|* Federal ID#: or Social Security #:|
|Persons Authorized to Sign Bids and Contracts:|
|Classification your business can support and for which your business wishes to be considered a bidder:
If you could not find the appropriate classification above please enter it below.
|By submitting this form, I certify that all 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. Further, by submitting this form, I certify that this vendor/individual is properly licensed for providing the goods/services specified.|
|Name of Authorized Person Submitting this Application:|
|Please provide a brief description of the goods and/or services your company provides.