<p> Design and Construction AN ISO 9001:2008 CERTIFIED ORGANIZATION</p><p>Office of Minority and Women-Owned Business Enterprises, 29th Floor, Corning Tower The Governor Nelson A. Rockefeller Empire State Plaza Albany, New York 12242 Phone: (518) 486-9284 FAX: (518) 486-9285</p><p>MWBE CERTIFIED LISTING REQUEST FORM Upon the request of a bidder/contractor/consultant, the OGS Office of Minority and Women-Owned Enterprises will prepare a listing of NYS certified minority and women-owned business enterprises (MWBEs) headquartered in the NYS counties identified by the bidder/contractor/consultant. Please note that there may be MWBEs that are not headquartered in the identified county(s) willing to perform or provide the services or supplies indicated for this project. To receive an expanded listing, please visit http://www.esd.ny.gov/MWBE.html and follow the on-line instructions to obtain a listing of MWBEs. Compan Contact Name: y Name:</p><p>Address Telepho Fax Number: : ne Number:</p><p>Email: Project Number:</p><p>Please indicate below the counties you wish to have searched.</p><p>All Counties (if not, check county(ies) below)</p><p>1. Albany 2. Allegany 3. Bronx 4. Broome 5. Cattaraugus 6. Cayuga 7. Chautauqua 8. Chemung 9. Chenango 10.Clinton 11. Columbia 12. Cortland 13. Delaware 14. Dutchess 15. Erie 16. Essex 17. Franklin 18. Fulton 19. Genesee 20. Greene 21. Hamilton 22. Herkimer 23. Jefferson 24. Kings 25. Lewis 26. Livingston 27. Madison 28. Monroe 29. Montgomery 30. Nassau 31. New York 32. Niagara 33. Oneida 34. Onondaga 35. Ontario 36. Orange 37. Orleans 38. Oswego 39. Otsego 40. Putnam 41. Queens 42. Rensselaer 43. Richmond 44. Rockland 45. St. Lawrence 46. Saratoga 47. Schenectady 48. Schoharie 49. Schuyler 50. Seneca 51. Steuben 52. Suffolk 53. Sullivan 54. Tioga 55. Tompkins 56. Ulster 57. Warren 58. Washington 59. Wayne 60. Westchester 61. Wyoming 62. Yates</p><p>Categories of the Trade(s) or Supplies you wish to have searched:</p><p>BDC 86 (Rev03) Please submit all requests to D&[email protected] or via fax at (518) 486-9285.</p>