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Subcontractor Application

A. General/Contact Information
Organization Name*
Primary Contact* Title
Address*
City*
State* Zip*
Phone* Fax
Email* WWW Home Page
Distinctions:
(Please provide any relevant
and active memberships,
certifications, languages,
licenses, awards, and
other notable distinctions.)


B. Organization Information*
Is Your Organization a:










Year Established Number of Full Time Employees
Please indicate the type of insurance coverage you have:




A certificate of liability insurance and a completed W-9 form will be required if a contract is signed.
Please indicate the geographic area in which you are willing to work:
Illinois:                 


C. Qualifications*
Capabilities:
(Please provide a
descriptive summary
of company expertise
and capabilities
(up to 100 words))
Principal role: Please check the one category below that best describes the services your organization most often provides to manufacturers:






Area of Expertise: Please rank, in order of their importance, up to four of the expertise codes listed below, which best describe your particular area(s) of expertise:
#1
#2
#3
#4
Industry Focus: Please rank in the order of their importance, up to four of the industry codes listed below, which best describe the particular industry(ies) with which you have worked.
#1
#2
#3
#4
Activity: Please indicate how many different clients you have served as a consultant in the past two years:
Number of Clients


D. Recommendations
Please provide recommendations from at least three clients for which your organization has served as a consultant. It is your responsibility to fill out the "Consulting Recommendation", which is a separate form to this application, to each client with a request to complete and submit.


E. Attachments (doc,docx,pdf,rtf,txt only)
To help us present your credentials to clients most effectively, you are welcome to attach the additional materials amounting to no more than 10 pages:
Attach Brochure or other marketing materials: 
Attach Additional letter(s) of reference: 
Attach Samples of Work: 

Comments:
 
Enter Text Below:


 
IMEC and its regional host organizations are affirmative action, equal opportunity organizations.