Name



Dear Vendor,

M.C. Dean, Inc. actively supports the U.S. Government Small Business Administration’s policy to provide maximum practicable opportunity for concerns controlled by socially and economically disadvantaged individuals to perform meaningful and substantive work in contracts let by Federal agencies. In order to comply with both the spirit and intent of the FAR, M.C. Dean, Inc. has established a goal of purchasing necessary equipment and supplies from small businesses inclusive of all categories, whenever possible.

To support us in achieving this goal, M.C. Dean, Inc. actively solicits small businesses for consideration in future contracting opportunities. Attached is a survey that requests information we maintain on all active and prospective vendors. This information includes basic data regarding your business (name, address, TIN, etc.) as well as an indication as to the services you offer, geographic areas in which you are willing to perform work, and data and documentation regarding your business size and status, if any, as Small, Minority-Owned, Woman-Owned, Veteran-Owned, Disadvantaged, and or similar business. All information you provide will be kept confidential.

Please complete and return the attached survey via email to Jillnell.Joiner@. With the completed survey, please include copies of any certifications or documentation (e.g. letters of attestation) concerning your status as a Small, Minority-Owned, Woman-Owned, Veteran-Owned, Disadvantaged, or similar business.

If you have any questions or would like information on how to become certified, please contact Jillnell Joiner at 703-802-6231 x1509 or Jillnell.Joiner@.

Thank you in advance for your assistance with this effort.

Sincerely,

[pic]

Jillnell Joiner

Small Business Liaison Officer

Company Contact Information

|Business Name: | |

|Contact Person and Title: | |

|Address: | |

| | |

|City, State, Zip: | |

|Phone Number: | |

|Fax: | |

|E-Mail: | |

|Web Address: | |

Business Information

|Year Established: | |

|Number of Employees | |

|NAICS Code(s) | |

| | |

|Sales Volume-Last Year: | |

|Sales Volume-2 Yrs Ago: | |

|Sales Volume-3 Yrs Ago: | |

|Business Organization | |Sole Proprietor | |

|State of Incorporation | |

|DUNS Number | |

|CAGE Code | |

|Federal Tax ID Number | |

|Bondable | |No | |Yes |Capacity | |

|Bonding Company |Name | |

| |Phone | |

|Insurance Company |Name | |

| |Phone | |

Classifications and Certifying Agency (please check all that apply):

|Category |Agency | |Category |Agency |

| |Minority-Owned | | | |HUBZone | |

| |Women-Owned | | | |Veteran-Owned | |

| |8(a) Small Business | | | |Local Disadvantaged | |

| |Service Disabled | | | |Small Disadvantaged | |

| |Veteran-Owned | | | | | |

| |Small Local Disadvantaged | | | |Other | |

Any special certifications your company has been awarded (such as MWAA, VDOT, MDOT, etc.):

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

References*

|Customer Name: | |

|Contact Person and Title: | |

|Phone Number: | |

|Fax: | |

|E-Mail: | |

|Customer Name: | |

|Contact Person and Title: | |

|Phone Number: | |

|Fax: | |

|E-Mail: | |

|Customer Name: | |

|Contact Person and Title: | |

|Phone Number: | |

|Fax: | |

|E-Mail: | |

*Government customers preferred

Ownership

|Name |Title |% Ownership |

| | | |

| | | |

| | | |

| | | |

Current Areas of Operation (please check all that apply):

|( Alabama |( Alaska |( Arizona |( Arkansas |( California |

|( Colorado |( Connecticut |( Delaware |( Florida |( Georgia |

|( Hawaii |( Idaho |( Illinois |( Indiana |( Iowa |

|( Kansas |( Kentucky |( Louisiana |( Maine |( Maryland |

|( Massachusetts |( Michigan |( Minnesota |( Mississippi |( Missouri |

|( Montana |( Nebraska |( Nevada |( New Hampshire |( New Jersey |

|( New Mexico |( New York |( North Carolina |( North Dakota |( Ohio |

|( Oklahoma |( Oregon |( Pennsylvania |( Rhode Island |( South Carolina |

|( South Dakota |( Tennessee |( Texas |( Utah |( Vermont |

|( Virginia |( Washington |( West Virginia |( Wisconsin |( Wyoming |

Please identify the services you provide:

| |Acoustical Tile | |Fencing | |Refrigeration Work |

| |Appraisals | |Fire Protection Systems | |RFI Shielding |

| |Architect/Engineering | |Fireproofing | |Rigging & Hauling |

| |Asbestos Removal | |Floors | |Roofing |

| |Bird Proofing | |Fuel Tank Removal | |Safety |

| |Boiler Repair & Installation | |Furnishings Installation | |SCADA Systems |

| |Carpentry | |Hydroseeding | |Security Systems |

| |Cassions | |Information Display Systems | |Shoring |

| |Cathodic Protection | |Instrumentation | |Software |

| |CCTV Systems | |Insulation Pipes | |Solar Energy Systems |

| |Concrete Work | |Landscaping | |Solar Film Projects |

| |Construction Inspections | |Lead Abatement | |Space Planning |

| |Construction Management | |Lighting Protections | |Special Systems |

| |Construction Testing | |Masonry Work | |Tank Installation |

| |Cooling Towers | |Metals | |Tank Lining Installation |

| |Core Drilling | |Neon Signs | |Test Boring |

| |Demolition | |Painting | |Waterproofing |

| |Direction Boring | |Partition Installation | |Welding |

| |Doors/Windows | |Paving | |Woodwork |

| |Electrical | |PCB Removal | |X-Ray Testing |

| |Elevator Installation | |Phone Services | |Other _____________ |

| |Elevator Seismic Protection | |Plumbing | |Other _____________ |

| |Environmental Work | |Railroad Extensions | |Other _____________ |

| |Exterior Building Cleaning | |Railways Bit, Concrete | |Other _____________ |

Please e-mail this form along with copies of any small business certifications (e.g. Woman-Owned, Small Disadvantaged, Hubzone, etc.) to Jillnell Joiner (Jillnell.Joiner@).

-----------------------

22461 Shaw Road

Dulles, VA 20166

TEL 703-802-6231

FAX 703-421-4670



VA DCJS License #11-2332

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download