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General Information
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*Legal Business Name:
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*Doing Business As:
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Division Name:
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Corporate Web Page URL:
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Federal Tax #:
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Insurance Cert #:
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Contractor License #:
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License Expiration:
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*Address Line 1:
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Address Line 2:
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City:
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State:
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*Zip:
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Country:
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County:
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*Cell Phone:
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*Office Phone:
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*Fax:
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*Email Address:
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*Business Start Date:
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Number of Employees:
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*Contractual Capacity:
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*Type of Organization:
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In Diverse Business Directory?:
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*Has your company previously worked with us?:
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Point of Contact
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*Name (Project Manager):
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*Email:
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*Phone:
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*Fax:
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Title:
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Name (Construction Coordinator):
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Email:
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Phone:
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Fax:
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Owner Information
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*Principal's Name:
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*Email Address:
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*Phone:
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*Fax:
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Title:
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Percent Owner:
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Principal's Name #2:
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Email Address:
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Phone:
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Fax:
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Title:
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Percent Owner:
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*Firm Subsidary to Another Firm?
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If yes, provide name of parent company:
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*Who owns the controlling interest in your firm?
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Business Type
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Certified Business:
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*Ethnicity:
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Firm Type:
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Certifications:
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WBE()
MBE()
VET()
GLBT()
Disabled()
SVD()
Letter of affidavit()
Other()
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Certifying Agency:
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MnUCP()
Program Minnesota()
SUBP()
MNDOT()
NCMSDC()
MEDA()
Quroum()
CERT()
WBDC()
Other()
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Goods & Service
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*NAICS Code:
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NAICS Code:
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NAICS Code:
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NAICS Code:
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Project Reference (MPS projects or other reference-able projects)
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*Project Name:
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*Contract Value:
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*Scope of Work:
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*Contact Name:
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*Contact Number:
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*Contact Email Address:
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Union Affliation
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Is your firm signatory to a Union?:
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Non Union Affiliated Firms
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Willing to enter into a Project Labor Agreement exclusive to MPS projects?
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Additional Business Work Experience
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Comments:
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