9-Attachment H - Corporate Profile.pdf

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Corporate Profile

General Information

Complete Offeror’s Legal Name:

d/b/a (if any)

Headquarter Address:

Regional Office Address:

Federal Tax ID Number:

SDAT Department ID Number:

eMMA Account Number:

Diversity Programs

MBE Certification Number:

MBE Minority status:

SBR Certification Number:

Primary Point of Contact (for this RFP)

Name:

Title:

Direct Phone Number:

Email Address:

Mailing Address:

Secondary Point of Contact (for this RFP)

Name:

Title:

Direct Phone Number:

Email Address:

Mailing Address:

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Background Information

Year Founded:

Primary Service Provided:

Number of Years Performing Services:

Number Full Time Employees (Corporate / Regional Office): /

Provide a brief narrative outlining the firm’s history.

Past Performance

Sales Volume

Provide sales volume and project completion data for the most recently completed five-year period. Note that information provided is to be for the regional/local office that would be responsible for completing work under this solicitation.

Volume Annual Sales Completed Projects Largest Project

Safety∗

Have you received any regulatory citations (e.g. federal or state OSHA) in the last three years? If so, provide explanation:

Provide your Workers’ Compensation Experience Modification Rates (EMR) for the last 5 years.

2020: 2021: 2022: 2023: 2024:

If EMR not applicable, provide explanation.

∗ Only applies to construction or demolition companies.

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Disclosure of Contract Issues; Litigation; Criminal Investigations

In the last five years, list and discuss any alleged prior or ongoing contract failures (potential judgment/settlement in excess of $100,000), contract breaches (potential judgment/settlement in excess of $100,000), other significant civil litigation, and all criminal litigation or investigations, which involved your firm.

Failure to Complete

In the last five (5) years, disclose any projects that your firm was involved with that were not completed.

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Firm References

Provide three (3) references. Note that references are to be from different projects; that is, only one reference per project is allowed. MSA staff members cannot be considered as an Offeror’s reference.

Project Name:

Company Name:

Name:

Title:

Phone Number:

Email Address:

Project Relationship:

Project Name:

Company Name:

Name:

Title:

Phone Number:

Email Address:

Project Relationship:

Project Name:

Company Name:

Name:

Title:

Phone Number:

Email Address:

Project Relationship:

Prepared By:

Name:

Title:

Signature:

Date: