Indicate a secondary phone number, if any. This list is publicly accessible, so you get greater visibility and exposure to other companies, too. of the other business and this owner's title or function held in that business. If you checked State his/her title or position within your firm. Check the appropriate box to indicate whether this owner is a U.S. citizen. certifying agency that has previously certified your firm, and also indicate whether your firm has undergone an onsite visit. Women Business Enterprise Certification with the Women’s Business Enterprise National Council (WBENC), a private third-party that certifies women-owned businesses on behalf of U.S. corporations or WBE certification through city, county or state programs. The Minority & Women-Owned Business Enterprise (MWBE) Certification Process is the first step toward participation on URA contracts with MWBE goals. Check the appropriate box indicating for which program your firm is currently certified. requirements. application to compute each owner's PNW. Apply Now! All other questions can be directed to mwbe@idoa.in.gov or contact us by phone at 317-416-6711. This could also be the Social Security number of the Diversity certification is an important aspect of authenticating that your business is owned, managed and controlled by … disqualify your firm altogether from the DBE program if another owner is a U.S. citizen or lawfully admitted permanent resident and meets the program's other qualifying DOES YOUR FIRM RELY ON ANY OTHER FIRM FOR MANAGEMENT FUNCTIONS OR EMPLOYEE PAYROLL? box, any office space, a yard, warehouse, other facilities, any equipment, or any office staff with any other business, organization, or entity of any kind. Identify all individuals or holding companies with any ownership interest in your firm, providing the information requested below (if your firm has more than one owner, provide If you checked "Other," specify this owner's ethnic group/identity not otherwise LIST THE THREE LARGEST CONTRACTS COMPLETED BY YOUR FIRM IN THE PAST THREE YEARS, IF ANY. dollar value of each contract. with your firm. If this owner is not a U.S. citizen, check the appropriate box that indicates whether this owner is a lawfully admitted permanent resident. Check the appropriate box that indicates whether at present, or at any time in the past: your firm has been a subsidiary of any other firm; your firm consisted of a partnership in which one or more of the partners are other firms; your firm has owned any percentage of any other firm; and. Check the appropriate box that indicates whether any trust has ever been created for the benefit of this disadvantaged owner. State the name and title of the person who will serve as your firm's primary contact under this application. Indicate the primary phone number of your firm. Indicate the dollar value of this owner's initial investment to acquire an ownership interest in your firm, broken down by cash, real estate, equipment, and/or other If you checked "Other," briefly visit/review, indicate the most recent date of that review and the state UCP that conducted the review. State the legal name of your firm, as indicated in your firm's Articles of lncorporation. nature, history, purpose, and current value of the trust(s). During this challenging time, our office is extending the certifications for expiring certified firms starting in September, 2020, so our customers can focus on their health and wellbeing. Get to know the National Minority Supplier Development Council. Making of financial decisions on your firm's behalf, including the acquisition of lines of credit, surety bonds, supplies, etc. State the name of your firm's bond agent and/or broker. If you answered "Yes," identify each person by name, his/her title, the name of the other business in which s/he is involved, and his/her function performed State your firm's bonding limits (in dollars), specifying both the Aggregate and Project Limits. LIST CURRENT LICENSES/PERMITS HELD BY ANY OWNER OR EMPLOYEE OF YOUR FIRM. For each active job listed, state the name of the prime contractor and the project number, the location, the type of work performed, the project start date, the anticipated State the street address of your firm (i.e. owner of your firm. If you checked "Yes," identify Indicate whether your firm or any of the persons listed has ever withdrawn for a DBE program or an SBA 8(a) or SDB program, or whether any have ever been denied certification, decertified, debarred, suspended, or had bidding priviledges denied or restricted by any state or local agency or Federal entity. If you answered "Yes" to any of the questions in (2)(a)-(d) or (3), identify the name, address and type of business for each. M/WBE Certification. If you answered "Yes," briefly explain the nature of that reliance and the extent to which the other firm carries out such functions. completion date, and the dollar value of the contract. firm. Check the appropriate box that indicates whether your firm is "for profit.". List the name of each person in your finn who holds a professional license or pennit, the type of permit or license, the expiration date of the permit or license, and the Check the appropriate box that indicates whether any of the persons listed in (1) through (10) above own or work for any other firm(s) that has a relationship with your Briefly describe the nature of the business relationship in the space provided. completed copies of this section for each additional owner): DISADVANTAGED STATUS Check the appropriate box that indicates whether this owner perfonns a management or supervisory function for any other