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Profile type:

Company
Agents

Please create a username and password for your company to be able to update this record

Company Name:*

Select Company

Name :*

Username:*

Name:*

E-mail:*

Password:*

Repeat Password:*

Business Information

Tax Id Number:*

Business Description:*

Website

Type of Vendor:*

Engineering and Consulting
Construction

Address

Mailing Address (for Solicitations & Purchase Orders) *

Street:

Suite:

City:

State:

Province:

Country:

Postal Code:

Administrative Contacts

Primary Contact Information*

First Name:*

Last Name:*

Title:*

Phone No (xxx-xxx-xxxx):* Required phone number format: (###) ###-####

Cell Phone No (xxx-xxx-xxxx):* Required phone number format: (###) ###-####

Fax No (xxx-xxx-xxxx):

Email Address:*

Authorized Contact Information*

Primary contact is authorized agent:

First Name:*

Last Name:*

Title:*

Phone No (xxx-xxx-xxxx):* Required phone number format: (###) ###-####

Cell Phone No (xxx-xxx-xxxx):* Required phone number format: (###) ###-####

Fax No (xxx-xxx-xxxx):*

Email Address:*

Billing Contact Information*

Same As Primary:

First Name:

Last Name:

Title:

Phone No (xxx-xxx-xxxx):

Cell Phone No (xxx-xxx-xxxx):

Fax No (xxx-xxx-xxxx):

Email Address:

Minority Business Certification

If certified as a minority business, please mail in a copy of you certification letter or certificate. If a copy of your certificate is not on file with Greater New Haven WPCA you will be considered as an uncertified minority business vendor. You confirmation page and e-mail will list the address of where to mail your Minority Business Certificate.
If certified as a Minority Business Enterprise, please indicate the type of minority certification(s) by checking the appropriate box(es):

Minority Business Enterprise:

MBE Cert #:

Small Business Enterprise:

MBE Cert #:

Women Business Enterprise:

MBE Cert #:

Other

Department of Administrative Services (DAS) Information:

Depending on the contractual value of the contract, bidders may be required to hold a current State of Connecticut DAS Prequalification Certificate as required by the DAS Contractor Prequalification Program (see CGS §4a-100).

See DAS Website for more details: Click Here

DAS Number:

DAS Expiration Date (mm/dd/yyyy):

See DAS website for more details: Click Here

Standard Specifications:

Anyone submitting a bid for a project must have in their possession a copy of the Greater New Haven WPCA Standard Specifications, dated September 12, 2006. The document can be obtained at our offices located at 260 East Street, New Haven, CT 06511 for a one-time fee of $100.00. Arrangements for a copy can be made using your FedEx account number through the GNHWPCA Engineering Department by calling 203-466-5280 ext. 321.

Acknowledgement

I certify under the penalties for perjury that the following is true and accurate and that no officer, owner, or principle connected with the business indicated above is now debarred or suspended with any state, local or federal government.
I also understand the updating of the above information, Including change of address,l is my responsibility and failure to do so may result in my removal from the vendor list.

I Agree:

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