California Department of Transportation(Caltrans)Middle-Mile Broadband Network Project

California Department of Transportation(Caltrans)

Middle-Mile Broadband Network Project

Subcontractor Questionnaire

Company Name*

Contact First Name*

Contact Last Name*

Email*

Phone Number*

Phone

Address*

Website/URL*

Where is your company located?*

Los Angeles County

Orange County

Riverside County

San Diego County

Other

Location (not listed above)

Company Type*

Subcontractor

Material Supplier (Broker/Dealer)

Material Supplier (Manufacturer)

Professional Services

Please list NAICS codes and/or services your company performs:*

Please attach a capability statement, if available:

Drag and drop files here or

How many employees does your company have?*

Certifications

Does your company have a current SBE certification with the California Department of General Services?*

Yes

No, but we are eligible

N/A

Does your company have a current DVBE certification with the California Department of General Services?*

Yes

No, but we are eligible

N/A

Please indicate any other certifications held by your company:*

DBE

MBE

WBE

VOSB

LGBTBE

8(a)

Other

N/A

Other Cert 2

Scopes of Interest

Please indicate Phase 2 scopes you are interested in bidding:*

AC Milling

AC Patch

Bridge Attachments

Certified Biologist

Erosion Control

Fiber Installation

Fiber Testing

Horizonal Directional Drilling (HDD)

Street Sweeping

Surveying

Traffic Control

Trucking

Materials: Bridge Connections

Materials: Slurry Backfill

N/A

Experience

Does your company have experience working for/with Kiewit?*

Yes

Does your company have experience working for/with Caltrans?*

Yes

What is the largest project your company has completed?*

Enter as approximate dollar amount.

Bonding

Is your company currently able to bond?*

Yes

N/A

Current bond rate:

Current bond limit:

If no or N/A, please explain:

Technical Assistance & Support

Do you have any concerns or challenges that would limit your organization's ability to participate in the project, if given the opportunity?*

Yes

Please explain:

How did you hear about this opportunity?*

B2G Message

BuildingConnected

Community/Industry Organization

Direct Email

Newspaper Ad/Solicitation

Social Media

Work of Mouth

Caltrans Event or Communication

Other

Other source not listed:

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