Fillable Vendor App Form VENDOR APPLICATION FORM

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Vendor App Form VENDOR APPLICATION FORM

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FormMCCBP4410:001

Page1of6

MOTT COMMUNITY COLLEGE • 1401 East Court St. • Flint, MI 48503 • (810)762-0200

VENDORAPPLICATIONFORM



TobeaddedtotheMottCommunity Collegedatabaseofactive&approvedvendors,pleasecompletethefollowing

application.Completeapplicationscanbefaxedto810‐762‐5645ormailedtothefollowingaddress:



MottCommunityCollege

Attn:PurchasingDepartment/NewVendorApplication

1401EastCourtStreet

Flint,MI48503



CompanyName



WebAddress



ParentCompany



TypeofOrganization

Individual Partnership  Corporation

FederalID#

SocialSecurityNumber



(forindividualsonly)

Dun&Bradstreet#



AddresstowhichBidForms&PurchaseOrdersaretobemailed

Address



 

NumberStreetSuite#



 

CityState Zip



Addresstowhichpaymentsaretobemailed

Address



 

NumberStreetSuite#



 

CityState Zip



AdditionalLocationsinMichigan







Maincontactauthorizedtosignbids&contractsincompany’sname(ifagent,pleasespecify)

Name

 Phone#

OfficialCapacity/Title



Print Form

FormMCCBP4410:001

Page2of6

Salescontact(ifdifferentfromabove)

Name

 Phone#

Email

 Fax#

OfficialCapacity/Title



GeneralInformation

Whatcountyisyourbusinesslocated in(MIresidentsonly)?



Doesthecompanyrequireahardcopyofverbalorders?

Yes No

Checkallthatapplyforpaymenttypesaccepted 

PurchaseOrder(PO) BlanketPO

ProcurementCards(Visa/Mastercard)

Checkallthatapplyfororderingoptions

ElectronicOrdering FaxOrders

ElectronicDiskCatalog



StandardPaymentTerm

PromptPaymentDiscount



FOBPoint



StandardDeliveryTime/DeliveryHours



Onwhatclassesofequipment,supplies,materialsand/orservicesdoesyourcompanydesiretobid?

Pleasecheckallthatapply.



Manufacturer  Wholesaler Retailer

Manufacturer’sagent Distributor Serviceestablishment



Thisnextsectionofthisapplicationistobeusedforreportingpurposesonly.



Pleasereadthefollowingclassificationsandchoosethecategorythatappliestotheownershipofyourbusiness;also

indicatethepercentagethatcategoryimplies.



MinorityBusinessEnterprise(MBE)

–Forpurposesofthisprogram,anindependentbusinessentitywhichisatleast

51%owned,operatedandcontrolledbyaminoritygroupmember(s)whoisaUnitedStatescitizen(s).Thebusiness

mustmeetthefollowingrequirements:



MinorityGroupMember

–Forpurposesofthisprogram,anindividualwhoisatleast¼or25%minimum

(documentationtosupportclaimof25%wouldberequiredfromapplicant)ofthefollowing:



AfricanAmerican–Auscitizenhavingoriginsin anyoftheBlackracialgroupsofAfrica

MOTT COMMUNITY COLLEGE • 1401 East Court St. • Flint, MI 48503 • (810)762-0200

FormMCCBP4410:001

Page3of6

HispanicAmerican–AUScitizenoftrue‐bornHispanicheritage(true‐bornmeaning“authenticallyorgenuinely”

asperWebster’sDictionary),fromanyoftheSpanish‐speakingareasofLatinAmericaorthefollowingregions:

Mexico,CentralAmerica,SouthAmericanandtheCaribbeanbasinonly.BraziliansshallbelistedunderHispanic

Designationforreviewandcertificationpurposes.



