Annual Request for Qualifications Online Form

Submission Form for Part 1 - UofA Consultant Data Sheet

  • After clicking on the SUBMIT PART 1 button you will be taken to the Part 2 file upload page. After uploading Part 2 you will have the option to print your Part 1 submission.

General Company Information

Company Name  
Company Address  
Company City  
State  
Zip  
Phone  
Fax
Email  
Partner Names
Contact Persons *Contacts for changes/revisions to the ARQ
 
  (For purposes of this document and as stated in A.R.S. § 41-1001 (19), a small business is defined as a concern, including its affiliates, which is independently owned and operated, which is not dominant in its field and which employs fewer than one hundred full-time employees or which had gross annual receipts of less than four million dollars in its last fiscal year. For purposes of a specific rule, an agency may define small business to include more persons if it finds that such a definition is necessary to adapt the rule to the needs and problems of small businesses and organizations

I. Disciplines
Please check only those that your firm is interested in providing as an independent, in-house service.
 

II. Experience Emphasis
   

III. Arizona Professional Licenses
Please check if your firm has professionals) licensed in Arizona and indicate how many individuals for each:
License Number of individuals
Please indicate other Az prof. licenses for firm

IV. Insurance
Please indicate the current dollar amount and provider for the following
Automobile $
Comprehensive $
Professional $
Workman's Comp $

University of Arizona Electronic Privacy Statement