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617 - Vendor Application1

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CITY OF LA VERGNE
VENDOR’S LIST APPLICATION
5093 MURFREESBORO ROAD TELEPHONE # (615) 793-6295
LA VERGNE, TN 37086 FAX # (615) 793-9804
www.lavergne.org
Please complete all information requested on this form and return it to the address noted above. Submission of this
form will provide the City of La Vergne with a database of vendors that can meet departmental needs for commodities
and services. A bid notification will be faxed to all vendors who can provide the commodities or services. If you do not
have a fax machine, you will not be notified, however, all bids are advertised in the Daily News Journal and on the City
of La Vergne website. All bids are available for review in the Purchasing Office located at the City Hall building.
Please notify the Purchasing Department immediately
of any and all changes to the information on this application.
1. FEDERAL TAX ID# OR SOCIAL SECURITY #:
2. CITY OF LA VERGNE BUSINESS TAX#:
3. RUTHERFORD COUNTY BUSINESS TAX#:
4. TENNESSEE SALES TAX #:
5. APPLICANT’S NAME & MAILING ADDRESS FOR
BID FORMS AND PURCHASE ORDERS:
6. MAILING ADDRESS FOR PAYMENTS
(IF DIFFERENT):
7. PERSON(S) TO CONTACT CONCERNING BIDS OR QUOTES:
NAME OFFICIAL CAPACITY TELEPHONE # FAX # E-MAIL ADDRESS
8. IS YOUR COMPANY A SMALL BUSINESS AS DEFINED BY THE U.S. SMALL
BUSINESS ADMINISTRATION?
YES NO
9. ARE YOU A GOVERNMENT AGENCY OR A NON-PROFIT
ORGANIZATION?
GOVERNMENT AGENCY:
YES NO
NON-PROFIT:
YES NO
10. ARE YOU INCORPORATED?
YES NO
11. IF YES, ARE YOU PUBLICLY TRADED?
YES NO
12. WHAT IS THE GENDER OF THE OWNER?
FEMALE MALE
13. IDENTIFY COMPANY OWNER CLASSIFICATION:
HISPANIC OR LATINO
AMERICAN INDIAN OR ALASKA NATIVE ASIAN NATIVE HAWAIIAN
BLACK OR AFRICAN AMERICAN CAUCASIAN OTHER
14. IS YOUR BUSINESS CLASSIFIED AS A
DISADVANTAGED BUSINESS?
YES NO OTHER ________________
15. ARE YOU AWARE OF ANY FAMILIAL RELATIONSHIPS
OR BUSINESS RELATIONSHIPS BETWEEN ANY MEMBER
OF YOUR FIRM AND ANY EMPLOYEE OR OFFICIAL OF
THE CITY OF LA VERGNE?
YES NO - IF YES, PLEASE EXPLAIN
THE NATURE OF THE RELATIONSHIP:
16. I HEREBY CERTIFY THAT THE INFORMATION SUPPLIED HEREIN IS CORRECT.
_________________________________________ ____________________________________
TYPE OR PRINT NAME AND TITLE SIGNATURE
OF PERSON SIGNING APPLICATION
CLASS LIST
Please place a checkmark (9) by items you are interested in supplying.
___ 005 Abrasives
___ 010 Acoustical Tile, Insulating Materials, and Supplies
___ 015 Addressing, Copying, Mimeograph, and Spirit Duplicating Machine
Supplies, Chemicals. Inks, Paper, Etc.
___ 019 Agricultural Crops and Grain including Fruits, Melons, Nuts, and
Vegetables
___ 020 Agricultural Equipment, Implements, and Accessories
___ 022 Agricultural Implement and Accessory Parts
___ 025 Air Compressors and Accessories
___ 031 Air Conditioning, Heating, and Ventilating: Equipment, Parts and
Accessories (See Related Items In Class 740)
