Bid_26-07-0711_Invitation_for_Bid_FINAL.pdf

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Attached to
Heavy Equipment State and local contract opportunity
Solicitation number
26-07-0711
Issued by
Virginia

About this file

This is an Invitation for Bid (IFB) issued by the Virginia Sheriffs' Association (VSA) for Heavy Equipment, with bid number 26-07-0711. The procurement is for heavy equipment to be available for bidding during the 2025-2026 contract year, with the bid period open from June 6, 2025, to July 11, 2025, at 12 noon EST. Key dates include a Pre-Bid Conference via Zoom on April 25, 2025, from 10:00 am to 12:00 pm EST, with a requirement to RSVP by April 16, 2025. The contract is set to be effective from August 15, 2025, to August 14, 2026, with the VSA publishing the first draft bid package on April 14, 2025, and the final bid tabulation results on July 15, 2025.

Bidders must submit their proposals electronically through VendorLink, with a minimum 6% discount off MSRP required for all line items. Additional requirements include providing a Certificate of Liability, bank reference, company summary, and manufacturer certification forms. Vendors must also submit government references, with one reference required to be from a public body within Virginia. Insurance requirements include Workers' Compensation, Comprehensive General Liability, Automobile Liability, and other specified coverages, with the VSA to be named as an additional insured. The bid emphasizes a drug-free workplace policy and requires detailed documentation, including financial standing, administrative capabilities, and customer service competencies.

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Other files for this state and local contract opportunity

Other files attached to Heavy Equipment, newest first.
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Bid_26-07-0711_Intent_to_Award_8.12.25.pdf PDF
Bid_26-07-0711_Final_Bid_Package_6.6.25_For_Vendors.pdf PDF
Bid_26-07-0711_Final_Bid_Package_6.6.25_For_Vendors.pdf PDF
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Bid_26-07-0711_Third_Final_Draft_Bid_Package_6.3.25_For_Vendors.pdf PDF
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Bid_26-07-0711_Third_Final_Draft_Bid_Package_6.3.25_For_Vendors.xlsx XLSX spreadsheet
Bid_26-07-0711_Third_Final_Draft_Bid_Package_6.3.25_For_Vendors.xlsx XLSX spreadsheet
Bid_26-07-0711_Second_Draft_Bid_Package_5.8.25_For_Vendors.pdf PDF
Bid_26-07-0711_Second_Draft_Bid_Package_5.8.25_For_Vendors.xlsx XLSX spreadsheet
Bid_26-07-0711_Second_Draft_Bid_Package_5.8.25_For_Vendors.xlsx XLSX spreadsheet
Bid_26-07-0711_Available_Groups_-_5.8.25.pdf PDF
VSA_H.E_Build_&_Option_Sample_Guide_4.15.25.pdf PDF
VSA_H.E_Build_&_Option_Sample_Guide_4.15.25.pdf PDF
VSA_H.E_Build_&_Option_Sample_Guide_4.15.25.pdf PDF
Bid_26-07-0711_First_Draft_Bid_Package_4.14.25_For_Vendors.pdf PDF
Bid_26-07-0711_Available_Groups_-_4.14.25.pdf PDF
Bid_26-07-0711_First_Draft_Bid_Package_4.14.25_For_Vendors.xlsx XLSX spreadsheet
Bid_26-07-0711_Available_Groups_-_4.14.25.pdf PDF
Bid_26-07-0711_Available_Groups_-_4.14.25.pdf PDF
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Bid_26-07-0711_First_Draft_Bid_Package_4.14.25_For_Vendors.pdf PDF
Bid_26-07-0711_Invitation_for_Bid_FINAL.pdf PDF
Bid_26-07-0711_Newspaper_Advertisement.pdf PDF
Bid_26-07-0711_Invitation_for_Bid_FINAL.pdf PDF
Bid_26-07-0711_NAPC_Advertisement_&_Confirmation.pdf PDF
Bid_26-07-0711_Invitation_for_Bid_FINAL.pdf PDF
Bid_26-07-0711_NAPC_Advertisement_&_Confirmation.pdf PDF
Bid_26-07-0711_Newspaper_Advertisement.pdf PDF
Bid_26-07-0711_Newspaper_Advertisement.pdf PDF
26-07-0711_Manufacturer_Certification_Form.pdf PDF
26-07-0711_Heavy_Equipment_-_Required_Documentation.pdf PDF
26-07-0711_Manufacturer_Certification_Form.pdf PDF
26-07-0711_Heavy_Equipment_-_Required_Documentation.pdf PDF
26-07-0711_Heavy_Equipment_-_Required_Documentation.pdf PDF
26-07-0711_Heavy_Equipment_-_Required_Documentation.pdf PDF
26-07-0711_Manufacturer_Certification_Form.pdf PDF
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Bid_26-07-0711_Available_Groups_-_3.14.25.pdf PDF
Bid_26-07-0711_Available_Groups_-_3.14.25.pdf PDF
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2025-2026_VSA_HE_Official_Calendar.pdf PDF
2025-2026_VSA_HE_Solicitation_-_FINAL.pdf PDF
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Text version

