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Capability & Interest Questionnaire

Company name*

Web URL*

First Name*

Last name*

Title*

Email*

Phone*

Headquarters Location

Country/Region*

Address*

City*

Zip / Postal code*

# of Employees*

Approx. Revenue Generated*

PSC Codes*

NAICS Codes*

Have you supported federal, state, or local government contracts? *

Yes

No

Are you registered in SAM.gov?*

Yes

No

Certifications*

None

8(a)

HUBZone

WOSB

SDVOSB

Other

Teaming Interest & Capacity*

Prime Contractor

Subcontractor

Joint Venture

Mentor/Protégé

Please describe 1) your core capabilities/services 2) industries or sectors you serve 3) examples of past performance*

Is there anything else we should know?*

Certified HUBZone and Minority Woman-Owned Business Enterprise

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