Contracting/Subcontracting/Vendor Due Diligence Questionnaire

Contracting/Subcontracting/Vendor Due Diligence Questionnaire

Welcome ~

Due diligence is a review of the business and financial affairs of a company in connections with a contract, subcontract, joint venture, teaming agreement, securities offering, financing, merger, acquisition, vendor (over $25,000 purchased) or other corporate transaction.

A prospective third party interested in working with Alutiiq is required to complete this form and submit the additionally noted reference materials. The contents of the submittal are considered confidential and used solely for the purposes of approving the third party as a qualified company for which we are authorized to engage in business with.

Please ensure that all information provided is complete and accurate. If a question is not applicable to your company, indicate with “N/A” rather than leaving the response blank. Failure to provide the information necessary for our review process may result in processing delay or rejection of the application.

The completed form and all attachments must be scanned and emailed to Alutiiq Risk Management at:. If you have questions about this form, your application or its processing, please email Eileen Terwilliger, VP of Risk Management, at .

1. GENERAL INFORMATION

Joint Venture Sub/Contractor Vendor Acquisition Other
Company Name:
Mailing Address:
City: / State: / Zip:
Contact Name/Title:
Contact Phone: / Email:
Alutiiq Contact Name:
Is applicant owned by a common parent? Yes  No
Parent Name:
Dunn & Bradstreet #: / Taxpayer ID#:
Subcontractors: Subcontract with Alutiiq = $1,000,000 or greater? Yes  No
Vendors: Goods and Materials sold to Alutiiq = $25,000 or greater?  Yes  No

1. BUSINESS PROFILE

Please indicate in which of the following your business is qualified (check all that apply.)
 Small /  Alaska Native Corporation /  Minority
 Large /  Tribal /  Subcontinent Asian Amer.
 Small Veteran /  Small Woman /  Hispanic
 Small Disadvantaged /  Black American /  DoT Certified DBE
 8(a) Certified /  Native American /  Native Hawaiian
 Asian-PacificAmer. /  Indian Tribe (Federal) /  Small Hub Zone
Can certifications be provided for the above marked classifications?  Yes  No

1. CAPABILITIES

Briefly describe your company’s capabilities and services:
Company website address:
List states in which you are presently able toconduct business:
Have you conducted business in a foreign country?  Yes  No
Please identify countries in which you have prior experience:

1. PAST PERFORMANCE

Attach a list of the major projects completed in the last three years, list work involving federal or governmental entity where you have performed as a prime or subcontractor. Please include:

• Project Name/Type
• Location
• Owner/Client

/

• Contract Value
• Project Initiation/Completion Date
• Reference Name/Phone/Email

Do you have the ability to complete certified payrolls?  Yes  No
What is your average job size? / $

Past Performance, continued

What is the largest job you’ve ever completed? / $
Within the prior three years, has your firm:

• Ever received a Show of Cause, negative CPAR or Cure Notice? Yes  No

• Ever received a Notice of Default? Yes  No

• Ever been in bankruptcy, voluntary or involuntary reorganization? Yes  No

• Ever been disbarred from pursuing public work? Yes  No

• Ever been fined by any regulatory agency for non-compliance? Yes  No

• Have any outstanding/unresolved financial/audit issues with DCAA? Yes  No

NOTE: For any items answered “Yes”, please provide a separate sheet with explanations.

1. FINANCIAL INFORMATION

Name of Bank:
Banking Contact Name: / Phone:
Value of outstanding loans: / Mid  HighLowNone / 5 6  7  8 figures
Lending amount available: / Mid  HighLowNone / 5 6  7  8 figures
Annual revenue for 2011? / $ / 2010? / $ / 2009? / $
Surety/Bonding Information (Construction subcontractor applicants only)
Bonding Contact Name: / Phone:
Name of Surety Company:
Single Limit? / $ / Total Program Limit? / $
Are you able to provide bid bonds? Yes  No
Please provide a copy of the following:

• Audited financials, balance sheet, income statement, or
• Letter of Bondability from Surety Broker (construction only)

NOTE: If financial information is not provided, your application may be delayed.
Exceptions to the financial disclosures requirement may be obtained from the divisional VP.

1. INSURANCE AND SAFETY

InsuranceBroker:
Name of Firm:
Broker Contact Name: / Phone:
Please provide copies of the following:

• Certificate of Insurance showingGeneral Liability, Auto Liability, Workers Comp.
• Design firm coverage must include Professional Liability.
• Abatement company coverage must include Pollution Liability/Asbestos Coverage.
• Broker letter showing Experience Rate Modification (EMR) for the prior three years

NOTE: If insurance information is not provided, your application will not be processed. Exceptions to this requirement may be obtained from the VP of Risk Management.
Do you have a full-time safety professional on staff? Yes  No
Safety Contact Name: / Phone:
Please provide copies of OSHA logs for the prior three years.
Have you had OSHA violations in the prior three years? Yes  No
NOTE: If safety information is not provided, your application will not be processed. Exceptions to this requirement may be obtained from the VP of Risk Management.

1. SECURITY AND CERTIFICATIONS

1. Does your company have security clearance? Yes  No

1. If yes, identify agency:

Federal Agency: / Clearance Level: / Date of Approval:

1. Certification Levels:

1. STATEMENT OF COMPLIANCE / AUTHORIZATION TO RELEASE INFORMATION

By submitting this application form, I certify that the responses contained herein are true and complete to the best of my knowledge and belief. Knowingly providing false or misleading statements will be grounds for disqualification of the application. I authorize Alutiiq to contact references noted or information provided herein for the purposes of verifying the qualifications of my company.I hereby release Alutiiq, LLC and its parent, subsidiaries, affiliates and each of its and their respective former and current owners, shareholders, members, officers, directors, representatives, agents, employees and successors and assigns from liability or damage that may result from furnishing the information requested.

Signature of Corporate Officer:
Printed Name:
Title:
Date:

Is your application complete?BEFORE you email it for review by Alutiiq, please take the time to verify that the following is included with your submission:

REQUIRED ENCLOSURES:

 / PAST PERFORMANCE: List of the major projects completed in the last three years.
 / PAST PERFORMANCE (G): Explanations for any items you have responded “yes” to.
 / FINANCIAL: Balance Sheet/Financials (Constructions subs provide letter of bondability)
 / INSURANCE: Certificate of Insurance, Experience Modification Rate for prior three years.
 / SAFETY:OSHA logs for prior three years.
 / VENDORS: Please include completed W-9 forms.
X / Alutiiq may gather additional information from external sources, including: Excluded Parties List System (EPLS), OSHA Inspections and Citations Database and Dunn & Bradstreet Risk & Financial Reports.

If you have questions about this applications or its processing, please email Eileen Terwilliger, VP of Risk Management, at .

Ver 1.2: Pre-Qualification Questionnaire - Page 1 of 6Initialed by Corporate Officer: ______