VENDOR REGISTRATION FORMcintimha.com/wp-content/uploads/2018/09/Vendor... · 2019. 5. 6. · VENDOR...
Transcript of VENDOR REGISTRATION FORMcintimha.com/wp-content/uploads/2018/09/Vendor... · 2019. 5. 6. · VENDOR...
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VENDOR REGISTRATION FORM
GENERAL INFORMATION (All fields required except Fax#)
Vendor Name:
Type of Business: Administrative/Professional Services Construction Goods/Services/Equipment
Street Address:
City:
State: Zip Code:
Phone:
Other Phone:
E-mail:
Fax#:
Contact Person:
Contact Person’s Title:
Number of Years Company has been in Business: Number of Employees:
BUSINESS CLASSIFICATION (Must select at least 1)
Taxpayer Identification Number or Social Security Number:
Individual/Sole Proprietorship:
Partnership:
Joint Venture:
Not-for-Profit:
Corporation:
State of Incorporation:
Resident Owned Business: Other:
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VENDOR REGISTRATION FORM
ECONOMIC INCLUSION (Must select at least 1)
Certifying documentation or a notarized declaration must be provided to CMHA to prove
status:
Not Applicable:
Disabled Owned:
Small Business Enterprise:
Veteran Owned:
Women Owned (at least 51%): Minority Owned (at least 51%):
Section 3 Business Concern: What is this?
VENDORS SERVICES AND/OR PRODUCTS (Must select at least 1)
Please specify the type of service(s) or product(s) that your business provides: Accessories and Parts
Accounting
ADA Compliance
Administrative/Secretarial
Appraisal (Real Property)
Architecture/Engineering
Asphalt Repair Automobile Supplies
Cabinet Installation
Carpet Cleaning
Catering
Chemicals
Collections
Community Support
Computer Software
Computers, Peripherals
Concrete Repair
Construction Management
Construction: Exterior Renovation
Construction: Interior Renovation
Construction: New
Construction: Repair
Consulting (Various)
Copiers
Data Entry
Demolition
Electrical Supplies
Elevators
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VENDOR REGISTRATION FORM
VENDORS SERVICES AND/OR PRODUCTS (Must select at least 1) Please specify the type of service(s) or product(s) that your business provides: Employee Pre-employment screening
Employee Benefits
Energy Services – Building Facilities
Engineering Planning Design: Civil – General
Engineering Planning Design: Civil – Transportation
Engineering Planning Design: Environmental
Engineering Planning Design: Geotechnical
Engineering Planning Design: Hazardous
Engineering Planning Design: Mechanical
Engineering Planning Design: Sanitary
Engineering Planning Design: Structural
Engineering Planning Design: Civil - Hydraulics
Equipment Small Tools
Financial
Fire Repair Restoration
Fire Suppression and Inspection
Flooring
Grounds Equipment
Hazardous Materials Removal
Heating Parts
HVAC
Insurance
Janitorial Services
Janitorial Supplies
Land Acquisition
Land Surveying
Landscape Architecture
Landscaping Services
Legal
Locks and Supplies
Lumber
Make Ready: Vacancy Prep Unit Turnover
Masonry
Meetings and Events
Moving and Packing
Mowing Services
Office Furniture
Office Supplies
Paint and Painting Supplies
Playgrounds
Plumbing
Plumbing Supplies
Printing and Graphic Services
Promotional and Event Services
Public Relations and Marketing Services
Real Estate Appraisals
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VENDOR REGISTRATION FORM
VENDORS SERVICES AND/OR PRODUCTS (Must select at least 1) Please specify the type of service(s) or product(s) that your business provides: Refrigerator Parts
Residential Cleaning
Roofing
Security Alarm Systems
Security Guards
Siding
Signs
Skills/Unskilled Labor
Storage
Structural Supplies
Substance Abuse Counseling Temporary Employment Services
Tools
TPA
Training
Uniforms
Vending Services
Waste Removal
Water Repair Restoration
Web Services
Other
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VENDOR REGISTRATION FORM
REFERENCES (Must enter at least 1 reference)
Please provide references (within the last 12 months) for the services or goods that your business provides:
1. Company:
Contact Name:
Phone:
E-mail:
2. Company:
Contact Name:
Phone:
E-mail:
3. Company:
Contact Name:
Phone:
E-mail:
DISCLAIMER
The completion and submission of the Vendor Registration Form does not guarantee any minimum or maximum amount of work for a Vendor. It simply means that a Vendor is registered to conduct business with CMHA as opportunities are made available. At that time, the Vendor may have the opportunity to submit a bid, quote or proposal. Likewise, the submission of a bid, quote or proposal does not guarantee any Vendor the right to an award as all procurement activity conducted by CMHA must be in full compliance with the following regulations:
• 2 CFR Part 200• HUD Procurement Handbook 7460.8 REV 2
• CMHA’s Procurement Policy and Procedures
For registrations you must submit a W-9 Form. To complete the form click here.
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