Please enter the following information The questions marked with an asterisk are required fields. If you have questions on any of the other fields, leave the field blank and your CIRAS APEX specialist will assist you after submitting the form. Business Name (DBA)* PhoneEmail* Contact Name* Prefix Mr.Mrs.MissMs.Dr.Prof.Rev. First Last Title Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code County*AdairAdamsAllamakeeAppanooseAudubonBentonBlack HawkBooneBremerBuchananBuena VistaButlerCalhounCarrollCassCedarCerro GordoCherokeeChickasawClarkeClayClaytonClintonCrawfordDallasDavisDecaturDelawareDes MoinesDickinsonDubuqueEmmetFayetteFloydFranklinFremontGreeneGrundyGuthrieHamiltonHancockHardinHarrisonHenryHowardHumboldtIdaIowaJacksonJasperJeffersonJohnsonJonesKeokukKossuthLeeLinnLouisaLucasLyonMadisonMahaskaMarionMarshallMillsMitchellMononaMonroeMontgomeryMuscatineO'BrienOsceolaPagePalo AltoPlymouthPocahontasPolkPottawattamiePoweshiekRinggoldSacScottShelbySiouxStoryTamaTaylorUnionVan BurenWapelloWarrenWashingtonWayneWebsterWinnebagoWinneshiekWoodburyWorthWrightDUNS Number Unique Entity Identifier (UEI) CAGE Code Website Primary Product/Service NAICS Code Number of Employees Have you been awarded a contract or subcontract with a government agency in the past?*YesNoIf yes, was your contract award within the past 24 months?*YesNoI request counseling assistance from Iowa State University CIRAS-APEX Accelerator. I understand and agree to participate in and return requested quarterly surveys within 7 days of request as they are designed to evaluate the APEX Accelerator services. As a client, I realize that I will occasionally receive notices, announcements, and marketing materials designed to inform and assist me. I further understand the following: Active Clients Can Expect: Responsibilities of an Active Client Include: CIRAS APEX will provide: One-on-One counseling on selling your products/services to the government (city, county, state, and federal) Customized government contracting action plan Customized procurement data reports and market research Customized bid match emails to identify bid opportunities Guidance on government registrations & certifications Reviews of bid/proposals Educational workshops and training events Networking and matchmaking events Interpretation of Federal Acquisition Regulations (FAR) and Iowa code Confidentiality on all matters discussed CIRAS APEX Will Not: Provide guidance on selling to non-profits or commercial sectors Market your products/services on your behalf Recommend pricing for your proposals Write your proposals Assist with finding or obtaining grants Contact agencies on your behalf What we expect: Engagement To remain an Active client, you must receive 30 minutes of one-on-one counseling or attend one APEX event in a 12 month period. Communication Notification of major company changes (i.e. move locations, new POCs) Updates in company capabilities and certifications Completion of Quarterly Survey Provide feedback on services provided Report any Federal, State or Local Contract or Subcontract Awards Information I understand that if the expectations of this Service Commitment are not met, CIRAS APEX reserves the right to change my status from Active to Inactive. By submitting this form, I certify the above information is correct. By my signature below, and in consideration of CIRAS-APEX Accelerator furnishing of procurement, management, or technical assistance, I waive all claims against Iowa State University, CIRAS-APEX Accelerator personnel and its host organization(s). I understand that there are no warranties or assurance in connection with the counseling assistance. This agreement must be executed by an authorized official of the Client company or organization. Printed Name* How did you hear about CIRAS?* CIRAS News/Print Publication CIRAS Marketing Email CIRAS Website CIRAS Staff Referral Twitter LinkedIn Colleague Referral Other If you selected other above, please specify: CAPTCHANameThis field is for validation purposes and should be left unchanged.