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Diverse Contractor Program – Interest Form
All proprietary information will be held in the strictest of confidence. We ask the following questions to construct a profile of the potential program participants.
General Information
Name
(Required)
First
Last
Title
(Required)
Race
Ethnicity
Gender
Contact Phone
(Required)
Email
(Required)
About Your Company
Business Name
(Required)
Business Phone
(Required)
Business Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Website
Are you Minority Owned?
(Required)
Yes
No
M/W/DBE Designation
(Required)
Minority Business Enterprise (MBE)
Women-Owned Business Enterprise (WBE)
Disadvantaged Business Enterprise (DBE)
Other (please specify)
Select all that apply
Other Designation
Are you currently M/W/DBE certified?
Yes
No
I am in the process of being certified
If Yes, which certification (s)?
Please enter a number greater than or equal to
0
.
Number of Years in Business
Please enter a number greater than or equal to
0
.
Number of Employees
Please enter a number greater than or equal to
1
.
Construction Type
(Required)
Commercial
Residential
Other (please specify)
Other Construction Type
Construction Services
(Required)
General Contractor
Trade Contractor
Material Supplier
Other (please specify)
General Contractor - Do you self-perform?
(Required)
Yes
No
General Contractor - Self Perform - What Trades?
(Required)
Trade Contractor - Please specify trade(s)
(Required)
Material Supplier - What materials do you supply?
(Required)
Other - Please specify
Material Supplier - Are you a stocking supplier?
(Required)
Yes
No
How do you bid?
Prime Contractor
Subcontractor
Tier 1
Tier 2
Please select all that apply
Union Signatory?
(Required)
Yes
No
Union Signatory - Please specify which unions
(Required)
Union Signatory - do you have a desire to explore Union membership?
(Required)
1 year of Personal and Business Tax Returns Available?
(Required)
Yes
No
1 year of Financial Statements Available?
(Required)
Yes
No
Last Year's gross revenue
(Required)
Current Year's Projected Revenue
(Required)
Have you worked with any of the collaborative partners, anchor institutions, or developers listed on Everybody Builds’ website?
Yes
No
Which collaborative partners, anchor institutions, or developers listed on Everybody Builds’ website have you worked with?
What incubator or training programs has your company participated in?
Please specify all. (e.g, Rebuild, Goldman Sachs 10,000 Small Businesses, TEC Construction Consortium, CM specific programs – Gilbane, Turner, etc.)
Business Goals / Vision
What are the 3 major barriers or needs for sustainable growth for your business?
(Required)
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