Thank You in Advance for Your Assistance with This Effort

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 . 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 .

Thank you in advance for your assistance with this effort.

Sincerely,

Jillnell Joiner

Small Business Liaison Officer

M.C. Dean, Inc Vendor and Subcontractor Survey

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 / Partnership / Corporation
Other (describe)
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 Veteran-Owned / Small Disadvantaged
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 ______
ExteriorBuilding 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 ().