25-84131500-ITN DFS BOR Attachment O Broker Information.pdf
PDF 112 KB Posted
- Attached to
- Insurance Broker of Record - Reinsurance Broker for Property and Casualty lines, Risk Management and
- Solicitation number
- ITN-13124
- Issued by
- St. Johns County, Florida
About this file
This document is Attachment O, a Broker Information form for Invitation to Negotiate (ITN) No. 25-84131500-ITN, which appears to be associated with the Department of Financial Services (DFS). The form is a blank template designed for potential brokers to complete, requesting comprehensive contact and location details for a prospective business opportunity. It requires respondents to provide information such as broker name, physical address, Federal Employer Identification Number (FEIN), primary work location, and detailed contact information for the primary point of contact.
The form solicits specific administrative details to establish the broker's credentials and contact methods, including street address, city, state, name, title, email address, phone numbers, fax number, and an emergency contact number. While the document itself does not contain completed information, it serves as a standardized data collection instrument for qualifying brokers interested in participating in the ITN process, likely as part of a larger procurement or service engagement with the state or local government entity.
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Text version
ITN No.: 25-84131500-ITN
ITN No.: 25-84131500-ITN
Attachment O
Broker Information
Broker Name:
Physical Address: _____________________________
FEIN: _
Primary Location(s) where the work will be performed:
Street Address:
City: __________________
State:_________________
Please provide contact information for the Respondent’s primary point of contact(s).
Name:
Title:
Street Address:
E-mail Address:
Phone Number(s):
Fax Number:
Emergency Number:
File details come from the government source that posted it. Updated .