Consulting Resource Application A. General Information

Organization Name Address City State Zip Code County Phone Number Fax Number Email address WWW Home Page

B. Contact Information

Primary Contact Title Phone Number Ext Additional Phone Number Fax Number Email Address (if different than above) City State Zip Code

Additional Contact Title Phone Number Ext Additional Phone Number Fax Number Email Address (if different than above) City State Zip Code

C. Organization Information

1. Is your organization a: Private company Economic Development agency Community college Professional or trade organization 4-year college or university Utility company Other education or training organization Other (please specify) Federal lab

2. Year Established 3. Number of Full Time Employees

4. Do you have professional liability insurance or the equivalent? Yes No If yes, please indicate the source of this insurance and its expiration date:

Source: Expires:

5. Please indicate the geographic area in which you are willing to work:

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D. Qualifications

1. Please provide a descriptive summary of your expertise and capabilities (up to 100 words): Include a response to the following questions, either here, in an email cover letter or in an electronic copy of your service description (samples and blanks are included on the NJEMP website): What do you do? How will NJMEP’s clients benefit from your services? How can NJMEP's account managers, who are sales consultants, identify and qualify potential clients? How do you price your services? How can we create a win-win-win situation for the client, you and NJMEP?

2. Distinctions: Please provide any relevant and active memberships, certifications, licenses, awards, and other notable distinctions.

3. Principal role: Please check the one category below that best describes the services your organization most often provides to manufacturers:

Management consulting Engineering services Training services Software development & application

4. Area of expertise: Please rank, in order of their importance, up to four of the expertise codes listed below, which best describe your particular area(s) of expertise:

#1 #2 #3 #4

Area of Expertise 1. Automation / Robotics 9. Human Resources 2. Business Systems / Business Management 10. Market Development 3. CAD/CAM/CAE 11. Material Engineering 4. Control Systems / Integration 12. Plant Layout / Manufacturing Cells 5. EDI / Communications 13. Process Improvements 6. Environmental 14. Product Development and Design 7. Financial 15. Quality / Inspection 8. General

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5. Industry focus: Please rank in the order of their importance, up to four of the industry codes listed below, which best describe the particular industry(ies) with which you have worked.

#1 #2 #3 #4

Industry Focus – Standard Industry Codes

20 Food Products 30 Rubber and Misc. Plastic Products 21 Tobacco Products 31 Leather Products 22 Textile Mill Products 32 Stone, Clay, Glass Products 23 Apparel and Other Textile Products 33 Primary Metal Industries 24 Lumber and Wood Products 34 Fabricated Metal Products 25 Furniture and Fixtures 35 Industrial Machinery and Equipment 26 Paper and Allied Paper 36 Electronic / Electric Equipment 27 Printing and Publishing 37 Transportation Equipment 28 Chemical and Allied Products 38 Instruments and Related Products 29 Petroleum and Coal Products 39 Miscellaneous Manufacturing

What do you see as the top two emerging initiatives in the industries you serve?

6. Activity: Please indicate how many different clients you have served as a consultant in the past two years:

clients

E. References:

Please provide references from at least three clients for which your organization has served as a consultant. It is your responsibility to forward the “Reference Questionnaire”, which is on page 5 in this application, to each reference with a request to complete and submit directly to [email protected] or fax to 973 – 860 – 4637 or mail to:

NJMEP 2 Ridgedale Ave, Suite 305 Cedar Knolls, NJ 07927 Attn: Rob Stramara, COO

F. Non-Competition:

Consultant hereby agrees and covenants that during, and for one (1) full year after expiration or termination of the Agreement, Consultant shall not, in the State of New Jersey, either as principal, partner, agent, employee, director, officer or in any other capacity whatsoever: (1) perform, directly or indirectly, any services similar to those provided by NJMEP and/or its affiliates and/or subsidiaries to or on behalf of any individual, firm, partnership, company, corporation and/or other entity to whom NJMEP introduced the Consultant and/or for whom Consultant performed services in connection with the Agreement or (2) solicit any business similar to the business engaged in by NJMEP from any individual, firm, partnership, company, corporation and/or other entity to whom NJMEP introduced the Consultant and/or for whom Consultant performed services in connection with the Agreement.

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Please print and sign below to indicate (1) that you believe the information you have provided is true and accurate to the best of your knowledge (2) you have read and agree to any terms and conditions NJMEP has provided above.

Printed Name of authorized signer:

Signed by ______Dated _____/____/______

G. Attachments

To help us present your credentials to clients most effectively, please attach the additional materials amounting to no more than 10 pages:

 Brochure or other marketing materials  Additional letter(s) of reference (optional)  Samples of Work (optional)

Thank you for your interest in working with NJMEP

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REFERENCE QUESTIONNAIRE

Consultant name:

Brief description of project(s):

Approximate dates of project: From: To:

Did you get the results you were expecting from the project? Yes No

Was the project completed within the timeframe you expected? Yes No

Would you hire this consultant again if a similar need arose in your company? Yes No

Would you recommend this consultant to your business acquaintances? Yes No

Do you have any additional comments you would like to make about your experience with this consultant?

Company name: Name and title: Phone:

Thank you. Please submit to [email protected] or fax to 973 – 860 – 4637 or mail to:

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Cedar Knolls, NJ 07927 Attn: Rob Stramara, COO

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