8-11 - Required Document - Vendor Supplemental Information.pdf
PDF 1 MB Posted
- Solicitation number
- 26-50-A
- Issued by
- Denton County, Little Cypress CDP, Texas
About this file
This is a Vendor Supplemental Information form required by the City of Lewisville, Texas for contract development related to an Annual Contract for Water & Wastewater Chemical - Activated Carbon. The form serves as a standardized document to collect essential vendor information prior to contract execution. Vendors must provide details regarding their state of formation, authorized contract signatories, implementation contacts, and notice recipients, along with their complete business addresses and contact information. The form requires vendors to identify their business structure, whether as a sole proprietorship, general partnership, limited partnership, corporation, limited liability company, or other entity type, and to provide corresponding legal names and physical business addresses.
The supplemental information form also requires vendors to disclose employee count (10 or more full-time employees), publicly traded status, and subsidiary relationships with publicly traded companies. For vendors operating in Texas, the form mandates registration verification with the Texas Secretary of State, requiring submission of supporting documentation or screenshots confirming business registration and any alternative names under which the business is registered. All submitted information must be certified as true and correct by an authorized representative through signature, printed name, title, and date. This documentation is essential for contract award consideration and must be completed in compliance with Local Government Code Chapter 252 and Americans with Disabilities Act requirements applicable to goods and services provided to the City of Lewisville.
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VENDOR SUPPLEMENTAL INFORMATION
The following information is required for contract development.
1. In what state was your business formed?
2. Provide the following information for the person authorized to execute contracts on behalf of your organization:
Name Title
Email Address Telephone No.
Mailing Address. _ _ City _ _ State Zip
3. Provide the following information for the contact person authorized to implement this contract on behalf of your organization:
Name
Email Address_
Mailing Address
Title
Telephone No
City_ State Ziq
4. Provide the following information for the person authorized to receive notices and communications regarding this contract on behalf of your organization:
Name Title
Email Address Telephone No
Physical Business Address City_
Notices and communications will be mailed to this physical address
5. Select and complete one of the following:
a. Sole Proprietorship
i. Legal name of Sole Proprietor:
ii. Physical business address:
City State
73 General Partnership
i. Legal name of Partnership:
ii. Physical business address:
City_
State_ Zip
State Zip _ _ .
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Updated March 24, 2022 Page 1 of 2
VENDOR SUPPLEMENTAL INFORMATION
C. Limited Partnership e.
f.
o
1. Legal name of Limited Partnership:
ii. General Partner( s):
If a legal entity, name of the entity:.
If an individual, name of the individual:
iii. Physical business address:
City
Corporation
i. Legal name of Corporation:
ii. Physical business address_
City
State
State
Limited Liability Company
i. Legal name of Limited Liability Company:
ii. Physical business address
City State
Other Entity ( not listed)
i. Legal name and type of Company:
ii. Physical business address.
Zip
Zip
Zip
City State_ _ _ Zip
6. Does your business have 10 or more full- time employees? No Yes
7. a. Are you a publicly traded business? No Yes — where traded:
b. Are you a wholly owned subsidiary of a publicly traded business? No Yes — which publicly traded business:_
8. a. Is your business registered with the Texas Secretary of State? No Yes
b. If yes, please provide records or screenshot( s) from the Texas Secretary of State' s website reflecting the name or names for which your business has been registered.
In signing this form, I acknowledge that I have read the above and state that the information contained therein is true and correct.
Signature:
Print Name:
Date:
Print Title:
Updated March 24, 2022
File details come from the government source that posted it. Updated .