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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 />SUBMIT WITH PROPOSAL <br />__________The Hills Tandem, LLC________05/19/2025 <br />Black <br />Docusign Envelope ID: 698F2B7F-27BB-45C9-9CCE-04BCCB3FB4C9