Awarded Vendor Disclosure Form

The County of Dupage

Wheaton, Illinois


In accordance with 35 ILCS 200/18-50.2, DuPage County is required to collect and electronically publish data from all vendors and subcontractors as to (1) whether they are a minority-owned, women-owned or veteran-owned business as defined by the Business Enterprise for Minorities, Women and Persons with Disabilities Act (30 ILCS 575/.01 et seq.) and (2) whether the vendor or any subcontractors hold any certifications for those categories or if the vendor or subcontractors are self -certifying; if self -certifying, the vendor and subcontractors shall disclose if they qualify as a small business under federal Small Business Administration standards.

Following award of a contract by DuPage County, the awarded vendor must complete the following information for itself and each subcontractor must separately complete the following information to perform work under this contract within 60 calendar days of the date of award

* = Required Fields

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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 DuPage County to verify any of this information as needed