12-Vendor Profile Information Form - 2024.docx
DOCX document 24 KB Posted
- Solicitation number
- BC-BID-26-22
- Issued by
- Bergen County, New Jersey
About this file
This is a Vendor Profile Information Form from the County of Bergen, Department of Administration and Finance, Division of the Treasurer, related to a cooperative catalog procurement for golf range equipment and supplies. The solicitation (BC-BID-26-22) seeks multiple catalog vendors to furnish and deliver golf range equipment and supplies for a 24-month period commencing on the date of award. The scope includes golf range equipment, accessories, repair parts, and related supplies. The form serves as the initial vendor registration document requiring submission of company information, authorized official contact details, and preferred communication method for purchase orders prior to participation in this New Jersey contract opportunity.
The Vendor Profile Information Form requests standard business registration information including company classification, tax identification details, remittance address if different from the primary business address, and certification of accuracy. Vendors must identify their business structure (sole proprietor, corporation, partnership, limited liability corporation, or other entity types) and indicate applicable designations such as small business, minority-owned, women-owned, or veteran-owned status. The form also allows vendors to specify whether they qualify as tax-exempt organizations. No pricing information, set-asides, incumbent vendor details, or specific funding amounts are contained within this form, as it functions solely as a vendor qualification and registration document for the golf range equipment and supplies cooperative catalog procurement.
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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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File details come from the government source that posted it. Updated .