City of San Leandro - Online Contractor Registration Form

* Today's Date
mm/dd/yyyy

* Company Name

* Address

* City

* State

* Zip

* County

* Phone
(xxx) 123-4567

FAX

Web Site URL

* Email for Bid and Quote Notices

Contact Name

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California State Contractor License(s) Include all that apply:

* License Number

* Lic. Type (A, B, C, _)

Additional License(s)
(License Number, Type)

Years in Business

Project Capacity

* Is the company currently certified as a Disadvantaged Business Enterprise (DBE) under DOT regulations?

Yes

No

* Is the company an Underutilized Disadvantaged Business Enterprise (UDBE) under DOT regulations?

Yes

No

* What were the company's gross annual receipts for last year?

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Services Provided (Select all that apply)

Please provide details if "Other" box is selected

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*

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