Contractor/Vendor Pre-Qualification Form (PQF)

1.

Telephone

Fax

2.

Title

Telephone

Fax

3.

4.

Form of Business: Sole OwnerPartnershipCorporationJoint Venture

Partnership

Is your company a subsidiary of another company? If yes, name of Company

Is your business a division of another company? If yes, name of Company

Is your business franchised by another company? If yes, name of Company

Has your company engaged in business with CenterPoint Energy within the last 12 months? If yes, name of CNP location where you are doing business

Are you an employee or relative of an employee of CenterPoint Energy?

If yes, explain

Minority Business Enterprise (MBE) -- A minority-owned business, as used in this form, refers to a business that is at least 51- percent owned by one or more minorities, and whose management and daily business operations are controlled by one or more minorities. Asian-Indian -- A U.S. citizen whose origins are from India, Pakistan and Bangladesh. Asian-Pacific -- A U.S. citizen whose origins are from Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia, the Philippines, Samoa, Guam, the U.S. Trust Territories of the Pacific or the Northern Marianas. African-American -- A U.S. citizen having origins in any of the Black racial groups of Africa. Hispanic -- A U.S. citizen of true-born Hispanic heritage, from any of the Spanish-speaking areas of Latin America or the following regions: Mexico, Central America, South America, and the Caribbean Basin only. Native American -- A person who is an American Indian, Eskimo, Aleut, or Native Hawaiian, and regarded as such by the community of which the person claims to be a part. Native Americans must be documented members of a North American tribe, band or otherwise organized group of native people who are indigenous to the continental United States and proof can be provided through a Native American Blood Degree Certificate (i.e., tribal registry letter, tribal roll register number Small Disadvantaged Business (SDB) -- A small disadvantaged business, as used in this document, refers to a small business 1) that is at least 51-percent owned by one or more individuals who are both socially and economically disadvantaged, or a publicly-owned business whose stock is at least 51-percent owned by one or more socially and economically disadvantaged individuals and 2) whose management and daily business operations are controlled by one or more such individuals. Women Business Enterprise (WBE) -- A women-owned business, as used in this form, refers to a business that is at least 51- percent owned by one or more women, and whose management and daily business operations are controlled by one or more minorities.

5. Business Classification Is your business currently certified as a Minority-Owned Business by any government agency or

purchasing council? YesNo

If yes, please identify from previous list:

Certification Number:

Expiration Date:

Certification Agency:

Certification Number:

Epiration Date:

Is your business currently certified as a Women-Owned Business by any government agency or

purchasing council? YesNo

Certification Number:

Expiration Date:

Certifying Agency:

Certification Number:

Expiration Date

Is your business currently certified as a Small Disadvantaged Business by any government agency or

purchasing council? YesNo

6.

How many years has your organization been in business under your present firm name?

7.

Contact for Insurance Information:

Title

Telephone

Fax

If service provider, Please attached a copy of your current ACORD Agreement

9.

Are you self insured for Worker’s Compensation Insurance? YesNo

Are you self insured for Worker’s Compensation Insurance? Yes

10.

General Information PQF Completed By:

Title

Telephone

Fax

Size

	Type of Work/Material	$M	Customer Contact	Telephone	Customer/Location

12. Are you now or have you ever been involved in any bankruptcy or reorganization proceedings?