Minority Participation questionnaire.pdf

MINORITY PARTICIPATION (DEC 2015)

Is the bidder a South Carolina Certified Minority Business? Yes No

Is the bidder a Minority Business certified by another governmental entity? Yes No

If so, please list the certifying governmental entity:

Will any of the work under this contract be performed by a SC certified Minority Business as a subcontractor? Yes No

If so, what percentage of the total value of the contract will be performed by a SC certified Minority

Business as a subcontractor? %

Will any of the work under this contract be performed by a minority business certified by another governmental entity as a subcontractor? Yes No

If so, what percentage of the total value of the contract will be performed by a minority business certified by another governmental entity as a subcontractor? %

If a certified Minority Business is participating in this contract, please indicate all categories for which the Business is certified:

Traditional minority Traditional minority, but female Women (Caucasian females) Hispanic minorities DOT referral (Traditional minority) DOT referral (Caucasian female) Temporary certification SBA 8 (a) certification referral Other minorities (Native American, Asian, etc.)

(If more than one minority contractor will be utilized in the performance of this contract, please provide the information above for each minority business.)

The Department of Administration, Division of Small and Minority Business Contracting and Certification, publishes a list of certified minority firms. The Minority Business Directory is available at the following URL: http://osmba.sc.gov/directory.html [04-4015-3]

BIDDER NAME DATE