RFQ_24_25-10_Attachment_5_-_Vendor_Information_Form_12_Fillable_Revised_11_30_2022.pdf
PDF 265 KB Posted
- Solicitation number
- RFQ 24/25-10
- Issued by
- Seminole County, Florida
About this file
This is a Vendor Information Form used by the City of Sanford, Florida for vendor registration and qualification purposes related to state and local contract opportunities. The form requires vendors to provide comprehensive business information including remittance details, primary vendor information, contact personnel, Federal ID or Social Security number, and banking information for Electronic Funds Transfer (EFT) enrollment. Vendors must describe the types of services they provide and include relevant commodity codes. The form mandates completion of all sections, submission of a W-9 form, vendor registration confirmation from the Florida Department of State (HTTPS://DOS.MYFLORIDA.COM), and selection of payment method options. Vendors must obtain a valid signature from an authorized company representative and submit the completed form via mail, fax, or email as directed by the requesting individual.
The form includes a "For City Staff Use Only" section where municipal personnel assign appropriate commodity and sub-commodity codes to categorize vendor services within the city's procurement system. Vendors seeking EFT payment must complete additional banking information including bank name, ABA number, and account details, with notification that an initial pre-note payment with zero balance will be sent to verify banking information. The form explicitly states that incomplete or unclear submissions will not be accepted and will be returned to appropriate departments. Updated as of November 2022, this form is part of the city's standard vendor qualification and registration process for procurement activities, including the Design Build Main Water Treatment Plant Improvements project valued at approximately $48.5 million.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Select one of the above
Remittance Name
Address P.O. Box or Street Address
City State Zip
Tel Fax: Contact
Federal I.D. No. - Social Security No_______-______-________
Name on Checks Name on Checks Required
Vendor Name
Address P.O. Box or Street Address
City State Zip
Country Tel Fax
Contact Email
Web Address
Vendor Name
Address P.O. Box or Street Address
City State Zip
Tel Fax Contact
Email address Web Address
►►NOTE: ALL ABOVE SECTIONS MUST COMPLETED AND INCLUDE A CONFIRMATION OR
REGISTRATION FROM HTTPS://DOS.MYFLORIDA.COM AND W-9 FORM, OPTION FOR ACH PAYMENT.
NOTE: COMPLETION INSTRUCTIONS: Clear copies, incomplete forms will not be accepted. Please complete these forms and return by either Mail, Fax or Email to address as instructed by the requesting individual: Attention
Updated 11/2022
NEW -CHANGE- VENDOR #VENDOR INFORMATION FORM
VENDOR AUTHORIZED SIGNATURE MUST have signature!
Vendor Signature: ___________________________ Date
Display Purchase Order Information
Display Vendor Bid Information https://dos.myflorida.com/
. Vendor: Describe what type of services you provide below; include commodity codes.
FOR CITY STAFF USE ONLY: Must be completed by City Staff only!
Please use the H.T.E or the City's intranet to get the commodities and sub-commodities write the number below that pertains to this vendor submit this with your vendor form. Incomplete forms will be forwarded to the appropriate departments. Thank you, Purchasing Division.
Commodity Sub-Commodity
Must be completed by the Department:
Requested by ______________________________________________________________________________
Dept./Division __________________________________________________ Date: ____________________
Electronic Funds Transfer (EFT) Enrollment Form If you wish to enroll in EFT you MUST fill out the below information
Bank Name:
Phone Number: ABA #
Account #________________________________________________________________________
Vendor Name:
Email address:
Email address used for payment notifications: Required
The first biweekly EFT will be a PRE-NOTE, which will be sent to the above email address with a zero balance. Please provide the City with an updated email address should you have any staff changes in the future.
\\SAN-CH-PRN\Finance_Dept\Purchasing\A-Purchasing Docs\Vendor Info_Tax Exempt_CityW9 Revised 11/30/2022 file://SAN-CH-PRN/Finance_Dept/Purchasing/A-Purchasing%20Docs/Vendor%20Info_Tax%20Exempt_CityW9
| Select one of the above |
| Updated 11/2022 |
| If you wish to enroll in EFT you MUST fill out the below information |
| Remittance Name: |
| Address: |
| City: |
| State: |
| Zip: |
| Tel: |
| Fax: |
| Contact: |
| Email: |
| Federal ID No: |
| undefined: |
| Name on Checks: |
| Vendor Name: |
| Address_2: |
| City_2: |
| State_2: |
| Zip_2: |
| Country: |
| Tel_2: |
| Fax_2: |
| Contact_2: |
| Email_2: |
| Web Address: |
| Vendor Name_2: |
| Address_3: |
| City_3: |
| State_3: |
| Zip_3: |
| Tel_3: |
| Fax_3: |
| Contact_3: |
| Email address: |
| Web Address_2: |
| Date: |
| Vendor Describe what type of services you provide below include commodity codes 1: |
| Vendor Describe what type of services you provide below include commodity codes 2: |
| undefined_2: |
| FOR CITY STAFF USE ONLY Must be completed by City Staff only: |
| Commodity 1: |
| Commodity 2: |
| Commodity 3: |
| Commodity 4: |
| Commodity 5: |
| Commodity 6: |
| Commodity 7: |
| Commodity 8: |
| Commodity 9: |
| Commodity 10: |
| Commodity 11: |
| undefined_3: |
| undefined_4: |
| undefined_5: |
| undefined_6: |
| undefined_7: |
| undefined_8: |
| undefined_9: |
| undefined_10: |
| undefined_11: |
| undefined_12: |
| undefined_13: |
| Requested by: |
| DeptDivision: |
| Date_2: |
| Bank Name: |
| Phone Number: |
| ABA: |
| Account: |
| Vendor Name_3: |
| Email address_2: |
| complete these forms and return by either Mail Fax or Email to address as instructed by the: |
| Check Box2: Off |
| Check Box3: Off |
| Text4: |
File details come from the government source that posted it. Updated .