SACRAMENTO ASIAN PACIFIC CHAMBER OF COMMERCE

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SACC Diverse Supplier Intake Form

Business Information

# of Employees (Last Three Years):

Registered System for Award Management (sam.gov)

Yes

No

Revenue (Last Three Years):

Type of Contractor

Prime

Subcontractor

Certification(s) - Check All That Apply:

DBE

8(a)

VOB

HubZone

SDB

SDVOB

Women-Owned Business

MBE Agency

WBE Agency

Non-Certified

Answer the Following Questions if the Business is interested in Obtaining Financial Assistance or Bonding:

Does the business currently hold a surety bond?

Yes

No

If not, has the business or a principal in the business ever held a surety bond in the past?

Yes

No

Has the business or a principal in the business filed for bankruptcy in the past?

Yes

No

Has a principal in the business had a prior felony conviction?

Yes

No

Type of Assistance Required

Type of Assistance - Check All That Apply:

Technical Assistance (accounting, contract review, marketing, bidding and estimating, project management, financing, etc...)

Financial Assistance

Bonding

Please provide a brief narrative of the type of assistance the business is seeking (be specific):

Thanks for submitting! Our team will be in touch in 1-2 business days!

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Address. 2331 Alhambra Blvd, Suite 100, Sacramento CA 95817

Tel. 916.446.7883

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