SBCA Certification Assessment

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SBCA's Certification Assessment

Rather than wasting your valuable time, SBCA has come up with a way to insure that certification is right for you. The process of becoming certified can be very complicated or even down right impossible. At the current time, over 70% of the applications are returned and 20% are rejected.

SBCA has designed this assessment to enable us to best determine your chances of becoming certified as a Small, Minority, Women-owned, Disadvantaged or Service Disabled Veteran Business Owned-Small Business Concern.

Why we charge a fee for this service! Over the years we receive a number of these forms filled out with bogus information and we waste hours trying to research these non-existent companies.

Our small fee ($25.00) for the analysis is reasonable and we hope will eliminate people without a legitimate business from completing the forms. If within 90 days of completing this assessment you hire SBCA to provide GSA Schedule packaging services we will refund your $25.00.

We ask that you complete the credit card questions for payment before submitting your assessment form. If you wish not to pay by credit card please check on Certification Assessment for downloadable copy of the form and enclose a check for $25.00 with your competed application.

Certification Assessment

Required Fields in Bold
Business Name
Street Address
City
State
Zip
Business Phone
Contact Person
Fax Number
Email
Web Site
Credit Card Number
Expiration Date
Name on Credit Card
Zip Code of Card Holder
Amount	$25.00

Is the business address/phone # the same as residence? yes no If yes, explain why you work from home:

Controlling interest in the business: Male Female

Controlling interest in the business is by (please check all that apply).

Minority Non- Minority Disabled Veteran.

Is the person applying for certification a US citizen? yes no

How long have you been in business?

What form of business have you established:

How much money did you need to start your business?

Where did the money come from:
checking, savings other

if other, please explain

What is the nature of your business?

Does your type of work require any licenses, permits, or degrees?

yes no

if yes, what type?

Partnerships and Corporations please provide the following information for any partners or shareholders of your company

Total number of shareholders:

Partner or Shareholder name

male female

Ethnicity Ownership Percentage

Total number of shares issued # of shares you own

Total cost Ownership date

Partner #2, name

male female

Ethnicity Ownership Percentage

Total Number of shares issued #of shares you own

Total cost Ownership date

Is the business owned in full or part by another company?
yes no

For Corporations name of the company Officers

President's Name

Ethnicity

Date Elected/Appointed

Vice President's Name

Ethnicity

Date Elected/Appointed

Secretary's Name

Ethnicity

Date Elected/Appointed

Treasure's Name

Ethnicity

Date Elected/Appointed

List the names of the current Board of Directors if they are not listed above.

Total # of Board of Directors

Name

Ethnicity

Name

Ethnicity

Who determined what jobs the company will undertake?
Name

Ethnicity

Who negotiates and signs for surety bonds, for insurance and Payroll?
Name

Ethnicity

List any major equipment your company owns.
equipment#1

Owned Leased

equipment#2

Owned Leased

equipment#3
Owned Leased

equipment#4
Owned Leased

List source and amount of Moines loaned to the company.
Source

Amount

Source

Amount

Have you ever been denied certification by any government agency?
yes no

If Yes, explain

Have any other Individuals in your company been denied certification?
yes no

If Yes, explain

What geographical area do you serve?

How did you hear about certification?

Why do you want to get certified?

How did you hear about SBCA?

Are you in a HUB Zone?
yes no

Comments

Shortcuts to:

Certification Assessment

GSA Schedule Assessment

SBCA prepares clients for winning Government Contracts

Small Business Consulting Agency
20539 E. Walnut Drive, Suite E Walnut CA 91789-2947
Voice 909-594-4491 FAX 909-594-4072 Info@1SBCA.com

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