Questions about application? CALL 850-983-1833 e-mail address: bidinfo@co.santa-rosa.fl.us Mailing address for bid notices: Santa Rosa County Procurement Department 6495 Caroline St, Suite G Milton, FL 32570 The fax number is 850-983-1918

VENDOR REGISTRATION APPLICATION Instructions Complete the items below (those in red are required) and click the "Submit Vendor Application" button at the bottom of this page. You will receive a copy of your submission by email. Is this a new or revised application?: - new application - revised application All USA firms that are established as an individual, self-employed, or sole proprietorship must provide either their Social Security Number or FEID number. All other businesses such as corporations must provide their federal employer identification number. (Items in red are required) I. Insert Federal Employer Identification Number or Social Security Number by which business is conducted. FEID:   99-9999999 (or) SSN:   999-99-9999 Is your business minority owned, and or woman owned? Yes No Check if a Florida based firm: II. Contact Person and Phone Number: Please list the contact person in charge of bidding for your company. Company Name: The name issued must be the legal name by which bids will be submitted and to which contract may be awarded. Mailing Address: Delivery address, city, state, and zip (nine digit) is the address to which invitations to bid will be mailed. Your Name: Title: E-mail Address: Date (mm/dd/yy): Company Name: Street Address: City: County: State: AA AE AK AL AP AR AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Zip: Phone Number:  999-999-9999 Fax Number:   999-999-9999     Physical Address (if different from mailing address): Street Address: City: County: State: AA AE AK AL AP AR AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK ON OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Zip: III. Check all commodities and/or contractual services that you wish to receive solicitations for: Advertising Services Architectural Services - Construction Architectural Services - Landscape Asbestos - Assessment, Abatement, Removal & Disposal Services Auctioneer Services Auditing Services Automobiles & Light Trucks Banking & Financial Services Boats, Marine Construction Bonds & Investment Consulting Services Bridge Construction Building & General Contractor Services Clothing, Apparel, & Uniforms Computer Software Computers & Supplies Concrete Products & Supplies Construction Consulting Services Construction Management Services Consultant/Lobbyist Demolition & Abatement Services Dredging Services Drilling & Boring Services Electrical Equipment & Supplies Electrical Services Engineering Services Environmental, Cleanup Services, Water Sampling, & Analysis Environmental Studies Services Fabricated Buildings & Structures Fencing Fuel, Lubricants & Oil Grass Mowing on Right-of-way Guardrail Hazardous Material & Waste Disposal Services Heavy Equipment, Accessories, & Generators Heavy Trucks & Tractors Insurance Insurance Consultant Services Janitorial Services & Custodial Services Janitorial Supplies Land Clearing Services Landfill Liners & Scales Landscaping & Lawn Services Lawn Equipment Livestock Equipment Mechanical Contracting Services Office Equipment & Copiers Office Furniture & Carpet Office Supplies Painting & Sandblasting Parks, Play Ground & Recreational Equipment Pipe-Concrete Pipe-Corrugated Metal Plumbing Equipment Plumbing Services Printing Services Radio & Telecommunication Systems Radio & Telecommunication Systems, Equipment & Accessories Reconstruction, Remodeling, & Renovation Recycling Equipment Road Construction Road & Highway Building Materials (Asphalt) Roofing Safety Equipment Security Equipment Security Services Signs Stone, Rip Rap, & Artificial Reefs Surveying Tanks Traffic-Markers, Plaques, Signs & Control Devices Trailers Treated Lumber Truck Equipment Underground Utility Installation Services Utility Consultant Services Video Equipment & Accessories Welding Services Other (please indicate: )   PLEASE CAREFULLY REVIEW YOUR APPLICATION BEFORE SUBMISSION.

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