPLETE THIS SURVEY AND RETURN WITH YOUR BID/PROPOSAL DOCUMENTS. NOT SUBMITTING THIS SURVEY WILL NOT DISQUALIFY YOUR BID/PROPOSAL. THIS IS FOR INFORMATIONAL PURPOSES ONLY. COMPANY NAME: ADDRESS: CITY, STATE, ZIP: TYPE OF BUSINESS: INCORPORATED FEDERAL ID#: – PARTNERSHIP ID#: – SOLE PROPRIETORSHIP SS#: – OTHER DESCRIBE: – WMBE: YES NO DESCRIBE: DISADVANTAGE (disabled) OWNED (DBE) WOMEN OWNED (WBE) MINORITY OWNED (MBE OR MWBE) 1. WHITE AMERICAN 4. HISPANIC AMERICAN 2. BLACK AMERICAN 5. ASIAN-PACIFIC AMERICAN 3. NATIVE AMERICAN 6. HASIDIC JEW NONE OF THE ABOVE (NEC) REGISTERED WMBE? YES NO REGISTRATION IN PROGRESS Signature Print Name and Title Date
WMBE PLEASE COMPLETE THIS SURVEY AND RETURN WITH YOUR BID/PROPOSAL DOCUMENTS. NOT SUBMITTING THIS SURVEY WILL NOT DISQUALIFY YOUR BID/PROPOSAL. THIS IS FOR INFORMATIONAL PURPOSES ONLY. COMPANY NAME: ADDRESS: CITY, STATE, ZIP: TYPE OF BUSINESS: INCORPORATED – FEDERAL ID#: PARTNERSHIP – ID#: SOLE PROPRIETORSHIP – SS#: OTHER – DESCRIBE: WMBE: YES NO DESCRIBE: DISADVANTAGE (disabled) OWNED (DBE) WOMEN OWNED (WBE) MINORITY OWNED (MBE OR MWBE) 1. WHITE AMERICAN 4. HISPANIC AMERICAN 2. BLACK AMERICAN 5. ASIAN-PACIFIC AMERICAN 3. NATIVE AMERICAN 6. HASIDIC JEW NONE OF THE ABOVE (NEC) REGISTERED WMBE? YES NO REGISTRATION IN PROGRESS Signature Print Name and Title Date
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