OTHER CATEGORIES. DISABLEDINDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies) - has a record of such an impairment; or - is regarded as having such an impairment. VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975. GENDER Male (M) or Female (F) PROC-1 (revised 2/2012) M/WBE UTILIZATION PLAN INSTRUCTIONS: This form must be submitted with any bid, proposal, or proposed negotiated contract or within a reasonable time thereafter, but prior to contract award. This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each certified Minority and Women-owned Business Enterprise (M/WBE) under the contract. Attach additional sheets if necessary. Offeror’s Name: Federal Identification Number: Address: Solicitation Number: City, State, Zip Code: Telephone Number: Region/Location of Work: M/WBE Goals in the Contract: MBE % WBE %
Appears in 1 contract
Samples: Program Administrator Agreement
OTHER CATEGORIES. DISABLEDINDIVIDUAL DISABLED INDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies) - has a record of such an impairment; or - is regarded as having such an impairment. • VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975. • GENDER Male (M) or Female (F) PROC-1 (revised 2/2012) OFFICE OF MINORITY/WOMEN-OWNED BUSINESS ENTERPRISE PROGRAM OPERATIONS M/WBE UTILIZATION PLAN INSTRUCTIONS: This form must be submitted with any bid, proposal, or proposed negotiated contract or within a reasonable time thereafter, but prior to contract award, for an OGS contract. This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each certified Minority and Women-owned Business Enterprise (M/WBE) under the contract. Attach additional sheets if necessary. Offeror’s Name: Federal Identification Number: Address: Solicitation Number: City, State, Zip Code: Telephone Number: Region/Location of Work: M/WBE Goals in the Contract: MBE % WBE %
Appears in 1 contract
Samples: Agreement
OTHER CATEGORIES. DISABLEDINDIVIDUAL o DISABLED INDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies) - has a record of such an impairment; or - is regarded as having such an impairment. o VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975. o GENDER Male (M) or Female (F) PROC-1 (revised 2/2012) EXHIBIT G-4: OFFICE OF CONTRACTOR AND SUPPLIER DIVERSITY M/WBE UTILIZATION PLAN INSTRUCTIONS: This form must be submitted with any bid, proposal, or proposed negotiated contract or within a reasonable time thereafter, but prior to contract award. This MWBE Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each certified Minority and Women-owned Business Enterprise (M/WBE) under the contract. Attach additional sheets if necessary. Federal Employer Identification No. (FEIN): Offeror’s Name: Federal Identification NumberRegion/Location of Work: Offeror’s Address: Solicitation NumberNo.: City, State, Zip Code: Project No.: Telephone Number: Region/Location of WorkNo.: M/WBE Goals in the Contract: MBE - % WBE - %
Appears in 1 contract
Samples: Capital Grant (Athenex, Inc.)
OTHER CATEGORIES. DISABLEDINDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies) - has a record of such an impairment; or - is regarded as having such an impairment. • VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975. • GENDER Male (M) or Female (F) PROC-1 (revised 2/2012) M/WBE UTILIZATION PLAN INSTRUCTIONS: This form must be submitted with any bid, proposal, or proposed negotiated contract or within a reasonable time thereafter, but prior to contract award. This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each certified Minority and Women-owned Business Enterprise (M/WBE) under the contract. Attach additional sheets if necessary. Offeror’s Name: Federal Identification Number: Address: Solicitation Number: City, State, Zip Code: Telephone Number: Region/Location of Work: M/WBE Goals in the Contract: MBE % WBE %
Appears in 1 contract
Samples: Program Administrator Agreement