BETA FOR County Forms - click the blue shadow buttons below to see a form by number. Click on The Expand link to show all data for your company or office. Yes, you can have multiple companies.
The first step is to create a Company (or Office if internal Lake County user) as most forms require Company information. Note that you will still have to have your forms notarized. This is beta software so Onyx is not responsible for errors, omissions, or bad data of any form. In other words, you use this at your own risk.Create a Company (To create forms automatically)
County Form 20 - VENDOR QUALIFICATION AFFIDAVIT COUNTY OF LAKE
VENDOR QUALIFICATION AFFIDAVIT COUNTY OF LAKE
The undersigned vendor hereby agrees that the following provisions shall apply to any and all future purchases of supplies, goods, machinery and equipment, any services delivered and any public works projects by purchase order by the County of Lake from the vendor:
1. No supplies, goods, machinery or equipment are to be delivered to any county office or department unless the vendor has received a purchase order approved by the Lake County Auditor and Lake County Purchasing Agent.
2. The County of Lake will not pay for any supplies, goods, machinery or equipment unless there is a valid purchase order.
3. Payment shall be made after receipt of invoice and a reasonable time after filing of an itemized claim by the department with the appropriate Lake County Government office.
4. A corporate vendor shall furnish upon request proof satisfactory to the Board that it is in good standing and is authorized to do business in the State of Indiana.
5. The Board of Commissioners of the County of Lake is a governmental agency and as such is not subject to payment of Indiana sales tax. No such sales tax be included or added to the price under this contract.
6. The vendor agrees by execution of this agreement that the vendor:
A. Has adopted a policy of equal employment.
B. Does not in its hiring, advancement, promotion, or any other condition of employment discriminate by reason of age, military service, race, religion, color, physical handicap, political affiliation, sex, national origin, or ancestry.
C. Certifies that its affirmative action and equal employment program is current and in compliance with all applicable Federal/State/Local laws and interpretive court decisions.
D. Acknowledges that if awarded the contract , breach of Federal/State/Local equal employment or affirmative action provision of the United States of America, the State of Indiana, or the County of Lake may be regarded as a material breach of the contract.
E. Agrees to provide to the County of Lake a copy of its equal employment opportunity and affirmative action program within ten (10) days of receipt of a written request.
F. Acknowledges that the provisions of all federal civil rights laws and the Indiana Civil rights law as applicable are incorporated by reference as part of this contract.
7. The provisions of IC 5-17-5 and IC 36-1-12-17 on timely payments are incorporated as part of this contract as if fully set out herein.
8. This contract is subject to and governed by the laws of the State of Indiana.
9. If applicable, the provisions of IC 5-22 shall apply and vendor has read an understands these purchasing statutes.
10. This agreement applies to service agreements, rental agreements, maintenance agreements or lease/purchase agreements.
11. Vendor agrees to abide by any subsequent changes in any Federal and/or State law affecting purchasing.
12. A copy of all current purchasing laws and procedures is on file with the Lake County Purchasing Agent, Brenda Koselke, 2293 N. Main Street, Crown Point, Indiana 46307. Vendors can review these any time during normal working hours.
13. This affidavit shall apply to all purchases made subsequent to the date that the affidavit is filed with the Lake County Purchasing Agent.
14. Vendors may become inactivated by the County of Lake after two consecutive years of inactivity.
Federal Excise and Indiana Retail Tax Exempt Number 356000168 003 4
This section to be completed by the Company, notarized and returned to the unit of County Government for which the work will be performed.
Office for which will be performed:_______________________________________________________________________________
Brief description of goods and/or service supplied by Company: ______________________________________________________
City, State & Zip:_______________________________________________________________________________________________
Telephone Number:______________________________________ Fax Number:___________________________________________
COMPANY REPRESENTATIVE SIGNATURE
SUBSCRIBED AND SWORN to before me, a Notary Public in and for said County and
State, this _____ day of __________________, 20___.
RESIDENT OF ____________ COUNTY
A W-9 EXECUTED BY THE COPMPANY MUST BE ATTACHED OR THE APPLICATION WILL NOT BE PROCESSED
All of which is approved this ________ day of ____________________, 20_____.
LAKE COUNTY PURCHASING MANAGER