DBEAssist.ai

February 13, 2023 Rickie Keys 25 Views

DBEAssist Interface

Step 1 of 6

File

Max. file size: 256 MB.

Personal Information

Name:

First Last

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone:

Email:

Business Information:

Legal name and doing business as (DBA) name:

Company address:

Street Address Address Line 2 City State ZIP Code

Company phone number:

Type of business organization (singular choice):

Sole Proprietorship

Partnership

Limited Partnership (LP)

Limited Liability Partnership (LLP)

Corporation (C-Corp)

S Corporation (S-Corp)

Limited Liability Company (LLC)

Cooperative (Co-op)

Benefit Corporation

Upload Incorporation Document:

Max. file size: 256 MB.

Federal Tax ID Number (EIN):

Date of establishment:

Names of all owners, officers, and directors:

Certification Information:

Reason for seeking certification:

Description of the goods and services offered:

List of relevant experience and past performance:

Current bonding capacity:

Bond types:

Bond limits:

Proof of insurance coverage and bonding capacity:

Max. file size: 256 MB.

Insurance types:

Insurance limits:

Insurance carrier information:

Insurance carrier name:

First Last

Insurance carrier address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone:

Policy expiration date:

Claims history:

Proof of insurance:

Max. file size: 256 MB.

Deductibles:

Additional insureds:

Ownership and Control Information:

Name

First Last

Ownership stake (%)

Name

First Last

Ownership stake (%)

Name

First Last

Ownership stake (%)

Name

First Last

Ownership stake (%)

Name

First Last

Ownership stake (%)

Details on how the business is controlled, including the roles of each owner and management structure:

Information on any partners, joint ventures, or parent companies:

Economic Disadvantage Information:

Proof of the personal net worth of all owners (Upload tax forms):

Max. file size: 256 MB.

Details on the annual gross receipts and net income of the business (Upload business tax forms):

Max. file size: 256 MB.

Information on the sources of the business's financial support (Upload loan forms):

Max. file size: 256 MB.

Have you had historic any past business failures or bankruptcy:

Yes

Please provide details of past business failures or bankruptcies:

Economic Disadvantage Information:

Copies of articles of incorporation, partnership agreements, or other legal documents (Upload documents):

Max. file size: 256 MB.

Resumes of all owners, officers, and key employees (Upload documents):

Max. file size: 256 MB.

List of current contracts and subcontracts:

Other relevant supporting documentation (Upload documents):

Max. file size: 256 MB.

DBEAssist Interface

Personal Information

Business Information:

Certification Information:

Ownership and Control Information:

Economic Disadvantage Information:

Economic Disadvantage Information:

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