Thank you for your interest in the MPP Program. We’re dedicated to helping your business succeed.

Port of Portland Mentor Protégé Program, in partnership with the Oregon Department of Transportation (ODOT) and AGC, is a three year business development program offering to pair your firm with seasoned executives as mentors and provide classes to solidify your business acumen.

If you have any questions, please do not hesitate to contact me at Irene.Appel@portofportland.com

Page 1
Page 2
Page 3
Page 4
Page 5

Url

MENTOR-PROTÉGÉ PROGRAM APPLICATION

You must meet the minimum qualifications listed below to be considered for the Port Mentor-Protégé Program.

1. COBID certified
2. In continuous operation for at least 3 years
3. Current on all taxes
4. Current on all licenses (if applicable)
5. I am not ineligible or debarred from public works by BOLI
6. I am not under litigation
7. I am willing to attend one class a month and one meeting a month

If you meet all the qualifications above, you may proceed filling out this 5-page application form. We suggest you have all your information ready before filling it out. Once you begin the form, it must be completed entirely before submitting. To advance to the next page of this application, please scroll to the top of the page and click the appropriate page number. Any attempt to navigate away from the site without completing the form and submitting will result in loss of content and require another attempt. Once you hit the submit button at the end of page 5, you'll receive a confirmation email from the Port of Portland.

BUSINESS INFORMATION

Name of Business Entity

Assumed Business Name

Federal Tax ID

Business Address

Mailing Address (If different)

COBID Certification

DBE MBE WBE ESB SDV

COBID Certification #

Professional Organizations

OAME NAMC PBDG Other

OMWBE Certification #

8a Certification #

CCB or LCB # (Construction or Landscape Contractors Board License)

Owner Completing Application Name

Race

Black Asian Asian Pacific Asian Indian Caucasian Latino Native American Other

Office Number

Email Address

Title

Gender

Cell Number

Website

Scroll to Top to advance to the next page of this application.

BUSINESS ENTITY

Business Tax Filing Designation

Is your business an LLC, LLP or LP?

LLC LLP LP None of the Above

If yes, how many members are part of the LLC

Name

% Ownership

Title

*Race

Black Asian Asian Pacific Asian Indian Caucasian Latino Native American Other

Gender

Name

% Ownership

Title

*Race

Black Asian Asian Pacific Asian Indian Caucasian Latino Native American Other

Gender

Name

% Ownership

Title

*Race

Black Asian Asian Pacific Asian Indian Caucasian Latino Native American Other

Gender

Business Registration date with the Oregon or Washington Secretary of State: Registration #

Provide a narrative of services your company provides

INSURANCE BONDING

Name of Insurance Company

Name of Surety (Bonding Co)

Bonding Per Project

Aggregate (All Projects) $

Have you had any claims against a bond or license in the last 5 years?

Have you had any claims against a bond or license in the last 5 years?

Yes

Have you had any claims against a bond or license in the last 5 years?

If yes, please provide details:

CURRENT BUSINESS OPERATIONS

Number of Field Employees

Total Number of Employees including Owner(s)

Number of Field Employees

Total Number of Employees including Owner(s)

Number of Office/Support Staff

Number of Sales employees

Number of Office/Support Staff

Number of Sales employees

Ideal Project Size

Ideal Number of Projects Per Year

Ideal Project Size

Ideal Number of Projects Per Year

% of Work Subcontracted

* African American, Caucasian, Native American, Asian, Asian Pacific, Asian Indian, Latino and others

Scroll to Top to advance to the next page of this application.

FINANCIAL

Please provide annual revenue for each of the last three fiscal years to this business entity.

Fiscal Year 1 *

Annual Gross Revenue $ *

Retained Earnings *

Fiscal Year 2 *

Annual Gross Revenue $ *

Retained Earnings *

Fiscal Year 3 *

Annual Gross Revenue $ *

Retained Earnings *

What is your Dunn and Bradstreet number?

What is your Dunn and Bradstreet number?

Is your credit score between 600-650 or 650 -700?

Is your credit score between 600-650 or 650 -700?

600-650 650-700

Are your financials cash basis or accrual?

Are your financials cash basis or accrual?

Cash Accrual

Do you have a CPA and a Bookkeeper?

Do you have a CPA and a Bookkeeper?

CPA Bookkeeper

COMPLIANCE

REQUIRED DOCUMENTS REQUESTED FROM APPLICANT

Q1: List the last year in which the business filed taxes:

List the last year in which the business filed taxes:

*Q 1: Upload proof of recent Tax Return filed

Q2: Is the business past due on any payroll taxes?

Is the business past due on any payroll taxes?

Yes No

*Q2: If yes, upload notices from IRS or Dept of Revenue

Q3: Has your business ever been late in paying payroll taxes?

Has your business ever been late in paying payroll taxes?

