Contractor Qualification Bid Form

Name of Firm(Required)

Office Address(Required)

Phone(Required)

Additional Phone Number

Email(Required)

Name of Contact Person(Required)

Years Contractor has been doing business under present name(Required)

General field contractor works in(Required)

Is the Company an EPA Lead Safe Certified Firm?(Required)

Yes

Name, Address, Phone Number of Insurance Company(Required)

Amount of Liability Insurance(Required)

NYS Worker's Compensation?(Required)

Yes

Are you a Minority or Women-Owned Business?(Required)

Yes

If Yes, are you a NYS Certified MWBE?(Required)

Yes

Number of Employees in your Firm(Required)

Name(Required)

Title(Required)

Date(Required)

Please upload insurance documents, references, and MWBE certification (if applicable)

Drop files here or

Max. file size: 256 MB.

I understand that all estimates provided for future job proposals will include all labor and material, permits, permit closeouts and a one year warranty for parts and labor including all costs of subcontractors and insurance. I understand that filling in this form does not guarantee my company contracts. I understand that RUPCO may share this information with other agencies for the purpose of seeking local contractors for their programs. The undersigned hereby affirms that all statements are true and accurate.

Contractor Qualification Bid Form

Main Office

Newburgh Office