HomeMy Public PortalAboutSupplier Data Form May 2018Supplier Data Form
Arial,Italic" 2Complete this form and submit to Purchasing
SUPPLIER NAME:
SUPPLIER ADDRESS FOR PURCHASE ORDERS:
CONTACT EMAIL:
ADDITIONAL CONTACT NAME:
CONTACT NAME:
ADDITIONAL CONTACT PHONE NUMBER:
CONTACT PHONE NUMBER:
CONTACT FAX NUMBER:
ADDITIONAL CONTACT FAX NUMBER:
ADDITIONAL CONTACT EMAIL:
SUPPLIER ADDRESS FOR PAYMENT (REMIT TO):
CITY, STATE, ZIP
ADDRESS LINE 1
ADDRESS LINE 2
PREFERRED PAYMENT METHOD:
TAXPAYER ID #:
DUNS NUMBER:
1099 REPORTABLE?:
INCOME TAX TYPE:
MINORITY STATUS
MBE:
MBE TYPE:
WBE:
CERTIFYING AGENCY, IF KNOWN:
REQUESTOR:
ADDITIONAL INFORMATION OR COMMENTS:
CHECK
ELECTRONIC
MISC1 - RENT
MISC3 - OTHER INCOME
MISC6 - MEDICAL & HEALTH CARE PAYMENTS
MISC7 - NON-EMPLOYEE COMPENSATION
MISC14 - GROSS PROCEEDS PAID TO AN ATTORNEY
ü
AFRICAN AMERICAN
ASIAN AMERICAN
HISPANIC AMERICAN
NO
YES
SUPPLIER
MANUFACTURER
SUPPLIER TYPE:
DEVELOPER
CONSULTANT
EMPLOYEE
CONTRACTOR CAPITAL CONSTRUCTION
EMPLOYEE #:
PREFERRED COMMUNICATION METHOD FOR
PURCHASE ORDERS:
FOR PURCHASING USE ONLY:
DATE SUPPLIER CREATED:
SUPPLIER #:
CREATED BY:
FAX - #
EMAIL:
REQUESTOR PHONE #:
RETURN THIS FORM TO: SUPPLIERS@STLMSD.COM
SUPPLIER DATA FORM
LIST PRODUCT AND SERVICES CODES AS APPLIES BELOW:
EASEMENT
TEMPORARY/PERMANENT
NEW/OLD PROJECT
EMERGENCY REQUEST
REASON (MUST BE FILLED IN)
IF YES, CHECK THE BOX TO THE RIGHT
Supplier Work Categories
CATEGORY CODE
DESCRIPTION
ITEMS:
005.00
ABRASIVES
010.00
ACOUSTICAL TILE, INSULATING MATERIALS, AND SUPPLIES
015.00
ADDRESSING, COPYING, MIMEOGRAPH, AND SPIRIT DUPLICATING MACHINES AND SUPPLIES
010.11
ADHESIVES AND CEMENTS, ACOUSTICAL TILE
ADHESIVES AND CEMENTS, INSULATION
025.00
AIR COMPRESSORS AND ACCESSORIES
031.00
AIR CONDITIONING, HEATING, AND VENTILATING: EQUIPMENT, PARTS
045.00
APPLIANCES AND EQUIPMENT, HOUSEHOLD TYPE
055.00
AUTOMOTIVE ACCESSORIES FOR AUTOMOBILES, BUSES, TRUCKS, ETC.
065.00
AUTOMOTIVE BODIES, ACCESSORIES, AND PARTS
060.00
AUTOMOTIVE MAINTENANCE ITEMS AND REPAIR/REPLACEMENT PARTS
075.00
AUTOMOTIVE SHOP EQUIPMENT AND SUPPLIES
070.00
AUTOMOTIVE VEHICLES AND RELATED TRANSPORTATION EQUIPMENT
080.00
BADGES, EMBLEMS, NAME TAGS AND PLATES, JEWELRY, ETC.
