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Countywide Bee-Line ParaTransit Innovative - Westchester County ...

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3. Are you certified with the State of New York as a minority business enterprise<br />

(“MBE”) or a women owned business enterprise (“WBE”)<br />

________ No<br />

________ Yes (as a MBE)<br />

________ Yes (as a WBE)<br />

4. If you are certified with the State of New York as an MBE, please specify the<br />

minority classifications which apply:<br />

5. Are you certified with the Federal Government as a small disadvantaged<br />

business concern<br />

________ No<br />

________ Yes<br />

Name of Firm/Business Enterprise:<br />

Address:<br />

Name/Title of Person Completing MBE/WBE Questionnaire:<br />

Signature:<br />

7

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