Yes No

*Q3: If yes, upload documentation of the reason

Q4: Does your company have any judgements, levies or liens from the IRS, Unions, Oregon Dept of Revenue or other parties?

Does your company have any judgements, levies or liens from the IRS, Unions, Oregon Dept of Revenue or other parties?

Yes No

*Q4: If yes, upload copies of judgements, liens and/or levies

Q5: The firm is not ineligible or debarred from public works by the Bureau of Labor and Industries.

The firm is not ineligible or debarred from public works by the Bureau of Labor and Industries.

Yes No

FILE UPLOADS

Please click on the black button below to upload the required documents requested from applicant. We accept one or more pdf, jpg, doc or txt files.

Q6: The firm is not currently under litigation or has been served court papers indicating such may occur.

The firm is not currently under litigation or has been served court papers indicating such may occur.

Yes No

Please list all Business Development Programs you’ve participated in past and present?

SUPPORT SERVICES

If accepted into the MPP Program, which areas could you use technical assistance and training:

Support Services

Business Operations & Workflow Project Management Project Scheduling Estimating Scope Development Blueprint Reading Accounting/Payroll Bonding & Insurance Access to Capital Human Resources Business Development Managing Growth Jobsite Safety Software Implementation Marketing Proposal Writing Brand Development Computer Training

APPLICANT BUSINESS GOALS

List 3 Marketing Goals you would like to accomplish:

Goal 1

Goal 2

Goal 3

List 3 Business Operations Goals you would like to accomplish:

Goal 1

Goal 2

Goal 3

List 3 Business Financial Goals you would like to accomplish:

Goal 1

Goal 2

Goal 3

At the end of the 3 year program, where do you want your bonding capacity to be?

Bonding Capacity

Scroll to Top to advance to the next page of this application.

PROJECT HISTORY

List major projects in the last 3 years performed by your business:

Customer

Customer 1

Customer 2

Customer 3

Customer 4

Customer 5

Customer 6

Customer 7

Customer 8

Customer 9

Customer 10

Customer 11

Customer 12

Customer 13

Phone

Phone 1

Phone 2

Phone 3

Phone 4

Phone 5

Phone 6

Phone 7

Phone 8

Phone 9

Phone 10

Phone 11

Phone 12

Phone 13

Contact Person

Contact Person 1

Contact Person 2

Contact Person 3

Contact Person 4

Contact Person 5

Contact Person 6

Contact Person 7

Contact Person 8

Contact Person 9

Contact Person 10

Contact Person 11

Contact Person 12

Contact Person 13

Project Type

Project Type 1

Project Type 2

Project Type 3

Project Type 4

Project Type 5

Project Type 6

Project Type 7

Project Type 8

Project Type 9

Project Type 10

Project Type 11

Project Type 12

Project Type 13

Amount

Amount 1

Amount 2

Amount 3

Amount 4

Amount 5

Amount 6

Amount 7

Amount 8

Amount 9

Amount 10

Amount 11

Amount 12

Amount 13

Year

Year 1

Year 2

Year 3

Year 4

Year 5

Year 6

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Year 13

*Type

P, Sub or JV 1

P, Sub or JV 2

P, Sub or JV 3

P, Sub or JV 4

P, Sub or JV 5

P, Sub or JV 6

P, Sub or JV 7

P, Sub or JV 8

P, Sub or JV 9

P, Sub or JV 10

P, Sub or JV 11

P, Sub or JV 12

P, Sub or JV 13

* Indicate if your business was (P) Prime Contractor; (JV) Joint Venture; (SUB) Subcontractor

Scroll to Top to advance to the next page of this application.

PARTICIPATION

State why you want to participate in the Mentor-Protégé Program:

I am willing to:

• attend a minimum of 4 hours for classes and mentoring per month?

I am willing to attend a minimum of 4 hours for classes and mentoring per month?

Yes

I am willing to attend a minimum of 4 hours for classes and mentoring per month?

• complete assignment given to me by my mentors and consultants by the given deadline.

I am willing to complete assignment given to me by my mentors and consultants by the given deadline.

Yes

I am willing to complete assignment given to me by my mentors and consultants by the given deadline.

• be open and honest with my mentors and consultants in all things concerning my business.

I am willing to be open and honest with my mentors and consultants in all things concerning my business.

Yes

I am willing to be open and honest with my mentors and consultants in all things concerning my business.

• allow my Mentors and the Port full access to company financials?

I am willing to allow my Mentors and the Port full access to company financials?

Yes

I am willing to allow my Mentors and the Port full access to company financials?

Do you have a mentor you would like to work with?

Do you have a mentor you would like to work with?

Yes

Do you have a mentor you would like to work with?

If yes, please supply their name and email.

PORT OF PORTLAND PHOTO RELEASE

(Please checkmark box below to confirm)

I give my consent to the Port Mentor-Protégé Program to use my name, business, quotes, images for any marketing purpose related to the program. *

I agree

I disagree

PROGRAM AGREEMENT AND STATEMENT OF TRUTH

The individual whose name is typed or signed on this page guarantees the truth and accuracy of all answers, statements, and any additional information submitted to process this application.
This statement page should show the name of the applicant, if sole proprietor. If a partnership, the application should show the name of an authorized partner. If a corporation, the application should show the name an authorized officer. If a limited liability, the application should show the name of an authorized member.
By signing this application, I certify that the foregoing statements and information provided in all sections of this application are correct and true as of the date of this application, and that I am an authorized representative.
I agree, as part of the program that I will grant access to my accounting system for support services and financial and other reports for my Mentor meetings.

Name of Individual Authorized to Sign on Behalf of the Company

Company Name

Title

Date

MENTOR-PROTÉGÉ PROGRAM APPLICATION

Page 1
Page 2
Page 3
Page 4
Page 5

Company

MENTOR-PROTÉGÉ PROGRAM APPLICATION

You must meet the minimum qualifications listed below to be considered for the Port Mentor-Protégé Program.

BUSINESS INFORMATION

Name of Business Entity

Assumed Business Name

Federal Tax ID

Business Address

Mailing Address (If different)

COBID Certification

DBE MBE WBE ESB SDV

COBID Certification #

Professional Organizations

OAME NAMC PBDG Other

OMWBE Certification #

8a Certification #

CCB or LCB # (Construction or Landscape Contractors Board License)

Owner Completing Application Name

Race

Black Asian Asian Pacific Asian Indian Caucasian Latino Native American Other

Office Number

Email Address

Title

Gender

Cell Number

Website

Scroll to Top to advance to the next page of this application.

BUSINESS ENTITY

Business Tax Filing Designation

Is your business an LLC, LLP or LP?

LLC LLP LP None of the Above

If yes, how many members are part of the LLC

Name

% Ownership

Title

Race*

Gender

Name

% Ownership

Title

Race*

Gender

Name

% Ownership

Title

Race

Gender

Business Registration date with the Oregon or Washington Secretary of State: Registration #

Provide a narrative of services your company provides

INSURANCE BONDING

Name of Insurance Company

Name of Surety (Bonding Co)

Bonding Per Project

Aggregate (All Projects) $

Have you had any claims against a bond or license in the last 5 years?

Have you had any claims against a bond or license in the last 5 years?

Yes No

If yes, please provide details:

CURRENT BUSINESS OPERATIONS

Number of Field Employees

Total Number of Employees including Owner(s)

Number of Office/Support Staff

Number of Sales employees

Ideal Project Size

Ideal Number of Projects Per Year

% of Work Subcontracted

Scroll to Top to advance to the next page of this application.

FINANCIAL

Please provide annual revenue for each of the last three fiscal years to this business entity.

Fiscal Year 1

Annual Gross Revenue $

Retained Earnings

Fiscal Year 2

Annual Gross Revenue $

Retained Earnings

Fiscal Year 3

Annual Gross Revenue $

Retained Earnings

What is your Dunn and Bradstreet number?

What is your Dunn and Bradstreet number?

Is your credit score between 600-650 or 650 -700?

Is your credit score between 600-650 or 650 -700?

600-650 650-700

Are your financials cash basis or accrual?

Are your financials cash basis or accrual?

Cash Accrual

Do you have a CPA and a Bookkeeper?

Do you have a CPA and a Bookkeeper?

CPA Bookkeeper

COMPLIANCE & *REQUIRED DOCUMENTS REQUESTED FROM APPLICANT

List the last year in which the business filed taxes:

List the last year in which the business filed taxes:

*Send proof of recent Tax Return filed

Is the business past due on any payroll taxes?

Is the business past due on any payroll taxes?

Yes No

*If yes, notices from IRS or Dept of Revenue

Has your business ever been late in paying payroll taxes?

Has your business ever been late in paying payroll taxes?

Yes No

*If yes, provide documentation of the reason

Does your company have any judgements, levies or liens from the IRS, Unions, Oregon Dept of Revenue or other parties?

Does your company have any judgements, levies or liens from the IRS, Unions, Oregon Dept of Revenue or other parties?

Yes No

*If yes, copy of judgements, liens and/or levies

The firm is not ineligible or debarred from public works by the Bureau of Labor and Industries.

The firm is not ineligible or debarred from public works by the Bureau of Labor and Industries.

Yes No

The firm is not currently under litigation or has been served court papers indicating such may occur.

The firm is not currently under litigation or has been served court papers indicating such may occur.

Yes No

FILE UPLOADS

Upload required documents here. We accept one or more pdf, jpg, doc or txt files.

Please list all Business Development Programs you’ve participated in past and present?

