APPENDIX B
SUBMITTAL FORM # 3.0 - CONTRACTOR QUESTIONNAIRE
All responses must be typewritten or printed. If an explanation is requested or additional space is required, please use include an additional page and sign each additional page. The signatory represents and warrants the accuracy of all information and responses provided on this form. Failure to submit a completed Submittal Form may cause the proposal to be deemed non- responsive and disqualified from further review. If a change occurs which would necessitate a modification of any response, the proposer should submit an updated form to the CCAC Procurement Department within thirty (30) calendar days.
GENERAL INFORMATION
1.
Legal Name of Organization:
2.
Principal Office/Business Address: Street Address:
City/State:
Zip Code:
3.
Business Phone Number:
4.
Fax Number:
5.
Website Address:
6.
Location of Branch Offices:
7.
Years in Business:
8.
Number of Employees:
9.
Federal Employer Tax ID No.:
ORGANIZATION STRUCTURE
1.
Type of Business Entity (check one):
Other ( please attach document describing ownership structure )
Corporation
Partnership
2.
Corporation Information (if applicable):
Date of Incorporation:
State of Incorporation:
President:
Vice-President(s):
Secretary:
Treasurer:
3.
Partnership Information (if applicable):
Date of Organization:
Type (limited; general):
Name/Addresses of Partners:
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