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Federal Tax Identification Number/Social Security Number: ________________________________
Is Offeror a "minority" business? ๔ Yes ๔ No If yes, please indicate the "minority" classification below:
๔ African American ๔ Hispanic American ๔ American Indian ๔ Eskimo ๔ Asian American ๔ Aleut ๔ Other; Please Explain:
Is Offeror Woman Owned? ๔ Yes ๔ No Is Offeror a Small Business? ๔ Yes ๔ No Is Offeror a Faith-Based Organization? ๔ Yes
๔ No
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