SUPPORT SERVICES

If accepted into the MPP Program, which areas could you use technical assistance and training:

Support Services

APPLICANT BUSINESS GOALS

List 3 Marketing Goals you would like to accomplish:

Goal 1

Goal 2

Goal 3

List 3 Business Operations Goals you would like to accomplish:

Goal 1

Goal 2

Goal 3

List 3 Business Financial Goals you would like to accomplish:

Goal 1

Goal 2

Goal 3

At the end of the 3 year program, where do you want your bonding capacity to be?

Bonding Capacity

Scroll to Top to advance to the next page of this application.

PROJECT HISTORY

List major projects in the last 3 years performed by your business:

* Indicate if your business was (P) Prime Contractor; (JV) Joint Venture; (SUB) Subcontractor

Scroll to Top to advance to the next page of this application.

Customer

Customer 1

Customer 2

Customer 3

Customer 4

Customer 5

Customer 6

Customer 7

Customer 8

Customer 9

Customer 10

Customer 11

Customer 12

Customer 13

Phone

Phone 1

Phone 2

Phone 3

Phone 4

Phone 5

Phone 6

Phone 7

Phone 8

Phone 9

Phone 10

Phone 11

Phone 12

Phone 13

Contact Person

Contact Person 1

Contact Person 2

Contact Person 3

Contact Person 4

Contact Person 5

Contact Person 6

Contact Person 7

Contact Person 8

Contact Person 9

Contact Person 10

Contact Person 11

Contact Person 12

Contact Person 13

Project Type

Project Type 1

Project Type 2

Project Type 3

Project Type 4

Project Type 5

Project Type 6

Project Type 7

Project Type 8

Project Type 9

Project Type 10

Project Type 11

Project Type 12

Project Type 13

Amount

Amount 1

Amount 2

Amount 3

Amount 4

Amount 5

Amount 6

Amount 7

Amount 8

Amount 9

Amount 10

Amount 11

Amount 12

Amount 13

Year

Year 1

Year 2

Year 3

Year 4

Year 5

Year 6

Year 7

Year 8

Year 9

Year 10

Year 11

Year 12

Year 13

*Type

P, Sub or JV 1

P, Sub or JV 2

P, Sub or JV 3

P, Sub or JV 4

P, Sub or JV 5

P, Sub or JV 6

P, Sub or JV 7

P, Sub or JV 8

P, Sub or JV 9

P, Sub or JV 10

P, Sub or JV 11

P, Sub or JV 12

P, Sub or JV 13

PARTICIPATION

State why you want to participate in the Mentor-Protégé Program:

I am willing to:

• attend a minimum of 4 hours for classes and mentoring per month?

I am willing to attend a minimum of 4 hours for classes and mentoring per month?

Yes No

• complete assignment given to me by my mentors and consultants by the given deadline.

I am willing to complete assignment given to me by my mentors and consultants by the given deadline.

Yes No

• be open and honest with my mentors and consultants in all things concerning my business.

I am willing to be open and honest with my mentors and consultants in all things concerning my business.

Yes No

• allow my Mentors and the Port full access to company financials?

I am willing to allow my Mentors and the Port full access to company financials?

Yes No

Do you have a mentor you would like to work with?

Do you have a mentor you would like to work with?

Yes No

If yes, please supply their name and email.

PORT OF PORTLAND PHOTO RELEASE

(Please checkmark box below to confirm)

I give my consent to the Port of Portland and its legal representatives, the permission to take photographs of me and use them for any Port marketing purpose. I understand that I will not be paid for these photographs and have no rights to them. I am participating as a volunteer. I hereby waive any right to inspect or approve the finished photograph or advertising copy or printed matter that may be used in conjunction therewith or to the eventual use that it might be applied. *

I agree

I disagree

PROGRAM AGREEMENT AND STATEMENT OF TRUTH

The individual whose name is typed or signed on this page guarantees the truth and accuracy of all answers, statements, and any additional information submitted to process this application.
This statement page should show the name of the applicant, if sole proprietor. If a partnership, the application should show the name of an authorized partner. If a corporation, the application should show the name an authorized officer. If a limited liability, the application should show the name of an authorized member.
By signing this application, I certify that the foregoing statements and information provided in all sections of this application are correct and true as of the date of this application, and that I am an authorized representative.
I agree, as part of the program that I will grant access to my accounting system for support services and financial and other reports for my Mentor meetings.

Name of Individual Authorized to Sign on Behalf of the Company

Company Name

Title

Date

MENTOR-PROTÉGÉ PROGRAM APPLICATION

BUSINESS INFORMATION

MENTOR-PROTÉGÉ PROGRAM APPLICATION

MENTOR-PROTÉGÉ PROGRAM APPLICATION

BUSINESS INFORMATION

Privacy Policy