2.

City/State/Zip:

1. Company Name and Address Name:

d/b/a:

Address:

Limited Liability Corporation

6. Project on which your company is bidding (or indicate general renewal):

5. Name and Address of the Company's Principal Office

Individual Proprietorship

(If principal office is same as above, skip to question #6.)

4. FEI Number:

of the following:Renewal

Name:

Address:

City/State/Zip:

HR&E EEO WS 2-2025

7. Please describe the major product or service of your company:

8. City of Urbana staff member assigned to your contract (or to the RFP):

Partnership

OFFICE OF HUMAN RIGHTS AND EQUITY

400 SOUTH VINE ST

URBANA, ILLINOIS 61801

217-384-2455 ohre@UrbanaIL.gov

Corporation3. Please check one New Certification

Telephone:

Equal Employment Opportunity (EEO) Workforce Statistics Form

Failure to properly complete each section of this form as instructed may result in a delay or denial of eligibility to bid or do business with the City of Urbana.

Section I. Identification

Yes No 1.

2.

3.

4.

5.

6.

7.

Section II. Policies and Practices

Does the company have a written Equal Employment Opportunity Statement?

(Note: An example of an EEO Statement is on the same webpage as this form.)

Please attach an EEO Statement in order to be considered eligible to do business with the City of Urbana.

Questions? 217-384-2455 or ohre@UrbanaIL.gov.

Has the company developed a written policy statement prohibiting sexual harassment? (Note: An example of a Sexual Harassment Policy statement is on the same webpage as this form.) Please attach a copy of your company's Sexual Harassment Policy in order to be considered eligible to do business with the City of Urbana.

Have all recruitment sources been notified that the company will consider all qualified applicants without regard to race, color, creed, class, national origin, religion, sex, age, marital status, mental and/or physical disability, personal appearance, sexual orientation, family responsibilities, matriculation, political affiliation, prior arrest, conviction record, or source of income?

Are you currently seeking to renew an existing or expired Urbana EEO certificate? (If yes, please complete Table B.)

Were you previously issued a "Provisional Certificate"? (If yes, please refer to the letter you received when your provisional certificate was issued and respond to all stipulations required for renewal.

Questions? 217-384-2455 or ohre@UrbanaIL.gov.

Is it the company's policy to recruit, hire, train, upgrade, promote and discipline persons without regard to race, color, creed, class, national origin, religion, sex, age, marital status, mental and/or physical disability, personal appearance, sexual preference, family responsibilities, matriculation, political affiliation, prior arrest, conviction record, or source of income?

Has someone been assigned to develop procedures, which will assure that the EEO policy is implemented and enforced by managerial, administrative, and supervisory personnel? If so, please indicate the name, title, and contact information of the official charged with this responsibility.

Name:

Telephone:

Email:

Title:

Yes N/A 8.

9.

10.

11.

12.

13.

If advertising is used, does it specify that all qualified applicants will be considered for employment without regard to race, color, creed, class, national origin, religion, sex, age, marital status, mental and/or physical disability, personal appearance, sexual orientation, family responsibilities, matriculation, political affiliation, prior arrest, convention record, or source of income?

Has the contractor/vendor/company/applicant notified all of its sub-contractors of their obligations to comply with the Equal Opportunity requirements either in writing, by inclusion in subcontract, or purchase orders?

Is the company a state certified minority/women owned business? If yes, please attach a copy of state certification.

Does the company have collective bargaining agreements with labor organizations?

Have the labor organizations been notified of the company's responsibility to comply with the Equal Employment Opportunity requirements in all contracts with the City of Urbana? (If yes, please include a copy of the letters sent.)

Does the company perform construction, rehabilitation, alteration, conversion, demolition or repair of buildings, highways, or other improvements to real property? (If yes, please complete Table C.)

M F M F M F M F M F M F M F

Professionals

Categories

Technicians

Sales Workers

Office & Clerical Craft Workers (Skilled) Operatives (Semi-Skilled)

OVERALL

TOTALS

Service Workers

Laborers (Unskilled)

Please note any additional information unique to your workforce (for example, the number of employees who non-disclose race/ethnicity; staff members identifying as non-binary; someone splitting their time in two or more departments):

Date of this Data:

Job

Section III. Employment Information IMPORTANT: Please complete the company workforce analysis below. Use the number of employees as of the most recent payroll period. Complete this form in its entirety and submit your organization's (1) EEO Statement and (2) Sexual Harassment Policy in order to be eligible to do business with the City of Urbana.

