2021 AZ MDCE Nomination Form

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* 1. Please fill out the information below:

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Industry Type:

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* 3. How many years has your company been a member of the MDCE?

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* 4. Chief Procurement Officer Name:

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* 5. Supplier Diversity Director/Manager/Coordinator:

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* 6. What is your company's total annual revenue?

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* 7. What is your company's total annual AZ spend?

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* 8. How many MBE Tier 1 firms are active in your supply chain?

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* 9. How many MBE Tier 2 firms are active in your supply chain?

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* 10. How many WBE Tier 1 firms are active in your supply chain?

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* 11. How many WBE Tier 2 firms are active in your supply chain?

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* 12. How many Veteran-owned (VOSB or SDVOSB) Tier 1 and Tier 2 firms are active in your supply chain?

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* 13. Do you gather data on disability-owned business enterprises (DOBEs) in your supply chain?

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* 14. Do you gather data on LGBT-owned business enterprises in your supply chain?

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* 15. Supplier Diversity Memberships/Affiliations (check all that apply)

National Center for American Indian Economic Development (NCAIED)

National Minority Supplier Development Council (NMSDC) and/or local affiliate

National Veteran Owned Business Associations (NaVOBA) and/or local affiliate

United States Hispanic Chamber or Commerce (USHCC) and/or local affiliate

US Black Chambers, Inc. (USBC) and/or local affiliate

US Pan Asian American Chamber (USPAAC)

Chinese Chamber of Commerce

Women's Business Enterprise National Council (WBENC) and/or local affiliate

Arizona Department of Transportation (AZ DOT)

City of Phoenix (COP EOD) and/or local affiliate

Other:

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* 16. ARIZONA Diverse Spend: Please provide dollar amount expended with diverse suppliers (Arizona based) during 2020 (or your most recent fiscal year) in Column A. If available, please complete column B, and then calculate C. (Please refer to the image above).

Tier 1 MBE Direct (AZ Diverse Spend $)

Tier 1 MBE Direct (AZ Total Spend $)

Tier 1 MBE Direct (AZ Diverse Spend %)

Tier 1 WBE Direct (AZ Diverse Spend $)

Tier 1 WBE Direct (AZ Total Spend $)

Tier 1 WBE Direct (AZ Diverse Spend %)

Total Tier 1 Spend (AZ Diverse Spend $)

Total Tier 1 Spend (AZ Total Spend $)

Total Tier 1 Spend (AZ Diverse Spend %)

Tier 2 MBE Direct (AZ Diverse Spend $)

Tier 2 MBE Direct (AZ Total Spend $)

Tier 2 MBE Direct (AZ Diverse Spend %)

Tier 2 WBE Direct (AZ Diverse Spend $)

Tier 2 WBE Direct (AZ Total Spend $)

Tier 2 WBE Direct (AZ Diverse Spend %)

Total Tier 1 & 2 MBE & WBE Spend (AZ Diverse Spend $)

Total Tier 1 & 2 MBE & WBE Spend (AZ Total Spend $)

Total Tier 1 & 2 MBE & WBE Spend (AZ Diverse Spend %)

Tier 1 VOSB-Owned and SDVOSB Small Business Enterprise Direct (AZ Diverse Spend $)

Tier 1 VOSB-Owned and SDVOSB Small Business Enterprise Direct (AZ Total Spend $)

Tier 1 VOSB-Owned and SDVOSB Small Business Enterprise Direct (AZ Diverse Spend %)

Tier 2 VOSB-Owned and SDVOSB Small Business Enterprise Direct (AZ Diverse Spend $)

Tier 2 VOSB-Owned and SDVOSB Small Business Enterprise Direct (AZ Total Spend $)

Tier 2 VOSB-Owned and SDVOSB Small Business Enterprise Direct (AZ Diverse Spend %)

Total VOSB & SDVOSB (AZ Diverse Spend $)

Total VOSB & SDVOSB (AZ Total Spend $)

Total VOSB & SDVOSB (AZ Diverse Spend %)

Total MBE, WBE, VOSB & SDVOSB (AZ Diverse Spend $)

Total MBE, WBE, VOSB & SDVOSB (AZ Total Spend $)

Total MBE, WBE, VOSB & SDVOSB (AZ Diverse Spend %)

2021 AZ MDCE Nomination Form

Question Title

* 1. Please fill out the information below:

Question Title

* 2. Industry Type:

Question Title

* 3. How many years has your company been a member of the MDCE?

Question Title

* 4. Chief Procurement Officer Name:

Question Title

* 5. Supplier Diversity Director/Manager/Coordinator:

Question Title

* 6. What is your company's total annual revenue?

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* 7. What is your company's total annual AZ spend?

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* 8. How many MBE Tier 1 firms are active in your supply chain?

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* 9. How many MBE Tier 2 firms are active in your supply chain?

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* 10. How many WBE Tier 1 firms are active in your supply chain?

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* 11. How many WBE Tier 2 firms are active in your supply chain?

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* 12. How many Veteran-owned (VOSB or SDVOSB) Tier 1 and Tier 2 firms are active in your supply chain?

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* 13. Do you gather data on disability-owned business enterprises (DOBEs) in your supply chain?

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* 14. Do you gather data on LGBT-owned business enterprises in your supply chain?

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* 15. Supplier Diversity Memberships/Affiliations (check all that apply)

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* 16. ARIZONA Diverse Spend: Please provide dollar amount expended with diverse suppliers (Arizona based) during 2020 (or your most recent fiscal year) in Column A. If available, please complete column B, and then calculate C. (Please refer to the image above).

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* 17. List initiatives that led to the success of the Arizona Supplier Diversity Program:

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* 18. List one or more local success stories:

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* 19. List any challenges facing your program/initiative in Arizona: