Company Name:

Address:

City:

State:

Zip:

Phone:

Address bids are to be mailed to (If different from above)

Type of organization (check one)

Individual        Partnership        Corporation

Incorporated under the Laws of the State of

Name(s) and Title(s) of Person(s) authorized to sign bid documents and contracts in company's name:

Name:

Title:

Telephone Number:

Identify Equipment, Supplies, Materials, and/or services on which you desire to bid.  Identify one (1) primary product and three (3) sub classes denoting 3-digit class code (click here for list).  Include a brief explanation for each code, use additional paper if needed.

Type of ownership (check one)

Other than Minority                          Minority Owned Business

Women Owned Business  

*Note: If MBE or WBE Business you must attach a copy of certification approval letter

Check One:              Initial Application            Revision