DVS Subcontractor Questionnaire Form

Thank you for your interest in MP Services, LLC

In order to best match your capabilities with upcoming opportunities, please fill out the following information and return to be added to our subcontractor database.
Legal Company Name:
Federal Tax Id Number:
Current Licenses:
Mailing Addresses:
Business Phone:
Please enter a valid phone number.
Business fax
Contact Name
Email:
example@example.com
Website:
Company Established (Month/Year):

MonthDayYear
Certification: check all that apply):

State (Prince George’s Certification, LSDBE etc)GSA ScheduleMDOT8aDisadvantaged Business EnterpriseWoman OwnedSwamHUBzoneWMATA
Number of Employees:
Experience - Completed Projects:

List five (5) most recent and similar projects completed, starting from the most recent completion date. You may include projects where the bidder (your company) and subcontractor were subcontractors.

Experience - Facilities and Equipment:
List your company’s facilities and major equipment, leased or owned
Any judgments, claims or suits pending or outstanding against your company?

YesNo
If yes, include a brief explanation of each
Any judgments, claims or suits pending or outstanding against a client or general contractor?

YesNo
If yes, include a brief explanation of each
Does your company provide health insurance for all employees?

YesNo
Does your company have workers compensation?

YesNo
Your current COI and W9

Cancelof

Insurance Information:

Are you willing to require your employees to be subjected to site,project, or owner specific drug and/or alcohol testing programs?

YesNo
Projected Annual Sales:
Are you willing to provide the following information, if required?
I certify that the information in this questionnaire is correct and complete
Name of Company Principal
Signature

Clear
Email
example@example.com
Date

MonthDayYear
Date
Should be Empty: