Skip to content
Business Enterprise Questionnaire - UNDC
*
1.
Company Name
(Required.)
2.
DBA (If Applicable)
*
3.
Contact Name
(Required.)
*
4.
Street/Suite
(Required.)
*
5.
City
(Required.)
*
6.
State
(Required.)
*
7.
Zip Code
(Required.)
*
8.
Phone Number (XXX-XXX-XXXX)
(Required.)
*
9.
Email Address
(Required.)
10.
Website
11.
Certification Status
MBE
WBE
M/WBE
SBE
LBE
SBA 8(a)
WOSB
SDVOB
VBE
LGBTQ+
Section 3
NOT CERTIFIED
*
12.
Certifying Entity
(Required.)
Federal
State
Local
Private
NOT CERTIFIED
*
13.
Certification Status - Disadvantaged Business Enterprises (DBE)
(Required.)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennesse
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
NOT CERTIFIED
*
14.
Section 3 Resident
(Required.)
Yes
No
*
15.
Business Type
(Required.)
Architectural/Engineering Services
Other Services (Including consultants)
Trade Partner/Subcontractor
Supplier
Broker/Manufacturer's Rep
Manufacturer/Fabricator
Trucker
16.
License Types (i.e. Electrical, Plumbing etc.)
License 1
License 2
License 3
*
17.
Industry Experience
(Required.)
Affordable Housing
Commercial
Education
Health Care
Heavy Civil/Highway
Life Sciences
Mixed Use
Residential
Sports Facilities
Transportation
Other (please specify)
18.
Union Affiliation
Yes
No
19.
Number of full time employees
20.
Number of part time employees
*
21.
% of work self performed (enter a whole number)
(Required.)
*
22.
Annual Revenue (enter a whole number)
(Required.)
*
23.
Largest Contract (enter a whole number)
(Required.)
*
24.
Average Contract (enter a whole number)
(Required.)
25.
Total Insurance Limit (enter a whole number)
26.
Total Bonding Capacity (enter a whole number)
27.
Experience Modification Rating (i.e. X.XXX)
*
28.
Reference 1
(Required.)
Company Name
Contact Name
Email Address
Phone Number
Project Name
Project Scope
Your Contract Value ($)
% of Work Self-Performed
*
29.
Reference 2
(Required.)
Company Name
Contact Name
Email Address
Phone Number
Project Name
Project Scope
Your Contract Value ($)
% of Work Self-Performed
*
30.
Reference 3
(Required.)
Company Name
Contact Name
Email Address
Phone Number
Project Name
Project Scope
Your Contract Value ($)
% of Work Self-Performed
*
31.
Judgements against your firm in the last 5 years
(Required.)
Yes
No
If yes, please explain
*
32.
Failure to complete a project in the last 5 years
(Required.)
Yes
No
If yes, please explain
*
33.
Prevailing wage violations in the last 5 years
(Required.)
Yes
No
If yes, please explain
34.
Safety violations in the last 5 years
Yes
No
*
35.
Is it ok to share your information with other firms/agencies for the purpose of identifying potential opportunities?
(Required.)
Yes
No
