7-Vendor Information Form - 2024.docx
DOCX document 24 KB Posted
- Attached to
- Aeration Services - Parks & GC Turf-Grass
- Solicitation number
- BC-BID-25-29
- Issued by
- Bergen County, New Jersey
About this file
This is a Vendor Information Form from the County of Bergen Department of Administration and Finance in New Jersey, specifically from the Division of the Treasurer located in Hackensack. The document is associated with a state and local contract opportunity (BC-BID-25-29) for Aeration Services for the County of Bergen Parks & Golf Course Turf-Grass, which is a 12-month contract with one 12-month renewal option. The form is designed to collect comprehensive vendor details for potential contractors interested in providing aeration services.
The form captures critical vendor information including company name, address, contact details, authorized official information, and payment preferences. It also includes a business classification section where vendors can identify their organizational structure (such as small business, minority-owned, women-owned, veteran-owned) and tax classification (C-Corp, S-Corp, Partnership, etc.). The form requires vendors to certify the accuracy of the submitted information through a signature and printed name, indicating a formal commitment to the truthfulness of the provided details. This document serves as a standardized method for the County of Bergen to collect and document vendor information for potential contract opportunities.
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Text version
COUNTY OF BERGEN DEPARTMENT OF ADMINISTRATION AND FINANCE
DIVISION OF THE TREASURER
One Bergen County Plaza• Suite 501 • Hackensack, N.J. 07601-7076
(201) 336-6550 • (201 336-6595
James J. Tedesco, Ill County Executive
Jon Rheinhardt
CFO
Melissa Howard Treasurer
* - Required field
VENDOR INFORMATION FORM
Vendor Information (as displayed on W-9 form):
Company Name*:
Address*:
City*:
State*:
Zip Code*:
Name of Authorized Official*:
Phone Number*:
Email Address*:
| Would you prefer that PO's to be emailed to the email address provided? * | |
| □Yes | □No |
Remittance Address: (if different than information above) Pay-To-Name:
Pay-To-Address:
Pay-To-City:
Pay-To-State:
Pay-To-Zip:
Pay-to Attn:
Payment Email:
Business Classification:
| Is your company a: * |
| IRS Classification: * |
| □ Small Business |
| □ Individual/ Sole proprietor |
| □ Minority Owned |
| □ C-Corp |
| □ Women Owned |
| □ S-Corp |
| □ Veteran Owned |
| □ Partnership |
| □ Other: |
| □ Trust/Estate |
| □ Not Applicable |
| □ Limited Liability Corp - Corporation |
□ Limited Liability Corp - S Corporation
□ Limited Liability Corp - Partnership
□ Tax-Exempt Organization
I certify that the information provided on this form is true and accurate to the best of my knowledge.
Print Name: Signature:
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File details come from the government source that posted it. Updated .