NativeAmerican–ApersonwhoisanAmericanIndian,Eskimo,AleutorNativeHawaiian,andregardedassuch

bythecommunityofwhichthepersonclaimstobeapart.NativeAmericansmustbedocumented membersof

aNorthAmericantribe,bandorotherwiseorganizedgroupofnativepeoplewhoareindigenoustothe

continentalUnitedStatesandproofcanbeprovidedthroughaNativeAmericanBloodDegreeCertificate(i.e.

tribalregistryletter,tribalrollregisternumber).MMBDCwillacceptthosetribesrecognizedbyeitherthe

federalgovernmentorstategovernment.AmericanIndianlistingonthetribalregistryandacceptancebythe

tribecanbesubmittedforthe25%bloodlinerequirement.



AsianPacificAmerican–AUnitedStatescitizenwhooriginsarefromJapan,China,Taiwan,Korea,Vietnam,

Laos,Cambodia,thePhilippines,Samoa,Guam,theU.S.TrustTerritoriesofthePacificortheNorthern

Marianas.



Asian‐IndianAmerican–UnitedStates citizenswhoseoriginsareinIndia,PakistanandBangaladesh.



MinorityOwned

AfricanAmerican%  HispanicAmerican  %

AsianPacificAmerican  %  NativeAmerican  %



WomanOwned

AfricanAmerican%  HispanicAmerican  %

AsianPacificAmerican  %  NativeAmerican  %



MichiganMinorityBusinessDevelopmentCertificationavailable? Yes No

 Certificate#



Classifiedasasmallbusiness?

Yes No



MOTTCOMMUNITYCOLLEGEISANEQUALOPPORTUNITY&AFFIRMATIVEACTIONCOLLEGE



Signatureofpersonauthorizedtosignthisapplication



Printednameofpersonsigning



Titleofpersonsigning



Date



MOTT COMMUNITY COLLEGE • 1401 East Court St. • Flint, MI 48503 • (810)762-0200

click to sign

signature

click to edit

FormMCCBP4410:001

Page4of6

MOTT COMMUNITY COLLEGE • 1401 East Court St. • Flint, MI 48503 • (810)762-0200

COMMODITY/SERVICELIST

Pleaseindicatewhichofthefollowingcommodities/servicesyourcompanyprovides.Pleasecheckall

commodities/servicesforwhichyourcompanywishestobeincludedonfuturebids.



A.ADVERTISING(specialties,publications)

025‐15Trophies,Plaques&Awards

037‐52AdvertisingSpecialties–Imprinted

080‐00Books&Manuals

350‐00Flags&Accessories

915‐00Communications&MediaServices



B.AUTOMOTIVE

055‐00Accessories

055‐20AutomotiveTools/Equipment

060‐00Maintenance&Repair 

060‐20AutoTech/Courseware

070‐00Vehicles

080‐00WeldingRelatedItems



C.BUILDINGS,GROUNDS&CUSTODIAL

031‐00HVAC

150‐00BuildersSupplies

155‐00Buildings&Structures

155‐05Carpentry,Custom/Mill

192‐05IceControlProducts

285‐00ElectricalEquipment&Supplies

320‐25GlassSupplies 

360‐00FloorCovering

405‐00Gas/FuelRelated

485‐00JanitorialEquipment&Supplies

485‐01JanitorialChemicals,WasteWater

515‐00LawnEquipment&LawnPartsCare

C.BUILDINGS,GROUNDS&CUSTODIAL(cont’d)

