Microsoft Word - Diversity-Supplier-info



Jefferson Community and Technical College Vendor Company Information FormPlease Complete All Areas With Your Business InformationCompany NameAccept Visa Y/NFed ID #No. of EmployeesPrimary ContactPhoneEmailWebsiteBusiness Classification:DisabledAsian AmericanNative American Women OwnedHispanic AmericanAfrican AmericanVeteran OwnedN/AOther (Please Explain): Description of Products/Services:In order to be placed on the correct commodity list, check the blank check box provided for the Commodity(s) or Service(s), which your firm can provide.MASTER COMMODITY LISTAnimalsHeating & Air Conditioning Equipment & SuppliesAudiovisual Equipment & SuppliesLadders & ScaffoldingAutomobiles, Buses & TrucksLocksAutomotive Parts, Supplies & RelatedMaintenance EquipmentAutomotive Bodies & TrailersMetal ProductsBiological ResearchPaints & Coatings, SuppliesBuilding Furnishings – DomesticPlumbing Equipment & SuppliesBuilding Furnishings – Institutional Chain, Rope, CordRefrigeration Equipment & SuppliesDATA PROCESSING EQUIP & SUPPLIESChemicalsMainframeClothing, Textiles, Leather & Emblems CONSTRUCTION & BUILDING MAINT.PC’s type MemoryConstruction Material & Supplies EarthPeripheralsMoving EquipmentSoftwareElevators, Escalators & Conveyors– SuppliesFence MaterialsDairy Equipment & SuppliesHardware, GeneralEDUCATIONALJANITORIAL & LAUNDRYBooks & PublicationsJanitorial EquipmentEducational Equipment & SuppliesLaundry EquipmentHobby & Occupational Therapy ItemsJanitorial & Laundry SuppliesMusicalELECTRICALBuilding Construction & MaintenanceLABORATORY & SCIENTIFIC MARINE & COMMERCIAL FISHINGMEDICAL EQUIPMENTCommunicationsAnesthesiaElectronicsMaterial HandlingPower SuppliesMedical Training AidsSurveillanceMonitoringOtherPatient CareENGINEERING & SURVEYINGFIRE FIGHTING, LAW ENFORCEMENT & SAFETYPhysical Therapy RadiographicFire Fighting Equip & Supplies (other than vehicles)RespiratoryLaw Enforcement Equipment & SuppliesUltrasoundSafety EquipmentFOODSVeterinaryMEDICAL SUPPLIESFoods, for Human consumptionGASES, GASOLINE & PETROLEUMAnesthesia CathetersAsphalt, liquidCustom Pack/KitsCoalDressingsGases, industrial & medical (acetylene, oxygen, etc)GlovesGasoline, diesel, kerosene, solvents, lube oils, grease, etc.Implants – OrthopedicNatural gasImplants – TissuePropaneHORTICULTURALInstruments – Hand held Instruments – OpticEquipmentIV Solutions & Sets– SuppliesHOSPITALMonitoring OstomyEquipmentPersonal Protective Devices– SuppliesRadiation MedicineRespiratoryVending ServicesSpecial Diagnostics/Cath LabWater Treatment ServicesUrologicalsOther VeterinaryOFFICE EQUIPMENT & SUPPLIESFurnitureSHOP SUPPLIES SIGNS & DECALSSPORTING EQUIPMENTMachinesAthletic & SportsSuppliesAmmunition, Reloading & WeaponsOPTICAL & PHOTOGRAPHIC PAPER & PLASTICSPark & PlaygroundSUNDRIESPaperPaper Products (other than printed forms)TANKS, STORAGE TOOLSPlasticsAutomotivePHARMACEUTICALSConstruction TradesPRINTING & BINDINGGeneral PurposeRENTALS (see TRANSPORTATIOIN for charters)Power ActuatedROBOTIC EQUIPMENT SERVICESTRANSPORTATION WEIGHING EQUIPMENTArmored Car ServicesOTHER SERVICES: (not listed above)Carpet InstallationCatering ServicesCOM Microfilming ServiceConcession ServicesConstructionGraphic Arts & ReproductionsMaintenanceNewspaper Clippings – Originals and/or PhotocopiesNuclear & Chemical Waste DisposalRepairSoftware Programming & ConsultingSource Document MicrofilmingUtilitiesSELECT THE AREA(s) OF THE STATE YOUR FIRM IS WILLING TO WORK. CHECK ALL THAT APPLY.STATEWIDEFAYETTE COUNTYCENTRAL KY (between I‐65 & I‐75)METRO JEFFERSON C. (Louisville & E‐town)EASTERN KY (I‐75 east)WESTERN KY (I‐65 west)IF YOU ARE A CONSTRUCTION CONTRACTOR, COMPLETE THE FOLLOWING SECTIONS OF THIS FORM:Designate the most appropriate contractor classification for your firm. Check only ONE box.A/EGENERALASBESTOS/HAZARDOUSGLASS (DIV 8)CARPENTRYMASONRYCONCRETEMECHANICALCONSTRUCTION MANAGERMETALSDRYWALLPAINTINGELECTRICALROOFING (DIV 7)ELEVATORSSITE WORKEQUIPMENTSPECIALTIES (DIV 10‐13)FINISHES (DIV 9)SPRINKLERFURNISHINGSOTHERNotes: ................
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