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<br />CONFIRMA TION OF MINORITY OWNED BUSINESS <br /> <br />A requested form to be made a p8.11 of our files for future use and information, Please fill out and <br />indicate in the appropriate spaces provided which category best describes your company. Return <br />this form with your bid proposal sheet making it an official part of your bid response. <br /> <br />( ) AMERICAN INDIAN <br />( ) ASIAN <br />( ) BLACK <br />(v( HISPANIC <br />( ) WOMEN <br />( ) OTHER <br /> (specify) <br /> <br />Do you possess a Certification qualifying your business as a "Minority O'NIled Business"? <br /> <br />,"" <br /> <br />YES <br /> <br />NO <br /> <br />./ <br /> <br />If YES, name the Organization from which this certification was obtained and date: <br /> <br />Issuing Organization for Certification <br /> <br />Date of CeI1.ification <br /> <br />THIS PAGE TO BE SUBMlTTED ALONG WITH PROPOSAL <br /> <br />89 <br /> <br />PG/ST 39t'd <br /> <br />t'8saNt'l NOS aNt' t'lIA <br /> <br />5LBES5LT9S <br /> <br />GS:9T L00G/P0/GT <br />