For descriptions of Job Categories, as well as Race/Ethnic Categories, please see the last page of this form.

TABLE A - TOTAL COMPANY/CONTRACTOR/VENDOR WORKFORCE

Hispanic or LatinoWhite

Black or African-

American

Asian;

Hawaiian or other Pacific

Islander

Native American or Alaskan Native

Other Races;

Two or More Races

Not of Hispanic Origin Not of Hispanic Origin

Total Employees in Category

Officials & Managers

M F M F M F M F

TABLE B - WORKFORCE TURNOVER SINCE PREVIOUS EEO REPORT

Job Categories

Total Employees Separated

Minority Employees Separated

Total Employees Newly Hired

Total Minorities Newly Hired

Please complete if your company previously received certification from the City of Urbana and now seeks renewal.

OVERALL

TOTALS

Officials & Managers

Professionals

Technicians

Sales Workers

Office & Clerical

Craft Workers (Skilled)

Operatives (Semi-Skilled)

Laborers (Unskilled)

Service Workers

M F M F M F M F M F M F

TABLE C* - EMPLOYEES TO BE ASSIGNED TO THE CITY OF URBANA CONTRACT

Black or African-

American

Asian;

Hawaiian or other Pacific

Islander

Native American or Alaskan Native

Total Employees in

Category Job Categories

Please complete if your answer to Section II, Question #13 (on page 3 of this form) was "Yes".

*Totals included in Table C should be a projection of the number of persons to be employed in the performance of the City contract.

For Contractors: Data provided in Table C will be verified by worksite inspections.

OVERALL

TOTALS

Service Workers

Hispanic or Latino

Other Races; Two or More Races

Laborers (Unskilled)

Officials & Managers

Professionals

Technicians

Sales Workers

Office & Clerical

Craft Workers (Skilled)

Operatives (Semi-Skilled)

Yes No

1.

2.

3.

Yes N/A

4.

Section IV. Certification

E-mail

Prior to Submitting this form, please check the answers to the following questions to verify your completion of this form:

By signing below, the company certifies that it has answered all of the foregoing questions truthfully to the best of its knowledge and belief and agrees to comply and abide by the City of Urbana's Code of Ordinances (Section 2-119).

Did you fill in all of the appropriate boxes in the tables in Section III, including the "TOTAL" row?

Have you enclosed/attached your company's EEO statement?

Have you enclosed/attached your company's Sexual Harassment policy?

If your company is renewing and previously received a "Provisional Certificate", have you enclosed/attached a "Good Faith Efforts" plan or update?

Date

Signature

Section V. Verification

Printed Name and Title Check box to authorize electronic signature

Please include your company's name in the title of each digitally submitted attachment.

DEFINITIONS OF TERMS LISTED ON THIS WORKFORCE STATISTICS FORM

DESCRIPTION OF RACE/ETHNIC CATEGORIES

Race/ethnic designations as used by the Office of Human Rights & Equity do not denote definitions of anthropological origins. For the purpose of this report, an employee may be included in the group to which he or she appears to belong, identifies with, or a community regards as belonging. However, please count no person in more than one column. The race/ethnic categories for this report are:

White (Not of Hispanic origin). All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

Black of African-American (not of Hispanic origin). All persons having origins in any of the Black racial groups of Africa.

Hispanic or Latino. All persons of Mexican, Puerto Rican, Cuban, Central, or South American, or other Spanish culture or origin, regardless of race.

Asian, Hawaiian, or other Pacific Islander. All persons having origins in any of the original peoples of the Asian continent or the

Pacific Islands. This category includes, but is not limited to, China, India, Japan, Korea, the Philippine Islands, and Samoa.

Native American or Alaskan Native. All persons having origins in any of the original peoples of North America. Includes those referred to as members of First Nations, and those who maintain cultural identification through tribal affiliation, or community recognition.

Other Races; Two or More Races. All persons who do not self-identify with the above categories, or who self-identify with two or more of the above categories.

