Vendor Profile Form.pdf
PDF 95 KB Posted
- Attached to
- 2026 Walleye Fingerlings
- Solicitation number
- DEEP091526CM
- Issued by
- Connecticut
About this file
This document is the State of Connecticut Agency Vendor Form (SP-26NB), a fill-in PDF form used to register vendors seeking to conduct business with Connecticut state agencies. The form collects comprehensive vendor information including legal business name, taxpayer identification numbers, business entity type, primary and secondary business classifications, and incorporation details for corporations. Vendors must provide complete business addresses, remittance addresses if different from the primary location, and detailed contact information including multiple phone numbers, fax numbers, and email addresses. The form requires the written signature of an authorized representative and specifies that all sections must be completed and returned by the vendor. Additionally, the form inquires whether the business holds certifications as a Connecticut Department of Administrative Services (DAS) certified small business enterprise or a Connecticut Department of Transportation (DOT) certified disadvantaged business enterprise, and requests disclosure if the vendor is a state employee.
The vendor form serves as a prerequisite registration document rather than a procurement solicitation itself. It does not establish pricing terms, set-asides, or contract specifics but instead functions as a registration mechanism to verify vendor eligibility and capability to conduct business with the state. The form notes that no verification of entered information occurs during submission, placing full responsibility on vendors for accuracy. Vendors must use Adobe Reader software to complete, save, and print the form, with specific instructions provided for proper form handling. The document emphasizes that the information page is not to be printed or submitted with the actual form submission, and designates a purchase order distribution email address for receiving procurement notices.
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
Fill-in Forms Information for the SP-26NB and W-9 Forms
Overview There is no verification of the information you enter. You are responsible for entering all information.
Some information must be handwritten on the form.
Software Requirements To view, complete and print the following fill-in PDF forms, you will need the freely available Adobe
Reader software installed on your computer.
Adobe Reader Adobe PDF files are a means to distribute publications and other information. To fill-in, download and print a PDF file, you will need to have the Adobe Reader software installed. You can download the latest version of Adobe Reader FREE from the Adobe Reader download page on Adobe's Web site.
Completing the form on your PC When positioning the cursor on a fill-in area, the cursor will change appearance.
The I-beam pointer allows you to type text.
The hand pointer allows you to select a check box or button.
Enter the appropriate data in each box or field.
To move from one field to the next, press the Tab key.
You can also use your mouse to move your cursor from field to field. Place your cursor in the field you want to fill in, then left-click.
Some fields limit the maximum number of characters you can enter and may automatically advance to the next field.
For additional help with fill-in forms, see the Adobe Reader's on-line help information at:
http://www.adobe.com/support/reader/
Saving a Form
When saving a file, be sure to use the Save function of Adobe Reader rather than the web browser's save.
Printing a Form
When printing Adobe PDF files from within your web browser, whether you are printing a blank form or printing a form after filling it in from your PC, use the print button at the left end of the special
Adobe Acrobat tool bar, which appears immediately above the viewing window.
THIS PAGE IS FOR INFORMATION ONLY AND DOES NOT NEED TO BE PRINTED NOR SUBMITTED WITH THE
FOLLOWING FORMS.
http://www.adobe.com/products/acrobat/readstep2.html� http://www.adobe.com/products/acrobat/readstep2.html http://www.adobe.com/products/acrobat/readstep2.html http://www.adobe.com/products/acrobat/readstep2.html http://www.adobe.com/support/reader/
STATE OF CONNECTICUT - AGENCY VENDOR FORM
IMPORTANT: ALL parts of this form must be completed, signed and returned by the vendor.
READ OMPLETE AREFULLY SP-26NB-IPDF Rev. 4/10 & C C
COMPLETE VENDOR LEGAL BUSINESS NAME Taxpayer ID # (TIN):
SSN FEIN
WRITE/TYPE SSN/FEIN NUMBER ABOVE
BUSINESS NAME, TRADE NAME, DOING BUSINESS AS (IF DIFFERENT FROM ABOVE)
BUSINESS ENTITY: CORPORATION LLC CORPORATION LLC PARTNERSHIP LLC SINGLE MEMBER ENTITY
NON-PROFIT PARTNERSHIP INDIVIDUAL/SOLE PROPRIETOR
NOTE: IF INDIVIDUAL/SOLE PROPRIETOR, INDIVIDUAL’S NAME (AS OWNER) MUST APPEAR IN THE LEGAL BUSINES
BUSINESS TYPE: A. SALE OF COMMODITIES B. MEDICAL SERVICES C. ATTORNEY FEES D. R
(R
E. OTHER (DESCRIBE IN DETAIL)
UNDER THIS TIN, WHAT IS THE PRIMARY TYPE OF BUSINESS YOU PROVIDE TO THE STATE? (ENTER LETTER FROM
UNDER THIS TIN, WHAT OTHER TYPES OF BUSINESS MIGHT YOU PROVIDE TO THE STATE? (ENTER LETTER FROM
NOTE: IF YOUR BUSINESS IS A PARTNERSHIP, YOU MUST ATTACH THE NAMES AND TITLES OF ALL PARTNERS TO Y
NOTE: IF YOUR BUSINESS IS A CORPORATION, IN WHICH STATE ARE YOU INCORPORATED?
