Amendment05BusinessManagementQuestionnaire.doc
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- Medical Adjudication Services Correction
- Solicitation number
- RFQ100-0006-07
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Business Management Questionnaire
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SEQ CHAPTER \h \r 1
ATTACHMENT
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:
(Phone)
(b) Contract Number
(c) Person to Contact
(d) Type of Work
(e) Amount of Contract
(f) Contract Status
☐Active ☐Complete
(2)(a) Customer & Address:
(b) Contract Number
(d) Type of Work
(e) Amount of Contract
(3)(a) Customer & Address:
(b) Contract Number
(d) Type of Work
(e) Amount of Contract
(4) Bank Reference:
(a) Name of Bank
(b) Address
(5) Total estimated amount of work under this contract that your firm will complete (excluding subcontractors): _______ percent.
(6) Please provide your DUNS (Data Universal Numbering System) number ________________________.
(7) If applicable, please provide your Parent Company's DUNS (Data Universal Numbering System) number ________________________.
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