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


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