Vendor Information Request Form

Vendor Information Request Form

PR #*

Please provide the number referenced in the email request.

Company Name*

Mailing Address*

Phone Number*

Phone

Fax Number

Phone

Email Address*

Check Payable to*

Remit to Address*

Remit to Phone Number

Phone

Remit to Fax Number

Phone

Remit to Email Address*

Do you accept Purchase Orders?*

If no, please upload a credit application below for account setup.

Select

Do you accept District checks?*

Select

Do you charge additional shipping/handling on your orders?*

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Will you provide services, repair, or installation (Public Works) on District Property?*

If yes, the Contractor is required to provide a certificate of insurance to Mt. San Jacinto Community College District prior to the start date of work to be performed. The Contractor’s insurance coverage must meet the minimum liability requirements of the District indicated below including listing the District as an additional insured.

The District will maintain for itself appropriate commercial general liability insurance coverage in the minimum amounts of $1,000,000 per occurrence (combined single limit for bodily injury and property damage); $1,000,000 for personal and advertising injury liability; $1,000,000 aggregate on products and completed operations and $2,000,000 for general aggregate.

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Work/Projects/Services Subject to SB 854 Requirements

The District has adopted the Uniform Construction Cost Accounting Procedure under Public Contract Code §22000 et seq. In accordance with the State of California Uniform Public Construction Cost Accounting Commission, the District is inviting all interested licensed contractors to submit their companies for inclusion on the District’s list of qualified contractors for the current calendar year. This is an annual requirement. You must resubmit a new application to be included on the current calendar year list, even if your company has submitted an application in prior years.

The District is using Planet Bids! If you or your company would like to be placed on the District’s current year's Qualified Contractor List, please go to the vendor portal link listed below and click NEW VENDOR REGISTRATION (all vendors will be required to register via this vendor portal):

https://pbsystem.planetbids.com/portal/50031/portal-home

Per California Public Contract Code 22032, any Public Works Project that is estimated to be $200,000 (Effective January 1, 2019) or less is subject to the Informal Bidding Procedures set forth by the State of California Uniform Construction Cost Accounting Commission. All trade categories are subject to Informal Bidding Procedures and the Qualified Contractor List requirements. Contractors that are interested in being on the current year's Qualified List are required to have a current license and are subject to verification through the Contractors State License Board at all times.

Contractors must be currently registered with the Department of Industrial Relations (DIR), and meet the requirements of Labor Code section 1725.5 prior to bidding on any District projects. Contractors must maintain valid registration with DIR throughout the current calendar year. Contractors shall be solely responsible for ensuring compliance with Labor Code section 1725.5 as well as any requirement implemented by DIR applicable to its services or its subcontractors throughout its work on any District project. The contractor shall also furnish certified payroll records as required pursuant to Labor Code section 1776 directly to the Labor Commissioner in accordance with Labor Code section 1771.4 and in a format prescribed by the Labor Commissioner throughout any District project. By submitting an application to be included on the District’s Qualified Contractor List, the contractor confirms that it is in compliance with all applicable DIR and Labor Code regulations and has the capacity to maintain compliance throughout the calendar year and during any District project.

DIR Registration Number and Current CSLB:

File Upload*

Please upload a signed W-9 (this is required to move forward).

https://www.irs.gov/pub/irs-pdf/fw9.pdf

Upload your company's credit application here, too, if applicable.

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