085.00
BAGS, BAGGING, TIES, AND EROSION CONTROL EQUIPMENT
100.00
BARRELS, DRUMS, KEGS, AND CONTAINERS
105.00
BEARINGS (EXCEPT WHEEL BEARINGS AND SEALS -SEE CLASS 060)
110.00
BELTS AND BELTING: CONVEYOR, ELEVATOR, POWER TRANSMISSION, A
115.00
BIOCHEMICALS, RESEARCH
125.00
BOOKBINDING SUPPLIES, ADHESIVES, PASTES, ETC
908.00
BOOKBINDING, REBINDING, AND REPAIRING
135.00
BRICKS AND OTHER CLAY PRODUCTS, REFRACTORY MATERIALS, AND ST
140.00
BROOM, BRUSH, AND MOP MANUFACTURING MACHINERY AND SUPPLIES
145.00
BRUSHES (ALL)
150.00
BUILDER'S SUPPLIES (ALL)
155.00
BUILDINGS AND STRUCTURES: FABRICATED AND PREFABRICATED
175.00
CHEMICAL LABORATORY EQUIPMENT AND SUPPLIES
180.00
CHEMICAL RAW MATERIALS (IN LARGE QUANTITIES PRIMARILY FOR MA
190.00
CHEMICALS AND SOLVENTS, COMMERCIAL (ALL)
192.00
CLEANING COMPOSITIONS, DETERGENTS, SOLVENTS, AND STRIPPERS -
193.00
CLINICAL LABORATORY REAGENTS AND TESTS (BLOOD GROUPING, DIAG
195.00
CLOCKS, TIMERS, WATCHES, AND JEWELERS' AND WATCHMAKERS' TOOL
200.00
CLOTHING, APPAREL, UNIFORMS, AND ACCESSORIES
915.00
COMMUNICATIONS AND MEDIA RELATED SERVICES
207.00
COMPUTER ACCESSORIES AND SUPPLIES
204.00
COMPUTER HARDWARE AND PERIPHERALS FOR MICROCOMPUTERS
206.00
COMPUTER HARDWARE AND PERIPHERALS FOR MINI AND MAIN FRAME CO
208.00
COMPUTER SOFTWARE FOR MICROCOMPUTERS (PREPROGRAMMED)
209.00
COMPUTER SOFTWARE FOR MINI AND MAINFRAME COMPUTERS (PREPROGR
210.00
CONCRETE AND METAL CULVERTS, PILINGS, SEPTIC TANKS, ACCESSOR
220.00
CONTROLLING, INDICATING, MEASURING, MONITORING, AND RECORDIN
225.00
COOLERS, DRINKING WATER (WATER FOUNTAINS)
578.20
COUNTERS, MECHANICAL: TALLY, ETC.
578.22
COUNTING MACHINES, ELECTRONIC (NOT TICOMETERS, SEE CLASS 600
232.00
CRAFTS, GENERAL - ALL
233.00
CRAFTS, SPECIALIZED
250.00
DATA PROCESSING CARDS AND PAPER
255.00
DECALS AND STAMPS
578.27
DEHYDRATING MACHINES AND PARTS
578.28
DEODORANT SPRAY, (HEAVY DUTY OUTDOOR TYPE)
578.31
DISPLAY AND SHOWROOM EQUIPMENT AND SUPPLIES
265.00
DRAPERIES, CURTAINS, AND UPHOLSTERY MATERIAL
992.36
DRILLING, CORE TESTING & SAMPLES
269.00
DRUG AND PHARMACEUTICALS
270.00
DRUGS, PHARMACEUTICALS AND BIOLOGICALS
271.00
DRUGS, PHARMACEUTICALS, AND SETS
280.00
ELECTRICAL CABLES AND WIRES (NOT ELECTRONIC)
285.00
ELECTRICAL EQUIPMENT AND SUPPLIES (EXCEPT CABLE AND WIRE)
287.00
ELECTRONIC COMPONENTS, REPLACEMENT PARTS, AND ACCESSORIES: A
295.00
ELEVATORS AND ESCALATORS, BUILDING TYPE
290.00
ENERGY COLLECTING EQUIPMENT AND ACCESSORIES: SOLAR AND WIND
305.00
ENGINEERING EQUIPMENT, SURVEYING EQUIPMENT, DRAWING INSTRUME
310.00
ENVELOPES, PLAIN OR PRINTED - ALL
315.00
EPOXY BASED FORMULATIONS FOR ADHESIVES, COATINGS, AND RELATE
941.00
EQUIPMENT & MAINTENANCE HVAC
320.00
FASTENING, PACKAGING, STRAPPING, TYING EQUIPMENT AND SUPPLIE
