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APPENDIX THREE

2. Name of HUB Subcontractor/Supplier:

Address: P h o n e : _ _ _ _ _ - _ _ _ _ _ - _ _ _ _ _ Owner(s): _

If GSC certified, enter Vendor Identification Number: certified, please complete the following information:

_______________

If not GSC

  • Black American

  • Native American

  • Woman

  • Male Female

  • Male Female

  • Hispanic American Male Female

  • Asian Pacific American Male Female

Date certification packet delivered to HUB subcontractor

_________________

3. Name of HUB Subcontractor/Supplier:

___________________________________________________________ Address: ___________________________________________________________ Phone: _____-_____- ______ Owner(s): ____________________________________________________

If GSC certified, enter Vendor Identification Number: certified, please complete the following information:

_______________

If not GSC

  • Black American

  • Native American

  • Woman

  • Male Female

  • Male Female

  • Hispanic American Male Female

  • Asian Pacific American Male Female

Date certification packet delivered to HUB subcontractor

_____

  • -

    10 -

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