10-Vendor Information Form - 2024.docx
DOCX document 24 KB Posted
- Solicitation number
- BC-BID-25-34
- Issued by
- Bergen County, New Jersey
About this file
This document is a Vendor Information Form issued by the Bergen County Department of Administration and Finance in Hackensack, New Jersey, specifically the Division of the Treasurer. The form is associated with a cooperative contract opportunity (BC-BID-25-34) for Dead Tree Removal Services along municipal-owned roads, with a proposed 24-month contract period beginning on the date of award. The contract appears to be available to CK04/11BECCP-NJ Cooperative Members and seeks to establish vendor qualifications and payment information for potential service providers.
The form captures comprehensive vendor details including business classification options such as small business, minority-owned, women-owned, and veteran-owned enterprises. Vendors are required to provide complete company information matching their W-9, including contact details, remittance address, and tax classification. The document allows vendors to specify their organizational structure (e.g., C-Corp, S-Corp, Partnership, LLC) and provides a certification section for verifying the accuracy of submitted information. While specific pricing terms are not detailed in this form, it serves as a critical preliminary step for vendor registration and potential participation in the municipal tree removal services contract.
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Text version
COUNTY OF BERGEN DEPARTMENT OF ADMINISTRATION AND FINANCE
DIVISION OF THE TREASURER
One Bergen County Plaza• Suite 501 • Hackensack, N.J. 07601-7076
(201) 336-6550 • (201 336-6595
James J. Tedesco, Ill County Executive
Jon Rheinhardt
CFO
Melissa Howard Treasurer
* - Required field
VENDOR INFORMATION FORM
Vendor Information (as displayed on W-9 form):
Company Name*:
Address*:
City*:
State*:
Zip Code*:
Name of Authorized Official*:
Phone Number*:
Email Address*:
| Would you prefer that PO's to be emailed to the email address provided? * | |
| □Yes | □No |
Remittance Address: (if different than information above) Pay-To-Name:
Pay-To-Address:
Pay-To-City:
Pay-To-State:
Pay-To-Zip:
Pay-to Attn:
Payment Email:
Business Classification:
| Is your company a: * |
| IRS Classification: * |
| □ Small Business |
| □ Individual/ Sole proprietor |
| □ Minority Owned |
| □ C-Corp |
| □ Women Owned |
| □ S-Corp |
| □ Veteran Owned |
| □ Partnership |
| □ Other: |
| □ Trust/Estate |
| □ Not Applicable |
| □ Limited Liability Corp - Corporation |
□ Limited Liability Corp - S Corporation
□ Limited Liability Corp - Partnership
□ Tax-Exempt Organization
I certify that the information provided on this form is true and accurate to the best of my knowledge.
Print Name: Signature:
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