1. Provide the Following Information for Your Corporate Headquarters

1.  Organizational Overview

1.  Provide the following information for your corporate headquarters:

Company Name:

Address:

Phone Number: Fax Number:

Email:

EIN: Business Type:

Supplier Type: Geographical Service Area:

Form of Entity (e.g., corporation, LLC, partnership etc.):

State of Incorporation/Formation:

Date of Incorporation/Formation:

State(s) Where Qualified to do Business as a foreign entity:

Company Website: Dun & Bradstreet Number:

Primary SIC Code: Primary NAICS Code:

Primary Contact: Name:

Title: Phone:

Email:

2.  Provide a brief background and history of your company:

3.  How many years has your company been in business?

4.  Identify prior names of your company, and organizations with which your company was previously affiliated for the same or similar goods or services under consideration:

5.  Provide a summary of your corporate structure, including a description of all parent companies, operating units, subsidiaries and affiliated companies:

6.  Number of employees: 2012 2011 2010

7.  Please check the classification(s) that best describe your company (check all that apply):

Select OneBlack American-Owned BusinessHispanic American-Owned BusinessNative American-Owned BusinessPacific American-Owned BusinessAsian Pacific American-Owned BusinessAsian Indian American-Owned BusinessOther Minority-Owned BusinessWomen-Owned BusinessHistorically Underutilized Business (HUB zone)Small/Disadvantaged Business (include type of SDB)Other Minority per Section 8(a)Small Business Act (15 USC 637 (a))

**Please provide a copy of all certifications of diversified supplier status by a recognized agency in each jurisdiction in which you conduct business.**

8.  Outline your office, manufacturing and other locations with the number of personnel in each location (attach an additional sheet to your response if more room is required):

Location / Type (office, manufacturing, etc.) / # of Personnel

9.  Please check the states and/or commonwealths in which your company is licensed to provide security services or other services or conduct any other type of business:

Select OneALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMN Select OneMSMOMTNENVNHNJNMNYNCNDOHOKORPAPRRISCSDTNTXUTVTVA Select OneWAWIWY

Please provide a copy of each business license and/or security service or other service license in any state or jurisdiction that has been checked.

10.  Are you licensed anywhere outside of the United States? Select OneYesNo If so, please list below:

11.  Please attach a current organizational chart.

12.  Please provide (on reference request form provided) and attach the name, address and a contact individual for three current and two former client/customer references within the past five years. References shall be summarized in no more than one page and shall include the following:

1. Reference organization’s name and purpose, full address, phone number and email address.
2. Contact person representing the reference organization, name, title, phone number and email address. The contact person must be familiar with the company’s experience and performance.
3. A summary narrative of the applicable services/products provided by your company for the reference organization, objectives and results.
4. Total period of performance for the reference organization.
5. Total cost of the contracts
6. Security service reference organizations should also disclose number of service hours per week.

g.  REFERENCES WILL BE VERIFIED.

13.  Does any government official, government agency or other organization own an interest in or exercise any control over your company? Select OneYesNo If so, describe the nature and extent of any such interest or control:

14.  Provide a list of all companies or other entities represented by your company:

15.  Provide a list of all principals in your company, including directors, officers, owners of equity interests, partners, active representatives, other persons having primary management, operational or supervisory responsibilities, etc

16.  Does your company or are any of the principals referred to in Question 15 employed by, or hold any interest in, other businesses? If yes, please identify such business:

17.  Does your company have any interest in, or do any of your company’s principals referred to in Question 15 above hold (or are agents for) any official position with, are employed by, or have any official duties for a foreign government? Select OneYesNo If yes, please describe the nature of the agent’s relationship with foreign government officials with whom the agent has contact:

B.  Selection and Screening

1.  Describe how you effectively recruit employees. How do you approach recruiting to ensure that qualified candidates are always available?

