1. Contractor's legal name and address:

Name:

---

Address:

---

---

Phone No., Fax No., E-Mail:

---

Contact Name:

---

Web Site:

---

Corporation

Partnership

Individual

Date Incorporated: Tax ID No:

---

State Registered in:

---

2.

Is your Company a Minority

Woman Owned

business?

3. List name(s) of officer and/or partners: Include number of years with the firm.

Name

Title

No. of Years with Firm

4. Permanent Personnel Record: List the number of employees for the past 2 years:

	Maximum	Minimum	Current
Supervisors/ Superintendents:
Foremen:
Estimators:
Engineers:
Clerical:
Technicians:
Other:

5. List construction industry experience of supervisory personnel:

Name	Title	Years of Construction Experience	Type of Construction Experience

6. Indicate amounts you care to bid on:
Maximum - $_____________ Minimum - $_____________

7. Check counties where you would be available to submit project bids:

Dutchess	Ulster	Greene	Orange
Columbia	Albany	Putnam	All Above

8. Please supply the following information on a separate sheet:

• Major equipment presently owned and operated by your company.
  

9. Has your company ever failed to complete a contract within the past 5 years?

• If yes, reason:
  
  
• With who?
  

10. Have you or your present company ever been involved in litigation within the past 5 years?

• Explain:
  

11. List several recently completed contracts within the past 2 years to include:

• owner
• description and location
• type of work
• original contract price
• final contract price
• original completion date
• final completion date
  

12. List type of work you are able to perform:

13. Indicate your present maximum
bonding capacity: $_________

You may provide any additional information about your company on a separate sheet of paper.

================================================================

Name of your Company: _______________________

By: _______________________
(Please print and sign)

Title: _________________ Date:________

Please return this completed form to:

Central Hudson Gas & Electric Corporation
Attention Purchasing Division
284 South Avenue
Poughkeepsie, NY 12601

Contract Section Contacts:
Ms. Ruthanne Kimball
Director of Purchasing & Stores
845-486-5553
rkimball@cenhud.com

Mr. Jon Antonucci
Buyer
845-486-5532
jantonucci@cenhud.com

Fax: 845-486-5746

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