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Contact Information Person *Company Name Company Name is Required *First Name This field is required *Last Name This field is required *Phone Number Invalid phone number *Email Address Invalid Email Address *Confirm Email Address Email Addresses must match Street Address City State Select State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code Product or Service *Product / Service Type Select a Product / Service Type Architect Auditor Automotive Construction Electrical Engineer Facilities Related Fire Safety Food Services Furniture General Contractor Info Tech Related Insurance Lawn or Landscape Service Leasing Legal Services Linen Rental Marketing Office Supplies Other Printing Rental Snow Removal Vending Company Name is Required Identify Product or Service on which you desire to bid. Show brand names, names of manufacturers, or other information that will be helpful to buyers in inviting, your firm to bid on agency requests. Company Classification Small Business means a firm that is classified as such by the State of Illinois. (If the applicant's business is a combination of the following, the information should be separated and proportioned accordingly. If in business less than a year, state anticipated dollar figures). Minority Owned Business means a business concern which is at least 51 percentum owned by one or more minority persons, or in the case of a corporation, at least 51 percentum of the stock which is owned by one or more minority persons: and the management and daily operations of which are controlled by one or more of the minority individuals who own it. Minority shall mean a person who is a citizen or lawful permanent resident of the United States and who is: Black, Hispanic, Asian American, or American Indian or Alaskan Native. (For clarification of ethnic categories, contact the Minority and Female Business Enterprise Division of the Illinois Department of Central Management Services.) Under this definition, this firm is (check where appropriate): Black Hispanic Asian American American Indian Alaskan Native Female Owned Business means a business concern which is at least 51 percentum owned by one or more females, or, in the case of a corporation, at least 51 percentum of the stock which Is owned by one or more females; and the management and daily business operations of which are controlled by one or more of the females who own it. Female shall mean a person who is a citizen or lawful permanent resident of the United States and who is of the female gender. (For clarification of ethnic categories, contact the Minority and Female Business Enterprise Division of the Illinois Department of Central Management Services.) Under this definition, this firm is: (check where appropriate) Black Hispanic Asian American American Indian Alaskan Native Not-for-Profit Agency for the Severely Handicapped shall be one which: Complies with Illinois laws governing not-for-profit organizations Is certified as a sheltered workshop by the Wage and Hour Division of the U.S. Department of Labor Mets the IDORS Just Standards for rehabilitation facilities. Under this definition, this firm is: A not-for-profit agency for the severely handicapped. Veteran Owned Disabled Owned Check here if you have been certified for your above selection Certified By Applicant Self-Certification The undersigned applicant does swear or affirm that: the information provided in the Bidder's Mailing List Application is true and correct as of the time of signing (NOTE: Any significant additional or modifying information must be submitted to the college at the time of the change), neither applicant nor any principal officer or employer, so far as is known, is now debarred or declared ineligible by any State agency from bidding or otherwise furnishing goods or services to the State, and applicant, its officers or employees, have not been convicted of bribery nor attempted bribery of an officer or employee of the State of Illinois, nor have made an admission of guilt of such conduct that is a matter of record. applicant is an equal opportunity employer and is in compliance with the equal opportunity requirements of state and federal laws and the Regulations Governing Procurement and Bidding at State Systems Universities in Illinois. Applicant understands that information provided herein may be audited by the State or verified by other means. Applicant further understands that failure to provide accurate information required by this form may, in accordance with the Illinois Purchasing Act, PA 83-1332, the Regulations Governing Procurement and Bidding at McHenry County College and other laws, result in penalties including but not limited to suspension from doing business with the college, termination of contracts, and loss of profits in appropriate cases. Checking this box constitutes signature and agreementSubmit your information
