This form is to be used as a sample or guideline only

10-1-09, 10-30-09 (as CO-756), 4-29-11, 5-27-11, 11-22-13, 3-28-14, 4-25-14, 11-21-14, 5-18-15, 2-26-16, 5-4-16. If Supplier represented its socioeconomic classification as either disadvantaged or minority owned, (i.e., Small Disadvantaged Business, Economically Disadvantaged Women-Owned Small Business or Minority Owned – Other Than Small Business) above, the supplier is requested to check ... ................
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