3-Form HUB-Supplemental-Vendor-Information 9.2021 (1).pdf
PDF 173 KB Posted
- Attached to
- Truist Stadium Paint project
- Solicitation number
- 59-Q6897
- Issued by
- Guilford County, North Carolina
About this file
This document is a North Carolina Historically Underutilized Businesses (HUB) Supplemental Vendor Information form, version dated 09/2021, issued by the State of North Carolina. The form is designed to encourage participation in state procurement processes by businesses owned by minorities, women, disabled individuals, disabled business enterprises, and non-profit work centers for the blind and severely disabled. The form requires vendors to provide detailed information about their HUB certification status and potential use of Tier 2 suppliers or subcontractors for goods and services procurement.
The document outlines three key sections for vendor response: Part I focuses on HUB certification, asking vendors to indicate whether they are currently NC-certified or qualify for certification; Part II requests information about Tier 2 suppliers for goods procurement, including company details, contact information, and percentage of total bid price; and Part III seeks information about subcontractors for service procurements, with similar reporting requirements. Vendors are instructed to contact the North Carolina Office of Historically Underutilized Businesses at 984-236-0130 or huboffice.doa@doa.nc.gov for questions about certification, and to follow the solicitation document's Q&A process for other inquiries.
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Text version
North Carolina HUB Supplemental Vendor Information Version Date: 09/2021
Page | 1
ATTACHMENT D: HUB Supplemental Vendor Information
Solicitation #: __________________________
Vendor Name: __________________________
Historically Underutilized Businesses (HUBs) consist of minority, women, and disabled business firms that are at least fifty-one percent owned and operated by an individual(s) from one of these categories. Also included in this category are disabled business enterprises and non-profit work centers for the blind and severely disabled.
Pursuant to G.S. 143B-1361(a), 143-48 and 143-128.4, the State invites and encourages participation in this procurement process by businesses owned by minorities, women, the disable, disabled business enterprises, and non-profit work centers for the blind and severely disabled. This includes utilizing individual(s) from these categories as subcontractors to perform the functions required in this Solicitation.
The Vendor shall respond to questions below, as applicable.
PART I: HUB CERTIFICATION
Is Vendor a NC-certified HUB entity? Yes No
If yes, provide Vendor #: _________________________
If no, does Vendor qualify for certification as HUB? Yes No
Vendors that check “yes” will be referred to the HUB Office for assistance in acquiring certification.
PART II: PROCUREMENT OF GOODS - SUPPLIERS
For Goods procurements, are you using Tier 2 suppliers? Yes No
If yes, then provide the following information:
Company Name
Company Address
Website Address
Contact Name
Contact Email
Contact Phone
NC HUB
certified?
Percent of total bid price
North Carolina HUB Supplemental Vendor Information Version Date: 09/2021
Page | 2
PART III: PROCUREMENT OF SERVICES - SUBCONTRACTORS
For Services procurements, are you using Subcontractors to perform any of the services being procured under this solicitation? Yes No
If yes, then provide the following information:
Company Name
Company Address
Website Address
Contact Name
Contact Email
Contact Phone
NC HUB
certified?
Percent of total bid price
Need more information?
Questions concerning the completion of this form should be presented during the Q&A period through the process defined in the Solicitation document.
Questions concerning NC HUB certification, contact the North Carolina Office of Historically Underutilized Businesses at 984-236-0130 or huboffice.doa@doa.nc.gov http://ncadmin.nc.gov/businesses/hub http://ncadmin.nc.gov/businesses/hub mailto:huboffice.doa@doa.nc.gov
ATTACHMENT D: HUB Supplemental Vendor Information
| Solicitation: |
| Vendor Name: |
| Is Vendor a NCcertified HUB entity: Off |
| If yes provide Vendor: |
| If no does Vendor qualify for certification as HUB: Off |
| For Goods procurements are you using Tier 2 suppliers: Off |
| Company NameRow1: |
| Company AddressRow1: |
| Website AddressRow1: |
| Contact NameRow1: |
| Contact EmailRow1: |
| Contact PhoneRow1: |
| NC HUB certifiedRow1: |
| Percent of total bid priceRow1: |
| Company NameRow2: |
| Company AddressRow2: |
| Website AddressRow2: |
| Contact NameRow2: |
| Contact EmailRow2: |
| Contact PhoneRow2: |
| NC HUB certifiedRow2: |
| Percent of total bid priceRow2: |
| Company NameRow3: |
| Company AddressRow3: |
| Website AddressRow3: |
| Contact NameRow3: |
| Contact EmailRow3: |
| Contact PhoneRow3: |
| NC HUB certifiedRow3: |
| Percent of total bid priceRow3: |
| For Services procurements are you using Subcontractors to perform any of the services being procured: Off |
| No_4: Off |
| Company NameRow1_2: |
| Company AddressRow1_2: |
| Website AddressRow1_2: |
| Contact NameRow1_2: |
| Contact EmailRow1_2: |
| Contact PhoneRow1_2: |
| NC HUB certifiedRow1_2: |
| Percent of total bid priceRow1_2: |
| Company NameRow2_2: |
| Company AddressRow2_2: |
| Website AddressRow2_2: |
| Contact NameRow2_2: |
| Contact EmailRow2_2: |
| Contact PhoneRow2_2: |
| NC HUB certifiedRow2_2: |
| Percent of total bid priceRow2_2: |
| Company NameRow3_2: |
| Company AddressRow3_2: |
| Website AddressRow3_2: |
| Contact NameRow3_2: |
| Contact EmailRow3_2: |
| Contact PhoneRow3_2: |
| NC HUB certifiedRow3_2: |
| Percent of total bid priceRow3_2: |
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