___ 035 Aircraft and Airport, Equipment, Parts, and Supplies
___ 037 Amusement, Decorations, Entertainment, Toys, Etc.
___ 040 Animals, Birds and Marine Life Including Accessory Items (Live)
___ 045 Appliances and Equipment, Household Type
___ 050 Art Equipment and Supplies
___ 052 Art Objects
___ 055 Automotive Accessories for Automobiles, Buses, Trucks, Etc.
___ 060 Automotive Maintenance Items and Repair [Replacement Parts)
___ 065 Automotive Bodies, Accessories, and Parts
___ 070 Automotive Vehicles and Related Transportation Equipment
___ 075 Automotive Shop Equipment and Supplies
___ 080 Badges, Emblems, Name Tags and Plates, Jewelry, Etc.
___ 085 Bags, Bagging. Ties, and Erosion Control Equipment
___ 090 Bakery Equipment, Commercial
___ 095 Barber and Beauty Shop Equipment and Supplies
___ 100 Barrels, Drums, Kegs, and Containers
___ 105 Bearings (Except Wheal Bearings and Seals - See Class 060)
___ 110 Belts and Belting: Conveyor, Elevator. Power Transmission, and
V-Belts
___ 115 Biochemical, Research
___ 120 Boats, Motors, and Marine and Wildlife Supplies
___ 125 Bookbinding Supplies
___ 135 Bricks and Other Clay Products, Refractory Materials, and Stone
Products
___ 140 Broom, Brush, and Map Manufacturing Machinery and Supplies
___ 145 Brushes (Not Otherwise Classified)
___ 150 Builder's Supplies
___ 155 Buildings and Structures: Fabricated and Prefabricated
___ 160 Butcher Shop and Meat Processing Equipment
___ 165 Cafeteria and Kitchen Equipment, Commercial
___ 175 Chemical Laboratory Equipment and Supplies
___ 180 Chemical Raw Materials (in Large Quantities Primarily for
Manufacturing Janitorial and Laundry Products)
___ 190 Chemicals and Solvents, Commercial (in Bulk)
___ 192 Cleaning Compositions, Detergents, Solvents, and Strippers -
Prepackaged
___ 193 Clinical Laboratory Reagents and Tests (Blood Grouping,
Diagnostic. Drug Monitoring, Etc.)
___ 195 Clocks, Timers, Watches, and Jewelers' and Watchmakers' Tools
and Equipment
___ 200 Clothing, Apparel, Uniforms, and Accessories
___ 201 Clothing Accessories (See Class 800 for shoes and boots)
___ 204 Computer Hardware and Peripherals for Microcomputers
___ 206 Computer Hardware and Peripherals for Mini and Main Frame
Computers
___ 207 Computer Accessories and Supplies
___ 208 Computer Software for Microcomputers (Preprogrammed)
___ 209 Computer Software for Mini and Main Frame Computers
(Preprogrammed)
___ 210 Concrete and Metal Culverts, Pilings, Septic Tanks. Accessories
and Supplies
___ 220 Controlling, Indicating, Measuring, Monitoring. and Recording
Instruments and Supplies
___ 225 Coolers, Drinking Water (Water Fountains)
___ 232 Crafts, General
___ 233 Crafts, Specialized
___ 240 Cutlery, Dishes, Flatware, Glassware, Trays, Utensils, and Supplies
___ 245 Dairy Equipment and Supplies
___ 250 Data Processing Cards and Paper
___ 255 Decals and Stamps
___ 260 Dental Equipment and Supplies
___ 265 Draperies, Curtains, and Upholstery Material (including Automobile)
___ 269 Drugs and Pharmaceuticals
___ 271 Drugs, Pharmaceuticals, and Sets (For Large-Volume Parenteral
Administration, Infusion, Irrigation, and Tube Feeding)
