MPP Questionnaire - PA Mentor Protege Program
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MPP Questionnaire

Protégé Questionnaire

Please Click Here to complete the Mentor Questionnaire.

Step 1 of 9 – General Firm/Company Structure

11%

Contact Person

Name(Required)






Address(Required)













What is the legal structure of your firm/company(Required)










Date Established(Required)







Are you a contractor or a consultant?(Required)





Number of employees

Identify and indicate the ownership percentage of all shareholders

Are you the sole owner of your company?(Required)






Name(Required)





Sum of ownership % totals should equal 100%

Name(Required)





Sum of ownership % totals should equal 100%

Name(Required)





Sum of ownership % totals should equal 100%

Name(Required)





Sum of ownership % totals should equal 100%

Name(Required)





Sum of ownership % totals should equal 100%

Name(Required)





Sum of ownership % totals should equal 100%

Name(Required)





Sum of ownership % totals should equal 100%

Name(Required)





Sum of ownership % totals should equal 100%

Name(Required)





Sum of ownership % totals should equal 100%

Name(Required)





Sum of ownership % totals should equal 100%

Insurance information

Is your firm's Business Partner Registered (BPR) On PennDOT ECMS System ?





Select your firm's current PennDOT ECMS status below.







Is your company a small, minority, or disadvantaged business enterprise certified through the PA UCP approval process?(Required)





If yes, please select all demographic categories that apply:(Required)















Bonding information


Certifications and References

DBE certification information

Date Certified(Required)







Most Recent Approval (if applicable)(Required)







Annual gross receipts for the past five (5) years

Has your firm/company participated in any additional PennDOT offerings (ex. programs, courses, training, networking events, etc.)
(Required)





Business references

Business association to which your firm belongs


Needs/Capacity Assessment

Please identify the categories in which you need assistance:
(Required)





































List (geographic) areas in which your firm/company has presence/does work

List all major owned/leased equipment

Are you willing to enter into a written agreement/developmental plan/confidentiality agreement as part of this program?
(Required)





Work Experience

Describe your contracting experience

Please enter a number from 0 to 100.Sum of work experience % totals should equal 100%”Please enter a number from 0 to 100.Sum of work experience % totals should equal 100%”

List significant projects that began (in progress) or completed in the last 5 years

ProjectTypeCustomer Name & ContactContract AmountDate CompletedCompleted on TimeAny Resulting Claims 

List all PennDOT projects completed in the past five (5) years:


ProjectTypeCustomer Name & ContactContract AmountDate CompletedCompleted on TimeAny Resulting Claims 

List all PennDOT projects began (in progress) in the last five (5) years:


ProjectTypeCustomer Name & ContactContract AmountDate CompletedCompleted on TimeAny Resulting Claims 

Additional recent work experience to be considered (this may include work that key individuals currently in your firm/company completed while at another firm/company):

ProjectTypeCustomer Name & ContactContract AmountDate CompletedCompleted on TimeAny Resulting Claims 

Has your firm/company ever bid on PennDOT projects?(Required)





Has your firm/company ever participated in PennDOT projects?(Required)





Has your firm been involved in a Mentor/Protégé relationship in the past?(Required)





What is your annual revenue?(Required)











How long have you been in business? If you have been in business for less than a year but have over 2 years of experience in professional consulting and engineering or previously running a business, please explain.(Required)

Years of Experience








Do you have an established track record as professional services consultant or contractor?(Required)





Are you an independent business entity from the Mentor?(Required)





Are you currently debarred or suspended from doing work by any governmental entity in any state?(Required)





Are you involved in any litigation as a result of professional liability with the Commonwealth of Pennsylvania?(Required)







Do you currently have a firm you would like to match with as a Mentor?(Required)





Are you registered with ProRank Academy, the online platform where virtual supportive services are delivered?(Required)





Do you currently utilize assistance from the DB or DBE Supportive Services Programs?(Required)





Have you taken an Annual Needs Assessment with the DB or DBE Supportive Services Center?(Required)





Are you able to commit to the reporting and participation requirements of this program for the term of a contract?(Required)





Please identify the work classifications in which your firm/company has experience:

Earthwork, specifically the following:















Base Course, specifically the following:







Pavement, specifically the following:























Incidental Construction, specifically the following:























Roadside, specifically the following:













Traffic & Accommodations, specifically the following:























Structures (Bridges):

























Do you provide similar services to those procured by PennDOT on transportation projects (i.e., Structural Design, Traffic Engineering, environmental consulting, etc.)? Please select all that apply











































What types of services do you want to add to your experience through participation in the Mentor/Protégé program? Please select all that apply











































Protégé Contractual Requirements Questions

Please acknowledge your willingness to comply with program requirements as noted below.

Work with the ProRank DBE Support Services to complete a Needs Assessment and Technical Assistance Plan.(Required)



Enter into one Mentor relationship per contract.(Required)



Protégés must specify the lead individual responsible for implementing the relationship.(Required)



Establish a Memorandum of Understanding with Mentor.(Required)



Conduct necessary due diligence in assessing a potential Mentor prior to entering into an agreement.(Required)



Provide a monthly progress report summarizing the number of hours worked for knowledge/transfer times and services provided.(Required)



The Protégé, together with the Mentor, will develop a Protégé Learning Plan that will be accomplished over the term of the relationship and will include metrics, regular meetings and milestones.(Required)



Honor the nondisclosure of any privileged or proprietary information.(Required)



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