330.00
FENCING
335.00
FERTILIZERS AND SOIL CONDITIONERS
340.00
FIRE PROTECTION EQUIPMENT AND SUPPLIES
345.00
FIRST AID AND SAFETY EQUIPMENT AND SUPPLIES (EXCEPT NUCLEAR
350.00
FLAGS, FLAG POLES, BANNERS, AND ACCESSORIES
578.37
FLOOD CONTROL DEVICES, EQUIPMENT, ACCESSORIES AND PARTS
360.00
FLOOR COVERING, FLOOR COVERING INSTALLATION AND REMOVAL EQUI
365.00
FLOOR MAINTENANCE MACHINES, PARTS, AND ACCESSORIES
395.00
FORMS, CONTINUOUS: COMPUTER PAPER, FORM LABELS, SNAP-OUT FOR
400.00
FOUNDRY CASTINGS, EQUIPMENT, AND SUPPLIES
405.00
FUEL, OIL, GREASE AND LUBRICANTS
420.00
FURNITURE: CAFETERIA, CHAPEL, DORMITORY, HOUSEHOLD, LIBRARY,
410.00
FURNITURE: HEALTH CARE AND HOSPITAL FACILITY
415.00
FURNITURE: LABORATORY
425.00
FURNITURE: OFFICE
430.00
GASES, CONTAINERS, EQUIPMENT: LABORATORY, MEDICAL, AND WELDI
435.00
GERMICIDES, CLEANERS, AND RELATED SANITATION PRODUCTS FOR HE
440.00
GLASS AND GLAZING SUPPLIES
445.00
HAND TOOLS (POWERED AND NON-POWERED), ACCESSORIES AND SUPPLI
450.00
HARDWARE AND RELATED ITEMS
578.50
HOLDERS, METAL: CARD, DOOR NAME CARD, LABEL, ETC.
460.00
HOSE, ACCESSORIES, AND SUPPLIES: INDUSTRIAL, COMMERCIAL, AND
465.00
HOSPITAL AND SURGICAL EQUIPMENT, INSTRUMENTS, AND SUPPLIES
470.00
HOSPITAL EQUIPMENT AND SUPPLIES: MOBILITY, SPEECH IMPAIRED,
475.00
HOSPITAL, SURGICAL, AND RELATED MEDICAL ACCESSORIES AND SUND
953.00
INSURANCE, ALL TYPES
485.00
JANITORIAL SUPPLIES, GENERAL LINE
495.00
LABORATORY AND FIELD EQUIPMENT AND SUPPLIES: BIOLOGY, BOTANY
490.00
LABORATORY EQUIPMENT AND ACCESSORIES (FOR GENERAL ANALYTICAL
505.00
LAUNDRY AND DRY CLEANING COMPOUNDS AND SUPPLIES
500.00
LAUNDRY AND DRY CLEANING EQUIPMENT, ACCESSORIES, PARTS AND S
510.00
LAUNDRY TEXTILES AND SUPPLIES
515.00
LAWN MAINTENANCE EQUIPMENT, ACCESSORIES, AND PARTS (NON-AGRI
520.00
LEATHER AND RELATED EQUIPMENT, PRODUCTS, ACCESSORIES, AND SU
525.00
LIBRARY AND ARCHIVAL EQUIPMENT, MACHINES, AND SUPPLIES
530.00
LUGGAGE, BRIEF CASES, PURSES AND RELATED ITEMS
540.00
LUMBER AND RELATED PRODUCTS
545.00
MACHINERY AND HARDWARE, INDUSTRIAL
550.00
MARKERS, PLAQUES AND TRAFFIC CONTROL DEVICES
555.00
MARKING AND STENCILING DEVICES
560.00
MATERIAL HANDLING AND STORAGE EQUIPMENT AND ALLIED ITEMS
578.55
MATS, ALL KINDS (NOT OTHERWISE CLASSIFIED)
565.00
MATTRESS MANUFACTURING MACHINERY AND SUPPLIES
570.00
METALS: BARS, PLATES, RODS, SHEETS, STRIPS, STRUCTURAL SHAPE
575.00
MICROFICHE AND MICROFILM EQUIPMENT, ACCESSORIES, AND SUPPLIE
578.00
MISCELLANEOUS PRODUCTS
600.00
OFFICE MACHINES, EQUIPMENT, AND ACCESSORIES
605.00
OFFICE MECHANICAL AIDS, SMALL MACHINES, AND APPARATUSES
615.00
OFFICE SUPPLIES, GENERAL
610.00
OFFICE SUPPLIES: CARBON PAPER AND RIBBONS, ALL TYPES
620.00
OFFICE SUPPLIES: ERASERS, INKS, LEADS, PENS, PENCILS, ETC.