___ 280 Electrical Cables and Wires (Not Electronic)
___ 285 Electrical Equipment and Supplies (Except Cable and Wire)
___ 287 Electrical Components, Replacement Parts, and Accessories: And
Miscellaneous Electronic Equipment
___ 290 Energy Collecting Equipment and Accessories: Solar and Wind
___ 295 Elevators and Escalators, Building Type
___ 305 Engineering Equipment, Surveying Equipment, Drawing
Instruments, and Supplies
___ 310 Envelopes, Plain or Printed
___ 315 Epoxy Based Formulations for Adhesives, Coatings, and Agents
___ 318 Fare Collection Equipment and Supplies
___ 320 Fastening, Packaging, Strapping, Tying Equipment and Supplies
___ 325 Feed, Bedding, Vitamins and Supplements for Animals
___ 330 Fencing
___ 335 Fertilizers and Soil Conditioners
___ 340 Fire Protection Equipment and Supplies
___ 345 First Aid and Safety Equipment and Supplies (Except Nuclear and
Welding)
___ 350 Flags. Flag Poles, Banners, and Accessories
___ 360 Floor Covering, Floor Covering Installation and Removal Equipment,
and Supplies
___ 365 Floor Maintenance Machines, Parts, and Accessories
___ 370 Food Processing and Canning Equipment and Supplies
___ 375 Foods: Bakery Products (Fresh)
___ 380 Foods: Dairy Products (Fresh)
___ 385 Foods, Frozen
___ 390 Foods: Perishable
___ 393 Foods: Staple Grocery and Grocer’s Miscellaneous Items
___ 395 Forms, Continuous: Computer Paper, Form Labels, Snap-Out
Forms, and Folders for Forms
___ 400 Foundry Castings, Equipment, and Supplies
___ 405 Fuel, Oil, Grease and Lubricants
___ 410 Furniture: Health Care and Hospital Facility
___ 415 Furniture: Laboratory
___ 420 Furniture: Cafeteria, Chapel, Dormitory, Household, Library, Lounge,
School
___ 425 Furniture: Office
___ 430 Gases, Containers, Equipment: Laboratory. Medical, and Welding
___ 435 Germicides, Cleaners, and Related Sanitation Products for Health
Care Personnel
___ 440 Glass and Glazing Supplies
___ 445 Hand Tools (Powered and Non-Powered), Accessories and Supplies
___ 450 Hardware and Related Items
___ 460 Hose, Accessories, and Supplies: Industrial, Commercial, and
Garden
___ 465 Hospital and Surgical Equipment, Instruments, and Supplies
___ 470 Hospital Equipment and Supplies: Mobility, Speech Impaired, and
Restraint Items
___ 475 Hospital, Surgical, and Related Medical Accessories & Sundry Items
___ 485 Janitorial Supplies, General Line
___ 490 Laboratory Equipment and Accessories (For General Analytical and
Research Use): Nuclear, Optical, and Physical
___ 493 Laboratory Equipment and Accessories: Biochemistry, Chemistry,
Environmental Science, Etc.
___ 495 Laboratory and Field Equipment and Supplies: Biology, Botany,
Geology, Microbiology, Zoology, Etc.
___ 500 Laundry and Dry Cleaning Equipment, Accessories, Parts and
Supplies - Commercial
___ 505 Laundry and Dry Cleaning Compounds and Supplies
___ 510 Laundry Textiles and Supplies
___ 515 Lawn Maintenance Equipment, Accessories, and Parts
(Non-Agricultural Applications)
