9-Vendor Information Form - 2024.docx
DOCX document 24 KB Posted
- Solicitation number
- BC-BID-26-17
- Issued by
- Bergen County, New Jersey
About this file
This is a Vendor Information Form from the County of Bergen, New Jersey, Department of Administration and Finance, Division of the Treasurer, related to a procurement for the Bergen County Sheriff's Office. The form is designed to collect essential vendor registration data required for participation in county contracting, specifically for Bid BC-BID-26-17, which involves the supply and delivery of one Harley Davidson 26 FLTRXP Road Glide Motorcycle. The procurement includes extension of pricing to New Jersey Cooperative Purchasing Alliance members for a 24-month period commencing from the date of award.
The form requests standard vendor information including company name, business address, authorized official contact details, and remittance address if different from the primary address. Vendors must specify their business classification, including options such as small business status, minority ownership, women ownership, veteran ownership, and IRS entity type (sole proprietorship, C-Corporation, S-Corporation, Partnership, Limited Liability Corporation, or Tax-Exempt Organization). The form also allows vendors to indicate their preference for electronic delivery of purchase orders and requires certification that all provided information is accurate and truthful.
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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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