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j RETURN OF THIS FORM WITH YOUR BID IS PREFERRED BID# <br />MINORITY (MBE)/WOMEN (WBE) BUSINESS PARTICIPATION <br />By Executive Order dated December 10, 1987, Governor Romer established a goal of 17°h <br />for minority participation in the State's business. Vendors, suppliers and contractors doing <br />business with the State of Colorado are encouraged to solicit quotations for supplies and <br />services, where needed to perform work on a State contract, from minority- and women- <br />owned businesses. <br />The Division of Minerals and Geology has need to track the extent of participation with <br />minority- and women-owned businesses. Please help us by answering the following <br />questions. The answers to these questions will not be used to determine the winning offer <br />for this Bid. Response to these questions is not mandatory for your bid to be considered. <br />However, response is a condition of award and will be necessary prior to issuance of a <br />purchase order or contract. <br />1. Is your firm minority-owned? Yes_ , No ~C <br />2. Is your firm woman-owned? Yes_ , No h <br />3. If your is not aminority- or woman-owned firm, please indicate what percent <br />of the products or services you will be providing to the State, should you be <br />the winning bidder, you will be acquiring from: <br />•minority-owned subcontractors and/or suppliers~% <br />•woman-owned subcontractors and/or suppliers ~% <br />Please list below the names of these firms and the estimated value of the business you <br />intend to conduct with them. <br />NAMES OF MBENVBE FIRMS <br />TOTAL AMOUNT <br />DOLLAR AMOUNTS <br />Company Name: l~Qms fe/~//er C.rcaya ~1ns -Lh~ <br />By: 1dJa~~~i~ /~~ <br />Name <br />c:\wp51 \spees\mbewbe.frm <br />