NAICS Plan Item Number (if applicable)/ % of Total Cert. Type Certified Firm Name Code Description of Work Bid Price for Goal Firm Address (6 digit) (2 decimal (MBE, Contact Name places) WBE, SBE) Phone No. and E-Mail (if available) Signature for Company: * Date: ____ Print Name: Phone: _________ *I understand that supplying inaccurate information may violate Texas Penal Code Section 37.10 and lead to City sanctions
NAICS Code (6 digit) Plan Item Number (if applicable)/ Description of Work % of Total Bid Price (2 decimal places) Cert. Type for Goal (MBE, WBE, SBE) Certified Firm Name Firm Address Contact Name Phone No. and E-Mail (if available) Signature for Company: * Date: ____ Print Name: Phone: _________ *I understand that supplying inaccurate information may violate Texas Penal Code Section 37.10 and lead to City sanctions
00570.docx