Company Name
Street Address
City
State
Zip
Contact Name
Contact Phone
Contact Email
Contact Fax
Tax Identification NumberThis field is required if you have been awarded a contract by SCTA or have submitted an invoice for payment. Individuals should provide their social security number.
Product/Services OfferedArchitecture and Engineering Services Building Repairs - Electrical Building Repairs - HVAC Building Repairs - Plumbing Concrete repair Document Printing and Reproduction Facilities - Fluid Pump Repair/Service Graphic Design Information Technology Products or Services Janitorial Services Landscaping Legal Services Marketing Painting Planning/Scheduling Consulting Services Public Relations Sign Production and Installation Site Pressure Washing Snow Plowing Supplier - Fasteners Supplier - Filters Supplier - Janitorial Supplies Supplier - Light Bulbs Supplier - Lubricants Website Design/Management Towing Other (please list)
Other - Products/Services OfferedPlease complete if "Other" was selected under Product/Services Offered
Number of Employees
Age of Firm(years)
Annual Gross ReceiptsLess than $500,000 $500,000 to $1,000,000 $1,000,001 to $2,000,000 $2,000,001 to $5,000,000 More than $5,000,000
NAICS Code/Classification
VA Certified Veteran-Owned Small BusinessYes no
Service Disabled Veteran-Owned Small BusinessYes No
Registered DBEYes No
If Yes to Registered DBEBlack Americans, which includes persons having origins in any of the Black racial groups of Africa Hispanic American, which includes persons of Mexican, Portuguese, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race Native Americans, which includes persons who are American Indians, Eskimos, Aleuts, or Native Hawaiians Asian-Pacific Americans, which includes persons whose origins are from Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia, the Philippines, Samoa, Guam, the U.S. Trust Territories of the Pacific, and the Northern Marianas Asian-Indian Americans, which includes persons, whose origins are from India, Pakistan, and Bangladesh Women, regardless of race, ethnicity, or origin Other, individuals found to be disadvantaged by the Small Business Administration Pursuant to Section 8(a) of the Small Business Act
DBE Certification Number
StateAlabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho IllinoisIndiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri MontanaNebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon PennsylvaniaRhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
