Vendor Assessment Form

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In order to be included in the District's potential vendor database, all required forms must be signed and submitted to SMWD. All documents must be completed and accurate. If the information is incorrect, your vendor request will not be accepted.
Contact Name*

First NameLast Name
E-mail*

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References

Please list at least three companies with whom you are currently doing business with
Does your company have an afterhours/holiday standby program for customer emergencies?
After Hours / Emergency Phone Number
YesNo
Company Name
Contact Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
- Company Name
- Contact Name
- Phone Number
  
  Area CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Company Name
- Contact Name
- Phone Number
  
  Area CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry

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The following documents must be submitted with this form:
General Liability and Automobile Insurance Certificate and Endorsements

Upload a File

Cancelof
Worker's Compensation Insurance Certificate and Endorsements

Upload a File

Cancelof
Professional Liability Insurance Certificate (Professional Services only)

Upload a File

Cancelof
W-9 Form*

Upload a File
Click here to download the W-9 form. Cancelof
Public Works Contractor Registration Certification

Upload a File
Click here to download the form. Cancelof
Other Attachments

Upload a File
Anything else that you would like to attach (eg. State License, Busines License, Contractors License, etc.) Cancelof

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Under penalty of perjury, I certify that all information on this form is true and correct.
Please print name and title:*
Date:*

MonthDayYear
Should be Empty:

Business Information: