Contact Person:
*_____________________________________________________________
Address of Principle Office: * ____________________________________________________
Telephone No.: * ________________ Fax No.: * _______________ Email: ___________________
Address of Other Offices: _________________________________________________________
Name of Principal Owner(s) (More than 50%) ___________________________________________
_____________________________________________________________________________
Certification(s)* ________________________________________________________________
_____________________________________________________________________________
Corp. FIN No.: ___________________________ or Social Security No.:
_______________________
Furnish/Install or Both: _____________________________________________________________
Open Shop, Merit or Union: * ________________________________________________________
Number of Employees: _________ Full Time ___________Part Time
Trade (Construction): * _____________________________________________________________
Specialtization: *__________________________________________________________________
1. Number of years in business: *
___________________________________________
2. Largest project expressed in dollar amount: *__________________________________
3. Annual revenue (dollars), last three years: ___________ ___________
___________
4. Number of years in business for specialization or trade: __________________________
5. Bonding capability (name, address and phone # of current agent, current limits) *
6. Insurance capability (name, address, contact and current limits): *
7. Has your firm ever been debarred from performing work with any organization or had a
contract terminated? Yes __________ No __________
If Yes, explain the circumstances.
8. Any prior experience working with Capital One? * Yes __________ No __________
If yes, please describe the experience. Identify project names, locations, type
of work performed and contact person.
9. Any prior experience working with Whiting-Turner Construction Company and/or any
other major construction company(ies)? Yes ______________ No _____________
If yes, please list the construction company(s) and briefly describe the experience.
Identify project names, locaitons, type of work performed and contact person.
10. List any other relevant project experience for the last three years.*
11. Do you have audited financial returns for the last two years available? Yes _______
No ______
If no, do you have tax returns for the last two years
available? Yes _______ No ______
12. Generally, do you sub-contract with other minority companies? * Yes _____ No ______
13. When you sub-contract with majority companies what are the reasons? *
I certify by signing this form that the information is true and correct.
______________________________________
Name of Person Completing the Form
______________________________________
Title
______________________________________
Date
