Contractor Questionnaire Form.pdf

1. Applicant’s Federal Employer Identification Number (or Social Security No. If Individual)

- - Social Security #

- Fed. Emp. I.D. #

3. Type of Organization General Contractor Design-Build Sub Contractor Maintenance

Other

5. Names of Officers of Firm

(A) President _________________________________________

(B) Vice-President _____________________________________

(C) Secretary _________________________________________

(D) Treasurer _________________________________________

7. Has your firm ever been denied a bond? Yes No

If yes, explain _________________________________________

Is your company bondable in MD.? Yes No

CONTRACTOR QUESTIONNAIRE

DEPARTMENT OF GENERAL SERVICES - OFFICE OF PROCUREMENT AND CONTRACTING

301 W. PRESTON STREET, WEST LOBBY, BALTIMORE, MD. 21201

TEL: (410) 767-4996

2. Business Name and Address to which Bid Requests Mailed

(include zip code)

Business Telephone ( ) Area Code Number

Business Fax ( ) Area Code Number

4. Construction Firm’s MD License #: - Expiration date __________________________________

Year firm established ________________________________

6. Names of Owners, Partners or Proprietors

8. Is Business Sole Proprietorship

Partnership

Corporation

State Incorporated ___________________________________

Names and Titles of Persons Authorized to Sign Bids and Contracts

9. Give value of any judgements or liens outstanding against your organization _____________________________________________

10. Has the firm or any officer of the firm been suspended or debarred by the State of Maryland or political subdivisions?

Yes No If yes, explain ____________________________________________________________________________________

DGS 340—8 (CQ-3) REV 1/97

ROOM M-7ROOM M-7

12. Is your firm certified as a Minority Business Enterprise with the State of Maryland?

No Yes Certification No. __________________

Majority Ownership-Check Appropriate Ones

Hispanic Asians, American Indians African Americans Women Physically and Mentally Disabled

Industrial: None Some Most All Manufacturing Warehousing Roadway

Residential:

Single-Family Multi-Family

Other: ___________

New Construction

13. How much of your work is done on each of the following project types (check as appropriate)

Building Size (Sq. Ft.)

Under 50,000 50,000 - 100,000 100,001 - 250,000 250,001 +

Building Height Under 4 floors 4 - 10 floors 11 floors or more

Building Location City Suburb Rural

Commercial: None Some Most All Office space Retail space Food service Lodging

Institutional:

Health care facilities Correctional facilities Educational facilities Parks or recreational

Renovations Utilities Military

14. Give at least three references of owners or contractors for whom you have worked.

Company Contact Name Telephone No.

15. List principal contracts completed in last 3 years. (Use back of last page for additional information)

Project Your Contract $ Year Owner/GC

11. Maximum value of contract work for which you could obtain Bond $ _____________________________________

Gross billings for work done Last Year $ _______________

2 Years Ago $ _______________

3 Years Ago $ _______________

Net worth as of last audited financial statement $ _______________

Number of full-time employees ________________

Company Contact Company ContactCompany Contact EmailEmail Address Phone Number

INSTRUCTIONS FOR COMPLETING CLASSIFICATION INDEX

16.

A. Refer to the classification index below which describes various types of contracting required by the State.

B. Circle the code number that identifies the types of contracting you are interested in undertaking.

DEPARTMENT OF GENERAL SERVICES

CLASSIFICATION INDEX

CONSTRUCTION AND MAINTENANCE SERVICES

Asbestos (Asbestos Related) 1101 Asbestos Abatement 1102 Industrial Hygiene Services

Communication 1201 Sound Systems 1202 Burglar Alarm Systems 1203 Fire Alarm Systems 1204 MATV Systems

Construction 1301 General Contractors

Construction Related 1401 Air Conditioning 1402 Aluminum Siding 1403 Antennas & Lightning Rods 1404 Boiler Installation Repairs 1405 Bulkheads, Repairs & Erosion Control 1406 Burner Service-Gas, Oil 1407 Carpentry and Woodwork 1408 Carpeting 1409 Ceilings 1410 Ceramic Tile 1411 Concrete and Woodwork 1412 Demolition 1413 Electrical, General 1414 Electrical, High Voltage 1415 Elevators 1416 Excavation Work 1417 Fences 1418 Glass & Glazing Work

17. Certification

I, the undersigned, hereby certify that the above information is a true and correct statement

SIGNATURE ______________________________________________

(Date)

NAME __________________________________________________

(Typed)

TITLE __________________________________________________

1419 Insulation-Boiler and/or Piping 1420 Masonry Construction 1421 Mechanical, General 1422 Overhead Doors 1423 Painting, Paper Hanging & Decorating 1424 Parking Equipment & Controls 1425 Partitions 1426 Paving & Paving Repairs 1427 Piping, Sanitary, Storm, Water, Steam 1428 Plastering, Drywall 1429 Plumbing/Heating 1430 Refractory 1431 Refrigeration 1432 Resivoir & Dam Spillway Repairs 1433 Roofing, Sheetmetal, Gutters, Downspouts 1434 Septic Tank Systems 1435 Sidewalks & Curbing-Asphalt, Concrete 1436 Sodding 1437 Structural Steel Erection 1438 Temp. Control Installation & Service 1439 Terrazzo, Tile, Marble, Stone and Stucco 1440 Underground Prefab Piping 1441 Ventilation 1442 Wall Covering 1443 Water Condition Systems & Services 1444 Waterproofing 1445 Welding 1446 Well Service, Drilling, Pumping Systems 1447 Window Replacement

1448 Other ________________________________________________

INFORMATION

Contractual Services to the State of Maryland are governed by all applicable Federal, State and Local Laws and the Rules and Regulations of the Department of General Services, including the provisions of Title VII of the Civil Rights Acts of 1964, COMAR Title 21 and the State Finance and Procurement Article of the Maryland Code.

EMAIL _________________________________________________EMAIL _____________________________________________________