Multitech MT5634IND Especificações descarregar pdf (Página 17)

WISCONSIN DEPARTMENT OF BID #268246 TRAFFIC DATA RECORDERS

TRANSPORTATION PAGE 17 OF 23

STATE OF WISCONSIN

DOA-3477 (R05/98)

ATTACHMENT A

VENDOR INFORMATION

1. BIDDING COMPANY NAME: _________________________________________________________

FEIN (Federal Employer ID Number) OR Social Security # (if Sole Proprietorship)

_________________________________ ___________________________________

Phone ( ) ______________________ Toll Free Phone ( ) __________________________

Fax ( ) ______________________ Email Address ( ) __________________________

Address: __________________________________________________________________________

City ____________________________ State ________ Zip + 4 _______________________

2. Name the person to contact for questions concerning this bid.

Name __________________________ Title ______________________________

Phone ( ) ______________________ Toll Free Phone ( ) __________________________

Fax ( ) ______________________ Email Address ( ) __________________________

Address: __________________________________________________________________________

City ____________________________ State ________ Zip + 4 _______________________

3. Any vendor awarded over $25,000 on this contract must submit affirmative action information to the

department. Please name the Personnel/Human Resource and Development or other person responsible

for affirmative action in the company to contact about this plan.

Name __________________________ Title ______________________________

Phone ( ) ______________________ Toll Free Phone ( ) __________________________

Fax ( ) ______________________ Email Address ( ) __________________________

Address: __________________________________________________________________________

City ____________________________ State ________ Zip + 4 _______________________

4. Mailing address to which state purchase orders are mailed and person the department may contact

concerning orders and billings.

Name __________________________ Title ______________________________

Phone ( ) ______________________ Toll Free Phone ( ) __________________________

Fax ( ) ______________________ Email Address ( ) __________________________

Address: __________________________________________________________________________

City ____________________________ State ________ Zip + 4 _______________________

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Multitech MT5634IND Especificações Página 17