5-ATTACHMENT II.pdf

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Attached to
G-COMMUNITY-BASED OUTPATIENT SUBSTANCE ABUSE & MENTAL HEALTH SERVICES-DETROIT, MI
Solicitation number
RFQ-TDAT-075-0
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Business Management Questionaire

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ATTACHMENT II

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 ______________________________

(Phone) ______________________________

(d) Type of W ork _____________________________

(e) Amount of Contract $_____________________________

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

(2) (a) Customer & Address ______________________________

(Phone) ______________________________

(b) Contract Number ______________________________

(c) Person to Contact _______________________________

(Phone) _______________________________

(d) Type of W ork ________________________________

(e) Amount of Contract $______________________________

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

(3) (a) Customer & Address ______________________________

(Phone) _______________________________

(b) Contract Number _____________________________

(c) Person to Contact ________________________________

(Phone) _____________________________

(d) Type of W ork _____________________________

(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 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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