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23 <br /> Attach to Bid Attach to Bid Attach to Bid Attach to Bid Attach to Bid Attach to Bid <br /> Supplemental Vendor Information: HISTORICALLY UNDERUTILIZED BUSINESSES <br /> Vendor Name: K (q S 0 I u,,-- L L(-- Date: 03' 4'z b <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? P 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: M�Y1uf �1 D0V-QA Si neSS— 01&E <br /> Any questions concerning NC HUB certification, contact the North Carolina Office of Historically <br /> ,U, n erutilize Businesses at(919) 807-2330. <br /> Page 27 <br />