NCA RFI Contractor Info Sheet 2.22.22.docx

Attachment 1 Contractor/Vendor Information Sheet

Please complete this form and return with your Request for Information/Sources Sought submission. The information provided will be used for market research. Please return to Kelly Minturn (Kelly.M.Minturn@fps.dhs.gov) by March 11, 2022, at 0800 AM PDT.

Legal Business Name:

Unique Entity Identifier No:

Mailing Address:

City, State, Zip Code:

Country:

Toll Free Number: Website Address:

Point of Contact:

Phone Number: Fax:

E-mail Address:

My interest in this project is as a (please check one):

[ ] Prime Contractor [ ] Joint Venture Participant [ ] Subcontractor [ ] Other (please specify) ___________________________________________

Is your firm an approved participant in the SBA Mentor Protégé Program: Yes____ No____

Have you performed federal or state guard services under NAICS Code 561612: Yes____ No____

Is your firm a small business under NAICS Code 561612 for guard services: Yes*____ No____ *If yes, complete socioeconomic status information below:

Socioeconomic Business Status:

Small Disadvantaged Business ______ 8(a) Certified _________ HUBZone Certified _______

Service-Disabled Veteran-Owned _____ Women-Owned Certified _______ None of the Above _________

Is your firm registered in SAM: Yes No

Does your firm currently hold a valid security/guard services license in California under your legal business name or a wholly owned subsidiary: Yes____ No____

Can your firm obtain a security/guard license in California under your legal business name or a wholly owned subsidiary of your business? Yes____ No____