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Request for Proposals (RFP) number DW-019 ... - Build-laccd.org

Request for Proposals (RFP) number DW-019 ... - Build-laccd.org

Request for Proposals (RFP) number DW-019 ... - Build-laccd.org

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COMMUNITY ECONOMIC DEVELOPMENT PROGRAM<br />

DISABLED VETERAN-OWNED BUSINESS OPPORTUNITIES<br />

LOCAL, SMALL, AND EMERGING BUSINESS OPPORTUNITIES<br />

ADDITIONAL BUSINESS IDENTIFICATION<br />

FORM OR-126<br />

INFORMATION PURPOSES ONLY<br />

The in<strong>for</strong>mation requested by this <strong>for</strong>m is required <strong>for</strong> in<strong>for</strong>mational purposes only. Proposers /<br />

Subconsultants are not graded, scored, evaluated, or ranked based upon the responses provided.<br />

Proposer/Subconsultant Name:<br />

Address, City, State, Zip:<br />

Company Contact:<br />

Title:<br />

Phone #: Email: Signature:<br />

Proposer’s/Subconsultant’s business is a (check all that apply and, if certified as such by a public agency,<br />

include name of certifying agency):<br />

Minority Business Enterprise (MBE) Certifying agency (if any)<br />

Woman-Owned Business Enterprise (WBE) Certifying agency (if any)<br />

Disadvantaged Business Enterprise (DBE) Certifying agency (if any)<br />

Exhibit J<br />

Page 11 of 11

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