4-VENDOR INFORMATION.pdf

PDF 948 KB Posted

Attached to
Clearinghouse/Electronic Claims and Print Mail Services
Solicitation number
RFP260106
Issued by
Jefferson County, Kentucky

About this file

This is a Vendor Information form from Louisville Metro Government, designed for potential vendors to provide comprehensive details about their business when submitting a proposal. The form allows vendors to specify their business classification, including ownership status (such as Minority-Owned, Women-Owned, Disabled-Owned, or LGBT-Owned) and various certifications like Minority Business Enterprise (MBE), Women Business Enterprise (WBE), or Veteran Owned Small Business (VOSB).

The document includes sections for capturing key vendor information such as full legal business name, contact details, tax identification numbers, and authorized representative information. Vendors can also self-identify their race/ethnicity for the Louisville Metro Human Relations Commission, with options including American Indian, Asian American, Black/African American, Caucasian, Latino/Hispanic, and others. The form is dated 9/12/2025 and features the Louisville Metro seal, indicating it is an official municipal procurement document for vendor qualification and potential contract opportunities.

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Text version

VENDOR INFORMATION

Full Legal Business Name of Proposer:

Address:

E-Mail Address:

Telephone:

Metro Louisville Revenue Commission Number:

Federal ID Number:

Unique Entity Identifier:

The following individual is authorized to submit this proposal on behalf of and enter subsequent negotiations should Louisville Metro Government determine our firm reasonable susceptible of being selected for award.

Contact for Contracts: Contact for Invoices:

Email: Email:

Name: Name:

Phone Number: Phone Number:

Authorized Agent Signature:

Printed Name:

Title:

E-Mail Address:

Date:

Supplier Classification Ownership Status (51% owned or controlled) Minority-Owned Women-Owned Disabled-Owned LGBT-Owned Non-Profit Not Applicable Certifications (if applicable) Minority Business Enterprise (MBE) Women Business Enterprise (WBE) Disabled Business Enterprise (DIBE) LGBT Business Enterprise (LGBTBE) Veteran Owned Small Business (VOSB) Service-Disabled VOSB (SDVOSB) Louisville Metro Human Relations Commission Certification Race / Ethnicity American Indian or Alaska Native Asian American Asian-Indian American Asian – Pacific American Black / African American Caucasian Latino or Hispanic Other

Form Date: 9/12/2025

Full Legal Business Name of Proposer:
Address:
EMail Address:
Telephone:
Metro Louisville Revenue Commission Number:
Federal ID Number:
Unique Entity Identifier:
The following individual is authorized to submit this proposal on behalf of:
Email:
Email_2:
Name:
Name_2:
Phone Number:
Phone Number_2:
Printed Name:
Title:
EMail Address_2:
Date:
Minority-Owned: Off
Women-Owned: Off
Disabled-Owned: Off
LGBT-Owned: Off
Non-profit: Off
Not Applicable: Off
MBE: Off
WBE: Off
DIBE: Off
LGBTBE: Off
VOSB: Off
SDVOSB: Off
American Indian or Alaska Native: Off
Asian American: Off
Asian-Indian American: Off
Asian-Pacific American: Off
Black African American: Off
Caucasian: Off
Latino Hispanic: Off
Other: Off

File details come from the government source that posted it. Updated .