Contractor Information (For Ordering and Contract Administration Purposes)
Total Page：16
File Type：pdf, Size：1020Kb
Bid 22661 – Attachment 3 Contractor and Reseller Information Contractor Name: Contractor Information (for Ordering and Contract Administration Purposes)
1. CONTRACTOR/COMPANY INFORMATION Company Name: Address: (From first page of RFP)
Company Website: Federal ID #: NYS Vendor ID #:
2. CENTRALIZED CONTRACT Contract Administrator Name: Title: Address:
Telephone Number: Toll Free Telephone Number: Fax Number: Toll Free Fax Number: E-mail:
3. SALES/BILLING Contact Name: Title: Address:
Telephone Number: Toll Free Telephone Number: Fax Number: Toll Free Fax Number: E-mail:
4. MAINTENANCE/SERVICE Contact Name: Title: Address:
Telephone Number: Toll Free Telephone Number: Fax Number: Toll Free Fax Number: E-mail: Hours of Availability:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller/Distributor Information Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail:
Bid 22661 Attachment 3, Contractor and Reseller Information Template MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #:
Bid 22661 Attachment 3, Contractor and Reseller Information Template NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail:
Bid 22661 Attachment 3, Contractor and Reseller Information Template MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #:
Bid 22661 Attachment 3, Contractor and Reseller Information Template NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail:
Bid 22661 Attachment 3, Contractor and Reseller Information Template MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #:
Bid 22661 Attachment 3, Contractor and Reseller Information Template NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Bid 22661 Attachment 3, Contractor and Reseller Information Template Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number:
Bid 22661 Attachment 3, Contractor and Reseller Information Template E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Bid 22661 Attachment 3, Contractor and Reseller Information Template Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number:
Bid 22661 Attachment 3, Contractor and Reseller Information Template E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Bid 22661 Attachment 3, Contractor and Reseller Information Template Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
Bid 22661 Attachment 3, Contractor and Reseller Information Template SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor
Bid 22661 Attachment 3, Contractor and Reseller Information Template Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail:
Bid 22661 Attachment 3, Contractor and Reseller Information Template MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #:
Bid 22661 Attachment 3, Contractor and Reseller Information Template NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Bid 22661 Attachment 3, Contractor and Reseller Information Template Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail:
Bid 22661 Attachment 3, Contractor and Reseller Information Template MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Reseller/Distributor Company Name: Address:
Federal ID #: NYS Vendor ID #: Contract Person: Title: Telephone Number: Fax Number: E-mail: MWBE Certification: Women owned Minority owned Both
SBE: NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: Take Orders Ship Direct Receive Payment
Qualifying Criteria Applicable to this Reseller:
Bid 22661 Attachment 3, Contractor and Reseller Information Template