INVITATION FOR BID

VIRGINIA SHERIFFS’ ASSOCIATION

BID NUMBER 26-07-0711

HEAVY EQUIPMENT

TABLE OF CONTENTS

I. Bid Calendar

II. Required Documentation Packet – This packet is to be submitted in VendorLink under Bid 26-07-0711 as part of your bid package once the bid period opens.

III. Manufacturer Certification Form – This form is to be submitted in VendorLink under Bid 26-07-0711 as part of your bid package once the bid period opens for each manufacturer you are bidding.

Please ensure the VSA Cooperative Bid Coordinator, Kaylyn Mitman, has your email address on file and you are receiving all correspondence from VendorLink. Kaylyn can be contacted at kmitman@virginiasheriffs.org or (919) 459-6471.

The Pre-Bid Conference will be held via Zoom on April 25th, 2025 from 10:00 am – 12:00 pm EST. Please RSVP to Kaylyn by April 16th, 2025 at kmitman@virginiasheriffs.org. Meeting materials will be provided to all who RSVP.

The First Draft Bid Package will be available in VendorLink on April 14th, 2025. All equipment requests must be submitted to Kaylyn Mitman at kmitman@virginiasheriffs.org by April 1st, 2025 for your products to be included in the First Draft Bid Package. If you have any questions on how to submit your request, please contact Kaylyn.

A copy of the Association’s Terms and Conditions can be found on the Virginia Sheriffs’ Association’s website - https://vasheriff.org/ https://vasheriff.org/procurement/

ALL BIDDING WILL BE COMPLETED ELECTRONICALLY AT:

https://www.myvendorlink.com/external/home

TO REGISTER PLEASE CALL KAYLYN AT 919-459-6471 AND VISIT:

https://www.myvendorlink.com/external/register mailto:kmitman@virginiasheriffs.org mailto:kmitman@virginiasheriffs.org mailto:kmitman@virginiasheriffs.org https://vasheriff.org/ https://www.myvendorlink.com/external/home https://www.myvendorlink.com/external/register

Start Date Due Date

VSA Publishes Solicitation for Vendors March 14, 2025 March 14, 2025

Vendor Registration - All bidders must create an account with VendorLink and be listed as

"Planholder" prior to the bid period opening .

March 14, 2025

June 5, 2025 at 5:00 pm EST

VSA Publishes Invitation for Bid Announcement Publication and Advertisement March 28, 2025 March 28, 2025

VSA Publishes NAPC Advertisement March 28, 2025 March 28, 2025

VSA Publishes Newspaper Advertisement March 28, 2025 March 28, 2025

Start Date Due Date

"Add/Delete" Form due to VSA (kmitman@virginiasheriffs.org) - Requests for any equipment that needs to be available for bidding for the 2025-2026 contract year. This form is available in

VendorLink within the "Documents" section of Bid 26-07-0711.

April 1, 2025 April 1, 2025

VSA Publishes First Draft Bid Package in VendorLink for Vendor Review April 14, 2025 April 14, 2025

Deadline for Vendors to Submit the Pre-Bid Conference RSVP to kmitman@virginiasheriffs.org -

Meeting materials will be provided to all who RSVP April 16, 2025 April 16, 2025

Deadline for Vendors to Respond to the VSA (kmitman@virginiasheriffs.org) regarding the First

Draft Bid Package - All responses must be submitted using the "Add/Delete" Form which is available in VendorLink within the "Documents" section of Bid 26-07-0711 - This response is for any additional changes that need to be made to the list of equipment included in the First Draft

Bid Package that will go out to bid.

April 22, 2025 April 22, 2025

Pre-Bid Conference for all Vendors - Meeting will be held via Zoom.

