7-Vendor Information Form - 2024.docx
DOCX document 24 KB Posted
- Solicitation number
- BC-Bid-26-12
- Issued by
- Bergen County, New Jersey
About this file
This is a Vendor Information Form issued by the County of Bergen Department of Administration and Finance, Division of the Treasurer in New Jersey, related to a procurement opportunity for Calcium Hypochlorite Tablets for the 2026 swim season. The form serves as the standardized vendor registration document required for participation in county contracting opportunities. Vendors are required to complete the form with their company information, including legal entity name, business address, authorized official contact details, and preferred method of purchase order delivery. The form requests identification of the remittance address if it differs from the primary business address, along with separate payment contact information and email preferences for invoice submission.
The form includes business classification fields that require vendors to identify their company structure—whether as a sole proprietor, corporation, partnership, limited liability company, or other entity type—and to specify their IRS classification. Additionally, vendors must indicate if their business qualifies for any socioeconomic certifications, including small business, minority-owned, women-owned, or veteran-owned designations. The form requires vendors to certify the accuracy of all information provided and obtain signatures from authorized company representatives. This standardized documentation enables Bergen County to maintain current vendor records and ensure compliance with procurement regulations prior to contract award for the specified product.
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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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