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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
No
Name, Address, Phone Number of Insurance Company
(Required)
Amount of Liability Insurance
(Required)
NYS Worker's Compensation?
(Required)
Yes
No
Are you a Minority or Women-Owned Business?
(Required)
Yes
No
If Yes, are you a NYS Certified MWBE?
(Required)
Yes
No
Number of Employees in your Firm
(Required)
Name
(Required)
Title
(Required)
Date
(Required)
MM slash DD slash YYYY
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