VENDOR ADDRESS STREET CITY STA
Add Additional Business Address & Contact information on back of this form.
VENDOR E-MAIL ADDRESS
VENDOR WEB SITE
REMITTANCE INFORMATION: INDICATE BELOW THE REMITTANCE ADDRESS OF YOUR BUSINESS. SAME AS VENDO
REMIT ADDRESS STREET CITY STA
CONTACT INFORMATION: NAME (TYPE OR PRINT)
1ST BUSINESS PHONE: Ext. # HOME PHONE:
2ND BUSINESS PHONE: Ext. #� 1ST PAGER:
CELLULAR: 2ND PAGER:
1ST FAX NUMBER:� TOLL FREE PHONE:
2ND FAX NUMBER:� TELEX:
WRITTEN SIGNATURE OF PERSON AUTHORIZED TO SIGN PROPOSALS ON BEHALF OF THE ABOVE NAMED VENDOR
SIGN HERE
TYPE OR PRINT NAME OF AUTHORIZED PERSON
TITLE OF AUTHORIZED PER
IS YOUR BUSINESS CURRENTLY A DAS CERTIFIED SMALL BUSINESS ENTERPRISE? YES (ATTACH COPY OF CE
IS YOUR BUSINESS CURRENTLY A CT DOT CERTIFIED DISADVANTAGED BUSINESS ENTERPRISE (DBE)? YES
IF YOU ARE A STATE EMPLOYEE, INDICATE YOUR POSITION,
AGENCY & AGENCY ADDRESS
PURCHASE ORDER DISTRIBUTION:
(E-MAIL ADDRESS)
NOTE: THE E-MAIL ADDRESS INDICATED IMMEDIATELY ABOVE WILL BE USED TO FORWARD PURCHASE ORDER
ADD FURTHER BUSINESS ADDRESS, E-MAIL & CONTACT INFORMATION ON SEPARATE SHE
G
OVERNMENT
S NAME BLOCK ABOVE.
ENTAL OF PROPERTY
EAL ESTATE & EQUIPMENT)
ABOVE) ➝
ABOVE) ➝
OUR BID SUBMISSION.
TE ZIP CODE
R ADDRESS ABOVE.
TE ZIP CODE
DATE EXECUTED
SON
RTIFICATE) NO
NO
S TO YOUR BUSINESS.
ET IF REQUIRED
PacholskiJ Note None set by PacholskiJ
PacholskiJ Note None set by PacholskiJ
PacholskiJ Note MigrationNone set by PacholskiJ
PacholskiJ Note MigrationNone set by PacholskiJ
| Fill-in Forms Information |
| Agency Vendor Form (SP-26NB) |
| Taxpayer ID SSN CB: |
| 0: Off |
| Vendor City TX: |
| 0: |
| Vendor State TX: |
| 0: |
| Vendor Zip Code TX: |
| 0: |
| 1st Business Phone Ext: |
| TX: |
| 2nd Business Phone Ext: |
| TX: |
| Certified SBE YES CB: |
| 0: |
| 0: Off |
| Legal Business Name TX: |
| Taxpayer ID FEIN CB: Off |
| Taxpayer ID # TX: |
| Trade Name, DBA TX: |
| Business Entity Corp CB: Off |
| Business Entity LLC Corp CB: Off |
| Business Entity LLC Partnership CB: Off |
| Business Entity LLC Single Member CB: Off |
| Business Entity Non-Profit CB: Off |
| Business Entity Partnership CB: Off |
| Business Entity Ind/Sole Prop CB: Off |
| Business Type Other TX: |
| Primary Business Type TX: |
| Other Business Type TX: |
| State of Incorporation TX: |
| Vendor Street Address TX: |
| E-mail Address TX: |
| Web Site Name TX: |
| Remit Same Vendor Address CB: Off |
| Remit Street Address TX: |
| Remit City TX: |
| Remit State TX: |
| Remit Zip Code TX: |
| Contact Information TX: |
| 1st Business Phone TXPH: |
| 2nd Business Phone TXPH: |
| Cell Phone TXPH: |
| 1st Fax Phone TXPH: |
| 2nd Fax Phone TXPH: |
| Home Phone TXPH: |
| 1st Pager NumberTX: |
| 2nd Pager NumberTX: |
| Toll Free Phone TXPH: |
| TELEX NumberTX: |
| Date Executed DA mm/dd/yyyy: |
| Authorized Person TX: |
| Authorized Person's Title TX: |
| Certified SBE NO CB: Off |
| DOT Certified DBE YES CB: Off |
| DOT Certified DBE NO CB: Off |
| State Employee Position TX: |
| State Employee Agency Info TX: |
| PO Distribution E-mail Address TX: |
| Overflow TX: |
| Clear Form BU: |
| Govt CB: Off |
File details come from the government source that posted it. Updated .