April 25, 2025 at 10:00 am EST

April 25, 2025 at 12:00 pm EST

Start Date Due Date

VSA Publishes Second Draft Bid Package in VendorLink for Vendor Review May 8, 2025 May 8, 2025

Deadline for Vendors to Respond to the VSA (kmitman@virginiasheriffs.org) regarding the Second

Draft Bid Package - All responses must be submitted using the "Add/Delete" Form which is available in VendorLink within the "Documents" section of Bid 26-07-0711 - This response is for any additional changes that need to be made to the list of equipment included in the Second Draft

Bid Package that will go out to bid.

May 15, 2025 May 15, 2025

Start Date Due Date

VSA Finalizes List of Equipment Eligible for Bidding - Published in VendorLink June 3, 2025 June 3, 2025

Bid Period Open - All bidding must be completed within VendorLink to be considered . June 6, 2025 July 11, 2025 at 12 noon EST

Deadline for Vendors to Submit Bid Package - All pricing and required documents to be submitted within VendorLink .

July 11, 2025 at 12 noon EST

July 11, 2025 at 12 noon EST

Deadline for 5 Government References to complete VSA online Government Reference Form for bidding Vendors.

July 11, 2025 at 12 noon EST

July 11, 2025 at 12 noon EST

VSA Publishes Bid Tabulation Results July 15, 2025 July 15, 2025 by 5:00 pm EST

VSA Review of all Bid Submissions July 16, 2025 August 11, 2025

VSA Publishes Intent to Award/Bidder Review of Award August 12, 2025 August 12, 2025

VSA Announces and Publishes Official Bid Award - All awarded contracts go into effect. August 15, 2025 August 15, 2025

Program Introduction and Solicitation

New/Updated Model Specification Review 1

New/Updated Model Specification Review 2

Bid Finalization and Announcement

Virginia Sheriffs’ Association 2025-2026 Heavy Equipment Calendar

Bid 26-07-0711

FOR SEALED BIDS ON

Heavy Equipment Bid 26-07-0711

Coordinated By:

The Virginia Sheriffs' Association

Submitted For:

Company Name

DEADLINE TO SUBMIT ALL BID REQUIREMENTS:

12:00 NOON EST – July 11, 2025

Solicitation for Bids and Terms & Conditions Signature Page:

By submission of this form, you are hereby certifying that your company agrees to the following:

• Contract Number: 26-07-0711

• Contract Title: Heavy Equipment

• Contract Effective Dates: August 15, 2025 – August 14, 2026

• Bid Period Opens: June 6, 2025

• Bid Period Closes: July 11, 2025 at 12 noon EST

Inquiries: Questions, which may arise as a result of this solicitation, may be addressed to Jason Bennett, VSA Contract Administrator, by email to jbennett@virginiasheriffs.org.

Inquires must be received at least ten (10) business days prior to the due date in order to be considered.

The signatures on page 15 of this document certifies that:

I agree to abide by all conditions of this Invitation for Bids and that I am authorized to sign this bid;

The accompanying bid is not the result of, or affected by, an unlawful act of collusion with another person or company engaged in the same line of business or commerce, or any act of fraud punishable under §18.2-498.1, et. seq. of the Code of Virginia. Furthermore, I understand that fraud and unlawful collusion are crimes under the Virginia Governmental Frauds Act, the Virginia Government Bid Rigging Act, the Virginia Antitrust Act, and Federal Law, and can result in fines, prison sentences, and civil damage awards;

That the accompanying bid is in compliance with applicable provisions of the State and Local Government Conflict of Interests Act (§2.2-3100, et. seq. of the Code of Virginia). Specifically, without limitation, no Virginia Sheriffs’ Association employee/representative or a member of the employee/representative’s immediate family shall have a proscribed interest in a contract; and

In compliance with this Invitation for Bids and to all conditions imposed therein, the undersigned offers and agrees to furnish the goods/services in accordance with this signed bid.

This section is required to complete.

• Complete Legal Name of Firm:

This section is required to complete (Continued from page 2).

• Order from Address:

• Remit to Address:

• Fed ID Number:

Virginia State Corporation Commission Registration Information:

By submission of this form, you are confirming the following information is true for the company in which this bid is being submitted:

The bidder shall check one of the following.

The bidder is:

□ a corporation or other business entity with the following SCC identification number: __________________

-OR-

□ not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust

□ an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the bidder in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from bidder’s out-of-state location)

□ an out-of-state business entity that is including with this bid an opinion of legal counsel which accurately and completely discloses the undersigned bidder’s current contacts with Virginia and describes why those contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles 13.1 or 50 of the Code of Virginia.

