New Northview School Project – Nubian Construction Group

Subcontractor and Supplier Interest Form

Vendor Information

Legal Name Under Which You Do Business

DBA

Current Street Address

City

State

ZIP Code

Contact Person's Name

Title

Email Address

Phone Number

Fax Number

Website

Number of Employees:

Full-Time:

Part-Time:

No. of Yrs. in Business

Annual Volume

Area(s) of Specialty/NAICS Code(s):

Business Geographical Area(s):

Are you certified by the City of Indianapolis?

Yes

No

Interested in becoming certified

Is your company certified by the State of Indiana?

Yes

No

Interested in becoming certified

Please check all certifications your company holds with the City:

MBE

WBE

VBE

DOBE

VOSB

As a Subcontractor, I am Interested in providing quotes for the following scopes:

Professional Services Scopes:

Construction Services Scopes:

By entering my name below, I verify that the information provided on this form is accurate.

Signature of applicant:

Your typed name above serves as your digital signature.

Date