17-15. NEW VENDOR FORM.docx
DOCX document 51 KB Posted
- Attached to
- BACKFLOW PREVENTION PARTS & SERVICES
- Solicitation number
- 27004
- Issued by
- Maricopa County, Arizona
About this file
This is a New Vendor Form from Scottsdale Unified School District #48 Purchasing Department for RFP #27004 regarding Backflow Prevention Parts & Services. The solicitation seeks qualified firm(s) to provide backflow prevention services on an as-needed basis, including annual inspections and certifications of fire, domestic, and irrigation devices, as well as repair or replacement of leaking or failed backflow devices. Successful vendors must furnish all necessary labor, materials, equipment, and transportation to perform the work. The form submission deadline is May 28, 2026.
The New Vendor Form requires prospective vendors to provide comprehensive organizational information including legal name, addresses, contact details, and a Unique Entity ID (formerly DUNS Number). Vendors must confirm acceptance of purchase orders and disclose any relationships with SUSD employees or governing board members. All vendors are required to comply with state statutes and federal equal opportunity and non-discrimination requirements under A.R.S. Title 41, Chapter 9, Article 4 and Executive Order Number 75-5. Critical provisions include the requirement that vendors only provide products or services upon receipt of an authorized SUSD Purchase Order, include the purchase order number on all invoices submitted directly to SUSD Accounts Payable, and direct all communications regarding purchase orders to the SUSD Procurement Office. Vendors must also submit a completed W-9 form with the New Vendor Form.
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Text version
Scottsdale Unified School District #48 New Vendor Form
Purchasing Department 9313 N. 95th Way Scottsdale, AZ 85258 480-484-6151
RFP #: 27004
PROJECT: BACKFLOW PREVENTION PARTS & SERVICES
| ORDER INFORMATION |
| PAYMENT INFORMATION |
| LEGAL NAME OF ORGANIZATION / INDIVIDUAL |
| LEGAL NAME OF PAYEE |
| STREET ADDRESS |
| STREET ADDRESS |
| STREET ADDRESS 2 |
| STREET ADDRESS 2 |
| CITY |
| CITY |
| STATE |
| ZIP |
| STATE |
| ZIP |
| PHONE NUMBER W/ EXTENSION |
| FAX NUMBER |
| PHONE NUMBER W/ EXTENSION |
| FAX NUMBER |
| CONTACT NAME |
| CONTACT NAME |
| EMAIL ADDRESS FOR PURCHASE ORDERS (required) |
| EMAIL ADDRESS FOR ACCOUNTS RECEIVABLE (required) |
| WEB ADDRESS | |
| DOES YOUR COMPANY ACCEPT PURCHASE ORDERS? | |
| YES | NO |
UNIQUE ENTITY ID (formerly DUNS Number)
ARE YOU A SUSD EMPLOYEE?
YES NO IF YES, EXPLAIN:
LOCAL REPRESENTIVE NAME
RELATIVE OF SUSD EMPLOYEE?
| LOCAL REPRESENTATIVE CONTACT PHONE | ||
| YES | NO | IF YES, EXPLAIN: |
MEMBER OR RELATIVE OF SUSD GOVERNING BOARD?
LOCAL REPRESENTATIVE EMAIL
YES NO IF YES, EXPLAIN:
VENDOR ACKNOWLEDGEMENTS - BY SIGNING BELOW, I HEREBY ACKNOWLEDGE THAT:
1. I am duly authorized to certify the information requested herein.
2. To the best of my knowledge, the elements of the information provided herein are accurate and true as of this date.
3. My organization will comply with all State statutes and Federal equal opportunity and non-discrimination requirements and conditions of employment in accordance with A.R.S. Title 41, Chapter 9, Article 4 and Executive Order Number 75-5 dated April 28, 1975.
4. Filing of a Vendor Registration Application supplies information only and does not constitute an assumed obligation by Scottsdale Unified School District (SUSD) to guarantee contractual awards or agreements to my organization.
5. Updating information contained on this form is solely the duty of my organization.
6. My organization will not provide any product or service without first having in our possession an authorized SUSD Purchase Order. No products or services will be provided based on a verbal promise of a Purchase Order or with the submission of a requisition for a Purchase Order. I understand that payment for any product or service provided without an authorized Purchase Order is not the responsibility of SUSD and that I will have to obtain payment from the individual requestor.
7. My organization will direct all communication regarding SUSD Purchase Orders to the SUSD Procurement Office.
8. My organization will provide the Purchase Order number on all invoices submitted to SUSD. I understand that invoices received without this information will not be paid.
9. My organization will submit all invoices directly to SUSD Accounts Payable and not to the requesting department or school.
| PRINTED OR TYPED NAME |
| TITLE |
| SIGNATURE |
| DATE |
Please Include a copy of your W-9 form.
RFP #: 27004 Page 1 of 1 Due: May 28, 2026 image1.png
File details come from the government source that posted it. Updated .