Purchasing

Vendor Application

PLEASE NOTE: The State of Florida has a broad public records law. All records of the state or political subdivisions of the state are open for public inspection and copying, subject to certain statutory exemptions. If you choose to provide personal information such as your name, email address, phone number(s), address or any other personal information in this contact form or other form on this site, unless exempted by Florida Statutes, this information is a public record under Florida's Government in the Sunshine Laws and is available for public inspection upon request. If you do not want this information released in response to a public records request, please do not submit this information. If you have questions about our website's privacy policies, please contact us at (954) 797-2200.

To view the email addresses of City personnel you must accept these terms by clicking the "I Accept" button.

City of Plantation

W-9 form
Local Business Tax #
*Federal I.D. #:
*Company Name:
*Address:
*City:
*State:
*Zip Code:
*Country:
*Phone No.:
 Ex: 954-444-4444
Ext.
Fax No.:
 Ex: 954-444-4444
*E-mail Address:
*Contact Person:
*Title:
Select the Category that best describes your Product and/or Service:

*Type of Organization:

Sole Proprietorship Partnership Corporation

If payment is to be mailed to an address different than the above address, please complete the following:

Address:
City:
State:
Zip Code:
Country:
Phone No.:
 Ex: 954-444-4444
Ext.
Fax No.:
 Ex: 954-444-4444
Contact Person:
Title:

Other governmental Entities to which you have sold in the past 2 years

If you currently hold any Florida state contracts, list Numbers and expiration dates.

Contract No.
Expiration Dates
(ex: 01/01/02)

*Principal line of business:
*How long in present business:

CERTIFICATION

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 IS KNOWN, IS NOW DISBARRED OR OTHERWISE DECLARED INELIGIBLE BY ANY PUBLIC AGENCY FROM BIDDING FOR FURNISHING MATERIALS, SUPPLIES OR SERVICES TO ANY AGENCY THEREOF. I ALSO UNDERSTAND THAT ALL CONTACTS WITH THE CITY OF PLANTATION ARE TO BE MADE SOLELY THROUGH THE PURCHASING DIVISION UNLESS OTHERWISE DIRECTED BY THE PURCHASING DIVISION. FOR ADDITIONAL INFORMATION, PLEASE CALL (954) 797-2648.

Check this application to ensure that a correct response has been given to each question. Any omissions will result in follow-up inquiry and delay your entry onto our Bidder's list. Please fill out a W-9 form and fax it to 954-797-2649.

It is understood that failure to bid or return the proper no bid form for any given Commodity Class could result in removal from the Bidder's list for that Class.


* Authorized Name

* Title

* Date (ex:(ex: mm/dd/yyyy)

Comments: