American Dynamics RAS917LS-1 Specifications download pdf (Page 7)

Vendor Information Sheet

2. Telephone/Fax/Contact Person

Name of Firm, Individual(s), Partners or Corporation

City State Zip Code

3. Ownership Disclosure

Title Gender

Race-

ethnicity Stock Ownership

NOTE:

The information provided by the vendor on this form should be consistent with that provided on the "Vendor's

pplication". All vendors must have a current vendor's application on file with M-DCPS, and have provided information and/or b

familiar with M-DCPS' policy regarding the following: (a) Employment Disclosure, (b) Drug Free Workplace, (c) Family Leave

Policy, (d) Code of Business Ethics, (e) Conflict of Interest, (f) Perception, (g) Gratuities, and (h) Business Meals. Failure to

provide M-DCPS a current vendor application may cause the vendor not to be awarded any new business with M-DCPS.

Vendor applications can be downloaded at: http://procurement.dadeschools.net

Street Address

If the contract or business transaction is with a corporation, partnership, sole proprietorship,or joint venture, the full legal name

and business address shall be provided for the chief officer, director, or owner who holds, directly or indirectly the majority of the

stock or ownership. If the contract or business transaction is with a trust, the full legal name and address shall be provided for

each trustee and each beneficiary. Post Office addresses are not acceptable

Name

1A.

Federal Employer Identification Number

Owner's Social Security Number

1B.

Address

_________________________________________

Contact Person

E-mail address

Telephone number

Fax number

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American Dynamics RAS917LS-1 Specifications Page 7