HomeMy WebLinkAboutAttachment CAttachment C - Vendor Information Sheet
Vendor Information Sheet
1A. / -003 7 2
Federal Employer Identification Number
Or
Owners Social Security Number
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Name of Firm ndividual(s), Partners or Corporation
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Street Address
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City State Zip Code
3. Ownership Disclosure
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ATTACHMENT C
2. Telephone/Fax/Contact Person
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Telephone number
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Fax number
Contact Person
If the contract or business transaction is with a corporation, partnership, sole proprietorship,or joint venture, the full legal name
and business address shall be provided for the chief officer, director, or owner who holds, directly or indirectly the majority of the
stock or ownership. If the contract or business transaction is with a trust, the full legal name and address shall be provided for
each trustee and each beneficiary. Post Office addresses are not acceptable.
Name Name
Title
Address
,Gender
Race -
ethnicity
Stock Ownership
A)//11.
NOTE: The information provided by the vendor on this form should be consistent with that provided on the "Vendor's
Application". All vendors must have a current vendor's application on file with M-DCPS, and have provided information and/or be
familiar with M-DCPS' policy regarding the following: (a) Employment Disclosure, (b) Drug Free Workplace, (c) Family Leave
Policy, (d) Code of Business Ethics, (e) Conflict of Interest, (f) Perception, (g) Gratuities, and (h) Business Meals. Failure to
provide M-DCPS a current vendor application may cause the vendor not to be awarded any new business with M-DCPS.
Vendor applications can be downloaded at: http://procurement.dadeschools.net