625.00
OPTICAL EQUIPMENT, ACCESSORIES, AND SUPPLIES
630.00
PAINT, PROTECTIVE COATINGS, VARNISH, WALLPAPER, AND RELATED
635.00
PAINTING EQUIPMENT AND ACCESSORIES
645.00
PAPER (FOR OFFICE AND PRINT SHOP USE)
640.00
PAPER AND PLASTIC PRODUCTS, DISPOSABLE
655.00
PHOTOGRAPHIC EQUIPMENT AND SUPPLIES (NOT INCLUDING GRAPHIC A
658.00
PIPE AND TUBING
659.00
PIPE FITTINGS
665.00
PLASTICS, RESINS, FIBERGLASS: CONSTRUCTION, FORMING, LAMINAT
670.00
PLUMBING EQUIPMENT, FIXTURES, AND SUPPLIES
578.59
PNEUMATIC TUBE EQUIPMENT, ACCESSORIES, AND SUPPLIES
675.00
POISONS: AGRICULTURAL AND INDUSTRIAL
700.00
PRINTING PLANT EQUIPMENT AND SUPPLIES (EXCEPT PAPERS)
715.00
PUBLICATIONS AND AUDIOVISUAL MATERIALS (PREPARED MATERIALS O
720.00
PUMPING EQUIPMENT AND ACCESSORIES
730.00
RADIO COMMUNICATION AND TELECOMMUNICATION TESTING, MEASURING
725.00
RADIO COMMUNICATION, TELEPHONE, AND TELECOMMUNICATION EQUIPM
735.00
RAGS, SHOP TOWELS, AND WIPING CLOTHS
578.63
REAL ESTATE: LAND AND IMPROVEMENTS
578.64
RECYCLING EQUIPMENT, MACHINES, AND SUPPLIES
740.00
REFRIGERATION EQUIPMENT AND ACCESSORIES
745.00
ROAD AND HIGHWAY BUILDING MATERIALS (ASPHALTIC)
750.00
ROAD AND HIGHWAY BUILDING MATERIALS (NOT ASPHALTIC)
765.00
ROAD AND HIGHWAY EQUIPMENT (EXCEPT ASPHALT, CONCRETE, AND EA
755.00
ROAD AND HIGHWAY EQUIPMENT AND PARTS: ASPHALT AND CONCRETE H
760.00
ROAD AND HIGHWAY EQUIPMENT: EARTH HANDLING, GRADING, MOVING,
998.00
SALE OF SURPLUS & OBSOLETE ITEMS
775.00
SALT (SODIUM CHLORIDE) (SEE CLASS 393 FOR TABLE SALT)
780.00
SCALES AND WEIGHING APPARATUS
790.00
SEED, SOD, SOIL, AND INOCULANTS
800.00
SHOES AND BOOTS
801.00
SIGNS, SIGN MATERIALS, SIGN MAKING EQUIPMENT, AND RELATED SU
803.00
SOUND SYSTEMS, COMPONENTS, AND ACCESSORIES: GROUP INTERCOM,
810.00
SPRAYING EQUIPMENT (EXCEPT HOUSEHOLD, NURSERY PLANT, AND PAI
820.00
STEAM AND HOT WATER BOILERS, STEAM HEATING, AND POWER PLANT
815.00
STEAM AND HOT WATER FITTINGS, ACCESSORIES, AND SUPPLIES
005.84
STEEL WOOL
825.00
STOCKMAN EQUIPMENT AND SUPPLIES
578.85
TACHISTOSCOPIC DEVICES
578.86
TAGS, KEY (ALL KINDS)
830.00
TANKS (METAL, WOOD, AND SYNTHETIC MATERIALS): MOBILE, PORTAB
832.00
TAPE (NOT DATA PROCESSING, MEASURING, OPTICAL, SEWING, SOUND
840.00
TELEVISION EQUIPMENT AND ACCESSORIES
845.00
TESTING APPARATUS AND INSTRUMENTS (NOT FOR ELECTRICAL OR ELE
578.91
TESTING MACHINES, DRIVER, AUTOMATED (INCLUDING DRIVER SIMULA
850.00
TEXTILES, FIBERS, HOUSEHOLD LINENS, AND PIECE GOODS
863.00
TIRES AND TUBES
934.84
TOILETS, PORTABLE (INCLUDING SERVICING)
578.94
TURF, ARTIFICIAL, INDOOR AND OUTDOOR
865.00
TWINE
870.00
VENETIAN BLINDS, AWNINGS, AND SHADES
880.00
VISUAL EDUCATION EQUIPMENT AND SUPPLIES (EXCEPT PROJECTION L
