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    Diversity Form

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    bobswd
    This document is a vendor pre-qualification questionnaire from New Jersey Natural Gas Company. It requests information from vendors such as company name and address, contact information, products/services offered, financial details, minority/women-owned business status, and diversity information. The purpose is to qualify vendors for potential work with New Jersey Natural Gas Company.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Diversity Form

    Uploaded by

    bobswd
    13 views1 page
    This document is a vendor pre-qualification questionnaire from New Jersey Natural Gas Company. It requests information from vendors such as company name and address, contact information, products/services offered, financial details, minority/women-owned business status, and diversity information. The purpose is to qualify vendors for potential work with New Jersey Natural Gas Company.

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    DiversityForm

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    This document is a vendor pre-qualification questionnaire from New Jersey Natural Gas Company. It requests information from vendors such as company name and address, contact information, products/services offered, financial details, minority/women-owned business status, and diversity information. The purpose is to qualify vendors for potential work with New Jersey Natural Gas Company.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    13 views1 page

    Diversity Form

    Uploaded by

    bobswd
    This document is a vendor pre-qualification questionnaire from New Jersey Natural Gas Company. It requests information from vendors such as company name and address, contact information, products/services offered, financial details, minority/women-owned business status, and diversity information. The purpose is to qualify vendors for potential work with New Jersey Natural Gas Company.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    New Jersey Natural Gas Company

    1415 Wyckoff Rd, PO Box 1464, Wall, NJ 07719

    VENDOR PRE-QUALIFICATION QUESTIONNAIRE


    COMPANY NAME (FULL LEGAL NAME)

    ADDRESS CITY STATE ZIP

    PHONE NUMBER FAX NUMBER E-MAIL ADDRESS

    OFFICER NAMES & TITLES

    LOCAL REPS NAMES & TITLES

    COMPANY PRODUCTS/SERVICES OFFERED

    COMPANY HISTORY NUMBER OF NUMBER OF


    YEARS IN BUSINESS EMPLOYEES
    PLEASE PROVIDE FINANCIAL STATEMENT OR ANNUAL REPORT

    UNION AFFILIATIONS NAME(S) OF LABOR UNION(S)


    YES NO

    MINORITY & WOMEN-OWNED BUSINESS STATUS

    Certification Number PLEASE PROVIDE COPY OF CERTIFICATION

    Check applicable status Certifying Entity


    MBE/MINORITY OWNED U S Small Business Administration
    WBE/FEMALE OWNED State Agencies Certification
    DSBE/DISABLE OWNED NY/NJ Port Authority
    Women Business Enterprise NC
    Please list applicable ethnic group codes
    (from list below)

    Ethnic Group Codes


    BF Black Female HG Hispanic Group OF Asian/Pacific Islander Female
    BM Black Male IF Asian/Indian Female OM Asian/Pacific Islander Male
    BG Black Group IM Asian/Indian Male OG Asian/Pacific Islander Group
    FF Filipino Female IG Asian/Indian Group MF Mixed Minority Female
    FM Filipino Male NF Native American Female MM Mixed Minority Male
    HF Hispanic Female NM Native American Male MG Mixed Minority Group
    HM Hispanic Male NG Native American Group WF White Female

    MG (Example: 33-1/3% Black Male, 33-1/3% Black Female, 33-1/3% White Male)
    BG (Example: 50% Black Male, 50% Black Female)

    BLACK AMERICANS:
    Persons having origins in any Black racial group of Africa.
    HISPANIC AMERICANS:
    All persons of Mexican, Puerto Rican, Cuban, South or Central American, Caribbean and other Spanish culture or origin.
    NATIVE AMERICANS:
    Persons having origins in any of the original peoples of North America or the Hawaiian Islands, in particular American
    Indians, Eskimos, Aleuts and Native Hawaiians.
    ASIAN AMERICANS:
    Persons having origins in Asia or the Indian Subcontinent, including, but not limited to persons from Japan, China,
    Philippines, Vietnam, Korea, Samoa, Guam, the U.S. Trust Territories of the Pacific, Northern Marianas, Laos, Cambodia,
    Taiwan, India, Pakistan and Bangladesh.

    DiversityForm.doc

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