CITY OF ATLANTA PARTNERSHIP Small Business Development Program Contractor/Consultant Questionnaire

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1 Instructions: A completed Questionnaire with all attachments must be delivered via , facsimile, or handdelivery no later than January 18, 2018, to the attention of Laura Cook at the address below. To submit the form electronically you may click on the SUBMIT button at the end of the Questionnaire or save a copy as a pdf and with all required documents to the address below. Attention: Laura Cook JAT Consulting Services, Inc Shiloh Road, Suite 1430 Kennesaw, GA P: F: lauracook@jatconsulting.net Once a completed questionnaire is received, an assessment process will be conducted. We will select companies for participation in the 2018 combined City of Atlanta Departments of Aviation & Watershed Management. Companies will be notified by of their acceptance to participate within days prior to the start of the program. The Small Business Development program is designed for Small, Minority and/or Female Owned Businesses established for a minimum of one year. Program Minimum Qualifications: A firm must meet these minimum qualifications in order to be accepted into the program: Be in business at least one calendar year. Demonstrate reasonable success potential. Business must comply with the applicable size standards as defined by the U.S. Small Business Administration. Please click here to access the SBA Standards. Name of Company: Contact Person / Title: Name of Representative that will attend SBDP Training: Physical Address: Street: City, State, Zip: Telephone.: Fax.: Address: Page 1 of 6

2 CERTIFICATIONS CITY OF ATLANTA PARTNERSHIP Do you have a current City of Atlanta MBE Certification Yes If yes, please attach copy Do you have a current City of Atlanta FBE Certification Yes If yes, please attach copy Do you have a current City of Atlanta SBE Certification Yes If yes, please attach copy Do you have a current Georgia DOT DBE Certification Yes If yes, please attach copy If you have a City of Atlanta certification application pending, please provide a copy of document acknowledging City of Atlanta s receipt of your documents for certification. TYPE OF BUSINESS Professional Services Program Management Construction Management Construction Services Other COMPANY DATA How long has your company been in business under its present name? Describe the services provided by your firm: Firm Owners/Titles: Total number of employees: Full-time: Part-time: Seasonal: Do you use 1099 staff? Approximate #: COMPANY EXPERIENCE List the largest active Contracts/Subcontracts your firm currently holds: Scope of Work List of projects recently bid: Type of Work Bid Page 2 of 6

3 List your three (3) most recently completed projects: Scope of Work List any City of Atlanta Department of Aviation or Watershed projects: Scope of Work INSURANCE COVERAGE BOND COVERAGE Does your company have coverage in the following areas? Has the firm had Performance Bonding? Yes General Liability Yes Amount: $ If yes, what is the amount? $ Professional Liability Do you have Workers Compensation? Yes Amount: $ Who is the surety? Yes Who is the Agent? FINANCIAL INFORMATION Identify your current Accounting System: In-House Outside Accounting/Bookkeeper If other, please identify Sage QuickBooks Pro Deltec Other Is your Accounting up-to-date? Yes Do you Maintain Job Costs Accounting Yes Define the Method of Accounting Cash Basis Accrual Basis Please provide the most recent financial statements as an attachment. Page 3 of 6

4 Are your Financial Statements (Balance Sheet and Income Statement) complete for Year 2016? Yes Current Payroll Processing In-House Outside Payroll Service Provider How do you make your Payroll Tax Payments? Write Check Automatic Withdrawal from Bank Account Can you provide a Certified Payroll Register? Yes Are your Payroll Tax Payments up to date? Yes Gross Revenues/Fees: Fiscal Year 2015: $ Fiscal Year 2016: $ Do you have an Accountant/Bookkeeper? Yes Do you have a CPA? Yes Do you have Schedule of Indirect Costs? Yes Please check any of the following specific work efforts in which your Company has experience: PROFESSIONAL SERVICES: Architectural/Engineering Program Management Contract Administration Management Consulting CONSTRUCTION SERVICES: Sitework Use of Explosives Demolition Clearing and Grubbing Temp/Perm Erosion and Sedimentation Control Dewatering Sheeting, Shoring and Bracing Earthwork Pipe Boring and Jacking Trench Excavation and Backfill Bore and Jack Casings Accounting/Finance Support Services Planning Public Involvement IT Support Services Horizontal Directional Drilling Gabions Riprap Steel Section Piles Tunnel and Shaft Excavation Granite Curb Granite Block Hexagonal Block Pavement Unit Pavers Auger Cast Concrete Piling Steel Piles Page 4 of 6

5 Geogrid Reinforced Earth Retaining Structures Geotechnical Instrumentation and Monitoring Asphalt Paving Preconditioning and Cleaning Manholes/Sewers Cured-in-Place Pipe Liner Cured-in-Place Service Lateral Liner Concrete Walks Concrete Curbs and Gutters Removing and Replacing Pavement Manholes, Junction Boxes, Catch Basins, Inlets Fire Hydrants Water Mains and Accessories Water Service Connections Fencing and Gates Storm-Sanitary Sewers, French Drains and Pipe Culverts Catch Basins, Grate Inlets and Headwalls SELF EVALUATION CITY OF ATLANTA PARTNERSHIP Please check how you rate your company in the following skills: Overhead Management / FAR Office Operations Pipebursting Method Gravity Sewers and Accessories Sewer Service Connections Internal Sewer Condition Assessment External Point Repair of Sanitary Sewers Railroad Work Trees, Plants and Ground Cover Seeding Atlanta Tree Ordinance Concrete Formwork Concrete Reinforcement and Dowelling Concrete Joints Cast-in-Place Concrete Doweling into Existing Concrete Concrete Repair Crack Injection Concrete Airfield Pavement Asphalt Airfield Pavement Skills Need Improvement Fair Good Marketing /Business Development Banking Relationships Prime/ Subcontractor Relations Cash Flow Management Accounting / Job Costing Joint Ventures Contract Negotiations Human Resources Computer Utilization Estimating Scheduling Please check any of the following areas in which your company needs improvement: Page 5 of 6

6 Scheduling Crews Equipment Maintenance Record-Keeping/Internal Controls Payroll and Taxes Lack of work New Hires / Human Resources Marketing / Branding Materials Developing Job Estimates Lack of Profit Cash Flow Relationship with Primes Job Cost Control Contract Language Management Joint Ventures Overhead Management STATEMENT OF CERTIFICATION: The information provided on this application is true, complete, and correct to the best of my knowledge and is provided in good faith. Name & Title (Print) Signature & Date te: Firms chosen to participate in the SBDP will be required to submit an original signed form. SUBMIT Page 6 of 6

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