~~It V~e' - . 0, , - Jersey City

Jul 09 2010 5:26PM HP LASERJET FAX p.5
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J~ City Orinae, r-829 estblishes a goal or ~ 20%. of
MmoritylWOnlán BusfBèS Enterrie (MBE) .
Questioi-uaire for Bidden .
. city proeuent to mi ority and woman ownd business entenses. .
the dollar am01,:.nt of tota
To as!J us in monitòr g ow: acluevement oftbs goal, plea indca below wlt:er your
company is or 'I$ not a 1. . ority owned and/or woma owned business, and retur tliÎg; form with
your bid prsal. .
Business Name:
Addrs.
Telephone No. :
Contact Name .~
Please check applicable
Mirity Owoc; Busess (MB)
Woma Owned . usines (WB)
Deltlons
. MSn0ri BuslnesEitwriu
~ MIorlty& Woman Owed
Business(ME)
~tñer
MinorIty Busi Bnierprfa . $Ina a nusnos whch is a sole proprrsfp, panership or ooipt"úh~; at least
.5J% ofwhlch is owed and cn trll$ by peons who are Afoan Amerc~ ffpani.c, Asiau Aierc:l2,.A
Indin or AIBS native. defi as føJJOlW .
Arca. American: 81 ersoo Jivlng origi in imy altho blaok racial grps of Attoa
Hlsallz .a per of! xJ Puero Rkan Ceir ør Sout AmericM or othr non-BuropeJ i ~ Spanish
cultu or orIgin rete, s of ra.
Ailan: ft peron havf~ rl~ in any ()fthe orlinid pees oftb Far Eas SOut Eat Asia Ir"Uan
subc:tl~ Hawai or tl Pacific Islads. .
A.io~lnt IndmN or A.1.,1 an Naf. 0 pmon having orfsln iuy of
Amera f#d who mal_ cutul identication tbUSb 1i affliation or comi:nunfty reogti~.
Woman BMSas Enterrfse
th origin peples oni i~rt
Wom8l Busin.ess Bnrple me i; a busInes which ~ a sole prOPrlrship, parerp or col'oraonIß: lea S J %
'OfwJfch is own and cotrlJc by a woma or WOrDen.
c~ ICE OF EQUAL OPPORTUNTY COpy