2.  If your company provides security services, do you require previous security, law enforcement or military experience for new hires? Select OneYesNo

3.  If you answered no to Question 2, can you fulfill this requirement for specific contracts? Select OneYesNo

4.  Please respond if the following are part of your minimum requirements or components of your employee screening process:

REQUIREMENT YES/NO # OF YEARS CHECKED

21 Years of Age

High School Diploma/GED

U.S. Citizen

I-9 Status Verification

Employment Application

Pre-Employment Drug Screen

Random Drug Screen

Criminal Record Check

Fingerprinting

Civil Check (bankruptcy, credit, etc)

Reference Check

Past Employment Verification

Physical Examination

Language Proficiency Tests

Psychological Aptitude Test

Driver’s License Verification

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Additional Requirements not listed above:

5.  Are your employees represented by any unions? Select OneYesNo If yes, please explain. Include: names of each union, local and the job classifications each union represents, the number of employees represented and geographical areas.

C.  Benefits

1.  Please respond to the following questions regarding your benefits offerings:

OFFICER(O) or OFFICER

QUESTION

a.  Do you offer medical insurance?

b.  Do you offer dental insurance?

c.  Do you offer short-term disability?

d.  Do you offer long-term disability?

e.  Do you offer a vision plan?

f.  Do you offer life insurance?

g.  Is there a waiting period before employees are eligible to join the plan?

h.  Do you offer educational benefits such as tuition reimbursement?

i.  Do you offer employee referral bonuses?

j.  Do you offer employee recognition programs?

YES/NO

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

Select OneYesNo

AND FAMILY (F)

Select OneOF

Select OneOF

Select OneOF

Select OneOF

Select OneOF

Select OneOF

Select OneOF

Select OneOF

Select OneOF

Select OneOF

**If you answered yes to any part of 1a-1f above, please provide the following:**

BENEFIT

a.  Medical Insurance

b.  Dental Insurance

c.  Short-Term Disability

d.  Long-Term Disability

e.  Vision

f.  Life Insurance

Monthly Cost to Employee

Total Monthly

Cost

Insurance Carrier

2.  Sick Pay

Do you offer sick pay? Select OneYesNo If Yes, How many days per year?

3.  Vacations

Do you offer paid vacation time? Select OneYesNo If yes, please outline your vacation policy:

4.  Holidays

1. Please specify which holidays your company recognizes (check all that apply):

New Years’ Eve New Years’ Day

Presidents’ Day Martin Luther King Jr. Day

Memorial Day Independence Day

Labor Day Thanksgiving Day

Christmas Eve Christmas Day

Other

1. At what rate are employees paid who work holidays?
2. Do you pay employees for non-worked holidays? Select OneYesNo

5.  Uniforms: Complete if your company provides security services

1. Which uniform styles do you offer (check all that apply)?

Hard Look/Military Soft Look/Corporate

Business Casual Other, please specify

1. Please attach pictures of your uniform styles with your response.

D.  Training

1.  How many hours is your pre-employment employee training?

2.  How is your pre-employment training conducted (check all that apply)?

Video Computer

Instructor Other, please specify

3.  How many hours is your on-the-job (OJT) training?

4.  Is your training made specific for individual customers? Select OneYesNo If yes, please detail how that is accomplished:

5.  What refresher training do you perform and with what frequency?

6.  Please detail any other training programs you wish to discuss.

E.  Service Delivery

Security service providers should answer Questions 1-3:

1.  What security related services does your company provide (check all that apply)? Please describe services such as security hardware maintenance and servicing, remote monitoring and control, rapid response services, armed security, asset protection, data protection, incident investigation, etc.

Unarmed security services Shuttle Services

Hardware Maintenance Remote Monitoring

Rapid Response Services Armed Security

Asset Protection Data Protection

Incident Investigation EMT Services

K-9 Services

Other:

2.  Vehicles

a.  Do you have a vehicle lease program? Select OneYesNo

b.  Are you capable of providing vehicle patrols? Select OneYesNo

3.  Please describe your practice with regard to meeting needs of clients for additional officers for special events or emergencies.

