Annual Contract for Medical Waste Pickup and Disposal Services ...

City of West Palm BeachBIDDER’S/PROPOSER’S INFORMATION & REFERENCESInstructions: Complete Section I below with your Company’s information.Complete Section II below with your company’s references. Use as many sheets as necessary.Section IProposer’s/Bidder’s Information:Proposer/Bidder Company Name:State of Incorporation: Attach copy of Letter of Incorporation and/or evidence of authorization to do business in Florida.FEIN:Primary Address:Principal Contact Person & Title:Street State ZipTelephone:Telephone Number: Cell Number: Fax Number: Email:Number of Years Company in Business: Years Total Number of Employees:Office Location which would service account:Address:Project Manager/Contact Person:Street State ZipTitle:Telephone:Number of Years of Experience in Profession of this Proposal Service:Number of Years with Company:Cell Number: Fax Number: Email:Billing Address if Different from above:Section IIProposer’s/Bidder’s References:Note: Failure to complete this form may result in bid/proposal rejection.Firm Name &Contract PersonAddressStreet/City/ZipContact InformationPhone/Fax/EmailProject NameDollar AmountContract1 $2 $3 $Page ___ of ___ITB 12-13-109 Annual Contract for Medical Waste Pickup and Disposal Services Page 18 of 28