Vendor Update

Company Name:

Mail Address

Address, City, State, Zip

Physical Address

If different from mailing address. Address, City, State, Zip

Phone Number

Fax Number

Email Address

Primary Service Line

Federal Tax ID #

Company Filing Status

Corporation

Sole Proprietor

Partnership

LLC

Engineering/Remediation Resources Group, Inc. (ERRG) is enhancing and formalizing its program for tracking and reporting on its vendors for the utilization of small business concerns, small disadvantaged business, women-owned small business, and other businesses with special status. We ask that an officer or owner of your firm indicate the applicable status of your business, sign, and return this letter to us.

List Primary NAICS Code

Choose One

Large Business Enterprise (LB)

Small Business Enterprise (ESB)

Historically Black Colleges and Universities

Minority Institutions

For definitions, links, and resources see our vendor classification page.

Check all that apply

Woman-Owned Business Enterprise (WBE)

Veteran-Owned Business Enterprise (VBE)

Service Disabled Veteran-Owned Business Enterprise (SDV)

HUBZone Business (HUB)

Disadvantaged Business Enterprise (SDB)

If you checked Disadvantaged Business Enterprise, check all that apply

Black American (BA)

Hispanic American (HA)

Native American (NA)

Asian Pacific Americans (APA)

Subcontinent Asian American (SAA)

SBA B(a) Certified

SBA SDB Certified

I certify the information provided above is true and correct as of 06/25/2017 and we will advise you of any change(s) to this information in the future should they occur.

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Title

Vendor Update

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