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Tax Filing Status: Check the box that
applies to you and complete the appropriate fields below. Click here for further explanation.
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Remittance Address (if different than above)
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CHECK WHAT APPLIES:
Definitions of DBE (Disadvantaged Business Enterprise):
MUST BE AN AMERICAN CITIZEN AND ANY OF THE FOLLOWING
“Black American” a person having origin in any of the Black racial groups
of Africa;
“Hispanic American” a person of Mexican, Puerto Rican, Cuban, Central
or South American, or other Spanish cultures of origins, regardless of race;
“Native American” a person who are American Indians, Eskimos, Aleuts,
or Native Hawaiians;
“Asian-Pacific American” a person whose origins are from Japan, China,
Taiwan, Korea, Vietnam, Laos, Cambodia, thePhilippines, Samoa, Guam, the U.S. Trust Territories of the Pacific, and
Northern Marians, and
“Asian-Indian American” a person whose origins are from India, Pakistan,
and Bangladesh.
Woman Owned Business Enterprise –Any American Woman, owned by woman or women
of any race
Not Applicable
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Click here for Explanation/Requirements.
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IMMIGRATION LAWS:
Lee County will not intentionally award County contracts to any contract/vendor
who knowingly employs unauthorized alien workers, constituting a violation of the
employment provisions contacined in 8 U.S.C Section 1324a(e) Section 274A(e) of
the Immigration and Nationalaity Acts (INA).
Hold Harmless and Indemnity Clause:
To the fullest extent permitted by applicable law, Contractor shall
protect, defend, indemnify, save, and hold the County, the Board of County Commissionors,
its agents, officials, and employees harmless from and against any and all claims,
demands, fines, loss or destruction of property, liabilities, damages, for claims
based on the negligence, misconduct, or omissions of the Contractor resulting from
the Contractor's work as further described in this contract, which may arise in
favor of any person or persons resulting from the Contractor's performance or non-performance
of its obligations under this contract except any damages arising out of personal
injury or property claims from third parties caused solely by the negligence, omission(s)
or willful misconduct of the County, its officials, commissions, employees or agents,
subject to the limitations as set out in Florida general law, Section 768.28, Florida
Statutes, as amended. Further, Contrator hereby agrees to indemnify the County for
all reasonable expenses and attorney's fees incurred by or imposed upon the County
in connection therewith for any loss, damage, injury, or other casualty. Contractor
additionally agrees that the County may employ an attorney of the County's own selection
to appear and defend any such action, on behalf of the County, at expense of the
Contractor. The Contractor further agrees to pay all reasonable expenses and attorney's
fees incurred by the County in establishing the right to indemnity.
I AGREE
I DISAGREE
Commodity Codes: Please carefully review the list of Products and/or Services.
Select the commodity products and services your company is able to provide to Lee
County. (To select more than one Product or Service, simply click on your first
selection, then hold down the CONTROL (CTRL) key and click the remainder of the
categories without releasing the CTRL key. Please indicate in the Text Box below,
if you could not locate any Products or Services you provide.
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Products:
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Services:
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Products/Services Not Listed:
Products/Services You've Selected:
A W-9 Form is required prior to adding your company
to our list.
Fax to: 239-485-5460.
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