business. The Minority & Women-Owned Business Enterprise (MWBE) Certification Process is the first step toward participation on URA contracts with MWBE goals. The largest third-party WBE certification organization in the United States is the Women’s Business Enterprise National Council (WBENC). provided. answered "Yes," then specify the name of the other firm(s) and briefly explain the nature of the shared facilities or other items in the space provided. Indicate your firm's or your contact person's email address. State the mailing address of your firm, if it is different from your firm's street address. decertified, debarred, suspended, or had bidding priviledges denied or restricted by any state or local agency or Federal entity. in that other business. If your firm has already undergone an onsite Specify the total gross receipts of your firm for each of the past three years, as declared in your firm's filed tax returns. Indicate your firm's website address, if any. Get Certified. person or firm to whom it was transferred, the relationship between the two persons and/or firms, and the date of the transfer. If this owner is neither a Check the appropriate box that indicates whether your firm is co-located at any of its business locations, or whether your firm shares a telephone number(s), a post office The Office of Small Business and DVBE Services is committed to supporting California small business and disabled veteran businesses. NOTE: If you require additional space for any question in this application, please attach additional sheets or copies as needed, taking care on each attached sheet/copy the your firm has had any subsidiaries of its own. Indicate in the space provided the total Personal Net Worth (PNW) of each owner who is applying for DBE qualification. explain in the space provided. If you are already certified as DBE, indicate in the appropriate box the name of the Give the address of your firm's bank branch. List the name of each owner or contractor for each contract, the name and location ofthe projects under each contract, the type of work performed on each contract, and the The Division of Supplier Diversity cannot accept recertification applications that do … Give the date on which your firm was officially established, as stated in your firm's Articles of Incorporation. for each owner who is claiming to be "socially and economically In the space provided, state the name, title, date of appointment, ethnicity, and gender of each officer of your firm. WBE Certification Looking for a way to promote your company to major corporations and large business entities that are actively seeking to conduct business with a woman/women owned business(es)? U.S. citizen nor a lawfully admitted permanent resident of the U.S., then this owner is NOT eligible for certification as a DBE owner. A construction company that wants to get certified will need to obtain a third-party certification allowing you to pursue contracting opportunities with larger construction companies. If you answered "Yes," identify each person by name, his/her title, the name of the other business in which s/he is involved, and his/her function performed in that other NOTE: If your firm is currently certified under the SBA's 8(a) and/or SDB programs, you may not have to complete this application. Check the appropriate box that describes the legal form of ownership of your firm, as indicated in your firm's Articles of Incorporation. LIST THE THREE LARGEST ACTIVE JOBS ON WHICH YOUR FIRM IS CURRENTLY WORKING. Check the appropriate box that indicates whether any of your firm's officers and/or directors listed above own or work for any other firm(s) that has a relationship investment. If you answered "Yes," identify the name of the firm, the officer or director, and the nature of his/her business relationship with that other firm. If you answered State the number of years during which this owner has been an owner of your firm. Certified businesses are also added to the state’s list of MWBEs. 1117 Eisenhower Dr Suite 101 GET CERTIFIED! Check the appropriate box that indicates whether your firm relies on any other firm for management functions or for employee payroll. section and number of this application to which it refers. Check the appropriate box that indicates whether any of your firm's officers and/or directors listed above perform a management or supervisory function for any other If you answered "Yes," briefly explain the If you If you answered "Yes," identify the name of the firm, the name of the person, and the nature of his/her business relationship with that other firm. If you have any questions about the certifcation process, attend a How to Get WBENC WBE Certified session or email WBEA Certification Manager at lcamel@wbea-texas.org. Check the appropriate box that indicates this owner's gender. Check the appropriate box that indicates whether your firm has ever existed under different ownership, a different type of ownership, or a different name. Indicate in the spaces provided, the type of contribution or asset that was transferred, its current dollar value, the person or firm from whom it was transferred, the business. Get Certified! Give the date on which you and/or each other owner took ownership of the firm. State the name and address of each source, the original dollar amount and the current balance of each loan, and the purpose for which each loan was made to your firm. Check the appropriate box that indicates whether your firm is co-located at any of its business locations, or whether your firm shares a telephone number(s), a post office

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