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Bidder's List Application and Commodity Form - Fauquier County

Bidder's List Application and Commodity Form - Fauquier County

Bidder's List Application and Commodity Form - Fauquier

FAUQUIER COUNTY GOVERNMENT AND PUBLIC SCHOOLS Procurement Division 320 Hospital Drive, Suite 23, Warrenton, Virginia 20186 Telephone: (540) 422-8352 Fax: (540)422-8355 Bidder’s List Application Please Complete and submit the application to add your firm to Fauquier County’s List of qualified bidders. Check all that apply: ______New Application ____Name/Address/Commodity Change Company Name and Mailing Address:(address to which bidding forms & purchase orders are to be mailed) Name:_____________________________________________________________________________ Address:___________________________________________________________________________ City,State,Zip:_______________________________________________________________________ Phone:__________________________ Fax:_______________________________ Type of Business (i.e. Retailer, Construction, etc.): ________________________________________ Federal ID Number/ Social Security Number__________ ____________ Type of Organization: __Individual __Partnership __Non Profit __Minority Business __Corporate __Small Business Persons Authorized to Sign Bids and Contracts: Name:_____________________________Official Capacity:_________________________________ Name:_____________________________Official Capacity:_________________________________ E-Mail Address for Bid/Proposal Notification: It is the vendors’ responsibility to keep their applications current and to notify the Purchasing Division when changes occur regarding the products or services offered, address, ownership, or status as a bidder. Placement on the bidders’ list does not guarantee receipt of a request of quotation, invitation to bid, or request for proposal. It is the vendor’s responsibility to check the bid notices posted by the Purchasing Division. Bidders may be removed from the bidders’ list if they do not respond to solicitations. However, a bidder may be retained on the bidders’ list by simply responding with a “no bid” if they are interested in bidding on the item(s) in the future. Solicitations may be viewed on our website at: www.fauquiercounty.gov/government/departments/procurement. then click on Current Solicitations. New State Corporation Commission (SCC) registration requirements effective July 1, 2010 require us to obtain the identification number issued by to you by the Virginia State Corporation Commission as proof of registration or to obtain justification for non-registration. The SCC may be reached at (804) 371-9733 or at www.scc.virginia.gov/default.aspx. Failure to include this information with bids and proposal submission may result in rejection of your bid/proposal. I certify that the information supplied herein is correct and that neither the applicant nor any person (or concern) in any connection with the applicant as a principal or officer, so far as it is known, is now disbarred or otherwise ineligible by any public agency from bidding for furnishing materials, supplies, or service to any agency thereof specified. Signature of Person Authorized to Sign This Application___________________________________ Name and Title of Person Signing_____________________________________________________ Date:_____________________ By my signature on this application, I certify that this vendor/individual is properly licensed for providing the goods/services specified. **RETURN THIS PAGE WITH THE FOLLOWING PAGE** Revised 8/13/10

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