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2. In accordance with the Illinois Public Act 102-0265, the Village of Northbrook is required to make a good faith effort to collect and publish certain demographic information provided by our vendors and subcontractors. We are now required to report whether the vendor or subcontractor is a minority, women, or veteran-owned business as defined by Illinois Law. In addition, we are required to disclose if the business is certified as a small business under Small Business Administration standards. We are kindly asking our vendors to provide us with current business information at your earliest convenience. 

4. Vendor Name (as shown on tax return)*
5. DBA Name (if different from Vendor Name)
7. Vendor Address*
9. City*
10. State*
11. Zip Code*
13. Vendor Phone *
14. Submitter Name*
18. Business Type Classification Indicators*

    Please indicate your classification indicators as defined in the Business Enterprise for Minorities, Women, and Persons with Disabilities Act (select all that apply):

    1. Minority-Owned Business
    2. Women-Owned Business
    3. Veteran-Owned Business
    4. None of the Above
19. Classification Certification*

    For your selected classification categories, does your business hold any certifications? Or, are you self-certifying?

    1. Yes (official certification held)
    2. No
    3. Self-Certifying
    4. Not Applicable
23. Self-Certifying

    If you are self-certifying, please also review and check the following, if applicable. 

    1. Small Business (as set by the SBA standards defined at www.sba.gov)
27. Data Access

    Once data has been collected, the Village will publish business demographic information on its website.

29. Questions

    Should you have any questions regarding the vendor information form, please contact Deputy Chief Financial Officer Anita Bozic at anita.bozic@northbrook.il.us or 847-664-4032.

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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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