Vendor Information Questionnaire – Long Form Page 1 of 4 VENDOR INFORMATION QUESTIONNAIRE – LONG FORM To properly qualify your company and its bid/proposal for the referenced solicitation, please provide the following information: 1. Vendor Name: _________________________________ Address: ______________________________________ City, State, Zip Code: ____________________________ Telephone No.: _____________________ E-mail: ____________________________ 2. Primary Contact Name and Title: _________________________________ E-mail: ____________________________ Telephone No.: _____________________ 3. Principal type of business: _________________________________ 4. Number of years in business: _______________ a. Number of years providing products/services similar to size and scope as those in this solicitation: _______________ b. Number of years providing products/services similar to size and scope as those in this solicitation to government agency clients: _______________ 5. Check One: Corporation Partnership Individual Sole Proprietorship Other: _____________________________________ 6. List any other names your Company has done business as within the last five (5) years: __________________________________________________________________________ 7. Is your Company wholly or majority owned by, or a subsidiary of, another company? If yes, name the parent company: ___________________________________________________ Vendor Information Questionnaire – Long Form Page 2 of 4 8. Provide information for all items below that are applicable, otherwise enter “n/a” if the item is not applicable: DGS Small Business Certification No.: ____________________ DGS DVBE Certification No.: ____________________ CA DIR (Department of Industrial Relations) Registration No. for Public Works Projects:____________________ CA DIR (Department of Industrial Relations) Registration No. for Janitorial Service Providers and Contractors: ____________________ CA Seller’s Permit or Certificate of Registration No.: ____________________ CA Business License No.: ____________________ Federal Tax ID No.: ____________________ Unique Entity ID (SAM.gov): ____________________ 9. Description of Vendor’s primary products/services: _________________________ 10. Description of Vendor’s typical clients: ___________________________________ 11. References: Please provide the following contact information for three (3) business references for whom you have provided similar services as those in this solicitation within the past three (3) years. (Please notify these references that they are being used as references.) a. Reference #1 Name: ____________________ Address: ____________________ Telephone No.: ____________________ E-mail: ____________________ b. Reference #2 Name: ____________________ Address: ____________________ Telephone No.: ____________________ E-mail: ____________________ c. Reference #3 Name: ____________________ Address: ____________________ Telephone No.: ____________________ E-mail: ____________________ Vendor Information Questionnaire – Long Form Page 3 of 4 12. List the annual contract value of the Vendor’s three (3) largest contracts for similar products and services in the past three (3) years. a. Contract #1: __________________ b. Contract #2: __________________ c. Contract #3: __________________ 13. List Vendor’s gross income/receipts for each year of the prior three (3) calendar years. (Court reserves the right to request additional financial information, records, profit and loss statements, etc.): __________________________________________________________ 14. List and describe significant transactional events in the past five (5) years: a. Bankruptcies: _______________________________________________________ b. Liens from Government Agencies: _______________________________________ c. Mergers: ___________________________________________________________ d. Acquisitions: ________________________________________________________ e. Initial Public Offerings (IPOs): ___________________________________________ f. Other: _____________________________________________________________ 15. List and describe any current or pending business disputes or litigation of any type: a. Lawsuits: __________________________________________ b. Bankruptcy Proceedings: ___________________________________________ c. Liens from Government Agencies: ____________________________________ d. Administrative Proceedings: _________________________________________ e. Arbitrations: ______________________________________________________ f. Mediations: ______________________________________________________ g. Other Formal Disputes: _____________________________________________ 16. List and describe any/all licenses, permits, etc., you hold that may be related to supplying products or performing the services in this solicitation within the State of California and within the County where the soliciting Court is located: _________________________________________________________________________ Vendor Information Questionnaire – Long Form Page 4 of 4 17. This final section applies only if you are proposing the use of subcontractors. Provide the following information for each Subcontractor: a. Subcontractor name and address: ________________________________________ b. Federal Tax Identification number: _____________________ c. If incorporated, identify the state of incorporation: ______________________ d. Description of the subcontractor’s business organization: ______________________ e. Principal type of business: ______________________ f. Total number of years in business: _______________ g. Number of years providing services similar in size and scope to those requested in this solicitation: _______________ h. Vendor’s gross income/receipts for each of the prior three (3) calendar years: ____________________________________________________ i. Significant transactional events in the past five (5) years such as: bankruptcies, liens from government agencies, mergers, acquisitions, initial public offerings (IPOs): _____________________________________________________________________