General

2. Registration #
3. Primary Business Name*
4. Primary Business Address*
5. City*
6. State*
7. Zip*
8. Primary Business Phone*

   (10-digit phone number)

9. Extension
10. Primary Business E-mail*
11. Website URL
12. Is your company a registered vendor in the MyFloridaMarketPlace e-Procurement System?* Yes No
13. Is your company registered with the Florida Division of Corporations?* Yes No
14. Is your company a State of Florida Certified Minority Business Enterprise?* Yes No
15. Is your Company registered with the Florida Department of Business and Professional Regulations (DBPR)?* Yes No
16. FEIN:* FEIN

Company Profile

1. How long has your present company been in your current business (in years)?* < 1 1 - 5 6 - 10 > 10
2. How many employees does your company have?* 1 - 10 11 - 25 26 - 100 101 - 500 > 500
3. What are your approximate annual gross sales?* $1 - 100,000 $100,101 - 500,000 $500,001 - 1,000,000 > $1,000,000 Services Only
4. Value of product inventory:* $1 - 100,000 $100,101 - 500,000 $500,001 - 1,000,000 > $1,000,000 Services Only
5. How many business locations does your company maintain in the State of Florida?* 0 1 2 - 5 5 - 10 > 10
6. List locations here that are able to serve Florida during an emergency (include any non-Florida locations):

Emergency Mobilization Capabilities and Commitments

In emergency situations, are items of equipment for (check all that apply):
1. 1. Short term rental
   2. Leasing
   3. Outright Purchase
2. Comments, if any:
3. Will your company offer discounts to Governmental Agencies after an Emergency Declaration is issued?* Yes No
4. If yes, discount from retail prices (MSRP) to be offered:
5. Briefly describe your company's escalation procedures for problem resolution during emergency operations:*
6. Briefly describe your company's plans for continuity of operations (employee and supply chain support) during emergency operations:*
7. Any additional comments you may wish to offer regarding the support your company can provide to the Florida Emergency Network, such as staff availability, equipment availability, relevant expertise and/or the value of your product inventory level: