Vendor Information Reporting Form

Pursuant to Section 18-50.2 of the Illinois Property Tax Code (35 ILCS 200/18-50.2), the Northbrook Park District is required to make a good faith effort to collect and electronically publish certain data from all vendors and subcontractors doing business with the Park District. Thank you for your cooperation in providing the information requested below.

Question Title

* 1. Company Information

Contact Name

Company Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 2. Company Status
(please check all that apply)

Certified Small Business / meets certification requirements as a small business under SBA standards.
*More information and definitions can be found at sba.gov.

Minority-Owned Business – A business which is at least 51% owned by one or more minority persons, or in the case of a corporation, at least 51% of the stock in which is owned by one or more minority persons; and the management and daily business operations of which are controlled by one or more of the minority individuals who own it.

Women-Owned Business – A business which is at least 51% owned by one or more women, or in the case of a corporation, at least 51% of the stock in which is owned by one or more women; and the management and daily business operations of which are controlled by one or more of the women who own it.

Veteran-Owned Business – A small business (i) that is at least 51% owned by one or more qualified veterans living in Illinois or, in the case of a corporation, at least 51% of the stock in which is owned one or more qualified veterans living in Illinois; (ii) that has its home office in Illinois; and (iii) for which items (i) and (ii) are actually verified annually by the Commission on Equity and Inclusion.

None of the above.

Organization is self-certifying.

Question Title

* 3. If applicable, list any certifications your organization hold for the previous categories.

Certification #1

Certification #2

Certification #3

Certification #4

Certification #5

Question Title

* 4. Upload Your Form W-9
(only PDF files are supported)

Form W-9 may also be mailed to Northbrook Park District, 545 Academy Drive, Northbrook, IL. 60062.

PDF file types only.

Choose File

Vendor Information Reporting Form

Question Title

* 1. Company Information

Question Title

* 2. Company Status(please check all that apply)

Question Title

* 3. If applicable, list any certifications your organization hold for the previous categories.

Question Title

* 4. Upload Your Form W-9(only PDF files are supported)

* 2. Company Status
(please check all that apply)

* 4. Upload Your Form W-9
(only PDF files are supported)