Other service providers should answer Question 4:

4.  Please describe in detail the services your company provides:

F.  Supplier Products

1.  What products does your company sell?

2.  Do you supply products for resale not for resale both

3.  If your company’s products are purchased by your company as commercial end products for resale, state the place(s) of manufacture:

4.  If your company’s products are assembled and/or manufactured by your company state the country/countries of origin all components:

G.  Insurance

1.  Please identify your typical insurance coverage amounts for the following categories:

Insurance Type

Auto

Workers Compensation

General Liability

Umbrella/Excess Liability

Crime Insurance/Fidelity Bond

Employers Liability

Property Insurance

Business Interruption

Product Liability

Public Liability

Professional Liability

Directors and Officers Insurance

Key Man Life Insurance

Transit Insurance

Income Protection Insurance

Credit Insurance for unpaid debts

Industrial Special Risk Insurance

Umbrella Insurance

Other

Coverage Amount

Insurance Carrier

2.  Please attach a sample certificate of insurance or other documentation outlining your company’s insurance coverage.

3.  In the last five years has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your company? Select OneYesNo If Yes, Explain

4.  In the last five years has there ever been a period when your company had employees but was without workers compensation insurance or state-approved self-insurance? Select OneYesNo If Yes, Explain

H.  Safety Information

1.  List your company’s Experience Modification Rate for each of the past three premium years. NOTE: An EMR is issued to your company annually by your workers compensation insurance carrier. The following rating scale applies:

Less than or = 0.95 / Well Qualified
0.95 to 1.00 / Generally Qualified
= or Greater than 1.00 / Not Qualified

Year 2012: Year 2011: Year 2010:

2.  Rate Category

DESCRIPTION / 2012 / 2011 / 2010 / 3 Yr. Avg.

OSHA Total # of Deaths

OSHA Recordable/Injury Rate

OSHA Lost Workdays Incident Rate

OSHA Lost Time Incident Rate

Total Man-Hours/Year

(Field Personnel)

3.  OSHA Citations

YEAR / NUMBER

2012

2011

2010

2009

If any citations are noted above, provide explanations on a separate sheet of paper, inclusive of nature of violation, status, inclusive of corrective action taken, type of violation, i.e. willful, serious, general, etc. and amount of fine or penalty

I.  Financial Information

1.  State your company’s average gross revenues for the last three years:

2.  Attach your company’s financial statement for the last two fiscal years, inclusive of balance sheets, income statements, statement of cash flow and auditor’s report if available, inclusive of notes to financials.

3.  At any time during the past five years, has any surety company completed a contract on your company’s behalf or paid for completion on your company’s behalf as a result of a default, to satisfy any claims made against a performance or payment bond issued on your company’s behalf, in connection with a security services contract, either public or private? Select OneYesNo

If Yes, Explain

4.  If you company does business with a surety insurer, attach a statement from your surety which states your current bonding capacity.

5.  During the past five years, has your company ever been denied bond coverage by a surety company, or has there ever been a period of time when your firm had no surety bond in place during a contracted period when one was required? Select OneYesNo If Yes, Explain

J.  Litigation

1.  In the past five years has any claim against your company concerning your company’s work on a contract been filed in court or arbitration with a customer? Select OneYesNo If Yes, Explain

2.  State all other lawsuits, litigation and regulatory actions in which your company and/or any officer, director, owner, partner or other person having primary management or supervisory responsibilities been involved in the last five years.

Provide a brief explanation of the reasons for the actions, their status, how they were resolved

and if there were any penalties, fines or other actions taken. Attached additional pages if

necessary:

K.  Subcontractor/Supplier Responsibility

Has your organization and/or any officer, director, owner, partner or other person having primary management, operational or supervisory responsibilities:

1.  Ever been sanctioned relative to any business or professional permit and/or license or had a revocation, suspension or disbarment of any professional permit and/or license? Select OneYesNo If Yes, Explain