JUSTICE, CA DEPT OF - SHOOTING FACILITY - 2006

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CALIFORNIA DEPARTMENT OF JUSTICE Office of the Attorney General 1300 I Street, Suite 740 Sacramento, CA 95814 Attn. Contracts & Purchasing Unit VOLUNTARY STATISTICAL DATA INFORMATION TO BE USED FOR REPORTING PURPOSES ONLY Please return this form with your signed contract OR fax to (916) 324-0680. Public Contract Code section 10116 requires state agencies to capture infonnation on cthnicity, race, and gt:mler of business owners on all awarded contracts and procurements. Government Code section 11139.8 and Public Contract Code section 10115.5 require state agencies to capture infonnation on the participation level of minority, women, and disabled veteran-owned business enterprises in awarded contracts and procurements The awarding department is prohibited from using this data to discriminate or provide a preference in the solicitation or acceptance of bids, quotes, or estimates for goods, services, and/or construction. Ths information shall not bc collected until after the:: contract award i~ made, The completion of this form is strictly voluntarv. The data you provide on this form should best describe the ownership of your busines,o;. Ownership of a business should be determined as follows: . For a business that is an individual proprietorship, partnership, corporation, or joint venture at least 51 percent is owned by one or more individuals in a classificatiou designated below or, in the case of any business whose stock is publicly held, at least 51 percent of the stock is owned by one or more individuals in a designated classification, or . For other business entities, the owner is the person controlling management and daily operations and who "owns" the business. For purposes of this report, respond only if the business has its home office in the United States and which is not a hranch or subsidiary of aforeign corporation, finn, or other business. , ~ LVendor Information Compaoy Name: Contract Number: (NOTE: The Contract Number will be provided by the DOJ Contracts Unit) l Genuer Classificatio~--- Female, 0 LRace Classification Male: 0 As identified by the U.S. Census Bureau ---, ~ o American Indian or Alaska Native o Black or African American o Other o Asian o Native Hawaiian or Other Pacific Islander o White EthnicitylMinority Classification As defined in Public Contract Code Section 10115.1 D o o o o o Asian-Indian- A per.son whose origins are from India, Pakistan, or Bangladesh. Black-Persons having origin~ in any of the black racial groups of Africa. Hispanic-Persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish or Portuguese culture or origin, regardless of race. Native American- An American Indian, Eskimo, Aleut, or Native Hawaiian. Pacific-Asian _ A person whose origins are from Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia, the Philippines, Samoa, Guam, or the United States Trust Territories oftbe Pacific including tbe Northern Marianas. Other Any other group of natural persons identified as minorities in the respective project specifications of an awarding department or participating local agency.