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2. Vendor Questionnaire

   VILLAGE OF ROMEOVILLE

4. Pursuant to  Public Act 102-0265,  the Village of Romeoville is required to make a good faith effort to collect and electronically publish data from all vendors and subcontractors doing business with the Village as to whether the vendor or subcontractor is minority-owned, woman-owned or veteran-owned, as defined in the  Business Enterprise for Minorities, Women and Persons with Disabilities Act.  All Vendors must complete this survey regardless of DBE status.

8. Company Name: *
10. Classification of Disadvantaged Business Enterprise (DBE)

    Minority-Owned Business Enterprise (MBE) – A business that is at least 51 percent owned by one or more minorities. A person who is a U.S. citizen or lawful permanent resident and is African American, Hispanic American, Asian American, Native American, as well as other groups found to be disadvantaged pursuant to Section 8 (a) of the Small Business Act. 

    Women-Owned Business Enterprise (WBE) – A business that is at least 51 percent owned by a woman or women who are United States Citizens or lawful permanent residents of the United States.

    Persons with Disabilities-Owned Business Enterprise (PDBE) – A business that is at least 51 percent owned by a person or group of persons with a disability, as recognized by the Americans with Disabilities Act, or as defined by the Commonwealth of Pennsylvania, Governor’s Office, Management Directive 205.25 Amended.

    Veteran-Owned Small Business (VOSB) – A business that is at least 51 percent owned by one or more veterans who are United States Citizens or lawful permanent residents of the United States.

12. Please select applicable DBE: *
    -- Select One -- Minority-Owned Business Enterprise (MBE) Women-Owned Business Enterprise (WBE) Persons with Disabilities-Owned Business Enterprise (PDBE) Veteran-Owned Small Business (VOSB) Not Applicable
14. If you indicated that you are a minority-owned, women-owned, persons with disabilities-owned, or veteran-owned business, do you hold a certificate for this classification or are you self-certifying? *

    1. I hold a certificate

    1. I am self-certifying

    1. Not Applicable
16. Do you qualify as a small business under the Small Business Administration (SBA) standards? *

    1. Yes

    1. No
18. Click here to determine if you qualify as a small business:
    SBA SIZE STANDARDS TOOL
22. Authorization:

    I hereby certify that the information supplied in this form is complete and correct to the best of my knowledge and belief. I authorize the Village of Romeoville to verify any of this information as needed.

24. Name: *
25. Title: *
27. Email Address: *
28. Date: *
    Date:
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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