(2) Check the appropriate box that indicates whether
at present, or at any time in the past:
(a) your firm has been a subsidiary of any other firm;
(b) your firm consisted of a partnership in which one
or more of the partners are other firms;
(c) your firm has owned any percentage of any other
firm; and
(d) your firm has had any subsidiaries of its own.
(3) Check the appropriate box that indicates whether any other
firm has ever had an ownership interest in your firm.
(4) If you answered "Yes" to any of the questions in (2)(a)-(d)
of (3), identify the name, address and type of business for each.
Section 3: OWNERSHIP
Identify all individuals or holding companies with any
ownership interest in your firm, providing the information
requested below (if your firm has more than one owner,
provide completed copies of this section for each additional
owner):
A. Background Information
(1) Give the name of the owner.
(2) State his/her title or position within your firm.
(3) Give his/her home phone number.
(4) State his/her home (street) address
(5) Check the appropriate box that indicates this owner's
gender.
(6) Check the appropriate box that indicates this owner's
Tribal affiliation. If you checked "Other Native American,"
specify this owner's Tribe name.
B. Ownership Interest
(1) State the number of years during which this owner has
been an owner of your firm.
(2) Indicate the dollar value of this owner's initial
investment to acquire an ownership interest in your firm,
broken down by cash, real estate, equipment, and/or other
investment.
(3) State the percentage of total ownership control of your
firm that this owner possesses.
(4) State the familial relationship of this owner to each other
owner of your firm.
(5) Indicate the number, percentage of the total, class, date
acquired, and method by which this owner acquired his/her
shares of stock in your firm.
(6) Check the appropriate box that indicates whether this
owner performs a management or supervisory function for
any other business. If you checked "Yes," state the name of
the other business and this owner's title or function held in
that business.
(7) Check the appropriate box that indicates whether this
owner owns or works for any other firm(s) that has any
relationship with your firm. If you checked "Yes," identify
the name of the other business and this owner's title or
function held in that business. Briefly describe the nature of
the business relationship in the space provided.
C. Immediate Family Member Businesses
Check the appropriate box that indicates whether any of
your immediate family members own or manage another
company. An "immediate family member" is any person
who is your father, mother, husband, wife, son, daughter,
brother, sister, grandmother, grandfather, grandson,
granddaughter, mother-in-law, or father-in-law. If you
answered "Yes," provide the name of each relative, your
relationship to them, the name of the company they own or
manage, the type of business, and whether they own or
manage the company.
Section 4: CONTROL
A. Identify your firm's Officers and Board of Directors:
(1) In the space provided, state the name, title, date of
appointment, ethnicity, and gender of each officer of your firm.
(2) In the space provided, state the name, title, date of
appointment, ethnicity, and gender of each individual serving
on your firm's Board of Directors.
(3) Check the appropriate box that indicates whether any of
your firm's officers and/or directors listed above performs a
management or supervisory function for any other business.
If you answered "Yes," identify each person by name, his/her
title, the name of the other business in which s/he is involved,
and his/her function performed in that other business.
(4) Check the appropriate box that indicates whether any of
your firm's officers and/or directors listed above own or work
for any other firm(s) that has a relationship with your firm.
If you answered "Yes," identify the name of the firm the
officer or director, and the nature of his/her business relation-
ship with that other firm.
B. Identify your firm's management personnel (by name,
title, ethnicity, and gender) who control your firm in the
following areas:
(1) Making of financial decisions on your firm's behalf,
including the acquisition of lines of credit, surety bonds,
supplies, etc;
(2) Estimating and bidding, including calculation of cost
estimates, bid preparation and submission;
(3) Negotiating and contract execution, including
participation in any of your firm's negotiations and
executing contracts on your firm's behalf;
(4) Hiring and/or firing of management personnel,
including interviewing and conducting performance
evaluations;
(5) Field/Production operations supervision, including site
supervision, scheduling, project management services, etc;
(6) Office management;
(7) Marketing and sales;
(8) Purchasing of major equipment;
(9) Signing company checks (for any purpose); and
(10) Conducting any other financial transactions on your
firm's behalf not otherwise listed.
(11) Check the appropriate box that indicates whether any
of the persons listed in (1) through (10) above perform a
management or supervisory function for any other
business. If you answered "Yes," identify each person by
name, his/her title, the name of the other business in which
s/he is involved, and his/her function performed in that
other business.
Instructions Page 2 of 3