□ **NOTE** >> Check this box if you have not completed any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for bids.

Bid Submission Checklist for Vendors:

Note: All bid submissions and documents must be uploaded into VendorLink by 12 noon EST on July 11, 2025 for your company’s bid to be considered. The Association will not accept any pricing or required documents outside of VendorLink.

Below is a list of action items required for your company’s bid submission to be considered:

□ Bid pricing entered in VendorLink for each item you would like to bid - This is not a requirement for items listed as a Catalog Discount.

□ Base price entered includes the required Commission Fee of three quarters of one percent (.0075), shipping/handling/freight, and a minimum discount of 6% off

MSRP.

□ Base price percentage has been entered for each line item you are bidding on and meets the minimum 6% requirement - This is still required if you are bidding a Catalog Discount line item as this will be the percentage offered off MSRP for all catalog items.

□ Option price percentage has been entered for each line item you are bidding on and meets the minimum 6% requirement - This is still required if there are no available options and if you are bidding a Catalog Discount line item.

□ Build Sheet uploaded for each item you would like to bid (No pricing is to be included within this document unless bidding a Catalog Discount item. The brand make and model listed for the item you are bidding MUST match the brand make and model listed within this document)

□ Option Sheet uploaded for each item you would like to bid (This document MUST specify the mandatory minimum discount of 6% off MSRP. Higher discounts may be offered. All model upgrades/downgrades must also be specified. DO NOT list any models that are already listed within the main equipment list)

Please note: If no options are available, you are required to state “NO OPTIONS” on a piece of letterhead or blank document and upload the document stating “NO OPTIONS” within the options file field in VendorLink for that item number.

□ Catalog Discount Submissions – Pricing is not to be entered into the base price field – Pricing must be listed on your build sheet and option sheet. In addition to a build sheet and option sheeting needing to be uploaded, a minimum 6% discount off MSRP for BOTH the Build and Option percentage fields must be entered. If a variety of discount percentages are offered within the catalog, please enter the lowest percentage as a greater discount may always be offered.

Bid Submission Checklist for Vendors (Continued):

□ Additional Documentation Requirements – See page 7.

□ Government Reference Requirements – See page 8.

□ This document has been reviewed and completed in its entirety.

□ This document has signed by all required parties and notarized – See pages 14- 15.

Additional Documentation Requirements:

I acknowledge in addition to submitting this completed document the following are also required to be uploaded into VendorLink by 12:00 noon EST on July 11, 2025.

1. Certificate of Liability: Please contact your insurance agency and request the Certificate Holder section includes the following within the specified sections.

• Description Section: Must include the following program name and bid number:

“VSA Heavy Equipment Procurement Program Bid 26-07-0711”.

• Certificate Holder Section: Must include the following address:

Virginia Sheriffs’ Association 901 East Byrd Street – Suite 1301 Richmond, VA 23219

2. Bank Reference: Please provide a current formal letter from your bank confirming your company is in good financial standing with the bank. This letter must be within the timeframe in which this bid was solicited (see bid calendar).

3. Company Summary: This summary needs to be a current outline of your company’s operations and administrative and customer service competencies.

4. Manufacturer Certification: One (1) form is required per manufacturer you are bidding. If the parent company has a different name other than the brand name listed, please note this on the form. If you are the manufacturer, complete the form as though giving your company permission to sell your product. See example provided in the Build and Option Sheet Sample Guide. The document required to be completed by the manufacturer is available in the “Documents” section of VendorLink.

Government Reference Requirements:

I acknowledge in addition to submitting this completed document, as the bidder I am responsible for contacting 5 different government references and providing the VSA online reference form for their completion by 12:00 noon EST on July 11, 2025.

• 5 Required – One of the five must be a public body located within the

Commonwealth of Virginia. Cooperative Purchasing Programs will not be accepted as a reference, and you must use five (5) different government agencies.

• The Association will let you know when all reference responses have been submitted and no additional are required.

• If you are a current contractor through the VSA Heavy Equipment Procurement Program, government reference responses are not required for Bid 26-07-0711 unless you have been instructed otherwise by the Association.

