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Diverse Business
Diverse Businesses Application
Step
1
of
2
50%
Contact Information
Additional Information
Business Name
(Required)
Legal Business Name (if different)
Office Phone
(Required)
Website
Number of Employees
General Email Address
Office Street Address
(Required)
Mailing Address (if different)
Office City/State/Zip
(Required)
Mailing City/State/Zip
Contacts
Primary Contact Name
(Required)
Additional Contact Name
Primary Contact Title
Additional Contact Title
Primary Contact Direct Number
Additional Contact Direct Number
Primary Contact Email
(Required)
Additional Contact Email
Liability Insurance Limit
Insurance Expiration Date
MM slash DD slash YYYY
License Number
Federal Tax ID Number
Preferred form of communication
Email
Phone
Other (please specify)
Other form of communication
Need assistance with this application? Contact us at diversesupplierinfo@evergreen.energy or (872)-298-4918.
Contact Information
Additional Information
Union Status
(Required)
Union
Non-Union
Business Type
(Required)
Contractor
Distributor
Consultant, Energy Efficiency or Otherwise
Marketing/Outreach
Program Implementation or Management
Engineering Services
Other
Other Business Type
Does your business hold any of the following certifications?
Certified Minority Owned Business
Certified Woman Owned Business
Certified Veteran Owned Business
LGBTQ+ Certified Owned Business
Certified Disability Owned Business
None of the above
*Certification will be requested after submitting this agreement.
(Optional) Annual Revenue Amount
Disclaimer: Revenue will impact which certification will be the best fit.
(Optional) NAICS Code
Click
here
for more information.
Is the business currently a registered Trade Ally of the Peoples Gas and North Shore Gas Energy Efficiency Programs?
Yes
No
Is the business at least 51% directly owned, managed, and controlled by one of the more individual of a qualified diversity group, including minority, women, veteran, disabled, LGBTQ+?
Yes
No
Qualifications for a Diverse Business Certification
Has the business owner ever previously received a certificate from an independent certifying body verifying that it is at least 51% directly owned, managed, and controlled by one or more individuals from a qualified diversity group?
Yes
No
Please summarize previous certification
Qualifications/Requirements for Business Owners
A. Is the business owner a member of any of the following minority groups:
Asian (Including Indian subcontinent and Far east)
Native Hawaiian or Other Pacific Islander
Black or African American
Hispanic or Latino
American Indian or Alaska Native
Other (please specify below)
None of the above
Prefer not to say
Other minority groups:
B. Does the business owner identify as a woman?
Yes
No
Does the business owner have a disability?
Yes
No
disability:IN list of disabilities
Does the business owner identify as LGBTQ+ (Lesbian, gay, bisexual, transgender, queer, or more)?
Yes
No
Additional Business Qualifactions
Has the business been operating for two years or more?
Yes
No
Is the business registered to do business in Illinois?
Yes
No
Is the business in good standing? If accepted to the Diverse Business Academy, business owner will be required to submit proof of good standing, business registration, and date of business inception.
Yes
No
Please provide an overview of the company.
If you'd prefer, you can also email this information to diversesupplierinfo@evergreen.energy
Please provide three references.
What are your goals or expected outcomes from participating in this program?
Service Area
City of Chicago
Lake County
Other (please specify)
Other service area
Program(s) of Interest
Residential
Multi-Family
Commercial and Industrial
Small Business
13. Business Service Offerings (Please select all that apply):
Air Sealing/Insulation
Appliances: Kitchen Equipment
Compressed Air
Controls: Building Automation
Controls: Industrial Systems
Duct Sealing
Energy Auditing
Energy Management
Engineering
Heat Recovery
HVAC: Boilers
HVAC: Furnaces
New Construction
Pipe Insulation
Plumbing
Process Heating
Service and Maintenance
Steam
Ventilation
Marketing
Program Implementation or Management
Outreach
Engineering Services
Other (please specify)
Other Products and Services
Please list any relevant licenses, professional certifications and memberships here:
Please list any non-English languages the business owner or key staff members are proficient in.
Need assistance with this application? Contact us at diversesupplierinfo@evergreen.energy or (872)-298-4918.
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