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Supplier Diversity

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Supplier Diversity Information Form

All fields are required.

Company Information
Company Name: Phone No:
Address: Fax No:
City:

 

 Primary Contact:
State:

 

 E-mail Address:
Zip Code:

 

 Web Site Address:
Number of Employees:

 

 FEIN:
Year Business Started:

 

 Avg. Annual Sales
Are you currently doing business with us?

If Yes, current internal contact name:


Type of Business

Fleet
Construction Products & Services
 Business Products & Services
 IT Products & Services

Business classification codes
(NAICS Codes):  
         
A minimum of one code must be completed.
Brief description of products/services:

 

Business Ownership Certification*

*Copies of your certification MUST be faxed to 630-983-9050 or e-mailed to supdiv@nicor.com.
Certifications accepted include (not limited to) the following:

City of Chicago
National Minority Supplier Development Council (NMDC) and regional affiliates
Women's business Enterprise National Council (WBENC) and regional affiliates
U.S. Small Business Administration (SBA)

 

Definitions
  1. Small Business Concern, as used in this provision, means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operations in which it might bid on government contracts, and qualified as a small business under the criteria and size standards in Federal Regulation title 13 part 121.
  2. Large Business Concern, as used in this provision, means a business that exceeds the small business size code standards established by the Small Business Administration as set forth in code of Federal Regulation title 13, part 121.
  3. Disadvantaged Business Concern, as used in this provision, means a business concern that (1) is at least 51% owned by one or more individuals who are both socially and economically disadvantaged, or a publicly owned business having at least 51% of its stock owned by one or more socially or economically disadvantaged individuals and (2) has its management and daily business controlled by one or more such individuals. Qualified Groups: Socially and economically disadvantaged individuals shall be presumed to include Black Americans, Hispanic Americans, Native Americans, Asian Pacific Americans, and Asian Indian Americans. These groups are qualified by the SBA under 13 CFR 124.1. Hispanic Americans, as used in this provision, means a United States citizen whose origins are in South and Central America, Mexico, Puerto Rico, Cuba, or the Iberian Peninsula. Native Americans, as used in this provision, means American Indians, Eskimos, Aleuts, and native Hawaiians. Asian Pacific Americans, as used in this provision, means a United States citizen whose origins are in Japan, China, the Philippines, Vietnam, Korea, Samoa, Guam, the US Trust Territory of the Pacific Islands, the Northern Marina Islands, Laos, Cambodia or Taiwan. Asian Indian Americans, as used in this provision, means a United States citizen whose origins are in India, Pakistan or Bangladesh.
  4. Women Owned Business Concern, as used in this provision, means a business that is at least 51% owned by a woman or women who are US citizens and who also control and operate the business.
  5. Disabled Veteran Business Concern, as used in this provision, means a business that is at least 51% owned by one or more disabled veterans who also control and operate it. A disabled veteran is a veteran of the military, naval or air service of the United States with a service-connected disability.

 


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