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

126 KB Posted

Attached to
Granola, Plain or Flavored, WG, Individual Serving
Solicitation number
26012AIT
Issued by
Clark County, Fish Springs CDP, Nevada

About this file

Written by GovTribe AI ·

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 companies to designate different types of contacts, including a principal contact (who can update company information and manage supplier communications), an account representative/manager (who can handle purchase order and invoice transactions), accounts receivable contacts (who can provide invoices and check payment status), and a technical contact (who can manage file and system-related inquiries).

The form requires detailed contact information for each designated role, with options to add or delete contacts and specify whether their business address matches the company's main address. Each contact section includes fields for name, title, business address, business phone, and business email. The document emphasizes that the school district will rely on this form until receiving written notice of any changes, with a reasonable time allowed for processing updates. The form is part of CCSD's vendor management process, enabling clear and structured communication channels between the school district and its suppliers.

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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:

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