___ 520 Leather and Related Equipment. Products, Accessories, & Supplies
___ 525 Library and Archival Equipment, Machines, and Supplies
___ 530 Luggage, Brief Cases, Purses and Related Items
___ 540 Lumber and Related Products
___ 545 Machinery and Hardware, Industrial
___ 550 Markers, Plaques and Traffic Control Devices
___ 555 Marking and Stenciling Devices
___ 556 Mass Transportation - Transit Bus
___ 557 Mass Transportation - Transit Bus Accessories and Parts
___ 558 Mass Transportation - Rail Vehicles and Systems
___ 559 Mass Transportation - Rail Vehicles Parts and Accessories
___ 560 Material Handling and Storage Equipment and Allied Items
___ 565 Mattress Manufacturing Machinery and Supplies
___ 570 Metals: Bars, Plates, Rods, Sheets, Strips, Structural Shapes,
Tubing, and Fabricated Items
___ 575 Microfiche and Microfilm Equipment, Accessories, and Supplies
___ 578 Miscellaneous Products
___ 580 Musical Instruments, Accessories, and Supplies
___ 590 Notions and Related Sewing Accessories, and Supplies
___ 595 Nursery Stock, Equipment, and Supplies
___ 600 Office Machines, Equipment, and Accessories
___ 605 Office Mechanical Aids, Small Machines, and Apparatuses
___ 610 Office Supplies: Carbon Paper and Ribbons, All Types
___ 615 Office Supplies, General
___ 620 Office Supplies: Erasers, Inks, Leads, Pens, Pencils, Etc.
___ 625 Optical Equipment, Accessories, and Supplies
___ 630 Paint, Protective Coatings, Varnish, Wallpaper, and Related
Products
___ 635 Painting Equipment and Accessories
___ 640 Paper and Plastic Products, Disposable
___ 645 Paper (For Office and Print Shop Use)
___ 650 Park, Playground, Recreational Area and Swimming Pool
Equipment
___ 652 Personal Hygiene and Grooming Equipment and Supplies
___ 656 Photographic Equipment and Supplies (Not Including Graphic Arts,
Microfilm, and X-Ray)
___ 658 Pipe and Tubing
___ 659 Pipe Fittings
___ 660 Pipes, Tobaccos, Smoking Accessories: Alcoholic Beverages
___ 665 Plastics, Resins, Fiberglass: Construction, Forming, Laminating, and
Molding Equipment, Accessories, and Supplies
___ 670 Plumbing Equipment, Fixtures, and Supplies
___ 675 Poisons: Agricultural and Industrial
___ 680 Police Equipment and Supplies
___ 685 Poultry Equipment and Supplies
___ 690 Power Generation Equipment, Accessories, Supplies
___ 691 Power Transmission Equipment - Electrical, Mechanical Air and
Hydraulic
___ 700 Printing Plant Equipment and Supplies (Except Papers)
___ 710 Prosthetic Devices, Hearing Aids, Auditory Testing Equipment,
Electronic Reading Devices, Etc.
___ 715 Publications and Audiovisual Materials (Prepared Materials Only,
Not Equipment, Supplies, or Production)
___ 720 Pumping Equipment and Accessories
___ 725 Radio Communication, Telephone, and Telecommunication
Equipment, Accessories, and Supplies
___ 730 Radio Communication and Telecommunication Testing, Measuring,
and Analyzing Equipment, Accessories and Supplies
___ 735 Rags, Shop Towels, and Wiping Cloths
___ 740 Refrigeration Equipment and Accessories
___ 745 Road and Highway Building Materials (Asphaltic)
___ 750 Road and Highway Building Materials (Not Asphaltic)
___ 755 Road and Highway Equipment and Parts: Asphalt and Concrete
Handling and Processing
___ 760 Road and Highway Equipment: Earth Handling, Grading, Moving,
Packing, Etc.
___ 765 Road and Highway Equipment (Except Asphalt, Concrete, and Earth
Handling Equipment In Classes 755 and 760)
___ 770 Rooting
___ 775 Salt (Sodium Chloride) (See Class 393 for Table Salt)
___ 780 Scales and Weighing Apparatus (See 175-08 for Laboratory
Balances)
___ 785 School Equipment and Supplies
___ 790 Seed, Sod, Soil, and Inoculants
___ 795 Sawing, Room and Textile Machinery, and Accessories
___ 800 Shoes and Boots
___ 801 Signs, Sign Materials, Sign Making Equipment, and Related
Supplies
___ 803 Sound Systems, Components, and Accessories: Group Intercom,
Music, Public Address, Etc.
___ 805 Sporting and Athletic Goods
___ 810 Spraying Equipment (Except Household, Nursery Plant, and Paint)
___ 815 Steam and Hot Water Fittings, Accessories, and Supplies
___ 820 Steam and Hot Water Boilers, Steam Heating, and Power Plant
Equipment
___ 825 Stockman Equipment and Supplies
___ 830 Tanks (Metal, Wood, and Synthetic Materials): Mobile, Portable,
Stationary, and Underground Types
___ 832 Tape (Not Data Processing, Measuring, Optical, Sawing, Sound, or
Video)
___ 840 Television Equipment and Accessories
___ 845 Testing Apparatus and Instruments (Not for Electrical or Electronic
Measurements)
