Contractor_Info_Sheet__-_Wuhan.docx

Contractor/Vendor Information Sheet

Please fill in all information below, type or print information clearly.

Please complete the following questions below and return to Nicolas Wilhelm (WIlhelmNA@state.gov and Shayani Mukherjee (Mukherjees1@state.gov)) by March 4, 2016 NLT 16:00 PM EST

Legal Business Name:

Tax ID No: DUNS No:

Mailing Address:

City, State, Zip Code:

Country:

Toll Free Number: Website Address:

Point of Contact:

Phone Number: Fax:

E-mail Address:

Country of Origin U.S. Firm ___ Foreign Vendor ___ Country: ___________

Size of Business:

Large ___ Small ___

Corporate Status:

Corporation ___ S-Corporation ___ Sole Proprietorship ___ Partnership ___ Other: _______________

Type of Ownership:

Woman ___ Veteran-owned___ (Service-disabled ____) Minority___ None of the Above ___ Other: _________________

Socio-Economic Status:

8(a) Status ___ HUBZone___ Disadvantaged____ None of the Above ___ Other:_________________

Registered in Systems Award Management: Yes No _

DCAA-approved accounting practices: Yes No _

Do you currently do business in China? Yes____ No____ Technical Questions:

1a. Has the prospective contractor performed services in Wuhan, China?

|_| YES

|_| NO

2a. Has the prospective contractor performed local guard services under the NAICS code 561612 – Security Guards and Patrol Services in Wuhan, China?

|_| NO

3. If the answer to any of the above questions is YES, please identify the contract number and Government Agency and/or Commercial Organization.

4a. Does the prospective contractor currently possesses active license(s) and/or permits to perform local guard services in Wuhan, China?

|_| NO

5a. Does the prospective contractor have the ability and resources to service a contract in all locations Wuhan, China?

|_| NO

If the answer is yes, please explain and list any prior related experiences.

6. Does the prospective contractor have any comments or concerns regarding the U.S. Consulate Wuhan solicitation?