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CONTRACTOR APPLICATION |
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PROFESSIONAL DESIGN SERVICES, CONSTRUCTION AND MAINTENANCE PROJECTS |
Instructions:
Please complete this form and mail to the address shown below to be included on our list of bidders for professional
design services, construction and maintenance projects. The Notice to
Contractors will be mailed to you as they are issued for the areas of interest
indicated on the page 3 of the form. Bid packages will be forwarded upon
request and payment of deposits as required in the Notice to Contractors.
This is not a prequalification document. If you are a successful
bidder on a university project, you may be required to provide additional information
regarding financial condition and references. No guarantee of notification is
conferred by addition to the list and the University reserves the right to
select/limit the number of Contractors to be mailed notifications at its
discretion. The University also reserves the right to contact and solicit bids
from firms not on the list. Eligibility to bid on University projects shall in
no way be restricted by creation of this list. All university projects remain
open to competitive bidding according the terms of Act 57 and other
Applications shall be considered valid for three
(3) years. Questions regarding completion of this form should be
directed to Purchasing at 814/393-2365.
Return completed application to Ruth
Wolfgong at following address:
Phone: 814/393-2365
Fax: 814/393-2033
E-mail: rwolfgong@clarion.edu
Application
for Admission to Bidders List for
Contractors/Professionals
This application will be used to
add bidders to
the
address shown in the Instructions. (Please type all requested information.)
Business Name: _____________________________________________________________________
Address :
__________________________________________________________________________
Address to which bid information is to be mailed (if different than above):
___________________________________________________________________________________
Name of Contact Person :
_______________________________________
Telephone Number: _____________________ Fax Number: _____________________
800 Telephone Number ______________________
E-mail address: __________________________
Can you retrieve attachments in Word format? ______________
Federal ID (FIN Number): _______________________________
Date/State of Incorporation :
____________________________________________________
PA Corp Tax No.:
_______________
PA Sales Tax No. : _______________
Names of Corporate Officers, owner or partners:
President:
__________________________ Vice
President: _____________________________
Secretary: __________________________
Treasurer: _________________________________
Sole Proprietor: ____________________________
Partners: __________________________________
___________________________________
Company Information:
1. Number
of full-time employees: ___________________________________
2. Are
you bondable within the state of
3. Have
you been certified as a minority business, women business enterprise or small
and disadvantaged business by the Department of General Services: ____Yes
____No
a.
Circle the appropriate business classification based on ownership:
00-Caucasian Male 01-Caucasian Female 02-Black
Male 03-Black Female
04-Hispanic
Male 05-Hispanic
Female 06- Non-Profit handicapped
07-For Profit-public owned
08-Other Government-owned 09-Family owned
10-Other Minority, male (specify
____________________________)
11-Other minority, female (specify
___________________________)
12-Other small business (specify
______________________________)
4. Worker’s compensation insurance information
____________________________________
(Carrier Name)
5. Liability insurance information:
_______________________________________________
(Carrier
Name)
6. Surety information:
______________________________________________________
(Carrier Name)
Type of Work Desired (must have a minimum of five years experience in areas
indicated):
Construction/Maintenance:
Professional Design Services:
____ General
Construction
_____ Architectural
____
Plumbing
_____ General Engineering
____
HVAC
_____ HVAC Design
____
Electrical
_____ Electrical Design
____
Painting
_____ Landscaping
_____Roofing
_____ Geological Testing
_____ Window
Replacement
_____ Other (please specify)
_____
Masonry
________________________
_____ Concrete
Installation/Repair
________________________
_____ Asphalt Installation/Repair
_____ Other (Please specify)
___________________________
___________________________