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184150-81915CITY OF BIRMINGHAM FINANCE DEPARTMENT PURCHASING DIVISION J. THOMAS BARNETT, JR. FINANCE DIRECTOR RANDALL WOODFIN MAYOR CARMEN JONES PURCHASING AGENT TRAVIS A. BROOKS ASST. PURCHASING AGENTVendors,To ensure your request will be added to the City of Birmingham’s bid list, you will need to complete the attached commodity form. Review the list of commodities provided before completing this form. Please mail or fax your completed form to:City of BirminghamPurchasing Division710 North 20th StreetRoom P-100Birmingham, AL 35203Fax: (205) 254-2484Thank you for having interest in doing business with the City of Birmingham.710 North 20th Street – P100 City Hall Birmingham, Alabama 35203 . Ofc: (205) 254-2265 . Fax: (205) 254-2484VENDOR INFORMATIONContact Person: ___________________________________________ Business Name: ___________________________________________ Business Address:___________________________________________ ___________________________________________ ___________________________________________ Minority Vendor: ________ Yes ________ NoEmail Address: _________________________________________ Phone Number: _(______)_________________________________ Fax Number: _(______)_________________________________Please Add My Company to The Following Bid List(s)1.______6.______11.______16.______21.______26.______2.______7.______12.______17.______22.______27.______3.______8.______13.______18.______23.______28.______4.______9.______14.______19.______24.______29.______5.______10.______15.______20.______25.______30.______ Example: 1. F-4 2. T-7 COMMODITIESA1ACOUSTICAL CEILINGSA2AIR COMPRESSORSA3AIR CONDITIONING /HEATINGA-3AAIR FILTERSA-3BALUMINUM FABRICATORSA-4AMMUNITIONA-5AMBULANCEA-6ANTI-FREEZEA-7APPLIANCES (MAJOR)A-7BARMORED CAR SERVICEA-8ASPHALT (PLANT MIX)A-9AUCTIONEER SERVICESA-10AUDIO VISUAL EQUIPMENT & SUPPLIESA-11AUTOMOBILE LEASINGA-12AUTO BODY REPAIRING & PAINTINGA-13AUTO PARTS & SUPPLY (USED & REBUILT)A-14AUTOMOBILE & TRUCKSA-15AUTOMOBILE PARTS & EQUIPMENTB-1BARRICADES & FLASHERSB-1ABAKERSB-2BATTERIESB-2ABANKING SERVICESB-3BERMUDA GRASSB-3ABINDERSB-4BLUEPRINTSB-5BOATB-6BOAT TRAILERSB-7BOILERSB-8BROOM FIBRE (STEEL)B-9BUILDING MATERIALB-9ABUNK BEDSB-10BURGLAR & FIRE ALARM SYSTEMSB-11BUSINESS FORMS & SYSTEMSB-12BUSINESS MACHINESB-13BUS RENTALC-1CABINET MAKERSC-2CABLE & CONNECTORS (TRAFFIC ENGINEERING & DATA PROCESSING)C-3CAR SALEC-4CAR WASHC-5CATALOGS-COMPUTER-OUTPUT (MICROFORM)C-6CELLULAR PHONESC-7CHEMICALS (WEED KILLERS, SANIFOAM, ETC)C-8SALE OF EQPT. (GEN. OFF. EQPT.)C-9SALE OF CITY EQPT. (HEAVY EQPT, AUTOS, TRUCKS)C-9ACOLOR SEPARATION, OFFSET PHOTO-ENGRAVING, ETCC-9BCLEANING AND REPAIRING TURNOUT GEARC-10COMMERCIAL LAUNDRY EQPTC-11COMMUNICATIONS EQPTC-11ACOMPUTER ROOMS-INSTALLATION & EQUIPMENTC-11BCABLE & WIRESC-12CONCRETE PRODUCTSC-13CONCRETE READY MIXC-14CONFISCATED PROPERTY & BICYCLE SALEC-14BIKEC-15CONTRACTORS - AIR CONDITIONINGC-16CONTRACTORS - ASBESTOS REMOVALC-17CONTRACTORS - BLASTINGC-18CONTRACTORS - CONCRETEC-19CONTRACTORS - DRYWALLC-20CONTRACTORS - ELECTRICC-21CONTRACTORS - EQPT & SUPPLIESC-22CONTRACTORS - EXCAVATINGC-23CONTRACTORS - GENERALC-24CONTRACTORS - GRADINGC-25CONTRACTORS - INSULATION - INDUSTRIALC-26CONTRACTORS - C-27CONTRACTORS - MASONC-28CONTRACTORS - MECHANICALC-29CONTRACTORS - PAINTINGC-30CONTRACTORS - PAVINGC-31CONTRACTORS - PLUMBINGC-31ACONTRACTORS - WATERPROOFINGC-32CONSTRUCTION MATERIALC-32ACONCESSIONSC-32BCONCESSIONAIRESC-33COPYING MACHINESC-34CRANESC-35CREOSOTE POLESC-36CROWD CONTROL BARRIERSC-37CRUSHED STONED-1DATA PROCESSING - MAINFRAME HARDWARE (NEW)D-2DATA PROCESSING - MAINFRAME HARDWARE (USED)D-3DATA PROCESSING - PERSONAL COMPUTER (HARDWARE)D-3ADATA PROCESSING - CADD-4DATA PROCESSING - PERSONAL COMPUTER SOFTWARE)D-5DATA PROCESSING - COMPUTER SUPPLIESD-6DATA PROCESSING - SALE OF DATA PROCESSING EQPT.D-7DEMOLITION OF HOUSESD-8DOORS, OVERHEAD & AUTOMATICD-9DRAPERIES & BLINDSD-9ADRY GOODSD-10DUMPSTER SERVICED-11DAIRIESE-1ELECTRONICE-2ELECTRICAL SUPPLIESE-3ELEVATOR MAINTENANCEE-4ENERGY MANAGEMENTE-5ENGINEERING EQUIPMENT & SUPPLIESE-6ENGINE - DIESELE-7EXERCISE EQUIPMENTE-8EXHAUST SYSTEMSF-1 FAX MACHINESF-2FENCEF-3FILING SYSTEMSF-3AFINANCIAL SOFTWAREF-4FIRE EQUIPMENTF-5FIREFIGHTER CLOTHINGF-6FIRE PROTECTION EQUIPMENT & SUPPLIESF-6AFLAGS & BANNERSF-7FLASHLIGHT BATTERIESF-8FLOOR COVERINGF-9FLOORS - RAISEDF-10FLOOR MACHINESF-11FOAM (FIRE DEPT.)F-12FOLDING CHAIRS & TABLESF-13FUEL DISPENSING SYSTEMS (AUTOMATED)F-14FURNITUREF-15SPRING FLING/ FALL FAIR @ FAIRGROUNDF-16FLEA MARKET PROVIDERSG-1GENERATORSG-2GEOPROCESSINGG-3GLASSG-4GUNS & GUNSMITHSH-1HARDWAREH-2HEAVY EQUIPMENTH-3HORSE FURNISHINGSH-4HORSES (BUY & SELL)I-1ICE MAKING EQUIPMENT & MACHINESI-2INDUSTRIAL CLEANING OF BUILDINGSI-3INTERNET PROVIDERJ-1JANITORIAL SERVICEJ-1AJANITORIAL SUPPLIESJ-2JUNK LISTL-1LANDSCAPINGL-2LAWN MAINTENANCEL-3LUMBERL-4LABORATORIES - TESTINGM-1MAILING MACHINES & EQUIPMENTM-1AMAILING SERVICEM-2MANHOLE BRICKM-2AMANNEQUINS, DISPLAY FIGURES & FORMSM-3MATERIAL HANDLING EQUIPMENTM-4MATTRESSESM-4AMEATS & REFRIGERATED GOODSM-5MEDICAL WASTE DISPOSALM-6METAL BUILDINGSM-6AMETAL DETECTORSM-7METAL LOCKERSM-7AMETAL RECYCLINGM-8MICROFILM EQUIPMENTM-9MICROFILMINGM-10MILLWORKM-11MOBILE TRAILER OFFICESM-11AMORTGAGE LENDERSM-12MOTORCYCLESM-13MOTORCYCLES (SALE OF)M-14MOVE & RELOCATE HOUSESM-15MOVERM-16MOWING EQUIPMENTM-17MUNICIPAL COURT & PROBATION CASE MANAGEMENT SOFTWAREN-1NURSESN-2NUTS & BOLTSN-3NURSERIES - PLANTS & TREESO-1OFFICE SUPPLIESO-2OIL GREASE & LUBRICANTSO-3ORNAMENTAL IRONO-4OUTBOARD MOTORSP-1PACKAGING MATERIALP-1BPAGERSP-2PAINTP-3PAINT STRIPPING MACHINEP-4PAPER DISTRIBUTORSP-4APAPER PRODUCTSP-5PAPER FOR PRINTINGP-6PARKING AREA MAINTENANCEP-7PARKING GATESP-8PARKING METERSP-9PARTITIONSP-9APERMITTING SYSTEM SOFTWAREP-10PEST CONTROLP-10APHARMACIESP-11PHOTOGRAPHIC EQUIPMENTP-11APICTURE FRAMINGP-11BPHOTOGRAPHERSP-12PIPE - BITUMINOUSP-13PIPE - CLAYP-14PIPE - CONCRETEP-15PIPE - IRONP-15APLASTIC PIPEP-16PLANT MAINTENANCE (INTERIOR)P-17PLUMBING FIXTURES & SUPPLIESP-18POLICE EQUIPMENTP-19POSTAGE EQUIPMENTP-20PRINTINGP-21PRINTING EQUIPMENTP-22PUMPSP-23PUMPERSP-24LIQUID PROPANE (LP) GASR-1RADIATORS PARTS & REPAIRR-2RADIOR-3RAIN SUITSR-4RECAPPINGR-4ARECHARGE TONER CARTRIDGESR-4BRECORDS STORAGER-4CRECREATIONAL VEHICLESR-5REHABILITATION HOUSESR-6RENTAL - TRUCKS, CARS & HEAVY EQUIPMENTR-7REPAIR HEAVY EQUIPMENTR-8RESCUE EQUIPMENT & SUPPLIESR-9RESCUE UNITSR-10ROOFING (RE-ROOFING)R-11RESTAURANT EQUIPMENTR-12REVERSE REPRINTSR-13REFRIGERATING EQUIPMENT (COMMERCIAL & INDUSTRIAL)S-1SAFETY EQUIPMENT & CLOTHINGS-2SAND BLASTINGS-3SAWSS-4SCAFFOLDING & AERIAL LIFTSS-5SECURITY GUARDSS-6SERVICE PINS/TROPHIESS-6ASOUVENIRS-7SHELVINGS-8SIGNSS-9SIGN MAKING EQUIPMENTS-10SIRENSS-11SOD & SODDING SERVICES-12SOLAR FILMS-13SOUND SYSTEMSS-14STAGE CURTAINSS-15SPORTING GOODSS-16STAGE LIGHTINGS-17STAGE PLATFORMSS-18STEAM CLEANERSS-19STORAGE TANKSS-20STEEL BARSS-20ASTEEL DISTRIBUTORSS-20BSTEEL BRIDGES (PREFAB)S-21SWIMMING POOLT-1TANKS - METALT-2TELEVISION SYSTEMS & EQUIPMENT (CLOSED CIRCUIT)T-3TELEPHONE SYSTEMST-4TEMPORARY EMPLOYMENT CONTRACTORST4-ATEXTILE CONTRACTT-5TIME RECORDERST-6TIRE REPAIRT-7TIREST-7ATOILETS T-7BTOWERST-8TRAFFIC CONEST-9TRAFFIC PAINTT-10TRAFFIC PAVEMENT MARKINGST-11TRAFFIC SIGNAL EQUIPMENT & STREET LIGHTING EQUIPMENTT-12TRAFFIC SIGNST-13TRAFFIC SIGN POSTST-14TRANSMISSION - AUTOMOBILET-15TRANSMISSION - TRUCK & TRACTORT-16TRUCK EQUIPMENT & PARTST-17TRUCK SCALEST-18TRUCK DUMPT-19TYPEWRITERST-20TRUNKING SYSTEMS (800 MEGAHERTZ)T-120TESTING EQUIPMENTU-1UNIFORMS (FIRE & POLICE)U-2UNIFORMS (WORKMAN & T-SHIRTSV-1VIDEOGRAPHERW-1WALLPAPER & WALL COVERINGSW-2WASTE RECEPTACLESW-3WATER CHILLERSW-4WATER TREATMENTW-5WEEDS (CUTTING OF)W-6WELDING SUPPLIESW-7WINDOWSW-8WINDOWS WASHINGW-9WORD PROCESSINGW-10WRECKER SERVICECity of Birmingham Transparency in City Government Disclosure FormIn addition to the vendor information form, each bidder must complete a City of Birmingham Transparency in City Government Disclosure Form. This form must be fully completed by each individual, firm, group, agency, non-profit and other entity (hereinafter referred to as “you” or “Applicant”) seeking to do business with the City, provide services to the City, enter into a contract or appointment with the City, or apply for City funding.Submit completed forms to the Mayor’s Office, Third Floor City Hall – Attention: Internal Audit and Contract Compliance Division. City of Birmingham Transparency in City Government Disclosure FormTRANSPARENCY IN CITY GOVERNMENT DISCLOSURE FORMAPPLICABLE TO ALL CITY CONTRACTS AND APPOINTMENTSNOT GOVERNED BY STATE COMPETITIVE BID LAWSINSTRUCTIONS:This form must be fully completed by each individual, firm, group, agency, non-profit and other entity (hereinafter referred to as “you” or “Applicant”) seeking to do business with the City, provide services to the City, enter into a contract or appointment with the City, or apply for City funding.Submit completed forms to the Mayor’s Office, Third Floor City Hall – Attention: Internal Audit and Contract Compliance Division. Answer all questions applicable to you. Respond “Not applicable” or “NA” if a question does not apply to you. Attach additional pages if needed. Completed forms will be submitted to the Birmingham City Council along with the Applicant’s proposed contract, appointment and/or funding request. ________________________________________________________________________1.Name of Applicant:2.Physical Street Address of Applicant:3.Mailing Address of Applicant (if different from street address):4.Phone Number of Applicant:5.Key Contact Person for Applicant:6.Identify all officers, directors, owners, substantial