Request for Qualifications for Underwriter Services Reissued

Attachment I
Proposal Coversheet:
Complete and include this form in Tab 1 of your Proposal Submission.
APPLYING FOR:
Check the box for any PQL and/or List you are applying for:
Tier 1 Senior Managing Underwriters PQL
Tier 2 Co-Managing Underwriters PQL
Tier 3 Selling Group Member List
GENERAL INFORMATION ON FIRM:
Legal Name of Firm: __________________________________________________________
Firm's Mailing Address: ________________________________________________________
Firm's Website: ______________________________________________________________
Firm's Main Telephone Number (including area code): ________________________________
Federal Tax ID Number: ________________________________________________________
Data Universal Numbering System Number (DUNS) : _________________________________
FINRA and/or SEC Registration Number (if applicable): _______________________________
MSRB Registration Number (if applicable): __________________________________________
Statewide Financial System (SFS) Vendor ID Number: __________________________________
MWBE Registration Number (if applicable): __________________________________________
Service-Disabled Veteran-Owned Business (SDVOB) Control / Registration Number (if
applicable): ____________________________________________________________________
MAIN CONTACT INFORMATION REGARDING THIS PROPOSAL:
Contact Name: _________________________________________________________________
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Contact Telephone Number (including area code): _____________________________________
Contact E-mail Address: __________________________________________________________
Contact Facsimile Number (including area code): ______________________________________
PRINCIPAL IN CHARGE:
The primary staff person(s) who will provide services to the Agency. Attach additional sheets if
necessary.
Contact Name: _________________________________________________________________
Contact Telephone Number (including area code): ______________________________________
Contact E-mail Address: __________________________________________________________
ADDITIONAL PRINCIPAL(S):
Contact Name: __________________________________________________________________
Contact Telephone Number (including area code): ______________________________________
Contact E-mail Address: __________________________________________________________
Contact Name: __________________________________________________________________
Contact Telephone Number (including area code): ______________________________________
Contact E-mail Address: __________________________________________________________
AS OUTLINED IN THE SOLICIATION ALL PROPOSAL SUBMISSIONS MUST SENT
VIA EMAIL TO: Nyhomes.Proposal@hcr.ny.gov
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