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AFFIRMATIVE ACTION IN CONTRACTING <br />CITY OF SOUTH BEND, INDIANA <br />APPLICATION FOP v3l DDER QUAi,I F I CA 1 ION <br />Y u. r<<ust qualify as a bid:7.e:.x. by c�)mplcting this application and <br />all r quired attachments. <br />1. LJIst the name and address of the company seeking to be qualified. <br />2. L�st the name ana address of company owner or owners. Use the <br />;: verse side .,f this sheet if necessary. <br />3. List the t.ypc or types of lousiness the company operates and the <br />S andard Industrial Code (SIC) classification which best <br />scribes your busir.--sss (if known). <br />4. L st the types of ccntracts which your company generally will be <br />s eking with --ht� CitA/ and the City boards to which you plan to <br />s bmit bids (d::plicate applications are not required). <br />�. Pease attach th fo_lc�.:inq completed documents to this <br />a e. plication: <br />a Hondiscr ,.mi.:a` ion comir„ t.ment <br />b Affirmat-.ivo ,iction ai-fidavit <br />C Afirmative :Iction plan _ <br />Please note that t.hc failure to submit this completed application <br />with -ho thrDe completed docwrie;-its cay disqualify the company from <br />being a responsible and responsive bidder on the City contract under <br />indi.a a lava. <br />Signature of person completing <br />application for company <br />Title: <br />Date: <br />Form �AQ1 /87 <br />a e of <br />