Nassau and Suffolk Counties Business Survey

Mason Tillman Associates, Ltd. requests your assistance by completing a Business Survey. Mason Tillman has been retained by Nassau and Suffolk counties to conduct a Disparity Study to determine whether minority and women-owned business enterprises (MWBEs), and service-disabled veteran- owned business enterprises (SDVOBs) have had equal access to public contracting opportunities. Your participation in this short survey will provide valuable information that will be utilized for the Study. For additional information about the Study, contact Mason Tillman by telephone at (516) 350-5405 or by email at NassauSuffolkDisparityStudy@mtaltd.com.

Thank you in advance for your participation.

Company Name

First Name

Last Name

Phone

Address Line 1

Address Line 2

City

State

Postal Code

1. Indicate the ethnicity of the majority business owner:

Asian AmericanAfrican AmericanCaucasian AmericanHispanic AmericanNative AmericanOther, please specify

2. Indicate the gender of the majority business owner:

MaleFemaleNot Applicable

3. Indicate the highest level of education completed by the majority business owner:

Less than high school degreeHigh school degree or equivalent, e.g. GEDTrade/Technical certificate or degreeAssociate degreeBachelor’s degreeGraduate degreeProfessional degree

4. List any professional licenses obtained by the majority business owner:

5. Which of the following certifications does your business hold? Check all that apply.

Airport Concession Disadvantaged Business Enterprise (ACDBE)Disadvantaged Business Enterprise (DBE)Janitorial Maintenance SBE (JMSBE)Minority-Owned Business Enterprise (MBE)Minority and Women-Owned Business Enterprise (MWBE)Service-Disabled Veteran-Owned Business Enterprise (SDVOB)Small Business Enterprise (SBE)Women-Owned Business Enterprise (WBE)Not Applicable

6. If your business is certified, please specify the certifying agencies:

7. Indicate the industry that best describes your business:

Architectural/Engineering ServicesConstructionGoods and CommoditiesLegal ServicesNon-Personal ServicesOther Personal ServicesTechnical/Trade ServicesTrucking

8. What type of goods and/or services does your business provide?

9. What year was your business established?

10. How many individuals does your business currently employ, including all full-time and part-time employees?

0-5 employees6-10 employees11-20 employees21-30 employees31-50 employeesOver 50 employees

What is the bonding limit?

Less than $50,000$50,00 to $100,000$100,001 to $300,000$300,001 to $500,000$500,001 to $1,000,000$1,000,001 to $3,000,000$3,000,001 to $5,000,000$5,000,001 to $10,000,000More than $10,000,000

12. Do you have an interest in being a prime contractor or subcontractor on a County contract?

Yes, as a prime contractorYes, as a subcontractorYes, as both a prime contractor and a subcontractorNot Applicable

13. How many bids, quotes, or proposals did your business SUBMIT to the County from January 1, 2015 to December 31, 2019?

As a prime contractor:

As a subcontractor:

14. How many County contracts was your company AWARDED from January 1, 2015 to December 31, 2019?

As a prime contractor

As a subcontractor

15. Would you like to participate in an interview to share your experiences contracting or attempting to contract with the County?

YesNo

16. Has your business ever implemented any capacity building techniques? Check all that apply.

Joint ventureSubcontractHiring temporary or seasonal employeesHiring full-time permanent employeesNot ApplicableOther, please describe

17. What range best represents your business's gross revenue/sales for 2019?

Less than $50,000$50,000 to $100,000$100,001 to $300,000$300,001 to $500,000$500,001 to $1,000,000$1,000,001 to $3,000,000$3,000,001 to $5,000,000$5,000,001 to $10,000,000More than $10,000,000

18. For the 2019 annual gross revenue reported above, how many individual contracts were performed?

0 Contacts

1 to 5 Contracts

6 to 10 Contracts11 to 20 ContactsMore than 20 ContractsNot Applicable

19. Approximately what percentage of your business’s total gross revenue for 2019 was derived from each of the following sources?
Round to the nearest whole number. Numbers must add up to 100%.

Public Contracts (%)

Private Contracts (%)

Other (%)

20. List the value of the three largest contracts that your business completed from January 1, 2015 to December 31, 2019:
Round to the nearest dollar.

21. Are you a member of any business or trade organizations?

YesNoNot Applicable

22. If yes, list the organizations that you are a member of:

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