Company Name
Address
City
State
Zip
Contact Person
Direct Phone
Cell Phone
Email
Type of Business Enterprise
Minority Small-Business Woman-Owned Disabled Veteran Disadvantaged Section 3 Certified Other None
Structure of Company
Corporation Sole Proprietor LLC Partnership General / Limited Joint Venture
President or Owner
Chief Estimator
Primary Trade (CS1 Code if known - ie: 03300-Concrete, 16000-Electrical)
Select All Types You Will Bid
All Types Retail Educational Commercial Medical Entertainment Public CM/Multi-Prime Hospitality Multi-Family
Date Established
License No.
Number of Employees
Firm Organization
Bank Reference and/or Dun & Bradstreet
Insurance Company & Amount of Coverage - Insurance Company Rating
Liability - Each Occurrence
Liability - General Aggregrate
Liability - Umbrella
Insurance - Vehicle & Equipment
Insurance - Worker’s Compensation
Company
Phone
Fax
Contact
Project
Contractor
Date Completed
Contract Value $
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