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VoIP & Cloud Phone Systems
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Cloud OnRamp
Network Function Virtualization
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Multi-Carrier SIM
Wireless Data
Mobile Device and Plan Management
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Access
Broadband
Dedicated Ethernet
Smart Multi-Tenant Solutions
Private Networks
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Structured Cabling
North American Rollouts
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edgeboot
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Supplier Diversity Questionnaire
Granite Partner: Thank you for providing Granite with your company’s supplier diversity qualifications. Please respond to ALL required questions in the below Supplier Diversity Questionnaire & SUBMIT when completed.
You, Supplier, represent, warrant and certify that the information provided in this questionnaire is true and accurate to the best of your knowledge and belief.
(Required)
Accept
Your Name
(Required)
Company Name
Name
Title
(Required)
Title
Phone
Email
(Required)
Date
(Required)
MM slash DD slash YYYY
NAICS Codes can be found on www.census.gov/eos/www/naics
(Required)
Primary NAICS Code
Number of Employees
At least 1 REQUIRED
(Required)
Please select one…
TaxID#
DUNS#
CAGE Code
TaxID#
(Required)
DUNS#
(Required)
CAGE Code
(Required)
Check all areas that apply to your business
(Required)
Large Business (including non-profit organization)
Small Business (SB)
SBA SMALL Business Classification – check all areas that apply to your business:
Small Disadvantaged Business (SDB) (Select checkbox and mark ethnicity)
HUBZone Small Business (Certified by SBA)
Woman Owned Small Business (WOSB)
Veteran Owned Small Business (VOSB)
Service-Disabled Veteran Owned Small Business (SDVOBD)
Minority Owned (MBE) (Select checkbox and mark ethnicity)
Woman Owned (WBE)
Gay Lesbian Bisexual Transgender (GLBT)
National Minority Supplier Development Council (NMSDC) as an American citizen of at least 25 percent heritage of African American, Hispanic, Asian-Indian, Asian-Pacific, or Native American descent
Since you chose Small, complete this section. Pick any additional socio-economic status that applies to your business.
(Required)
African American
Hispanic American
Asian American
Native American
Verified in SAM or DSBS as of
MM slash DD slash YYYY
You, Supplier, represent, warrant and certify that the information provided is true and accurate to the best of your knowledge and belief and you agree to maintain and update your business status within thirty (30) days of a change in status.
(Required)
Agree
Do Not Agree
YOU, SUPPLIER, UNDERSTAND AND ACKNOWLEDGE, PURSUANT TO 15 U.S.C. 645(D), ANY PERSON WHO MISREPRESENTS ITS SIZE AND/OR STATUS MAY BE SUBJECT TO FINE, IMPRISONMENT, ADMINISTRATIVE REMEDIES AND/OR INELIGIBILITY FROM PARTICIPATION IN PROGRAMS CONDUCTED UNDER AUTHORITY OF THE SMALL BUSINESS ACT.
(Required)
Agree
Do Not Agree
If there are any questions regarding this questionnaire, please contact Supply Diversity Department at SupplierDiversity@granitenet.com
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