Business Management Questionnaire.docx

DOCX document 18 KB Posted

Attached to
FSA Dialectical Behavior Therapy Protocol Federal contract opportunity
Solicitation number
BRQ15BNAS23Q00000022
Issued by
Department of Justice Bureau of Prisons Central Office

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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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