Become A Third-Party Provider

GENEDGE ALLIANCE relies on outside private and public consulting resources to deliver services for many of our projects with manufacturers. Although inclusion in the GENEDGE ALLIANCE database of third party providers does not guarantee that you will be awarded contracts, it does assure that your services will be considered by our project managers as needs arise.

Just take a few moments to read Important Facts About Being a GENEDGE ALLIANCE Third Party Provider and then complete this online application. Please note that applications will only be considered through this secure website submission. The application requests information about your areas of expertise, industry focus, general qualifications, and three references that we may contact about consulting work you have conducted in the past.

We look forward to receiving your completed online application and to the possibility of working with you!

Primary Contact:

 

Title:

 

Secondary Contact:

 

Title:

 

Organization:

 

Street Address:

 

Mailing Address:

 

City: State: Zip Code:

 

E-Mail Address: URL Address:

 

Primary Phone: Fax:

 

Secondary Phone: Fax:

 

Is your organization a:

If 'Other' please specify:

 

Please indicate the number of people your organization employs full time.

 

Are you a Certified Small Business? YesNo

Minority Business Enterprise Information

 

Are you eVA registered? YesNo

eVA Information

 

Do you have an active Security Clearance? YesNo

If 'Yes' what level? Expiration date

 

Do you have professional liability insurance or the equivalent? YesNo

Liability amount $

 

If yes, please indicate the source of this insurance and its expiration date.

Source Expiration Date

 

Please indicate the DAILY rate (or a range) that you normally charge clients for contract work.

 

Please indicate the geographic areas of Virginia in which you are willing to work.

 

Optional ~ Please provide a descriptive summary of your expertise and capabilities.

 

Please list any relevant and active memberships, certifications, licenses, awards, and other notable distinctions.

 

Please select the one general category that best describes

the services your organization most often provides to manufacturers.

 

Please rank in order of importance up to four expertise codes that best describe your particular area(s) of expertise.

#1: #2: #3: #4:

 

Please rank in order of importance up to four industry focus codes that best describe the particular industry(ies) with which you have worked.

#1: #2: #3: #4:

 

Please indicate how many years your organization has provided consulting services.

 

Please indicate how many years of industry experience your organization has.

 

Please indicate how many different clients you've served as a consultant in the past 2 years.

 

Please provide at least three references who we may contact concerning projects for which your organization served as a consultant. Please list references with projects that are as similar as possible to those you anticipate conducting through GENEDGE ALLIANCE.


IMPORTANT - Your application will not be
processed unless two or more references are provided.

 


Contact: Title:

 

Organization:

 

Address:

 

City: State: Zip Code:

 

Email:

 

Phone: Fax:

 

Project Start Date: Project End Date:

 

Project Description:

 


Contact: Title:

 

Organization:

 

Address:

 

City: State: Zip Code:

 

Email:

 

Phone: Fax:

 

Project Start Date: Project End Date:

 

Project Description:

 


Contact: Title

 

Organization:

 

Address:

 

City: State* Zip Code

 

Email:

 

Phone: Fax

 

Project Start Date: Project End Date

 

Project Description:

 


How did you first hear about GENEDGE ALLIANCE?

 

*IMPORTANT*

 

I have read and agree to the Important Facts About Being a GENEDGE ALLIANCE Third Party Provider

YesNo

 

To retain a copy of your completed application please

print before clicking on the "Submit Application" button.