Vendor Application Letter
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Queen
OFFICE OF BUDGET AND FINANCE
The Liberty Building Anne’s 107 North Liberty Street County Centreville, Maryland 21617 Telephone: (410) 758-4064 Fax: (410) 758-3036 County Commissioners:
James J. Moran, At Large County Administrator: Todd R. Mohn Jack N. Wilson, Jr., District 1 Director, Budget & Finance: Jeffrey A. Rank J. Patrick McLaughlin, District 2 Philip L. Dumenil, District 3 Christopher M. Corchiarino, District 4 As a Vendor to the Queen Anne’s County Government, you are required to fill out the attached W-9 form (in its entirety) and also complete the information on the bottom of this page. Both of these must be on file in the County Finance office
(Accounting Division) before that department can issue a check. Please use the address or fax number above to return the forms. If you prefer to e-mail the information, please send it to kprice@qac.org.
Conflict of Interest:
Vendors may not be involved in any arrangement or activity with County employees or their relatives or with other County vendors that are or might appear to be a conflict of interest. All potential situations must be reported to the Ethics Committee for review by the Vendor.
Employment of Illegal Aliens:
Vendors providing goods or services to Queen Anne's County Government as a condition of doing business with the County, are required to comply with all applicable laws and regulations relating to the employment of aliens.
Should vendors providing goods or services to Queen Anne's County fail to comply with applicable laws and regulations relating to the employment of aliens, such failure shall constitute material breach of the vendor's contractual relationship with Queen Anne's County and the County shall take all reasonable steps to terminate the County's contractual relationship with the vendor.
Affidavit for Certification as a Local Vendor:
Local Vendors are businesses that operate from within Queen Anne’s County. As a Local Vendor, you may be eligible for preference on certain County procurements. Qualifying Local Vendors must certify below that your principal place of business is designated in the State Department of Assessments & Taxation (SDAT) as Queen Anne’s County or if you are a sole proprietor, you have identified Queen Anne’s County as your County of Residence on your most recent Maryland
Tax Return.
I certify that I meet the above condition as a Local Vendor in Queen Anne’s County.
Vendor Name Contact Person Phone Number I certify that I am in compliance with all applicable laws and regulations relating to the employment of aliens and that I don’t have any Conflict of Interest issues with Queen Anne’s County Government.
______________________________________________________ _______________________
Signature Date