1. Provide the following information for your corporate headquarters:

Transcription

1 Eight Tower Bridge. 161 Washington Street. Suite 600. Conshohocken PA Upon completion of this form, please return to A. ORGANIZATIONAL OVERVIEW 1. Provide the following information for your corporate headquarters: Company Name: Address: Phone Number: Fax Number: 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: Primary SIC Code: Primary Contact: Title: Dun & Bradstreet Number: Primary NAICS Code: Name: Phone:

2 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: Please check the classification(s) that best describe your company (check all that apply): **Please provide a copy of all certifications of diversified supplier status by a recognized agency in each jurisdiction in which you conduct business.**

3 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: 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? 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: a. Reference organization s name and purpose, full address, phone number and address. b. Contact person representing the reference organization, name, title, phone number and address. The contact person must be familiar with the company s experience and performance. c. A summary narrative of the applicable services/products provided by your company for the reference organization, objectives and results. d. Total period of performance for the reference organization. e. Total cost of the contracts f. Security service reference organizations should also disclose number of service hours per week. g. REFERENCES WILL BE VERIFIED.

4 13. Does any government official, government agency or other organization own an interest in or exercise any control over your company? 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? If yes, please describe the nature of the agent s relationship with foreign government officials with whom the agent has contact:

5 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? 3. If you answered no to Question 2, can you fulfill this requirement for specific contracts? 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 Additional Requirements not listed above:

6 5. Are your employees represented by any unions? 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: 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 OFFICER(O) or OFFICER AND FAMILY (F) **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

7 2. Sick Pay Do you offer sick pay? If Yes, How many days per year? 3. Vacations Do you offer paid vacation time? If yes, please outline your vacation policy: 4. Holidays a. Please specify which holidays your company recognizes (check all that apply): New Years Eve Presidents Day Memorial Day Labor Day Christmas Eve Other New Years Day Martin Luther King Jr. Day Independence Day Thanksgiving Day Christmas Day b. At what rate are employees paid who work holidays? c. Do you pay employees for non-worked holidays? 5. Uniforms: Complete if your company provides security services a. Which uniform styles do you offer (check all that apply)? Hard Look/Military Business Casual Soft Look/Corporate Other, please specify b. Please attach pictures of your uniform styles with your response.

8 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 Instructor Computer Other, please specify 3. How many hours is your on-the-job (OJT) training? 4. Is your training made specific for individual customers? 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.

9 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 Hardware Maintenance Rapid Response Services Asset Protection Incident Investigation K-9 Services Other: Shuttle Services Remote Monitoring Armed Security Data Protection EMT Services 2. Vehicles a. Do you have a vehicle lease program? b. Are you capable of providing vehicle patrols? 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:

10 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

11 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? 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? 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 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)

12 3. OSHA Citations YEAR NUMBER 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? If Yes, Explain 4. If your 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? If Yes, Explain

13 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? 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? If Yes, Explain 2. Ever been suspended, debarred, proposed for debarment or disqualified from the government contracting process or been disqualified or declared ineligible on any government procurement, permit or license? If Yes, Explain

14 3. Ever been the subject of any investigation whether open or closed, by any government entity for a civil or criminal violation? If Yes, Explain 4. Ever been charged with, indicted, granted immunity, entered a plea of no bargain or convicted of or subject to a judgment or finding of fault or liability for conduct constituting a felony, misdemeanor or other crime or a civil or regulatory violation pursuant to any criminal, civil or administrative proceeding at the federal, state or local level? If Yes, Explain 5. Ever been convicted of or had a civil judgment rendered against any of them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state or local government contract or subcontract; violation of federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating federal criminal laws or receiving stolen property? If Yes, Explain 6. Presently indicted for, or otherwise criminally or civilly charged by a government entity with commission of any criminal offense or any civil offense enumerated in Question 5 above? If Yes, Explain

15 7. Ever been notified within the last three years of any delinquent federal taxes for which the liability remains unsatisfied? If Yes, Explain Has your company: 8. Ever been denied a contract award or had a bid rejected based upon a non-responsibility finding by a government entity? If Yes, Explain 9. Ever had a denial, decertification, revocation or forfeiture of a certification of Minority-Owned Business Enterprise, Women-Owned Business Enterprise, or Disadvantaged Business Enterprise status for other than a change of ownership? If Yes, Explain 10. Ever agreed to a voluntary exclusion from bidding/contracting with a government entity? If Yes, Explain 11. Ever initiated a request to withdraw a bid submitted to a government entity in lieu of responding to an information request or subsequent to a formal request to appear before a government entity? If Yes, Explain

16 12. Ever had a government entity find a willful prevailing wage or supplemental payment violation or any other willful violation of any labor law? If Yes, Explain 13. Other than previously disclosed: a. Ever been subject to fines or penalties imposed by government entities? If Yes, Explain b. Ever been convicted of a criminal offense pursuant to any administrative and/or regulatory action taken by any governmental entity? If Yes, Explain 14. Ever been suspended, cancelled or terminated for cause or default on any contract, including but not limited to, a non-responsibility finding by a government entity? If Yes, Explain 15. Ever been subject to an administrative proceeding or civil action seeking specific performance or restitution in connection with any contract? If Yes, Explain

17 16. Ever received any formal unsatisfactory performance assessments from any government entity on any contract? If Yes, Explain 17. Ever had any liquidated damages assessed (regardless of final settlement) during or after completion of either a public or private contract? If Yes, Explain 18. Ever had any liens or judgments (not including UCC filings) filed against it which remain undischarged? If Yes, Explain 19. Ever initiated or been the subject of any bankruptcy proceedings, whether or not closed, within the last seven years, or any is any bankruptcy proceeding pending? If Yes, Explain 20. Ever failed within the last 10 years to file or pay any tax returns required by federal, state or local tax laws? If Yes, Explain 21. Ever failed within the last 10years to file or pay any state unemployment insurance returns? If Yes, Explain

18 22. During the last seven years have any governmental audit(s) completed? If Yes, Explain If Yes, did any audit identify any reported significant deficiencies in internal control, fraud, illegal acts, material violations of provisions of contract or grant agreements, significant abuse or any material disallowance? 23. Our Company: participated in a previous contract or subcontract subject to the requirements of federal Executive Order Equal Opportunity; and filed all required compliance reports. Our company is exempt, EXPLANATION: 24. Respond to only one statement: a. Company represents that at each establishment, affirmative action programs required by the rules and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2): Are developed and are on file Are not developed and are not on file b. Company has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor. c. Company certifies that it is exempt from filing requirements. EXPLANATION:

19 25. Check as applicable: Company deems itself responsible in accordance with FAR which includes having satisfactory records of integrity, past performance and business ethics, adequate financial resources, technical equipment, facilities, and the organizational experience, skills and controls available or obtainable to perform contracts as awarded. Company s policy or practices prohibits engaging in the trafficking of persons, the use of forced labor, or the procuring of commercial sex acts as further defined in 22 U.S.C CERTIFICATION The undersigned certifies that (s)he: is knowledgeable about the company s business and operations; has read and understands all of the questions and representations contained herein; has not altered the content of this document in any manner; has reviewed and/or supplied full and complete responses to each question and representation; to the best of his/her knowledge, information and belief, confirms that the company s responses are true, accurate and complete, including all attachments, if applicable; understands that AlliedBarton will rely on the information disclosed in this document when entering into any contract with the company; and is under and obligation to update the information provided herein to include any material changes to the company s responses prior to the award and/or approval of any contract or during the term of any contract. Signature of Authorized Representative: Printed Name of Signatory: Title: Organization Name: Date: