Vendor Information Reporting Form

Vendor Information Reporting Form

Pursuant to the Illinois General Assembly Revenue Property Tax Code (35 ILCS 200/18-50.2), Schaumburg Park District is required to make a good faith effort collect and electronically publish data from all vendors and subcontractors doing business with the District. Thank you for providing the information requested.
Company Information
Company Name *
Company Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
example@example.com
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 http://www.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 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 of which is owned by one or more qualified veterans living in Illinois. Does Not Apply
If applicable, list any certifications your organization holds for the above categories.
Is the organization self-certifying? (Schaumburg Park District shall publish whether the vendor qualifies as a small business under federal Small Business Administration standards.) *

Yes No
By signing below, you represent and warrant that the information on this Vendor Information Reporting Form is accurate and complete to the best of your knowledge.
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Date

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Date
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Vendor Information Reporting Form

Company Information

Company Status