• Please provide the following link to each of your references to complete:

https://ncsheriffs.org/vsa-government-reference-form-heavy-equipment https://ncsheriffs.org/vsa-government-reference-form-heavy-equipment

Vendor Information:

• Company Name:

• DBA:

• Federal Employer Identification Number (FEIN):

• Company Type:

• Individual (Yes/No) :

• Partnership (Yes/No) :

• Corporation (Yes/No) :

• LLC (Yes/No) :

• Minority Business Enterprise: (Yes/No) :

• Physical Address:

• City, State, Zip:

• States Eligible to Sell Within:

Contacts to Include on Vendor Directory:

• Contact:

• Office Number:

• Cell Phone Number:

• Fax Number:

• Email Address:

• Cell Phone Number:

• Cell Phone Number:

• Cell Phone Number:

Bidder Qualifications:

By submission of this form, you are confirming the following information is true for the company in which this bid is being submitted:

1. Your company is an authorized distributor for all products that are being bid.

2. You have uploaded into VendorLink the Manufacturer Certification Form from each manufacturer confirming your authorized status.

3. You confirm your company is in good credit standing.

4. You confirm your company has the financial means to successfully handle the contractual obligations for the VSA contract.

5. You have uploaded a banking reference and/or a complete financial statement showing your company’s financial competency?

6. You are aware that the VSA reserves the right to conduct onsite inspections of your premises, including inventory. An inspection is to confirm your company’s ability to administer and fulfill contractual requirements, provide replacement parts, and warranty service.

7. You are aware that the VSA reserves the right to award this bid in its entirety or in part, and to make any award determined by the VSA to serve in the best interest of the VSA.

8. You have uploaded into VendorLink a company summary outlining your overall operations, administrative capabilities, and customer service competencies?

Drug-Free Workplace:

By submission of this form, you are hereby certifying that your company agrees to the following:

The Viriginia Sheriffs’ Association shall require in every contract over $10,000 the following provisions:

1. The contractor shall provide a drug-free workplace for its employees.

2. The contractor shall post in conspicuous places, available to its employees and applicants for employment, a statement notifying employees that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the contractor’s workplace and specifying the actions that will be taken against employees for violations of such prohibition.

3. The contractor shall state in all solicitations or advertisements for employees placed by or on behalf of the contractor that the contractor maintains a drug-free workplace.

4. The contractor shall include the provisions of the foregoing clauses in every subcontract or purchase order of over $10,000, so that the provisions will be binding upon each subcontractor or vendor.

Insurance Checklist:

Proposer and Insurance Agent Statement:

We understand the Insurance Requirements of these specifications, as noted by the items checked below, and that evidence of this insurance may be required within five (5) days after bid opening.

1. (REQUIRED) Workers’ Compensation and Employer’s Liability per the statutory limits of the Commonwealth of Virginia.

2. (REQUIRED) Comprehensive General Liability (occurrence form), limits of liability $1,000,000.00 per occurrence for bodily injury property damage to include Premises/Operations; Products, Completed Operations and Contractual Liability.

Contractual Liability and Contractual Indemnity (Hold harmless endorsement exactly as written in “insurance requirements” of specifications). General aggregate $3,000,000.00

3. (REQUIRED) Automobile Liability - $1,000,000.00 each occurrence - owned/non-owned/hired automobiles included.

4. Excess Liability - $ .00 per occurrence to follow the primary coverages.

5. (REQUIRED) The VSA must be named as an additional insured on the liability policies, and it must be stated on the Certificate of Liability (Please provide a pdf version of the Certificate to VSA).

6. (REQUIRED) Other insurance as indicated:

• Builders Risk completed value $

• Liquor Liability $

• Fire Legal Liability $

• Protection and Indemnity $

• Employee Dishonesty Bond $

• (REQUIRED) Other (Garage) $ 1,000,000.00

7. (REQUIRED) Thirty (30) days written cancellation notice required.

8. (REQUIRED) Best’s guide rating B+:VI or better, latest edition.

9. (REQUIRED) The certificate must state the bid number, title, and bidder and insurance agent statement (above).

Terms and Conditions:

The undersigned declares that he or she has read, understands, accepts and will comply with the terms, conditions and specifications of this bid and any addenda issued.

The failure or omission to review this document shall in no way relieve dealer principal or dealer’s authorized agent of obligations with respect to this bid. The submission of a bid and signature below shall be taken as evidence of acceptance of the terms and conditions of this bid.

The undersigned further declares that no other persons other than the dealer/company principal or dealer/company’s authorized agent herein named has any interest in this bid or in the contract to be taken, and that it is made without any connection with any other person or persons making proposal for the same article, and is in all respects fair and without collusion or fraud.