investors in (5% or more of Applicant’s stock) and partners of the Applicant:7. Are any of these persons City employees?City of Birmingham Transparency in City Government Disclosure Form8.Are any of these persons related by blood or by marriage to City officials or employees? If yes, list all pertinent relationships.9.Identify all key employees or personnel of the Applicant:10.Are any of these persons City employees?11.Are any of these persons related by blood or by marriage to City officials or employees? If yes, list all pertinent relationships.12.Has the Applicant ever received City funding, entered into a contract or appointment with the City, or provided services to the City? 13.If you answered “Yes” to Question No. 12 :a)State the amount of funds received or amount of the contract or appointment.b)Describe in detail the work performed, scope of appointment, or purpose for which the funds were used, and attach supporting documentation such as receipts and invoices.c)Attach a copy of the contract or appointment.14.Attach resumes of Applicant’s key personnel.City of Birmingham Transparency in City Government Disclosure Form15.Attach Applicant’s articles of incorporation if applicable.16.Attach Applicant’s 501(c)(3) letter from Internal Revenue Service if applicable.17.Attach Applicant’s City of Birmingham business license, if applicable.18. Describe in detail the work Applicant seeks to perform for the City.19. Identify all sources and amounts of public funding (federal, state and local) theApplicant has received within the past three (3) years.20. Has the Applicant ever been suspended or barred from participating in federal contracts or other federal assistance? If yes, explain.21. Has any individual associated with the Applicant ever been suspended or barred from participating in federal contracts or other federal assistance? If yes, explain.22. During the past three (3) years, has Applicant retained, hired or paid any lobbyist, political consultant or attorney to assist Applicant in its bid to perform work for the City or obtain a City contract, appointment or funding? If yes, identify by individual name, firm name, address and telephone number any such lobbyist, political consultant or attorney. 23.Identify any business or firm in which:The Applicant or its key personnel owns 5% or more of the stock;The Applicant or its key personnel serves as an officer or director;The Applicant or its key personnel is a partner.City of Birmingham Transparency in City Government Disclosure FormApplicant’s failure to file a Transparency in City Government Disclosure Form is punishable by state or local law to the maximum allowed by law and subject to any federal penalties required by the U.S. Code Annotated.I declare under penalty of perjury that the Applicant’s answers to each and every question on the City of Birmingham Transparency in City Government Disclosure Form are true and correct:_______________________________Signature_______________________________Print Name_______________________________Date______________________________Title/Position with ApplicantREVISED 12/11/2017 CJ ................
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