885.00
WATER AND WASTEWATER TREATING CHEMICALS
890.00
WATER SUPPLY AND SEWAGE TREATMENT EQUIPMENT (NOT FOR AIR CON
895.00
WELDING EQUIPMENT AND SUPPLIES
898.00
X-RAY AND OTHER RADIOLOGICAL EQUIPMENT AND SUPPLIES (MEDICAL
SERVICES:
990.05
ALARM SERVICES
906.00
ARCHITECT AND OTHER PROFESSIONAL DESIGN SERVICES (FOR CONSTR
909.00
BUILDING CONSTRUCTION SERVICES - EQUIPMENT, FURNISHINGS, AND
910.00
BUILDING MAINTENANCE AND REPAIR SERVICES
997.05
CONCRETE CONSTRUCTION
909.24
CONCRETE CONSTRUCTION SERVICES
913.46
CONSTRUCTION, SEWER AND STORM DRAON - CITY
913.47
CONSTRUCTION, SIDEWALK AND DRIVEWAY (INCL. PEDESTRIAN AND HA
913.56
CONSTRUCTION, UTILITY
913.57
CONSTRUCTION, VAULTED SIDEWALK
913.58
CONSTRUCTION, VIADUCT (INCL. RECONSTRUCTION)
913.60
CONSTRUCTION, WATER SYSTEMS, MAIN AND SERVICE LINE
913.45
CONSTRUCTION. SEWER AND STORM DRAIN - COUNTY
918.00
CONSULTING SERVICES
920.00
DATA PROCESSING SERVICES AND SOFTWARE
924.00
EDUCATIONAL SERVICES
925.00
ENGINEERING SERVICES, PROFESSIONAL
928.00
EQUIPMENT MAINTENANCE, RECONDITIONING AND REPAIR SERVICES FO
939.00
EQUIPMENT MAINTENANCE, RECONDITIONING, AND REPAIR SERVICES - OFFICE EQUIPMENT
929.00
EQUIPMENT MAINTENANCE, RECONDITIONING, AND REPAIR SERVICES: HEAVY EQUIPMENT
934.00
EQUIPMENT MAINTENANCE, RECONDITIONING, AND REPAIR SERVICES: IRRIGATION SYSTEMS
938.00
EQUIPMENT MAINTENANCE, RECONDITIONING, AND REPAIR SERVICES: LABORATORY EQUIPMENT
940.00
EQUIPMENT MAINTENANCE, REPAIR, AND CONSTRUCTION SERVICES - R
946.00
FINANCIAL SERVICES
948.00
HEALTH RELATED SERVICES
918.73
LANDSCAPING
954.00
LAUNDRY AND DRY CLEANING SERVICES
962.00
MISCELLANEOUS SERVICES
964.00
PERSONNEL, TEMPORARY (EMPLOYMENT AGENCY SERVICES)
966.00
PRINTING AND RELATED SERVICES
965.00
PRINTING PREPARATIONS: ETCHING, PHOTOENGRAVING, AND PREPARAT
968.00
PUBLIC WORKS, CONSTRUCTION, AND RELATED SERVICES
971.00
REAL PROPERTY RENTAL OR LEASE
981.00
RENTAL OR LEASE OF EQUIPMENT - GENERAL EQUIPMENT
975.00
RENTAL OR LEASE SERVICES OF EQUIPMENT - AGRICULTURAL, AIRCRA
977.00
RENTAL OR LEASE SERVICES OF EQUIPMENT - APPLIANCES, CAFETERI
979.00
RENTAL OR LEASE SERVICES OF EQUIPMENT - ENGINEERING, HOSPITA
983.00
RENTAL OR LEASE SERVICES OF EQUIPMENT - JANITORIAL, LAUNDRY,
985.00
RENTAL OR LEASE SERVICES OF EQUIPMENT - OFFICE, PHOTOGRAPHIC
988.00
ROADSIDE, GROUNDS, RECREATIONAL AND PARK AREA SERVICES
770.00
ROOFING
990.00
SECURITY, FIRE, SAFETY, AND EMERGENCY SERVICES
968.76
STREET RECONSTRUCTION
997.07
TRENCHLESS SEWER CONSTRUCTION
OTHER - NOT LISTED (WRITE IN):
Please see second tab for the list
BID LIST ONLY SUPPLIER
PROPERTY OWNER
CERTIFICATE EXPIRATION DATE
CUSTOMER
updated 05.11.18