1-Supplier Contact List Designation Form 09-2022.pdf
PDF 126 KB Posted
- Solicitation number
- RFP 27002JBD
- Issued by
- Clark County, Nevada
About this file
This is a Supplier Contact List Designation Form from the Clark County School District (CCSD) Purchasing Department, located in Las Vegas, Nevada. The form serves as an administrative document enabling vendors and suppliers to designate authorized contacts who are permitted to conduct various business activities on behalf of their company with the district. The form does not relate to a specific procurement or contract opportunity but rather functions as a standing authorization document that remains valid until the district receives written notice of changes and has had reasonable time to process such modifications.
The form allows suppliers to designate up to six types of contact roles: two principal contacts (who receive district communications and possess authority to update company information including banking details for payments), a sales representative or account manager (who can access purchase order and invoice transactional data), two accounts receivable contacts (authorized to provide invoices and inquire about payment status), and a technical contact (who manages file-related matters and system issue reporting). Each contact designation includes fields for name, title, business address, phone number, city/state/zip code, and business email, with the option to indicate whether the contact's address matches the company's primary address. Suppliers can add or delete contacts as needed through this form, which must be submitted to the CCSD Purchasing Department at 4212 Eucalyptus Avenue, Building 7, Las Vegas, Nevada 89121.
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Text version
Supplier Contact List Designation Form Purchasing Department
4212 Eucalyptus Avenue Bldg. 7 Las Vegas, NV 89121
Telephone: (702) 799-5225 Fax: (702) 799-5018
This form provides the Clark County School District with a list of contacts authorized to conduct various business activity on behalf of your company.
We can rely on this form until we receive written notice of a change and we have had reasonable time to act on it.
Part 1: Confirm your company details
Name:
DBA:
Vendor Number (CCSD Use Only) Address City, State and Zip Code Telephone Email
Part 2: Add or Change contacts
Use this section to add or change principal contact, account representative/manager, accounts receivable and technical contact.
The principal contact is the person your company designates as supplier emails and phone calls. They have the authority to add/ update company information including bank account information for payments.
An account representative/ manager can request and provide purchase order and invoice transactional data.
An account receivable contact can provide invoices and inquire about payment status.
A technical contact can request file resends and inquire about files names and delivery information, incoming files and system outage and issues.
Principal Contact #1
Name and title:
What do you want to do for this contact? Add Delete
Is the contact’s address the same as the company address? Yes No
Business address Business phone City, State, Zip code Business email
Principal Contact #2
Sales Rep/Account Manager
Accounts Receivable #1
Accounts Receivable #2
Technical Contact
| Add: Off |
| Delete: Off |
| Yes: Off |
| No: |
| Add_2: Off |
| Delete_2: Off |
| Yes_2: Off |
| No_2: |
| Add_3: Off |
| Delete_3: Off |
| s address the same as the company address: Off |
| Yes_3: |
| ness address_3: |
| ness phone_3: |
| p code_3: |
| l_3: |
| Add_4: Off |
| Delete_4: Off |
| s address the same as the company address_2: Off |
| Yes_4: |
| ness address_4: |
| ness phone_4: |
| p code_4: |
| l_4: |
| Add_5: Off |
| Delete_5: Off |
| s address the same as the company address_3: Off |
| Yes_5: |
| ness address_5: |
| ness phone_5: |
| p code_5: |
| l_5: |
| Add_6: Off |
| Delete_6: Off |
| s address the same as the company address_4: Off |
| Yes_6: |
| ness address_6: |
| ness phone_6: |
| p code_6: |
| l_6: |
| Name: |
| DBA: |
| Vendor Number: |
| Address: |
| City, State Zip: |
| Telephone: |
| Email: |
| Name & Title: |
| Business address: |
| Business phone: |
| Business City State Zip: |
| Business Email: |
| Contact 2 Name & Title: |
| Business address_2: |
| Business City State Zip code_2: |
| Business phone_2: |
| Business Email2: |
| Rep Name & Title: |
| AR Name & Title: |
| AR 2 Name & Title: |
| Tech Contact Name & Title: |
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