All proposals submitted in response to this Request shall be ...

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Community Relations Office102 North Neil StreetChampaign, Illinois 61820(217) 403-8830 or (217) 403-8835 (fax)Requested by:Approved by:Office Use OnlyDate:Date:Vendor Number: Code: Entered: CROFINCertificate Number:AFFIRMATIVE ACTION REPORT FORMCertificate Expiration Date:Failure to properly complete and sign this form prior to the execution of a contract with the City, or within 7 daysafter a request to submit this report, will result in it being returned unprocessed thereby resulting in adelay or denial of eligibility to bid or do business with the City of Champaign.Section I. Identification1. Company Name and Address:d/b/a:Chief Executive Officer:Address:City/State/Zip:Telephone: ( ) - Fax: ( ) -FEI Number:E-mail Address:Check one of the following:Social Security Number:Corporation Partnership Individual Proprietorship Limited Liability Corp.2. Name and Address of the Company’s Principal Office (answer only if not the same as above):Name:Address:3. Major activity of your company (product or service):City/State/Zip:4. Nature of Business:Contract:Bid:
Register as a new vendor for future projects.Other:SECTION II. Policies and PracticesDescription of Equal Employment Opportunity (EEO) Policies and Practices YES NOA. Is it the Company’s policy to recruit, hire, train, upgrade, promote and discipline persons withoutregard to race, color, sex, religion, national origin, age, mental and/or physical disability?B. Has someone been assigned to develop procedures, which will assure that the EEO policy isimplemented and enforced by managerial, administrative, and supervisory personnel? If so,please indicate the name and title of the official charged with this responsibility.Name: Title:Telephone:E-mail:Fax:C. Has the company developed a written Affirmative Action Plan? Note: a copy of the AffirmativeAction Plan must be submitted with this form in order to be considered eligible to dobusiness with the City of Champaign. If you would like technical assistance in developing a plan,please contact the Community Relations Office at (217) 403-8830.D. Has the company developed a written policy statement prohibiting Sexual Harassment? Note:Please attach a copy of the policy statement.E. If advertising is used, does it specify that all qualified applicants will be considered foremployment without regard to race, color, sex, religion, national origin, mental and/or physicaldisability, or age?F. Has the contractor notified all of its sub-contractors of their obligations to comply with the EqualOpportunity requirements either in writing, by inclusion in subcontracts or purchase orders?G. Is your company a minority/women owned business? (Defined as at least 51% owned byindividuals who are of the female gender and/or who have origins in one or more of the followinggroups: African American, Hispanic, Asian American, and Native American.)H. If you answered “YES” to G, please check all classifications that apply: African AmericanAsian American Hispanic Native American FemaleI. If you answered “YES” to G, would you like to be added to our Minority E-mail Group and/orMinority Directory? Please include your e-mail address:J. Is the company a state certified minority/women owned business? If yes, please attach a copy ofstate certification.
Page 2: All proposals submitted in response
Page 5: G. Section and subsection numbering
Page 9: 1.12 Acceptance of Proposal Content
Page 12 and 13: materials, supplies, and equipment
Page 14 and 15: XI.Cost ProposalThis section shall
Page 16 and 17: For the 11 multi-strand drop cable
Page 18 and 19: C. The removable outdoor protective
Page 20 and 21: device and will also connect to the
Page 22 and 23: Network design for atypical Anchor
Page 24 and 25: C. PARTNERSHIP OR L.L.C.The busines
Page 28 and 29: K. Is your company certified with I
Page 30 and 31: DEFINITIONS OF TERMINOLOGY LISTED I
Page 32: DUAL REPRESENTATION AFFIDAVIT(Note:

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