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Supplemental Vendor Information: HISTORICALLY UNDERUTILIZED BUSINESSES <br />Vendor Name: ____________________________________________________ Date: _________ <br />Per G.S. 143-128.4, Historically Underutilized Businesses (HUBs) consist of minority, women and disabled <br />business firms that are at least fifty-one percent (51%) owned and operated by an individual(s) who are <br />members of the following groups: Black, Hispanic, Asian American, American Indian, Female, Disabled, <br />Disadvantaged. <br />The Vendor shall respond to question No 1 and No 2 below. <br />1)Is Vendor a Historically Underutilized Business? Yes No <br />If yes, please select from the following: <br />Ethnicity: Gender Disabled <br /> Black Male Yes <br /> Hispanic Female No <br /> Asian American <br /> American Indian <br />2)Is Vendor Certified with North Carolina as a Historically Underutilized Business? Yes No <br />If so, state HUB classification: _______________________________________________________ <br />Any questions concerning NC HUB certification, contact the North Carolina Office of Historically <br />Underutilized Businesses at (919) 807-2330. <br />Docusign Envelope ID: 3C46D4D9-4262-4835-B314-9FEB472CCC00