To comply with federal requirements, the Texas Department of Transportation's (TxDOT) Civil Rights Division is required to collect prime contractor and subcontractor data.

All prime contractors and subcontractors interested in seeking TxDOT work are asked to complete this survey each fiscal year.

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* 1. Vendor name:

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* 2. Primary owner name:

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* 3. Vendor Number (VID, EIN or Tax ID):

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* 4. Headquarters address:

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* 5. City:

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* 6. State:

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* 7. Zip Code:

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* 8. Phone (XXX-XXX-XXXX):

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* 9. Business Structure:

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* 10. Select ethnicity of company's majority owner/operator (select all that apply):

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* 11. Select gender of company's majority owner/operator:

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* 12. Estimated annual gross receipts:

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* 13. Number of years in business:

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* 14. Bidding role of your company (select all that apply):

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* 15. What sector(s), if any, has your company performed work in? (Select all that apply)

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* 16. In which of the following areas of work or business does your company participate? (Select all that apply)

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* 17. TxDOT district(s) where you conduct business (select all that apply):

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* 18. Certification Status (select all that apply):

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* 19. If a DBE, select certifying entity:

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* 20. Did your company seek TxDOT work this past year?

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* 21. Does your company intend to seek work with TxDOT next year?

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* 22. In which role(s) will your company seek work with TxDOT in the next year? (Select all that apply)

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* 23. If you selected subcontractor in question 22, how does your company currently receive notification of subcontracting opportunities with TxDOT? (Select all that apply)

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* 24. Survey completed by:

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* 25. Email:

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* 26. Phone (XXX-XXX-XXXX):

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