4.0 - Attachment C (Profile of Firm Form).doc

INVITATION FOR BIDS (IFB) No. B23007, Kitchen and Bathroom Cabinets and Countertops

PROFILE OF FIRM FORM

(IFB Attachment C)

(This Form must be fully completed and submitted to the Agency when notified to do so by the Agency after the submittal deadline.)

(1) Prime( Sub-contractor( (This form must be completed by and for each).

(2) Name of Firm:

Telephone:

Fax:

Email:

(3) Street Address, City, State, Zip:

(4) Please attached a brief biography/resume of the company, including the following information: (a) Year Firm Established; (b) Year Firm Established in Montana; (c) Former Name and Year Established (if applicable); (d) Name of Parent Company and Date Acquired (if applicable).

(5) Identify Principals/Partners in Firm (submit under Tab No. 5 a brief professional resume for each):

[Table No. 1] (1)

Name (2)

Title (3)

% of Ownership

(6) Identify the individual(s) that will act as project manager and any other supervisory personnel that will work on project; please submit under Tab No. 5 a brief resume for each. (Do not duplicate any resumes required above):

[Table No. 2] (1)

Name (2)

Title

(7) Bidder Diversity Statement. You must mark all the following that apply to the ownership of this firm and enter where provided enter the correct percentage (%) of ownership of each:

( Caucasian

( Public-Held

( Government

( Non-Profit

American (Male) Corporation

Agency

Organization

Resident- (RBE), Minority- (MBE), or Woman-Owned (WBE) Business Enterprise (Qualifies by virtue of 51% or more ownership and active management by one or more of the following):

(Resident- (African (Native (Hispanic (Asian/Pacific (Hasidic (Asian/Indian

Owned* American American American American Jew American

(Woman-Owned (Woman-Owned (Disabled (Other (Specify):

(MBE) (Caucasian) Veteran

WMBE Certification Number:

Certified by (What Agency):

(NOTE: A CERTIFICATION/NUMBER IS NOT REQUIRED TO PROPOSE – ENTER IF AVAILABLE)

(8) Federal Tax ID No.:

(9) Local Business License No. (if applicable):

(10) State of Montana License Type and No. (if applicable):

(11) Federal License Type and No. (if applicable):

(12) Worker’s Compensation Insurance Carrier:

Policy No.:

Expiration Date:

(13) General Liability Insurance Carrier:

Policy No.

Expiration Date:

(14) Automobile Liability Insurance Carrier:

Policy No.

Expiration Date:

Signature

Date Printed Name Company

HomeFront, MT