Socio-Economic Business Status Form

Vendor

Address

City

State
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip

Contact Name

Contact Email Address

NAICS Code

Phone

Socio-Economic Categories

Check all that apply:

Small Business
Includes affiliates that are independently owned and operated, not dominant in the field of operation in which it is bidding on government contracts and qualifies as a small business under the criteria and size standards. (48 CFR § 19.102)

Women-Owned Small Business
A small business at least 51% owned by one or more women and the management and daily business operations of which are controlled by women. (13 CFR 127 Part B)

Small Disadvantaged Business
A small business owned and operated by one or more socially and economically disadvantaged individuals, the net worth of each individual does not exceed $750,000 excluding their equity in the business and primary residence. (13 CFR § 124.104)

Service-Disabled Veteran-Owned Small Business
A small business at least 51% owned by one or more service-disabled veterans and the management and daily business operations of which are controlled by service-disabled veterans. (48 CFR § 19.14 et seq)
Veteran-Owned Small Business
A small business at least 51% owned by one or more veterans and the management and daily business operations which are controlled by veterans. (38 CFR § 74)
HUB Zone Business
A small business located in a qualified census tract and certified as such by the U.S Small Business Administration. (13 CFR 126 Part B)
Minority Owned Business or Minority Business Enterprise (MBE)
A for-profit enterprise, regardless of size, physically located in the U.S. or its territories, which is 51% owned, operated, and controlled by minority group members. In the case of a publicly-owned business, at least 51 % of the stock is owned by one or more such individuals. Further, the management and daily operations are controlled by those minority group members. A minority group member is defined as an individual who is a U.S. citizen with at least ¼ or 25% minimum of the following: Asian-Indian; Asian-Pacific; African American; Hispanic; or Native American.
None of the above apply

Certifications

Please upload a copy of your business socio-economic certification(s).