Lee County Contracts Management
BIDDER / CONSULTANT / CONTRACTOR  APPLICATION

Application Requirements - MUST READ BEFORE SUBMITTAL

Tax Filing Status:  Check the box that applies to you and complete the appropriate fields below.  Click here for further explanation.

 Individual/ Sole Proprietor   Non- Profit Organization   Partnership   Corporation Government Foreign
Social Security #
 
(please enter your SSN# as 555555555 not 555-55-5555)
Federal Tax ID #
 
(please enter your Fed Tax # as 555555555 not 55-5555555)
Tax Exempt Cert #
 
 
Business Name/ DBA
Individual Name
Parent Company Name
Address
Address (Cont.)
City
County
State
Zip Code
Country
Business Phone (Include Area Code)
Fax Number (Include Area Code)
Pager Number (Include Area Code)
Cellular Number (Include Area Code)
E-Mail Address
Contact Name

CHECK WHAT APPLIES:

Definitions of DBE (Disadvantaged Business Enterprise):

MUST BE AN AMERICAN CITIZEN AND ANY OF THE FOLLOWING

“Black American” a person having origin in any of the Black racial groups of Africa;

“Hispanic American” a person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish cultures of origins, regardless of race;

“Native American” a person who are American Indians, Eskimos, Aleuts, or Native Hawaiians;

“Asian-Pacific American” a person whose origins are from Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia,         thePhilippines, Samoa, Guam, the U.S. Trust Territories of the Pacific, and Northern Marians, and

“Asian-Indian American” a person whose origins are from India, Pakistan, and Bangladesh.

Woman Owned Business Enterprise –Any American Woman, owned by woman or women of any race

Not Applicable

Click here for Explanation/Requirements.
 
Remittance Address (if different than above)
Remittance Name
Remittance Address
City
State
Zip Code
Licensing Information
State Certified License # State Registration License #
Lee County Occupational License # Lee County Competency License #

IMMIGRATION LAWS:

Lee County will not intentionally award County contracts to any contract/vendor who knowingly employs unauthorized alien workers, constituting a violation of the employment provisions contacined in 8 U.S.C Section 1324a(e) Section 274A(e) of the Immigration and Nationalaity Acts (INA).


Hold Harmless and Indemnity Clause:

To the fullest extent permitted by applicable law, Contractor shall protect, defend, indemnify, save, and hold the County, the Board of County Commissionors, its agents, officials, and employees harmless from and against any and all claims, demands, fines, loss or destruction of property, liabilities, damages, for claims based on the negligence, misconduct, or omissions of the Contractor resulting from the Contractor's work as further described in this contract, which may arise in favor of any person or persons resulting from the Contractor's performance or non-performance of its obligations under this contract except any damages arising out of personal injury or property claims from third parties caused solely by the negligence, omission(s) or willful misconduct of the County, its officials, commissions, employees or agents, subject to the limitations as set out in Florida general law, Section 768.28, Florida Statutes, as amended. Further, Contrator hereby agrees to indemnify the County for all reasonable expenses and attorney's fees incurred by or imposed upon the County in connection therewith for any loss, damage, injury, or other casualty. Contractor additionally agrees that the County may employ an attorney of the County's own selection to appear and defend any such action, on behalf of the County, at expense of the Contractor. The Contractor further agrees to pay all reasonable expenses and attorney's fees incurred by the County in establishing the right to indemnity.

I AGREE I DISAGREE

I hereby certify that the information supplied herein is correct:
Name
Title
E-Mail Address
A W-9 Form will be required prior to adding your company to Lee County's Bidder / Consultant / Contractor's List.  Click here to obtain the W-9 form.

Commodity Codes: Please carefully review the list of Contracting and/or Professional Services.  Select the services your company is able to provide to Lee County. (To select more than one Contracting or Professional Service, simply click on your first selection, then hold down the CONTROL key and click the remainder of the categories. Please indicate in the Text Box below,  if you could not locate any Services you provide. 
 
General, Highway & Street, Heavy and Special Trade Contractors: Professional and Other Professional Services:

Contracting or Professional Services Not Listed: