Annual Request for Qualifications Online Form

Submission Form for Part 1 - UofA Consultant Data Sheet


General Company Information

Company Name
Company Address
Company City
State
Zip
Phone
Fax
Email
Partner Names
Contact Persons *Contacts for changes/revisions to the ARQ
 
  (For purposes of this document and as stated in A.R.S. § 41-1001 (19), a small business is defined as a concern, including its affiliates, which is independently owned and operated, which is not dominant in its field and which employs fewer than one hundred full-time employees or which had gross annual receipts of less than four million dollars in its last fiscal year. For purposes of a specific rule, an agency may define small business to include more persons if it finds that such a definition is necessary to adapt the rule to the needs and problems of small businesses and organizations

I. Disciplines
Please check only those that your firm is interested in providing as an independent, in-house service.
 

II. Experience Emphasis
   

III. Arizona Professional Licenses
Please check if your firm has professionals) licensed in Arizona and indicate how many individuals for each:
License Number of individuals
Please indicate other Az prof. licenses for firm

IV. Insurance
Please indicate the current dollar amount and provider for the following
Automobile $
Comprehensive $
Professional $
Workman's Comp $

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