12-Contact Information Form.pdf
PDF 365 KB Posted
- Attached to
- Progressive Design-Build Services for Town of Palm Beach Mid-Town Seawall Replacement Project
- Solicitation number
- RFQ No.2026-020
- Issued by
- Palm Beach County, Florida
About this file
This is a Contact Information Form submitted to the Town of Palm Beach, Florida's Procurement and Contracts Division for the Progressive Design-Build Services for Town of Palm Beach Mid-Town Seawall Replacement Project. The form requests comprehensive company and contact information organized into four sections: Company Information, Contact Information, Purchase Orders Contact, and Accounts Receivable. The Town is soliciting Design-Build services at a Guaranteed Maximum Price for the replacement of the existing Mid-Town Seawall, which spans approximately 2,700 linear feet along South Ocean Boulevard between Gulfstream Road and Royal Palm Way. The project encompasses the Town's right-of-way, Town-owned property, and work seaward of the coastal construction control line. Attendance at the mandatory Pre-Proposal Meeting and Site Visit scheduled for March 31, 2026 at 10:00 AM EST at the Public Works Building (951 Okeechobee Road, West Palm Beach, Florida 33401) is mandatory, with the site visit to follow at the Worth Avenue Clock Tower (423 South Ocean Boulevard, Palm Beach, Florida 33480). Firms failing to attend will be disqualified from consideration. Proposals must be submitted online through the EUNA Procurement platform with a proposal withdrawal restriction of 180 days.
The Contact Information Form serves as a preliminary document requiring vendors to provide detailed information about their organization's primary contact, alternate contacts, emergency after-hours contacts, and designated representatives for purchase orders and accounts receivable functions. The primary contact listed on the form must be capable of committing the company to an agreement with the Town of Palm Beach. No pricing terms, set-asides, or funding source information is contained within this administrative form, which functions solely as a data collection instrument for vendor qualification and communication purposes.
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Text version
Please Take a Moment to Provide the following Company Information
Contact Information Form Procurement and Contracts Division 951 Okeechobee Rd.
West Palm Beach, FL 33401 Phone: 561-838-5406 Fax: 561-835-4688 Web: www.townofpalmbeach.com
Part 1 | Company Information
State: Zip:
Company Name:
DBA Name (If Applicable):
Physical Address (No P.O. Boxes):
Mailing Address (If Di�erent than Above):
City:
Owner’s Name(s):
Part 2 | Contact Information
O�ce Fax:
Alternate Contact:
Alternate Phone:
Web Site:
Alternate Email :
Part 3 | Purchase Orders
Contact for Issuing Purchase Orders:
Contact Phone:
Contact Email:
TOWN OF PALM BEACH
Alternate Contact Cell Phone:
Primary Contact:
Primary Contact Phone:
Primary Contact Cell Phone:
Primary Contact Email:
Emergency After Hours Contact:
Emergency After Hours Phone:
Emergency After Hours Email:
Part 4 | Accounts Receivable
Accounts Receivable Contact:
Contact Phone:
Contact Email:
TOWN OF PALM BEACH - Contact Information Form
Note: Primary Contact must be capable of committing the company to an agreement with the Town.
| Company Name: |
| DBA: |
| Physical Address: |
| Mailing Address: |
| City: |
| State: |
| Zip: |
| Owner's Name: |
| Main Phone: |
| Fax: |
| Website: |
| Main Contact: |
| Main Contact Phone: |
| Main Contact Cell: |
| Main Contact Email: |
| Emergency After Hours Contact: |
| Emergency After Hours Phone: |
| Alternate Contact: |
| Alternate Phone: |
| Alternate Cell Phone: |
| Alternate Email: |
| Emergency After Hours Email: |
| CONTACT FOR PURCHASE ORDERS: |
| Agents Name: |
| Agents Phone: |
| A/R Contact: |
| A/R PHONE: |
| A/R EMAIL: |
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