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Village of Roselle Vendor Questionnaire

  1. Vendor Questionnaire

    Pursuant to Public Act 102-0265, the Village of Roselle is required to make a good faith effort to collect and electronically publish data from all vendors and subcontractors doing business with the City as to whether the vendor or subcontractor is minority-owned, woman-owned or veteran-owned, as defined in the Business Enterprise for Minorities, Women and Persons with Disabilities Act. All Vendors must complete this survey regardless of DBE status.

  2. DBE Information

    Classification of Disadvantaged Business Enterprise (DBE)

    An MBE/WBE/PDBE/VOSB is a business enterprise that meets one of the below requirements:

    Minority-Owned Business Enterprise (MBE) – A business that is at least 51 percent owned by one or more minorities. A person who is a U.S. citizen or lawful permanent resident and is African American, Hispanic American, Asian American, Native American, as well as other groups found to be disadvantaged pursuant to Section 8 (a) of the Small Business Act. Business Enterprise (MBE) 

    Woman-Owned Business Enterprise (WBE)  - A business that is at least 51 percent owned by a woman or women who are United States Citizens or lawful permanent residents of the United States.

    Persons with Disabilities-Owned Business Enterprise (PDBE) Persons with Disabilities-Owned Business Enterprise (PDBE) - A business that is at least 51 percent owned by a person or group of persons with a disability, as recognized by the Americans with Disabilities Act, or as defined by the Commonwealth of Pennsylvania, Governor’s Office, Management Directive 205.25 Amended.

    Veteran-Owned Small Business (VOSB) Veteran-Owned Small Business (VOSB) - A business that is at least 51 percent owned by one or more veterans who are United States Citizens or lawful permanent residents of the United States.

  3. DBE Type*

    Check all that apply.

  4. If you indicated that you are a minority-owned, women-owned, or veteran-owned business, do you hold a certificate for this classification or are you self-certifying?

  5. Authorization

    I hereby certify that the information supplied in this form is complete and correct to the best of my knowledge and belief. I authorize the Village of Roselle to verify any of this information as needed.

  6. Leave This Blank:

  7. This field is not part of the form submission.