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Contractor Profile

All submitted registrations will be reviewed by the Office of Affirmative Action and the Department of Development Quarterly before being added to the City's Local & Preferred contractor lists. Incomplete or missing required information may cause a delay in the review of your registration. Each list will be cleared August of each year and will require re-registry.
For questions contact the Affirmative Action Office at (518) 382-5199 xt 5374 Or the Department of Development at (518) 382-5147
Contractor Profile Information
Name of Business or Firm*
Office Address
Name of Owner*
Address of Owner*
Email Address
Business Phone
Cell Phone/ Emergency Contact Number*
Note: The City of Schenectady requires contractors to carry cell phones or to supply us with an emergency phone number so they may be contacted during non-business hours.
Business Type
i.e. Sole-Proprietor, Partnership, LLC, Corporation, etc.
Check all that apply for Local, NYS, or Federal designation(s)*
1. MWBE- NYS Certified Minority/ Women Owned Business
2. DVOB- NYS Certified Disabled Veteran Owned Business
3. DBE- Certified Disadvantaged Business Enterprise
4. Section 3
Social Security Number of Owner
Business Federal Tax ID Number
No. of Years Firm has been in Business
List the number of employees in the firm with the following skills:
Carpenter
Licensed Plumbers
Licensed Electricians
Masons
Roofers
HVAC
General Construction
Painters
Are you and/ or your employees certified under EPA to work with Lead Interim controls or Lead Abatement?
1. Yes
1. No
Upload: EPA Certification
Total number of employees including Owner
1. 1 (Only Owner/ Operator)
1. 2-4
1. 5-10
1. 11 or more
Do you regularly use subcontractors?
1. Yes
2. No
Do you use union contractors?
1. Yes
2. No
Subcontractor (1) Name
Subcontractor (1) Address
Subcontractor (1) Skill
Subcontractor (2) Name
Subcontractor (2) Address
Subcontractor (2) Skill
Subcontractor (3) Name
Subcontractor (3) Address
Subcontractor (3) Skill
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Insurance

In accordance with local and state laws governing the same, the contractor must carry complete Workman's Compensation Insurance for themselves and all employees and subcontractors engaged in work on the contract premises. All contractors bidding on work must have appropriate levels of liability and Worker's Compensation Insurance
I understand the following statement:*
The Contractor shall furnish evidence of a comprehensive public liability insurance coverage of not less than $1,000,000.00, in the event of bodily injury including death, and $1,000,000.00 in the event of property damage arising out of work performed by contractor.
1. Yes
1. No
Insurance Company
Phone number
Insurance Company Address
Insurance Agent
Agent's phone number
Agent's Address
Agent's Email
Upload: Liability Insurance Binder*
Upload: Worker Compensation Insurance Binder*
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Questionaire

List major suppliers that your firm uses
Separate each company name with a comma ( , ) or semicolon ( ; )
List Name and Address of the Bank, Credit Union or Financial Institution that you do business with:
Company Name
Branch Address
Company Name
Branch Address
Company Name
Branch Address
Have you completed any home remodeling or other projects in the past Twelve (12) months in Schenectady?*
1. Yes
1. No
Name of Project or Service provided
Address
Contact Number
Name of Project/ Service provided
Address
Contact Number
Name of Project/ Service provided
Address
Contact Number
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Signature & References

Name
Address
Phone Number
Email
Name
Address
Phone Number
Email
Name
Address
Phone Number
Email
Name
Address
Phone Number
Email
Name
Address
Phone Number
Email
By signing below you are certifying that all information provided is true and complete to the best of your knowledge and belief. You also authorize the City of Schenectady (COS) to perform such verifications of this information as they deem necessary.
This form may be electronically signed or printed and signed in ink.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date*
Date

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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