CONTRACTOR/VENDOR APPLICATION
COMPANY NAME:
PHONE:
ADDRESS:
CONTACT PERSON
TITLE:
DATE OF INCORPORATION ______________ STATE OF INCORPORATION:
IF PARTNERSHIP, LIST OF NAMES AND ADDRESS OF ALL PARTNERS:
IF PROPRIETORSHIP, LIST NAME OF PROPRIETOR:
CURRENT NUMBER OF EMPLOYEES:
HIGHEST BOND RECEIVED IN THE PAST 2 YEARS: $ BONDING LIMIT:
NAME OF BONDING COMPANY
* IF AN OUT-OF-TOWN COMPANY, LIST SUB-CONTRACTORS & CONTACT PERSONS
LOCATED IN NORTHEASTERN PA WHOM YOU WORKED WITH:
LIST MAJOR PROJECTS AWARDED: (LAST 5 YEARS)
Name of Project/Client
Year Worked
Location
Size of Project
Contract Fee
Owner Contact (name/phone)
Note: Attach separate sheet listing prior work experience with the specific information requested above.
“I certify that the above and enclosed information is true and correct.”
SIGNATURE and TITLE
DATE SUBMITTED
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