BUSINESS_MANAGEMENT_QUESTIONNAIRE.docx

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Physical Therapy Services
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RFQP01131400013
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Business Management Questionnaire

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BUSINESS MANAGEMENT QUESTIONNAIRE

DEST:Invis_1073741825

(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 Name _______________________________________________________

Address

(b) Contract Number _____________________________ Email_________________

(c) Person to Contact Phone_________________

(d) Type of Work _____________________________

(e) Amount of Contract $

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

(2)(a) Customer Name _______________________________________________________

Address

(b) Contract Number _____________________________ Email_________________

(c) Person to Contact Phone_________________

(d) Type of Work _____________________________

(e) Amount of Contract $

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

(3) (a) Customer Name _______________________________________________________

Address

(b) Contract Number _____________________________ Email_________________

(c) Person to Contact Phone_________________

(d) Type of Work _____________________________

(e) Amount of Contract $

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

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

(D) Please provide your DUNS (Data Universal Numbering System) number __________________

(E) If applicable, please provide your Parent Company's DUNS (Data Universal Numbering System) number

[END OF ADDENDUM TO FAR 52.212-1]

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