Contractor List Application

Company Name(Required)

Contact Name(Required)

First Last

Company Mailing Address

Street Address Address Line 2 City State ZIP Code

Company Email Address(Required)

Company Phone Number(Required)

Company Website

Types of work:(Required)

Certifications Held

DBE Certification

WBE Certification

SBE Certification

DVBE Certification

Select all that apply and provide certification number below if available

DBE Certification #

WBE Certification #

SBE Certification #

DVBE Certification #

Current Licensing(Required)

Class

License Number

Expiration Date

DIR Registration

Registration Number

Expiration Date

Name

This field is for validation purposes and should be left unchanged.

Kern County Public Works Department

Mission Statement: To provide public infrastructure, facilitate development, and deliver services that protect and enhance the lives of the people of Kern County.

Contractor List Application

Kern County Public Works Department

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