___ 850 Textiles, Fibers, Household Linens. and Place Goods
___ 855 Theatrical Equipment and Supplies
___ 860 Tickets, Coupon Books, Sales Books, Strip Books, Etc.
___ 863 Tires and Tubes
___ 864 Train Controls, Electronic
___ 865 Twine
___ 870 Venetian Blinds, Awnings, and Shades
___ 875 Veterinary Equipment and Supplies (See Class 325 for Vitamins and
Supplements for Animals)
___ 880 Visual Education Equipment and Supplies (Except Projection Lamps
See Class 285)
___ 883 Voice Response Systems
___ 885 Water and Wastewater Treating Chemicals
___ 890 Water Supply and Sewage Treatment Equipment (Not for Air
Conditioning, Steam Boiler, or Laboratory Reagent Water)
___ 895 Welding Equipment and Supplies
___ 898 X-Ray and Other Radiological Equipment and Supplies (Medical)
___ 905 Aircraft Operations Services
___ 906 Architectural Services, Professional
___ 907 Architectural and Engineering Services, Non-Professional
___ 908 Bookbinding, Rebinding, and Repairing
___ 909 Building Construction Services - Equipment, Furnishings, and Work
Covered by Building Construction Contracts Only
___ 910 Building Maintenance and Repair Services
___ 912 Construction Services, General
___ 913 Construction Services, Heavy
___ 914 Construction Services, Trade (New Construction)
___ 915 Communications and Media Related Services
___ 918 Consulting Services
___ 920 Data Processing Services and Software
___ 924 Educational Services
___ 925 Engineering Services, Professional
___ 926 Environmental and Ecological Services
___ 928 Equipment Maintenance, Reconditioning and Repair Services for
Automobiles, Trucks, Trailers, Transit Buses and Other Vehicles
___ 929 Equipment Maintenance, Reconditioning, and Repair Services -
Agricultural, Heavy Industrial Equipment, and Marine Equipment
___ 931 Equipment Maintenance, Reconditioning, and Repair Services -
Appliance, Athletic, Cafeteria, Furniture, Musical Instruments, and
Sewing Equipment
___ 934 Equipment Maintenance, Reconditioning, and Repair Services -
Laundry, Lawn, Painting, Plumbing, and Spraying Equipment
___ 936 Equipment Maintenance, Reconditioning, and Repair Services -
General Equipment
___ 938 Equipment Maintenance, Reconditioning, and Repair Services -
Hospital, Laboratory, and Testing Equipment
___ 939 Equipment Maintenance, Reconditioning, and Repair Services -
Office, Photographic, and Radio/Television Equipment
___ 940 Equipment Maintenance, Repair, and Construction Services -
Railroad
___ 941 Equipment Maintenance, Reconditioning, Repair, and Related
Services - Power Generation
___ 945 Fishing, Hunting, Trapping, Game Propagation, and Related
Services
___ 946 Financial Services
___ 947 Forestry Services
___ 948 Health Related Services (For Human Services See Class 952)
___ 952 Human Services
___ 953 Insurance. All Types
___ 954 Laundry and Dry Cleaning Services
___ 956 Library Services (See Class 98 for Bookbinding, Rebinding, and
Repairing)
___ 958 Management Services
___ 959 Marine Construction Services-, Marine Equipment Maintenance and
Repair, Related Marine Services
___ 961 Miscellaneous Professional Services
___ 962 Miscellaneous Services
___ 965 Printing Preparations: Etching, Photoengraving, and Preparation of
Mats, Negatives and Plates
___ 966 Printing and Related Services
___ 968 Public Works, Construction, and Related Services
___ 971 Real Property Rental or Lease
___ 975 Rental or Lease Services of Equipment - Agricultural, Aircraft,
Automotive, Heavy Equipment and Marine - Equipment
___ 977 Rental or Lease Services of Equipment - Appliances. Cafeteria,
Film, Furniture, Hardware, Musical, Sewing, and Window and Floor
Coverings
___ 979 Rental or Lease Services of Equipment - Engineering, Hospital,
Laboratory, Precision Instruments, Refrigeration, Scales, and
Testing Equipment
___ 981 Rental or Lease of Equipment - General Equipment
___ 983 Rental or Lease Services of Equipment - Janitorial, Laundry, Lawn,
Painting, Spraying, and Textile Equipment
___ 984 Rental or Lease services of Computers, Data Processing and Word
Processing Equipment
___ 985 Rental or Lease Services of Equipment - Office, Photographic,
Printing. Radio/Television/Telephone Equipment
___ 988 Roadside, Grounds, Recreational and Park Area Services
___ 989 Sampling and Sample Preparation Services (For Testing)
___ 990 Security. Fire, Safety, and Emergency Services
___ 992 Testing and Calibration Services
___ 998 Sale of Surplus & Obsolete Items
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617 - Vendor Application1

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Completed 13 July 2020

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