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Company Name*

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Number of Employees*

Annual Revenue*

Percentage of Annual Revenue from Energy Customers*

Directional Boring Services

Is this an area of interest?

Yes

No

What is your annual revenue in this area?

What is your number of equipment items owned for this area?

How many employees do you have dedicated to this area?

Describe your capabilities to perform the work in this area, if applicable.

Hydro Excavation Services

Is this an area of interest?

Yes

No

What is your annual revenue in this area?

What is your number of equipment items owned for this area?

How many employees do you have dedicated to this area?

Describe your capabilities to perform the work in this area, if applicable.

Underground Cabling Installation Services

Is this an area of interest?

Yes

No

What is your annual revenue in this area?

What is your number of equipment items owned for this area?

How many employees do you have dedicated to this area?

Describe your capabilities to perform the work in this area, if applicable.

Underground Duct Bank Installation Services

Is this an area of interest?

Yes

No

What is your annual revenue in this area?

What is your number of equipment items owned for this area?

How many employees do you have dedicated to this area?

Describe your capabilities to perform the work in this area, if applicable.

Overhead Line Electrical Installation Services

Is this an area of interest?

Yes

No

What is your annual revenue in this area?

What is your number of equipment items owned for this area?

How many employees do you have dedicated to this area?

Describe your capabilities to perform the work in this area, if applicable.

Quality Information

Describe your Quality Management Program

List any Quality Certifications

Safety Information

List your North American Industry Classification System (NAICS) Code (6 Digit Number on OSHA 300 Log)

Summarize your Safety Management Program

Lost Workdays Away (LWA) Rate

LWAs - 2015

LWAs - 2016

LWAs - 2017

LWA - Comments

Days Away/Restricted or Job Transfer (DART) Rate

DART Rate - 2015

DART Rate - 2016

DART Rate - 2017

DART Rate - Comments

Supplier Diversity Information

Diverse Business Enterprise Certification - Minority, Woman, Veteran, LGBT

Annual Diverse Revenue Total and % of Overall Revenue

Client References

Reference 1 - Client Name

Year and Description of Work

Client Contact Information (name, email, phone)

Reference 2 - Client Name

Year and Description of Work

Client Contact Information (name, email, phone)

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