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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. Certification Status - Disadvantaged Business Enterprises (DBE)

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* 14. Section 3 Resident

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* 15. Business Type

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

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* 17. Industry Experience

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* 18. Union Affiliation

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* 19. Number of full time employees

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* 20. Number of part time employees

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* 21. % of work self performed (enter a whole number)

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* 22. Annual Revenue (enter a whole number)

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* 23. Largest Contract (enter a whole number)

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* 24. Average Contract (enter a whole number)

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* 25. Total Insurance Limit (enter a whole number)

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* 26. Total Bonding Capacity (enter a whole number)

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

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* 28. Reference 1

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* 29. Reference 2

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* 30. Reference 3

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

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

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* 33. Prevailing wage violations in the last 5 years

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* 34. Safety violations in the last 5 years

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

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