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)