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Bidder's Mailing List Application

Office of Business Services

MCC is requesting information that is necessary to accomplish the statutory purpose as outlined under, III. Public Comm. College Act, Ch. 122 pars. 103-27.1. Disclosure of this information is REQUIRED. Failure to provide information will result in this form not being processed.

INSTRUCTIONS: In order to be placed on the College's Bidder Mailing List, the applicant must execute this form in accordance with the instructions shown herein. Applicant must respond to all 20 required questions. If appropriate answer is "same,""not applicable," or "none," applicant shall so state so as to indicate the question has not been overlooked. It is the responsibility of the applicant to notify McHenry County College of any and all changes in the content of this application at the time of the change. Submit form when completed.

(* Required Fields)

Contact Information









Product or Service
Company Classification

A. " " means a firm that is classified as such by the State of Illinois. (If the applicant's business is a combination of the following, the information should be separated and proportioned accordingly. If in business less than a year, state anticipated dollar figures :)

B. " " means a business concern which is at least 51 percentum owned by one or more minority persons, or in the case of a corporation, at least 51 percentum of the stock which is owned by one or more minority persons: and the management and daily operations of which are controlled by one or more of the minority individuals who own it.

Minority shall mean a person who is a citizen or lawful permanent resident of the United States and who is: Black, Hispanic, Asian American, or American Indian or Alaskan Native. (For clarification of ethnic categories, contact the Minority and Female Business Enterprise Division of the Illinois Department of Central Management Services.)

Under this definition, this firm is: (check where appropriate)

We reserve the right to verify this information with CMS.

C. "" means a business concern which is at least 51 percentum owned by one or more females, or, in the case of a corporation, at least 51 percentum of the stock which Is owned by one or more females; and the management and daily business operations of which are controlled by one or more of the females who own it.

"Female" shall mean a person who is a citizen or lawful permanent resident of the United States and who is of the female gender. (For clarification of ethnic categories, contact the Minority and Female Business Enterprise Division of the Illinois Department of Central Management Services.)

Under this definition, this firm is: (check where appropriate)

We reserve the right to verify this information with CMS.

D. shall be one which:

  1. complies with Illinois laws governing not-for-profit organizations
  2. is certified as a sheltered workshop by the Wage and Hour Division of the U.S. Department of Labor
  3. meets the IDORS Just Standards for rehabilitation facilities.

Under this definition, this firm is:

Applicant Self-Certification

The undersigned applicant does swear or affirm that:

  1. the information provided in the Bidder's Mailing List Application is true and correct as of the time of signing (NOTE: Any significant additional or modifying information must be submitted to the college at the time of the change),
  2. neither applicant nor any principal officer or employer, so far as is known, is now debarred or declared ineligible by any State agency from bidding or otherwise furnishing goods or services to the State, and
  3. applicant, its officers or employees, have not been convicted of bribery nor attempted bribery of an officer or employee of the State of Illinois, nor have made an admission of guilt of such conduct that is a matter of record.
  4. applicant is an equal opportunity employer and is in compliance with the equal opportunity requirements of state and federal laws and the Regulations Governing Procurement and Bidding at State Systems Universities in Illinois.

Applicant understands that information provided herein may be audited by the State or verified by other means.

Applicant further understands that failure to provide accurate information required by this form may, in accordance with the Illinois Purchasing Act, PA 83-1332, the Regulations Governing Procurement and Bidding at McHenry County College and other laws, result in penalties including but not limited to suspension from doing business with the college, termination of contracts, and loss of profits in appropriate cases.

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