1. PTAC CONTRACT AWARD REPORT

Please take just a minute or two to respond to these questions. We are required by our funding agency to seek this information from you and report totals on a quarterly basis. Your responses are very important to us!

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* 1. May we have your Company name, address, phone and name of owner or other contact person?

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* 2. Date contract awarded:

Date

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* 3. Entity (or government agency) awarding contract:

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* 4. Amount of contract awarded:

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* 5. Contract Number (if available) and/or Title of Project:

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* 6. Entity awarding contract is a (select one):

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* 7. Your involvement in this contract (select one):

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* 8. Number of Full-time jobs created as a result of this contract being awarded to you:

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* 9. Number of Part-time jobs created as a result of this contract being awarded to you:

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* 10. Number of jobs you retained as a result of being awarded this contract:

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* 11. Date of second contract you were awarded (if applicable):

Date

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* 12. Entity (or government agency) awarding contract:

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* 13. Amount of contract awarded:

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* 14. Contract Number (if available) and/or Title of Project:

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* 15. Entity awarding contract is (select one):

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* 16. Your involvement (select one):

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* 17. Number of Full-time jobs created as a result of this contract being awarded to you:

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* 18. Number of Part-time jobs created as a result of this contract being awarded to you:

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* 19. Number of jobs you retained as a result of being awarded this contract:

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* 20. To determine bidding activity in the area, would you mind letting us know how many projects you bid on this quarter?

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* 21. Please select the assistance PTAC has provided your business that helped in your being awarded this contract:

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* 22. Thank you for taking the time to respond to this survey. If you have any questions for PTAC, or require assistance with any registrations or certifications, we want to know. Submit your request in the box below along with your name and preferred method of contact, and we'll get back to you as soon as we possibly can.

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