560‐00MaterialHandlingEquipment

630‐02PaintingEquipment&Supplies

670‐00PlumbingEquipment

670‐05PoolRelatedSupplies&Chemicals

770‐00Roofing

801‐00Signage

910‐50NurseryItems

910‐59PestControl

979‐00SafetyEquipment,FirePrevention

981‐00Rental/LeaseEquipment

981‐01Commercial/IndustrialMaintenance

Equipment



D.COMMUNICATIONS

280‐00Cabling

287‐00ElectronicComponents

725‐00Radio/Telephone/Telecom

730‐00TelecommunicationTesting

800‐00AVPresentationSystems

803‐00SoundSystems

840‐00TelevisionEquipment



E.COMPUTERS

204‐00Hardware&Peripherals

207‐00Accessories&Supplies

208‐00Software



FormMCCBP4410:001

Page5of6

MOTT COMMUNITY COLLEGE • 1401 East Court St. • Flint, MI 48503 • (810)762-0200

F.CONSULTINGSERVICES

918‐04Fiscal

918‐15Architectural

918‐31Construction

918‐42Engineering

918‐66HumanResources

918‐74Legal

918‐80IT



G.CONTRACTORS

913‐94Paving/Resurfacing

914‐00ConstructionGeneral

914‐38Electrical

914‐61Painting

914‐68Plumbing

914‐73Roofing



H.FOODSERVICES

165‐00KitchenEquipment–Commercial

165‐01FoodProducts



I.FURNITURE

415‐00Laboratory

420‐00Cafeteria/Classroom/Library

425‐00OfficeFurniture

425‐10ADAFurniture

460‐05FloorFurnishings/Carpet/Tile

480‐06OutdoorFurniture&TrashContainers

870‐05WindowCoverings



J.INSTRUCTIONAL&LIBRARYPRODUCTS

050‐00ArtEquipment&Supplies

050‐20CustomFraming

050‐50EarlyChildhoodItems

095‐00CosmetologyProducts

150‐20AidsforPhysically&LearningChallenged

260‐00DentalProducts

490‐00LaboratoryEquipment&Sup plies

490‐05MedicalEquipment,Supplies&TrainingAids

525‐00LibraryEquipment&Supplies

545‐00Machinery&Har dware

580‐00MusicRelatedSheets&Instruments

655‐00PhotographicEquipment&Supplies

670‐00Tools

785‐20Books&Manuals

805‐00Sporting/AthleticEquipment

805‐01PhysicalTherapyEquipment&Supplies

845‐00PrecisionMeasuringEquipment

880‐11AVEquipment&Supplies



K.OFFICEEQUIPMENT&SUPPLIES

600‐00OfficeMachines&Accessories

615‐00OfficeSupplies,General

645‐00Paper(office&printshop)

700‐10Bag,Shipping&P ackagingSupplies



L.PRINTINGPRODUCTS&SERVICES

615‐05MailingServices

700‐00PrintingPlantEquipment&Supplies

966‐00Printing&RelatedServices



FormMCCBP4410:001

Page6of6

MOTT COMMUNITY COLLEGE • 1401 East Court St. • Flint, MI 48503 • (810)762-0200

M.SERVICES

515‐00LawnCare&GroundsKeeping

650‐10RecordShreddingServices

820‐01FloristServices

880‐15AVRepair

904‐00DebitCard/Coin‐OperatedServices

906‐00InteriorDesignServices

906‐40GraphicDesign

910‐13ElevatorInstallation&Maintenance

910‐27TrashRemoval

910‐36HVACServices

910‐39JanitorialServices

910‐54PaintingServices

910‐59PestControl

924‐00EducationalServicesTraining/Workshops

954‐05Laundry&Linen

961‐15Catering

961‐78Travel&CharterServices

962‐43Hotel&MotelAccommodations

962‐47InsuranceServices

962‐56MovingServices

962‐75WarehouseStorage,Rigging&Records

Management



964‐00TemporaryPersonnel

990‐46Guard&SecurityServices



N.MISCELLANEOUS

045‐00Appliances,Equipment&Household

200‐00Clothing,Apparel,Uniforms&Accessories

300‐05GraduationItems

390‐00FoodRetail

N.MISCELLANEOUS(cont’d)

900‐05LawEnforcementEquipment

962‐00Entertainment



Pleaselistanyadditionalcommoditiesorservicesyour

companyprovides,alongwithdetailedinformation:









PurchasingOfficeContactInformation



CarolBuford,PurchasingSpecialist 810‐762‐5393

LindaBolter,PurchasingSpecialist 810‐762‐0203

JodyBonamy,PurchasingSupervisor 810‐762‐0048



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