MNPS DIVERSITY BUSINESS ENTERPRISE REGISTRATION FORM

DIVERSITY BUSINESS ENTERPRISE PROGRAM REGISTRATION FORM

Metro Nashville Public School (MNPS) invites your company to become a part of its new DBE Directory. MNPS Purchasing Agents and Construction staff utilize the directory when sourcing goods and services. Prime contractors who are required to outreach and identify DBE subcontractors, sub-consultants, and suppliers also rely on the directory. The new DBE Directory will be posted on MNPS website. Please complete the form below to be listed in MNPS DBE Directory.

INSTRUCTIONS: Please respond to each question below. It is essential to respond to each question below so that we can provide accurate information when listing your company in the directory. After completing the registration form, click the “REVIEW BUTTON” to ensure you have completed each section. Incomplete section questions will be highlighted for you to complete. After reviewing, click the “SAVE BUTTON” to save the document for future editing. You cannot "SUBMIT" the registration form if these two steps are not completed. After submitting the form, you should receive an email confirming your registration submission. If you have questions regarding the form, contact MNPS Business Diversity Consultant: gwendolyn.davis@mnps.org
SECTION I. GENERAL BUSINESS INFORMATION
Legal Business Name as Registered with the State of Tennessee (if applicable)*
Legal Business Name
First Name of Legal Business Owner:*
First Name
Last Name of Legal Business Owner*
Last Name
Address*
Street Address
City *
State*
Postal / Zip Code*
Confirm Email*
example@example.com
Email:*
Website:
Business (Legal Structure):*
Please Select
Year Business Established Under Current Name:*

MonthDayYear
Phone Number:*

Area CodePhone Number
SECTION II. PRODUCT & SERVICES

IMPORTANT: Accurate information provided herein will help MNPS in its efforts to identify procurement opportunities for your company. In addition, this information will assist in facilitating partnerships between DBEs and prime contractors.
INDUSTRY CLASSIFICATION*
PRODUCTS/SERVICES*
IMPORTANT: Please Provide a Brief Description of Your Company's "Products and Services" *
Annual Sales Volume:*
Annual Sales Dollars
SECTION III. LICENSES

Please Provide Information on Your Company's Required License(s)
Current Type of License (s)
SECTION IV. INSURANCE INFORMATION

Please Provide Information on Your Company's Insurance Coverage
Company Insurance Coverage: *
Company Insurance Coverage: Please indicate YES or NO from the above drop-down menu
General Liability Insurance If Applicable:
Insurance Limits
Professional Liability Insurance if Applicable:
Insurance Limits
Workman Comp Insurance If Applicable:
Insurance Limits
SECTION V. BONDING INFORMATION

Please Provide Information on Your Company's Bonding" Status. If Not Required for the Type of Products and Services You Provide, Indicate N/A
Describe Bonding Coverage:
If not required indicate: N/A
SECTION VI. COMPANY EXPERIENCE

List two largest Contract(s) and/or Purchase Order(s) performed by your company
PAST CONTRACTS/PURCHASE ORDERS: Client Name, Work Preformed, Date, Dollar Amount*
Past Experience: List Contracts/Purchase Orders Performed
SECTION VII. DIVERSITY BUSINESS ENTERPRISE CERTIFICATION

NOTE: MNPS recognizes the agencies listed in the below drop-down menu
Diversity Business Enterprise Classification:*
Select DBE Classification
Certification Agency and/or Small Business Approval Agency:*
Upload a copy of your MBE/WBE/SBE/SDVBE Certification, or BAO Small Business Approval Letter.

Upload Documents
MBE/WBE/SBE/SDVBE Certification or Small Business Approval Letter Cancelof
Take Photo If You are unable to Upload a Copy of Certification
Certification Expiration Date:*

DayMonthYear
If you are unable to provide a certification expiration date because you are not currently certified, please type the number "0" in the MM/DD/YYY fields.
SECTION VIII. OWNERSHIP INFORMATION

IMPORTANT: Provide the information below on the "Majority Business Owner"
Majority Business Owner:*

First Name Last Name
Ethnic Classification: *
Select Ethnicity
Gender:*
Select Gender
% of Ownership:*
% of Ownership
Other Owners: Please List the Name, Ethnicity, Gender and Percentage of Additional Owners*
If Company is 100% Owned, Please Indicate N/A
SECTION IX. SIGNATURE
IMPORTANT: IT IS ESSENTIAL TO KEEP INFORMATION ON YOUR REGISTRATION CURRENT AND ACCURATE.
Signature*
The Signature above hereby declares that all information provided on this Diversity Business Enterprise (DBE) Program Registration form by the business owner and all attachments provided are genuine, accurate, and complete and will be accepted as statement of fact. Further, the typed signature above will be considered as my offical signature for this DBE Program Registration.
Should be Empty:

SECTION I. GENERAL BUSINESS INFORMATION

SECTION II. PRODUCT & SERVICES

SECTION III. LICENSES

SECTION IV. INSURANCE INFORMATION

SECTION V. BONDING INFORMATION

SECTION VI. COMPANY EXPERIENCE

SECTION VII. DIVERSITY BUSINESS ENTERPRISE CERTIFICATION

SECTION VIII. OWNERSHIP INFORMATION

SECTION IX. SIGNATURE