DCAP MBE Supplier Intake Form

DCAP MBE Supplier Intake Form
Name*

First NameLast Name
Job Title*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Legal Business Name*
Year Founded*
Website URL*
Primary Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DC Ward (if applicable)*
What primary industry category most accurately captures your business?*

Architecture & DesignEngineeringCatering & Food ServicesCleaning & JanitorialProperty Maintenance & ManagementCommunications & MarketingConstructionTrades (Includes new builds and maintenance)Product-Based Offerings (Includes supplies and equipment)Professional ServicesOther Services
Which Architecture & Design subcategories most accurately capture your business?*

Architectural EngineeringDesign/BuildHistoric PreservationInterior/Exterior Design RenovationTenant Build-Outs/ImprovementsOther
Which Engineering subcategories most accurately capture your business?*

Civil EngineeringMEP EngineeringStructural EngineeringEnvironmental EngineeringOther
Which Catering & Food Services subcategories most accurately capture your business?*

Full-Service Catering - Large (250+ guests)Full-Service Catering - Small (under 250 guests)Boxed Meals/Individually Packaged MealsAutomated Delivery PlatformOther
Which Cleaning & Janitorial subcategories most accurately capture your business?*

Janitorial/CustodialGlass & Window CleaningCOVID-19 CleaningOther
Which Property Maintenance & Management subcategories most accurately capture your business?*

Property Management ServicesGrounds Maintenance/Landscaping/Snow RemovalWaste Management/Recycling/Trash Removal/HaulingHandyman and Handywoman ServicesPest ControlControls/Building Automation SystemsFire Protection SystemsInspectionsOther
Which Communications & Marketing subcategories most accurately capture your business?*

AdvertisingMarketingBrandingWeb Design & Development/Video AnimationOther
Which Construction subcategories most accurately capture your business?*

General ContractingProject & Construction ManagementCommissioningThird Party InspectionsOwner's Representatives ServicesOther
Which Trades subcategories most accurately capture your business?*

HVACPlumbingElectricalPaintingDrywallFlooring/CarpentryOther
Which Product-based offerings subcategories most accurately capture your business?*

Office Supplies (including furniture)Furniture DistributorPromotional Items/StationerySignageOther
Which Professional Services subcategories most accurately capture your business?*

Financial Services (i.e. Accounting, Auditing, Tax, Payroll, Operational Audits)LegalTemporary Staffing/RecruitingLanguage TranslationTravel ServicesIT ServicesOther
Which Other Services subcategories most accurately capture your business?*

Ground TransportationEvent PlanningAudiovisual Design & BuildPhotographyFurniture Movers/Management ServicesTravel ServicesOther
Is at least 51% of your business minority-owned?*

YesNo
With which racial/ethnic community does the business owner(s) identify?*

American Indian or Alaska NativeAsianBlack or African-AmericanHispanic, Latino, or SpanishMiddle Eastern or North AfricanNative Hawaiian or Other Pacific IslanderOther
Is at least 51% of your business woman-owned?*

YesNo
Is your business a Certified Business Enterprise (CBE)?*

YesNo
How many full-time employees, excluding yourself, does your business employ?*
How many part-time employees does your business employ?*
How many of your total employees are residents of the District of Columbia? An estimate is acceptable.*
Have you done business with any hospitals in the District of Columbia? If yes, check the appropriate box(es).*

BridgePoint HospitalGeorgetown University Hospital (MedStar)George Washington University Hospital (UHS)Howard University Hospital (Adventist HealthCare)MedStar National Rehab Hospital (MedStar)Psychiatric Institute of WashingtonProvidence Health Village (Ascension)Sibley Memorial Hospital (Johns Hopkins Health System)United Medical Center (UHS)Washington Hospital Center (MedStar)N/AOther
Have you done business with any universities in the District of Columbia? If yes, check the appropriate box(es).*

American UniversityCatholic UniversityHoward UniversityGallaudet UniversityGeorgetown UniversityGeorge Washington UniversityTrinity Washington UniversityUniversity of the District of ColumbiaN/AOther
Have you done business with any utility companies in the District of Columbia? If yes, check the appropriate box(es)*

DC WaterPepcoWashington GasN/AOther
Are you a client with any of our referral partners? If yes, check the appropriate box(es).*

DSLBD / DC PTACLEDCWacifN/A
Is there anything else you would like to share with us?
Please upload your latest capability statement.

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