Specifications

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CONTRACTOR INFORMATION
SOLICITATION NUMBER 1767
___________________________________ ________________________________________
(Authorized Signature) (Date)
___________________________________ ______________________________
(Print Name) (Title)
___________________________________ ______________________________
(Company Name) (Federal I.D. Number)
______________________________________________________________________________
(Address)
______________________________________________________________________________
(City, State, Zip)
____________________________________
(County)
___________________________Ext. ______ _____________________Ext.______
(Telephone Number) (Toll Free Phone)
____________________________________ ______________________________
(Fax Number) (Toll Free Fax Number)
____________________________________
(E-mail)
New York State Small Business Circle One: Yes No
New York State Certified Minority Owned Business Circle One: Yes No
New York State Certified Woman Owned Business Circle One: Yes No
Do you understand and is your firm capable of meeting
the insurance requirements to enter into a contract with
New York State? Circle One: Yes No
Does your proposal meet all the requirements of this solicitation? Circle One: Yes No