SPC Bidders List Data Form

Part A: Business Data

The SPC is required per 49 CFR Part 26.11 (c) to create and maintain a comprehensive Bidders List. This Bidders List Data Form will be used to collect bidder information used to determine the relative availability of Disadvantaged Business Enterprise (DBE) and non-DBEs, and will assist with establishing the agency’s annual DBE goal. Each Bidders List is a compilation of bidders, proposers, quoters, subcontractors, and suppliers of materials and services who have submitted bids during the advertising period of a solicitation for services. Please provide the following information:

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* 1. Contact Information

Contact Person

Business Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address *

Phone Number

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* 2. County in Which Business is Located

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* 3. Is this business certified as a DBE under the PA Unified Certification Program?

Yes

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* 4. Business Annual Gross Receipts

<$500,000

$500,000 to $1,000,000

$1,000,000 to $2,000,000

$2,000,000 to $5,000,000

>$5,000,000

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* 1. Contact Information

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* 2. County in Which Business is Located

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* 3. Is this business certified as a DBE under the PA Unified Certification Program?

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* 4. Business Annual Gross Receipts

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* 5. Age of Business (Years, Months)