Business Management Questionnaire.docx

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FSA Dialectical Behavior Therapy Protocol
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BRQ15BNAS23Q00000022
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BUSINESS MANAGEMENT QUESTIONNAIRE

(a) Provide the work distribution, by percentage, among commercial contracts and Government contracts (including prime and subcontracts).

Commercial: __________percent Government: __________percent

(b) List the last three contracts awarded to your firm which are of a related nature, indicating for each the following:

(1)(a) Customer & Address: __________________________________________________

(b) Contract Number:_____________________________

(c) Person to Contact:___________________________
(Phone)____________________________________________

(d) Type of Work: ___________________________________

(e) Amount of Contract:$________________________________

(f) Contract Status: [ ] Active [ ] Complete

(2)(a) Customer & Address: __________________________________________________

(b) Contract Number:_____________________________

(c) Person to Contact:___________________________
(Phone)____________________________________________

(d) Type of Work: ___________________________________

(e) Amount of Contract:$________________________________

(f) Contract Status: [ ] Active [ ] Complete

(3)(a) Customer & Address: __________________________________________________

(b) Contract Number:_____________________________

(c) Person to Contact:___________________________
(Phone)____________________________________________

(d) Type of Work: ___________________________________

(e) Amount of Contract:$________________________________

(f) Contract Status: [ ] Active [ ] Complete

(4) Bank Reference:

(a) Name of Bank:____________________________________________

(b) Address: ____________________________________________________________ (Phone)_____________________________________________________

(c) Person to Contact:______________________________________
(Phone)____________________________________________________

(5) Total estimated amount of work under this contract that your firm will complete (excluding subcontractors):

__________ percent

(6) Please provide your Unique Entity Identification (UEI) Number

(7) If applicable, please provide your Parent Company’s Unique Entity Identification (UEI) Number

Business Management Questionnaire - RFQ: 15BNAS23Q00000022 Page 2 of 2

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