Form_7.16_-_Representative_Certification_Form.pdf
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- Solicitation number
- ITB-26-18-CW
- Issued by
- Volusia County, Florida
About this file
This is a Representative Certification Form (Form 7.16) for the City of Port Orange, Florida, related to a Mitigation Reconstruction of a Flood Prone Home Project. The form requires respondents to provide official company information, including company name, mailing address with zip code plus four, telephone numbers (voice and facsimile), website URL, and designated company contact for contract management. The designated contact must include name, telephone number with extension, facsimile number, and email address. All respondents are required to complete and submit a Federal Form W-9 (Taxpayer Identification Form) along with their bid submission.
This certification form serves as a mandatory administrative document to verify contractor eligibility and establish communication protocols for the home rebuild project, which involves installation of a new elevated manufactured home in a Port Orange manufactured home park community. The form does not specify pricing, contract term, award dates, or other substantive project details, functioning instead as a preliminary documentation requirement to establish the contractor's official business information and tax identification status prior to bid evaluation.
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Text version
TAXPAYER IDENTIFICATION
Form 7.16
REPRESENTATIONS/CERTIFICATIONS
Respondent must complete Federal Form W-9 and submit it with their bid.
OFFICIAL COMPANY INFORMATION AS REGISTERED (Type/Print}
COMPANY NAME:
MAILING ADDRESS:
(City)
TELEPHONE NO.:
(State)
EXTENSION:
(Zip Code+ 4)
(Toll-Free Preferred) VOICE:
L-- -------------' �------�
WEBSITE URL:
OTHER: FAX:
COMPANY CONTACT FOR CONTRACT MANAGEMENT (Type/Print)
NAME:
TELEPHONE NO.:
(Toll-Free Preferred) VOICE: EXTENSION:
OTHER: FAX:
EMAIL ADDRESS:
File details come from the government source that posted it. Updated .