Deadline For Submission is October 17, 2014 **CONFIDENTIAL**

2014 AZ MDCE Re-Certification Form

Deadline For Submission is October 17, 2014 **CONFIDENTIAL** Million Dollar Circle of Excellence [AZ MDCE] members are Arizona corporations who have at least $1 Million in Tier 1 spending annually with minority- and/or womenowned suppliers certified.

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Million Dollar Circle of Excellence Membership Re-Certification Company Name: Address (Street): City, State, Zip: Contact Name: Email: Telephone:

Year 2013 Supplier Diversity Procurement Information 1. What is your company’s total revenue?: 2. What is your company’s total AZ spend?: 3. What is your company’s total Tier 1 MBE & WBE Spend?: 4. How many MBE Tier 1 firms are active in your supply chain?: 5. How many WBE Tier 1 firms are active in your supply chain?:

6. Supplier Diversity Affiliations [check all that apply]: National Minority Supplier Development Council [NMSDC] Women’s Business Enterprise National Council [WBENC] United States Hispanic Chamber of Commerce [USHCC] National Center for American Business Alliance [NCABA] US Pan Asian American Chamber [USPAAC] National Veteran Owned Business Associations [NaVOBA] National Center for American Indian [NCAIED] US Black Chambers, Inc. [USBC]

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Million Dollar Circle of Excellence Membership Re-Certification 7. Supplier Diversity Program Overview [If Applicable]: Please provide information on the following topics. [Include information with the application submission] 

Current Program Highlights Including Goals and Target Spend

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Program Structure and Organization Chart

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Awards and Other Types of Recognition

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Supplier Success Stories

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Other Significant Information By signing this re-certification form you are acknowledging that your Tier 1 MBE & WBE spend meets or exceeds the $1MM threshold for eligibility into the AZ Million Dollar Circle of Excellence.

Date:

Print Name:

Title:

Signature:

List a local success story [Optional]:

Definitions by Question: 2. Total AZ Spend - Total spend without all outside suppliers during the most recently reported 12 month period. 3. Supplier Diversity Spend - To participate in the Arizona Million Dollar Circle of Excellence, companies must have at least $1 million in Tier 1 spend with minority and/or women owned suppliers who are certified by the National Minority Supplier Development Council [NMSDC] or the Women’s Business Enterprise National Council [WBENC] or other comparable certifying entity [subject to approval of nominating committee]. 4. & 5. Number of active MBE/WBE firms - Number of firms who have spent $1.00 or more during the most recently reported 12 month period. Qualifying Firm Certifications:  Minority-owned Business Enterprise [MBE]  Women-owned Business Enterprise [WBE] Arizona Certifying Organizations: Pacific Southwest Minority Supplier Development Council [PSMSDC] 3  Small Business Administration [SBA]  Women’s Business Enterprise National Council [WBENC]

Million Dollar Circle of Excellence Membership Re-Certification Member Criteria for Entry The Candidate: 1. Must be a viable corporation, Government Entity, or Educational Institution which awards at least $1 Million on a first tier basis to minority and women enterprises. 2. Must have an interest in developing a supplier diversity program. 3. Dollars awarded to minority and women suppliers must be auditable and verifiable. 4. Must be a member of NMSDC, WBENC, DBE, 8A or other comparable certifying entity. [Subject to nominating council approval] 5. Induction is for one year - you must re-apply yearly

Submission Checklist: √ Re-Certification form/self submission √ Signed by Chief Procurement Officer or other company representative √ Any applicable items listed in section 7

Submit completed survey to:

The Arizona Hispanic Chamber of Commerce ATTN: Terri Morgan 255 East Osborn Road Suite #201 Phoenix, AZ 85012 Fax: [602] 279.8900 Or via email to [email protected] Receipt of the MDCE Application will be confirmed. If assistance is needed, contact Terri Morgan at [602] 279.1800 or [email protected]

Thank you for completing the 2013 Membership Application for the Arizona Million Dollar Circle of Excellence

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