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Business Enterprise Questionnaire-BEQ Survey
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1.
Company Name
(Required.)
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2.
Contact Name
(Required.)
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3.
Street/Suite
(Required.)
*
4.
City
(Required.)
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5.
State
(Required.)
*
6.
Zip
(Required.)
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7.
Phone #
(Required.)
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8.
Email
(Required.)
9.
Website
10.
Certified Entity-M/WBE/DBE/SBE Other
Yes
No
Other (please specify)
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11.
Certifying Entity
(Required.)
Federal
State
City
Local
Private
N/A
Other (please specify)
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12.
Section 3 Resident
(Required.)
Yes
No
*
13.
Owner Gender > %
(Required.)
F
M
X
Prefer Not to Answer
N/A
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14.
Owner Ethnicity > %
(Required.)
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Another Race
N/A
Prefer Not to Answer
*
15.
Business Type
(Required.)
Architectural/Engineering Services
Other Services (Including consultants)
Trade Partner/Subcontractor
Supplier
Broker/Manufacturer's Rep
Manufacturer/Fabricator
Trucker
Other (please specify)
*
16.
Trade License Holder
(Required.)
Yes
No
N/A to Trade
17.
Professional Service Type
18.
Standard Service Type
19.
Supplier
Stocking
Broker/Rep
Describe Products
20.
Primary NAICS Code
21.
Primary CSI Code
*
22.
Union Affiliation
(Required.)
Yes
No
Open Shop
N/A
23.
# Full Time Emp.
24.
# Part Time Emp.
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25.
% Self Performed
(Required.)
10%
25%
50%
75%
100%
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26.
Annual $
(Required.)
<$100K
<$500K
<$1MM
<$5MM
<$10MM
>$10MM
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27.
Largest Contract
(Required.)
<$100K
<$500K
<$1MM
<$5MM
>$5MM
*
28.
Average Contract $
(Required.)
<$100K
<$500K
<$1MM
<$5MM
>$5MM
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29.
Backlog
(Required.)
<$100K
<$500K
<$1MM
<$5MM
<$10MM
>$10MM
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30.
Gen'l Liability Aggregate
(Required.)
<$1MM
<$3M
<$5M
<$10M
>$10M
N/A
*
31.
Bonding Aggregate
(Required.)
$750K or Less
<$1MM
,$3MM
<$5MM
<$10M
>$10M
N/A
32.
EMR #(Contractors)
33.
Reference 1
Company Name
Contact Name
Email Address
Phone Number
Project Name
Project Scope
Your Contract Value ($)
% Self-Performed
34.
Reference 2
Company Name
Contact Name
Email Address
Phone Number
Project Name
Project Scope
Your Contract Value ($)
% Self-Performed
*
35.
Judgements- Last 5 years
(Required.)
Yes
No
If yes, please explain
*
36.
Incomplete Projects Last 5 Yrs?
(Required.)
Yes
No
If yes, please explain
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37.
Prevailing Wage Violations Last 5 years
(Required.)
Yes
No
If yes, please explain
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38.
Certification Denied/Revoked Last 5 years?
(Required.)
Yes
No
If yes, please explain
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39.
Share Firm Details? Contract Opps Only
(Required.)
Yes
No
