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2. Introduction

   This form is intended to collect information from businesses interested in doing business with the City of Fitchburg.

   Please enter your contact information below to be added to our mailing list.

   For more information on City Procurement and policies, please visit www.FitchburgMA.gov/Procurement.

4. Business Name
5. Owner Name
7. Contact Name
8. Contact Title
10. Contact Email Address
11. Contact Phone Number
13. Address
15. City
16. State
17. Zip Code
19. Type of Industry/Services Provided

    1. Architecture/Design
    2. Carpentry
    3. Construction - Buildings
    4. Construction - Heavy & Highway
    5. Educational Services
    6. Electrical
    7. Emergency Services
    8. Energy, Fuel, Utility (Equipment, Services, Suppliers)
    9. Engineering - Civil
    10. Engineering - Electrical
    11. Engineering - Mechanical
    12. Environmental Services
    13. Facilities/Real Property

    1. Financial Services
    2. General Contractor
    3. Healthcare
    4. Human & Social Services
    5. Information Technology
    6. Office Equipment, Services, Supplies
    7. Paving/Sidewalks
    8. Plow/Snow Removal
    9. Professional Services
    10. Public Safety Equipment, Supplies
    11. Vehicles, Transportation
    12. Other (Please specify in comment box)
21. Notes on Services Provided
23. Demographic Information

    State and Federal laws often require municipalities to track the demographic information of contractors/services hired with public funds. The demographic information below is optional, but will assist the City in its outreach to a broad group of qualified vendors/contractors/service providers.

    State and Federal procurement laws, such as those regarding low-bid, remain in place to ensure responsible expenditure of taxpayer funds. There is no preferred vendor status.

25. Owner Race
    -- Select One --WhiteBlack/African-AmericanAsianNative American/Alaska NativeNative Hawaiian, Pacific IslanderMultiracial
26. Ethnicity
    -- Select One --Hispanic/LatinoNot Hispanic/Latino
28. Owner Gender
    -- Select One --MaleFemaleNonbinary
29. Owner Military Service
    -- Select One --VeteranNon-Veteran
31. Owner LGBTQ+ Identity
    -- Select One --LGBTQ+Not LGBTQ+
32. Owner Disability Status
    -- Select One --DisabledNon-disabled
34. My business is certified as a:

    1. Airport Concession DBE (ACDBE)
    2. Disability-Owned Enterprise (DOBE)
    3. Disadvantaged Business Enterprise (DBE)
    4. Lesbian Gay Bisexual Transgender Enterprise (LGBTE)
    5. Minority Business Enterprise (MBE)
    6. Service-Disabled Veteran-Owned Enterprise (SDVOBE)
    7. Veteran Business Enterprise (VBE)
    8. Women Business Enterprise (WBE)

    
    As certified by one of the following certification agencies:

    • Supplier Diversity Office (SDO) - State
    • MassDOT Office - UCP
    • City of Boston (COB)
    • Women's Business Enterprise National Council (WBENC)
    • National Minority Supplier Development Council (NMSDC)
    • National Gay and Lesbian Chamber of Commerce (NGLCC)
    • Disability: IN (USBLN)
    • U.S. Veterans Affairs (VetBiz)
36. If you are not certified as one of the above, would you like more information on becoming certified?
    -- Select One --YesNo
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field