4-Supplier Contact List Designation Form 09-2022.pdf

126 KB Posted

Attached to
Boiler Repair Parts
Solicitation number
26016SGG
Issued by
Clark County, Nevada

About this file

Written by GovTribe AI ·

This 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 an official list of contacts authorized to conduct various business activities on behalf of a vendor. It allows companies to specify multiple types of contacts including a principal contact, sales representative/account manager, accounts receivable contacts, and a technical contact, each with distinct responsibilities such as managing supplier communications, handling purchase orders and invoices, and addressing technical file and system-related inquiries.

The form enables vendors to add or update contact information, with options to specify whether a contact's address matches the company's primary address. Vendors can add up to two principal contacts, two accounts receivable contacts, one sales representative/account manager, and one technical contact. The document emphasizes that the school district will rely on the information provided until receiving written notice of changes, with a reasonable period allowed for processing updates. The form includes blank fields for capturing detailed contact information such as names, titles, business addresses, phone numbers, and email addresses, providing a comprehensive template for maintaining current vendor communication channels.

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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:

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