VENDOR REGISTRATION FORM

GENERAL INFORMATION (All fields required except Fax#)

Vendor Name:

Type of Business: Administrative/Professional Services Construction Goods/Services/Equipment

Street Address:

City:

State: Zip Code:

Phone:

Other Phone:

E-mail:

Fax#:

Contact Person:

Contact Person’s Title:

Number of Years Company has been in Business: Number of Employees:

BUSINESS CLASSIFICATION (Must select at least 1)

Taxpayer Identification Number or Social Security Number:

Individual/Sole Proprietorship:

Partnership:

Joint Venture:

Not-for-Profit:

Corporation:

State of Incorporation:

Resident Owned Business: Other:

VENDOR REGISTRATION FORM

ECONOMIC INCLUSION (Must select at least 1)

Certifying documentation or a notarized declaration must be provided to CMHA to prove

status:

Not Applicable:

Disabled Owned:

Small Business Enterprise:

Veteran Owned:

Women Owned (at least 51%): Minority Owned (at least 51%):

Section 3 Business Concern: What is this?

VENDORS SERVICES AND/OR PRODUCTS (Must select at least 1)

Please specify the type of service(s) or product(s) that your business provides: Accessories and Parts

Accounting

ADA Compliance

Administrative/Secretarial

Appraisal (Real Property)

Architecture/Engineering

Asphalt Repair Automobile Supplies

Cabinet Installation

Carpet Cleaning

Catering

Chemicals

Collections

Community Support

Computer Software

Computers, Peripherals

Concrete Repair

Construction Management

Construction: Exterior Renovation

Construction: Interior Renovation

Construction: New

Construction: Repair

Consulting (Various)

Copiers

Data Entry

Demolition

Electrical Supplies

Elevators

VENDOR REGISTRATION FORM

VENDORS SERVICES AND/OR PRODUCTS (Must select at least 1) Please specify the type of service(s) or product(s) that your business provides: Employee Pre-employment screening

Employee Benefits

Energy Services – Building Facilities

Engineering Planning Design: Civil – General

Engineering Planning Design: Civil – Transportation

Engineering Planning Design: Environmental

Engineering Planning Design: Geotechnical

Engineering Planning Design: Hazardous

Engineering Planning Design: Mechanical

Engineering Planning Design: Sanitary

Engineering Planning Design: Structural

Engineering Planning Design: Civil - Hydraulics

Equipment Small Tools

Financial

Fire Repair Restoration

Fire Suppression and Inspection

Flooring

Grounds Equipment

Hazardous Materials Removal

Heating Parts

HVAC

Insurance

Janitorial Services

Janitorial Supplies

Land Acquisition

Land Surveying

Landscape Architecture

Landscaping Services

Legal

Locks and Supplies

Lumber

Make Ready: Vacancy Prep Unit Turnover

Masonry

Meetings and Events

Moving and Packing

Mowing Services

Office Furniture

Office Supplies

Paint and Painting Supplies

Playgrounds

Plumbing

Plumbing Supplies

Printing and Graphic Services

Promotional and Event Services

Public Relations and Marketing Services

Real Estate Appraisals

VENDOR REGISTRATION FORM

VENDORS SERVICES AND/OR PRODUCTS (Must select at least 1) Please specify the type of service(s) or product(s) that your business provides: Refrigerator Parts

Residential Cleaning

Roofing

Security Alarm Systems

Security Guards

Siding

Signs

Skills/Unskilled Labor

Storage

Structural Supplies

Substance Abuse Counseling Temporary Employment Services

Tools

TPA

Training

Uniforms

Vending Services

Waste Removal

Water Repair Restoration

Web Services

Other

VENDOR REGISTRATION FORM

REFERENCES (Must enter at least 1 reference)

Please provide references (within the last 12 months) for the services or goods that your business provides:

1. Company:

Contact Name:

Phone:

E-mail:

2. Company:

Contact Name:

Phone:

E-mail:

3. Company:

Contact Name:

Phone:

E-mail:

DISCLAIMER

The completion and submission of the Vendor Registration Form does not guarantee any minimum or maximum amount of work for a Vendor. It simply means that a Vendor is registered to conduct business with CMHA as opportunities are made available. At that time, the Vendor may have the opportunity to submit a bid, quote or proposal. Likewise, the submission of a bid, quote or proposal does not guarantee any Vendor the right to an award as all procurement activity conducted by CMHA must be in full compliance with the following regulations:

• 2 CFR Part 200• HUD Procurement Handbook 7460.8 REV 2

• CMHA’s Procurement Policy and Procedures

For registrations you must submit a W-9 Form. To complete the form click here.

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