The undersigned further declares that he or she has carefully examined the specifications and is thoroughly familiar with its provisions and with the quality, type and grade of materials required.

The undersigned further declares that he or she has provided a discount on all factory options included in this bid, and such discount will be included in all customer orders.

The undersigned further declares that he or she understands the financial responsibility associated with this bid as stated in the terms and conditions, and further declares that he or she has the ability to meet the financial responsibility associated with this bid. The principals understand the dealership is not guaranteed a profit as a result of a bid award. The dealership may experience a loss of revenue as a result of sales based on their actual bid.

The undersigned further declares that he or she proposes to furnish the articles called for within the specified time in this proposal for the price stated on the bid form, and guarantees that parts and service are available within the Commonwealth of Virginia.

The foregoing instrument was acknowledged before me on the date listed below by the Dealer/Company Principal and Authorized Representative listed below who is personally known to me or who has produced identification and who did take an oath.

Note: All fields below are required.

• Month:

• Date:

• Year:

Note: All fields below are required (Continue from page 14)

Signature of Dealer/Company Principal

Printed Name of Dealer/Company Principal

Signature of Authorized Representative

Printed Name of Authorized Representative

Signature of Notary Public State of

Date Commission Expires County of

(Official Seal or Stamp)

By signing the above, I acknowledge that I have reviewed and accepted the Terms and Conditions contained in pages 1 through 15 of this document and that the information provided herein is true and accurate to the best of my knowledge and belief.

Manufacturer Certification Form

Heavy Equipment Bid 26-07-0711

This form is to be completed for all manufacturers in which your company is bidding.

Vendor (Bidder):

PLEASE NOTE: This certification form must be executed by an authorized employee of the manufacturer ONLY. Dealers/Representatives are not authorized to execute this certification form on behalf of the manufacturer. The manufacturer must execute this certification form even if they are offering their own products. Failure to submit this certification form with your response as required shall result in the disqualification of the response.

The section below is to be completed by the manufacturer representative.

This is to certify that the above vendor/bidder is the manufacturer and/or a manufacturer’s authorized dealer for the following manufacturer in the Commonwealth of Virginia.

Manufacturer Name:

Address:

City, State, Zip:

Contact Information of Representative:

Office Phone: Mobile Phone:

E-mail:

Signature of Manufacturer Representative: Title:

Printed Name of Manufacturer Representative: Date:

Note: Signatures must be physical or timestamped.

Company Name:
Complete Legal Name of Firm:
Check Box4: Off
Check Box5: Off
Check Box6: Off
Order from Address 1:
Order from Address 2:
Order from Address 3:
Remit to Address 1:
Remit to Address 2:
Remit to Address 3:
Fed ID Number:
number:
Check Box7: Off
Check Box8: Off
Check Box9: Off
Check Box10: Off
Check Box11: Off
Check Box13: Off
Check Box14: Off
Check Box15: Off
Check Box16: Off
Check Box17: Off
Check Box18: Off
Check Box19: Off
Check Box20: Off
Check Box21: Off
Check Box22: Off
Check Box23: Off
Company Name_2:
DBA:
Federal Employer Identification Number FEIN:
Individual YesNo:
Partnership YesNo:
Corporation YesNo:
LLC YesNo:
Minority Business Enterprise YesNo:
Physical Address:
States Eligible to Sell Within:
Contact:
Office Number:
Cell Phone Number:
Fax Number:
Email Address:
Contact_2:
Office Number_2:
Cell Phone Number_2:
Fax Number_2:
Email Address_2:
Contact_3:
Office Number_3:
Cell Phone Number_3:
Fax Number_3:
Email Address_3:
Contact_4:
Office Number_4:
Cell Phone Number_4:
Fax Number_4:
Email Address_4:
Excess Liability:
undefined:
undefined_2:
undefined_3:
undefined_4:
undefined_5:
Month:
Year:
Printed Name of DealerCompany Principal:
Printed Name of Authorized Representative:
Date Commission Expires:
State of:
County of:
Signature2_es_:signer:signature:
Signature3_es_:signer:signature:
Vendor Bidder:
Manufacturer Name:
Address:
City State Zip:
Office Phone:
Mobile Phone:
Email:
Title:
Printed Name of Manufacturer Representative:
Date:
Signature1_es_:signer:signature:

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