Vendor Application Packet.pdf

City of Oceanside

VENDOR APPLICATION

All vendors working for the City of Oceanside are required to complete and submit the following forms and documentation as outlined below PRIOR to doing business with the City. A vendor is defined as a person or company that sells goods or provides a service to the City. A Professional Service Agreement (PSA), Public Agency Contract, Purchase Orders, etc. does not replace the requirement for completing a Vendor Application Packet. This vendor application packet represents the basic form of a contract.

Please complete this entire packet which includes the following:

1. Page 1 – Vendor Information Form

2. Page 2 – Indemnification Agreement/Insurance Requirements

3. Page 3 – Signed W-9 Form – This form certifies, under penalty of perjury, that the Taxpayer Identification Number is correct and said vendor is not subject to backup withholdings. IRS Code Section 6109 requires vendors to provide the City with the entity’s name, taxpayer identification, and ownership status. Payments may be delayed and/or 31% Federal Income Tax will be withheld if vendor fails to submit an IRS W-9 form.

4. Page 9 – Electronic Banking Direct Deposit Form (optional)

Return ALL documentation to your representative you will be working with in the City

Questions? Contact your representative at the City directly, or the Risk Management department.

Email: Vendors@Oceansideca.org Phone: 760-435-3860

VENDOR INFORMATION

Date: NAICS Code: Vendor No:

Vendor Name: DBA:

Business Physical Address:

City: State: Zip Code:

Sales Contact: Email Add:

Sales Contact Phone No: Ext:

Office Contact: Email Add:

Office Contact Phone No: Ext:

Website Address: Fax No:

Remittance Address (If different from above):

City: State: Zip Code:

Specific Services/Work Provided:

Independent Contractor: Yes No Tax ID, or if applicable, SS#:

City Employee & Dept You Are Working With:

For City Use Only

New Vendor: Yes Contract: Yes No If yes, attach copy of contract.

For Financial Services Department Use Only

V# VT: Date: Init:

Requested By: Dept: Ext:

Dept Authorized Signature: Date:

Risk Authorized Signature: Date:

Revised June 2020 mailto:Vendors@Oceansideca.org

Vendor Name:

INSURANCE REQUIREMENTS

The City may require a vendor to provide specific insurance as outlined below. The City reserves the right to increase the minimum insurance requirements listed below, or require other types of insurance, not listed below, based on the type of work or services the vendor will be performing for the City.

The minimum insurance and/or requirements are:

During the term of this written agreement, VENDOR shall maintain in full force, the insurance and limits specified below, as deemed applicable.

a) Comprehensive General Liability Insurance OR Commercial General Liability Insurance with a $2,000,000 combined single limit for each occurrence and $4,000,000 General Aggregate

b) Additional Insured Endorsement naming the City of Oceanside as an additional insured on the General Liability policy (CG 20 10 or equivalent) for ongoing operations.

c) Additional Insured Endorsement naming the City of Oceanside as an additional insurance on the General Liability policy (CG 20 37 or equivalent) for completed operations (if applicable)

d) Primary and Non-Contributory endorsement for the General Liability policy

e) Waiver of Subrogation for the General Liability policy

f) Comprehensive Auto Liability (including owned, non-owned and hired automobile hazards) with a $1,000,000 combined single limit for each occurrence

g) Workers’ Compensation and Employer's Liability complying with any statutory requirements, or proof of exemption of such coverage

h) Waiver of Subrogation for the Workers’ Compensation policy

i) Errors & Omissions with a $2,000,000 minimum coverage for each occurrence (if applicable)

j) Cyber Liability Policy with a $2,000,000 combined single limit for each occurrence (if applicable)

k) Pollution Liability Policy with a $2,000,000 limit for each occurrence (if applicable)

All certificates of insurance need to have the “CERTIFICATE HOLDER” box to read:

300 N Coast Hwy Oceanside, CA 92054

INDEMNITY AGREEMENT

"VENDOR'S INDEMNIFICATION OF CITY. To the greatest extent allowed by law, VENDOR shall indemnify and hold harmless the CITY and its officers, agents and employees against all claims, demands or liability for damages to persons or property arising out of or resulting from VENDOR's performance under any agreement with the CITY, except for those claims arising from the willful misconduct, sole negligence or active negligence of the CITY, its officers, agents, or employees. VENDOR'S indemnification shall include any and all costs, expenses, attorney's fees, expert fees and liability assessed against or incurred by the CITY, its officers, agents, or employees in defending against such claims or lawsuits, whether the same proceed to judgment or not. Further, VENDOR at its own expense shall, upon written request by the CITY, defend any such suit or action brought against the CITY, its officers, agents, or employees resulting or arising from the conduct, tortious acts or omissions of the VENDOR. VENDOR'S indemnification of CITY shall not be limited by any prior or subsequent declaration by the VENDOR."

The undersigned is authorized to, and hereby does, agree to the above terms and conditions on behalf of the Vendor.

Signature

Print Name

Date

Title

Revised: June 2020