DESCRIPTION OF JOB CATEGORIES

Count each employee in only one job category. Select the category containing the jobs most similar to that performed by the employee. The jobs listed in each category provide examples, not a complete list, of all job titles falling into that category.

Officials and managers. Occupations requiring administrative and managerial personnel who set broad policies, exercise overall responsibility for execution of these policies, and direct individual departments or special phases of a firm’s operations. Includes:

officials, executives, middle management, plant managers, department managers, and superintendents, salaried supervisors who are members of management, purchasing agents and buyers, railroad conductors and yardmasters, ship captains, mates and other officers, farm operators and managers, and kindred workers.

Professionals. Occupations requiring either college graduation or experience of such kind and amount as to provide a comparable background. Includes: accountants and auditors, airplane pilots and navigators, architects, artists, chemists, designers, dietitians, editors, engineers, lawyers, librarians, mathematicians, natural scientist, registered professionals nurses, personnel and labor relations specialist, physical scientist, physicians, social scientist, teachers, surveyors and kindred workers.

Technicians. Occupations requiring a combination of basic scientific knowledge and manual skill, obtainable through 2-years of post-high school education, such as offered in many technical institutes and union colleges, or through equivalent on-the-job training. Includes: computer programmers, drafters, engineering aides, junior engineers, mathematical aides, licensed, practical or vocational nurses, photographers, radio operators, scientific assistants, technical illustrators, technicians (medical, dental, electronic, physical science), and kindred workers.

Sales. Occupations engaging wholly or primarily in direct selling.

Includes: advertising agents and sales workers, insurance agents and brokers, real estate agents, and brokers, stock and bond sales workers, demonstrators, sales workers and sales clerks, grocery clerks, and cashiers/checkers, and kindred workers.

Office and clerical. Includes all clerical-type work regardless of difficulty, where the activities are predominantly non-manual though some manual work not directly involved with altering or transporting the products is included. Includes: bookkeepers, collectors (bills and accounts), messengers and office helpers, office machine operators (including computer), shipping and receiving clerks, stenographers, typists and secretaries, telegraph and telephone operators, legal assistants, and kindred workers.

Craft workers (skilled). Manual workers of relatively high skill level having a thorough and comprehensive knowledge of the processes involved in their work. These workers exercise considerable independent judgment and usually receive an extensive period of training. Includes: the building trades, hourly paid supervisors, and lead operators who are not members of occupations, compositors and typesetters, electricians, engravers, painters (construction and maintenance), motion picture projectionists, pattern and model makers, stationary hand painters, coaters, bakers, decorating occupations, and kindred workers.

Operatives (semiskilled). Workers who operate machine or processing equipment or perform other factory-type duties of an intermediate level, skills mastered in a few weeks and requiring only limited training. Includes: apprentices (auto service and stitchers, dryers, furnace workers, heaters, laundry and dry cleaning operatives, milliners, mine operatives and laborers, motor operators, oilers and greasers (except auto), painters (manufactured articles), photographic process workers, truck and tractor drivers, knitting, looping, taping and weaving machine operators, welders and flame cutters, electrical and electronic equipment assemblers, butchers and meat cutters, inspectors, testers and graders, hand packers and packagers, and kindred workers.

Laborers (unskilled). Workers in manual occupations, which generally require no special training who perform elementary duties that may be learned in a few days and require the application of little or no independent judgment. Includes: garage laborers, car washers and greasers, groundskeepers and gardeners, farmworkers, stevedores, woodchoppers, laborers performing lifting, digging, mixing, loading and pulling operation and kindred workers.

Service workers. Workers in both protective and nonprotective service occupations. Includes: Attendants (hospital and other institutions, professional and personal service, including nurses aides, and orderlies), barbers, char workers and cleaners, cooks, counter and fountain workers, elevator operators, firefighters and fire protection, guards, doorkeepers, stewards, janitors, police officers and detectives, porters, waiters and waitresses, amusement and recreation facilities attendants, guides, ushers, public transportation attendants, and kindred workers.

HR&E EEO WS 3-2023 8.

HR&E EEO WS 3-2023 8.

HR&E EEO WS 3-2023 8.

HR&E EEO WS 3-2023 8.

HR&E EEO WS 3-2023 8.

HR&E EEO WS 3-2023 8.

HR&E EEO WS 3-2023 8.