under Question 7. Activity % of 11.a. Revenues % % % 13. Please include a list of the Applicant’s five (5) largest jobs or projects during the past three (3) years. (Do not complete for Insurance Agents and Brokers) Project / Client Name Service Performed for Revenue from those Date Service Former Employer Pct. of gross Client Services Began of Applicant revenue (Yes or No) Staff Information 14. Please provide the following: (Please include all principal and key employee resumes) Name of all Principals, Professional Years with Applicant Years in Practice Continuing Position with Partners, Owners and Qualifications Firm Education Firm Key Employees (Yes or No) 15. Provide information on the Applicant’s Staff: Full Time Part Time a. Total Number: b. Number hired within the past 12 months c. Number terminated, retired or resigned within the past 12 months: 16. Does any current member of the Applicant provide any professional services to any client in which any Applicant member or SPOUSE serves as a director, officer or partner or own any equity or financial interest, or is the Applicant owned by, Associated with or controlled by any entity? (If please provide full details) Yes No “yes”, 17. In the past five (5) has any professional liability claim or suit ever been made against the Applicant or any of its predecessor firms, if any? If how many ? Yes No “Yes”,
under Question 7. Activity % of 11.a. Revenues % % % 13. Please include a list of the Applicant’s five (5) largest jobs or projects during the past three (3) years. (Do not complete for Insurance Agents and Brokers) Project / Client Name Service Performed for Client Revenue from those Services Date Service Began Former Employer of Applicant (Yes or No) Pct. of gross revenue Staff Information 14. Please provide the following: (Please include all principal and key employee resumes) Name of all Principals, Partners, Owners and Key Employees Professional Qualifications Years with Applicant Firm Years in Practice Continuing Education (Yes or No) Position with Firm 15. Provide information on the Applicant’s Staff: Full Time Part Time a. Total Number: b. Number hired within the past 12 months c. Number terminated, retired or resigned within the past 12 months: 16. Does any current member of the Applicant provide any professional services to any client in which any Applicant member or SPOUSE serves as a director, officer or partner or own any equity or financial interest, or is the Applicant owned by, Associated with or controlled by any entity? (If “yes”, please provide full details) Yes No 17. In the past five (5) has any professional liability claim or suit ever been made against the Applicant or any of its predecessor firms, if any? If “Yes”, how many ? Yes No
Consultants-EO.docx