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RETURN OF THIS FORM WITH YOUR BID IS PREFERRED BID#PM - `'° 4hi <br />MINORITY (MBE)/WOMEN (WBE) BUSINESS PARTICIPATION <br />By Executive Order dated December 10, 1987, Governor Romer established a goal of 17% <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 , NoX <br />2. Is your firm woman - owned? YesX , No <br />3. If your is not a minority- 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 MBE/WBE FIRMS <br />TOTAL AMOUNT <br />DOLLAR AMOUNTS <br />Company Name: <br />By: <br />c: \wp51 \specs\mbewbe.frm <br />b1 T - t\► -1K ,it\1e- <br />Name <br />