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* 1. Company Name

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* 2. DBA (If Applicable)

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* 3. Contact Name

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* 4. Street/Suite

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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 Number (XXX-XXX-XXXX)

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* 9. Email Address

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* 10. Website

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* 11. Certification Status

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* 12. Certifying Entity

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* 13. Certifying Entity - Disadvantaged Business Enterprise (DBE)

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* 14. Certifying Entity - Service Disabled Veteran (SDVOB, SDVBE)

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* 15. Certifying Entity - Veteran Business Enterprise (VBE)

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* 16. Certifying Entity - LGBTQ+

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* 17. Certifying Entity - Local Business Enterprise (LBE)

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* 18. Certifying Entity - Small Business Enterprise (SBE)

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* 19. Certifying Entity - Section 3 Business Concern (S3BC)

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* 20. Section 3 Resident

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* 21. Name of person with largest % ownership

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* 22. Gender of person with largest % ownership

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* 23. Ethnicity of person with largest % ownership

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* 24. Business Type

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* 25. License Types (i.e. Electrical, Plumbing etc.)

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* 26. Professional Services (i.e. Architect, Engineer, Survey etc.)

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* 27. Service Type (i.e. Security, Janitorial, Pest Control etc.)

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* 28. Supplier Type (i.e. Drywall, Tools, MRO etc. )

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* 29. Industry Experience

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* 30. NAICS Codes

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* 31. NIGP Codes

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* 32. Union Affiliation

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* 33. Union Local (i.e. 638)

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* 34. Trade Type (i.e. GC, Carpentry, Electrician etc)

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* 35. Number of full time employees

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* 36. Number of part time employees

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* 37. % of work self performed (i.e. 25%, 50%, 75%, 100%)

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* 38. Annual Revenue ($X,XXX,XXX)

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* 39. Largest Contract ($X,XXX,XXX)

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* 40. Average Contract ($X,XXX,XXX)

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* 41. Total Insurance Limit

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* 42. Total Bonding Capacity

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* 43. Experience Modification Rating (i.e. X.XXX)

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* 44. Reference 1

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* 45. Reference 2

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* 46. Reference 3

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* 47. Judgements against your firm in the last 5 years

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* 48. Failure to complete a project in the last 5 years

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* 49. Prevailing wage violations in the last 5 years

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* 50. Certification Denied or Revoked in the last 5 years?

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* 51. Is it ok to share your information with other firms/agencies for the purpose of identifying potential opportunities?

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