9-Vendor Information Form - 2024.docx
DOCX document 24 KB Posted
- Attached to
- Exotic Animal Veterinarian Consultant
- Solicitation number
- BC-RFQ-25-011
- Issued by
- Bergen County, New Jersey
About this file
This document is a Vendor Information Form from the Bergen County Department of Administration and Finance in New Jersey, specifically from the Division of the Treasurer located in Hackensack. The form is associated with a Request for Proposals (RFP) for an Exotic Animal Veterinarian Consultant position serving the Bergen County Department of Parks and Recreation, specifically for the Van Saun Zoological Park in Paramus and the James McFaul Environmental Center in Wyckoff.
The vendor information form captures critical business classification details, requiring vendors to specify their business type (such as small business, minority owned, women owned, etc.), IRS classification (C-Corp, S-Corp, Partnership), and contact information. The form mandates completion of key fields including company name, address, authorized official details, and provides options for payment communication preferences. Vendors must certify the accuracy of their submitted information through a signature, with the form serving as a standard procurement document for potential contractors seeking to do business with Bergen County.
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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 .