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Vendor / Bidder / Consultant Application

Tax Filing Status: Check the box that applies to you and complete the appropriate fields below.
Click here for further explanation.



Social Security # (please enter your SSN# as 555555555 not 555-55-5555)
Federal Tax ID # (please enter your Fed Tax # as 555555555 not 55-5555555)
Tax Exempt Cert #
DUNS # (please enter your DUNS # as 555555555)

Business Name/ DBA
Individual Name
Parent Company Name
Address
Address (Cont.)
City
County
State
Zip Code
Country
Business Phone (Including Area Code)
Fax Number (Including Area Code)
Cellular Number (Including Area Code)
E-Mail Address
Contact Name

Remittance Address (if different than above)
Remittance Name
Remittance Address
City
State
Zip Code

Licensing Information
 
State Certified License #
State Registration License #
Lee County Competency License #
Lee County Local Business Tax Receipt #

*REQUIRED IF BUSINESS LOCATION IN LEE COUNTY; OR CANNOT REGISTER YOUR COMPANY


DISADVANTAGED BUSINESS ENTERPRISE GUIDELINES:

DBE is defined by Federal Register 49 CFR, part 23. A business firm which is at least 51 percent (51%) owned and controlled by disadvantaged/minority group members or women, or in the case of a publicly owned business, at least 51 percent (51%) of the stock of which is owned by disadvantaged/minority persons or women. The disadvantaged/minority or woman ownership must exercise actual day to day management and control of the business. If you feel you may meet the definition of DBE, and would like to receive further information, you are encouraged to contact FGCU, Small Business Office at 239.225.4220.


CHECK WHAT APPLIES:

Definitions of DBE (Disadvantaged Business Enterprise):







Click here for Explanation/Requirements.


IMMIGRATION LAWS:

Lee County will not intentionally award County contracts to any contract/vendor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contacined in 8 U.S.C Section 1324a(e) Section 274A(e) of the Immigration and Nationalaity Acts (INA).

Lee County shall consider the employment by any Contractor of unauthorized aliens a violation of Section 274A(e) of the INA. Such violation by the recipient of the employment provisions contained in Section 274A(e) of the INA shall be grounds for unilateral cancellation of the contract by Lee County.


Hold Harmless and Indemnity Clause:

To the fullest extent permitted by applicable law, Contractor shall protect, defend, indemnify, save, and hold the County, the Board of County Commissionors, its agents, officials, and employees harmless from and against any and all claims, demands, fines, loss or destruction of property, liabilities, damages, for claims based on the negligence, misconduct, or omissions of the Contractor resulting from the Contractor's work as further described in this contract, which may arise in favor of any person or persons resulting from the Contractor's performance or non-performance of its obligations under this contract except any damages arising out of personal injury or property claims from third parties caused solely by the negligence, omission(s) or willful misconduct of the County, its officials, commissions, employees or agents, subject to the limitations as set out in Florida general law, Section 768.28, Florida Statutes, as amended. Further, Contrator hereby agrees to indemnify the County for all reasonable expenses and attorney's fees incurred by or imposed upon the County in connection therewith for any loss, damage, injury, or other casualty. Contractor additionally agrees that the County may employ an attorney of the County's own selection to appear and defend any such action, on behalf of the County, at expense of the Contractor. The Contractor further agrees to pay all reasonable expenses and attorney's fees incurred by the County in establishing the right to indemnity.



I hereby certify that the information supplied herein is correct:
Name
Title
E-Mail Address

Commodity Codes: Please carefully review the list of Contracting and/or Professional Services.  Select the services your company is able to provide to Lee County. (To select more than one Contracting or Professional Service, simply click on your first selection, then hold down the CONTROL key and click the remainder of the categories. Please indicate in the Text Box below,  if you could not locate any Services you provide. 

General, Highway & Street, Heavy and Special Trade Contractors: (Select Below) Professional and Other Professional Services:
(Select Below)
Products: (Select Below) Services: (Select Below)

Products/Services Not Listed:

A W-9 Form is required prior to adding your company to our list. Fax to: 239-485-5460. (Click here for a blank form)