2-Supplier Contact List Designation Form 09-2022.pdf
PDF 126 KB Posted
- Attached to
- RFP 26014MLD School Bus Stop-Arm Camera
- Solicitation number
- RFP 26014MLD
- Issued by
- Clark County, Fish Springs CDP, Nevada
About this file
The document is a Supplier Contact List Designation Form from the Clark County School District (CCSD) Purchasing Department located in Las Vegas, Nevada. The form is designed to provide the school district with a comprehensive list of authorized company contacts who can conduct various business activities on behalf of a vendor. The form allows suppliers to designate and update multiple types of contacts, including principal contacts, sales representatives/account managers, accounts receivable personnel, and technical contacts.
The form enables vendors to specify detailed contact information for each role, with options to add or delete contacts and indicate whether the contact's address matches the company's main address. Each contact type has specific responsibilities: principal contacts can update company information and manage payment details, account representatives can handle purchase order and invoice data, accounts receivable contacts manage invoicing and payment status inquiries, and technical contacts can address file and system-related issues. The document emphasizes that CCSD will rely on this form until receiving written notice of any changes, with reasonable time allowed to implement updates.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-4-RFP26014MLD Customer Reference Form.docx | DOCX document | |
| 6-Supplier Public Disclosure Form 3-15-11.docx | DOCX document | |
| 8-Supplier Federal 2CFR200 Certification Form 10.20.23.docx | DOCX document | |
| 9-1-RFP 26014MLD School Bus Stop-Arm Camera.doc | DOC document | |
| 5-2-RFP 26014MLD - Attach A Function Feature Matrix R 1.08.25.docx | DOCX document | |
| 3-supplier-application-update-form-4-2025-fillable.pdf | ||
| 4-W-9 2024 (3).pdf | ||
| 7-3-RFP26014MLD Submittal Form.doc | DOC document |
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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: |
File details come from the government source that posted it. Updated .