Supplier information form 05 15

Page 1

Suppliers who are interested in bidding on and/or supplying products or services to the District should fill out this form as completely as possible, attaching information about your company (i.e., background, financial reports, etc.), then submit all documents to the address at the bottom of this form. You may then be contacted when your particular product or service is required. This Supplier Information Form will remain active for a period of three years. Supplier is responsible for resubmitting. Completion/submission of this form does not imply nor guarantee work with the District. Contact Person

PO Box and Physical Address

E-mail Address

City/State/Zip

Telephone and/or Mobile #

Online Website Address

Fax #

Ownership of Business

Partnership

State of Corporation

Corporation

Federal Tax Identification #

Commodity Type

Supplier Name

FOR TID USE ONLY:

SUPPLIER INFORMATION FORM

Sole Proprietorship

Payment Terms

Shipping Terms

W-9 Attached

Number of years in business

Number of employees

If from out of state, does your company collect California State Sales Tax?

Yes

No

Does your company have online order tracking capability?

Yes

No

Is your catalog/line card/price list attached?

Yes

No

Describe your products or services (check all that apply): PARTS: Electrical Supplies Electronic Supplies Equipment Equipment Rental Fencing & Gates Flooring Fuel & Lubricants Furniture

Discounts Available – State/Government Contracts:

Hardware Hazmat Supplies Industrial Supplies & OEM Parts Janitorial Supplies Lodging Office Equipment Office Supplies

Yes

No

Paint & Coatings Pipe / Steel Reprographics / Sorting Safety Supplies Security Supplies Telecommunications Tools Transformers

Transmission Equipment & Supplies Transportation Uniforms Vehicle Parts Vehicles Water Treatment

Power Plant Power Resources Public Relations

Security Training

Power Distribution Power Plant Recycling Security & Fire Protection

Telecommunication Const. Testing Uniforms Vehicle Service & Repairs

If yes, specify

CONSULTING/ PROFESSIONAL SERVICES: Architects Energy Efficiency Programs

Special licensing requirements?

Engineering Civil Engineering Electrical Environmental

Yes

No

Financial Services Information Technologies Management / Personnel

If so, Type / #:

OUTSIDE SERVICES: Aircraft Asphalt & Paving Drilling Electrical Contractor Equip. Maint. & Repairs

Fabrication & Welding Facilities/Building Maint. Fencing General Contractor Hazmat Trans. & Disposal

Janitorial Landscaping Marine Office Equipment Painting

On-site work if applicable (able to provide): General Liability Insurance: Contractor License # (if applicable):

Yes

No

Workers Comp:

Yes

No

SB854 Registration No.:

Classification (i.e.: C10):

Additional comments:

Submitted by: RETURN TO:

Date: Turlock Irrigation District, Materials Management Department P.O. Box 949, Turlock, California 95381-0949 Phone: 209-883-8401 Fax: 209-656-2146 E-mail: purchasing@tid.org

Supplier Name

Abatement Aggregate Air Conditioning Auctions Cable & Wire Chemicals Computers Cranes


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