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Home My WebLink AboutAgreement_General_10/11/2018_Pride Enterprises Customer Application • P R I D E Please complete,sign,and submit[his form • � �� to:cus[omerservice��pride-enterprisesAr9 � 11 t Or fax to(H13) 324-5758 CUStORIfI'aMC�CO�ItaCt�I1f01'ItlaLlOfl(Completeallfieldsbelow) Company Name: VillaDe of Tequesta Accounts Payabie's Name: BillingAddress: •3��yjuE•.•tc; �;- Telephone: 561.768.0473 Facsimile: l city: 1e�;,��5�.�, state: F� Z�P� 33'1�05 Email Address: gcorbiltL�Tequesta.org Shipping Address: 399 SCabCook Rd. Primary Purchaser's Name: Greg CoCbitt City� Tequesta state: FL zip: 33469 Email address: gcorbitt�Tequesta.or_ CUStOfllei'T�/pe(Select the type that best describes your company/agency) Fcr-Profit • Local/City Government S[ate Government DC Employee No[-for-Profit County Government Federal Government PRIDE Employee Type of eusiness: Parks& Recreation Business Identifieation��rexemPt.provideuswithacopyofyourcompany's5tafe5a/esTaxCertificatewiththisappliwtiontoavoiddelays) FEID No.: �—�j��(j�l scace 5a125 T�:t ID No.: ��— �015'G33C��qC -7 Purchasing Details 1�'over �1�,�� S• Are purchase orders required? � Yes o No Is th�s for resal�7 .r•:e�. o.o��de�� is c,r,r:�r,:�i Yes � No bVill payments be made with Visa or tvlasterCard7t Yes o No If for resale,will you be sellinc outside of Florida? Yzs No References$ TradeReference: � � �(�k ContactName: "L�r�� U�f�IlCill��ephone: �p�-,,��j,3-a1�3 Address: ��;� S- US (��,Uy � City: (�Q (,��'S`�Q� State: �� Zip: Accouni No.: Terms: L� Average Monthly Purchases: TradeReference: ��V(�11�� 1,.��`I��l ContactName: Telephone: Q��G'�-a�—�j��p C � '"J Addres=_: p��'C..'� rQ.�t �ZC[ZL;� S-4-r' IC��j`� c�cy: �Ui"�`1Q�ti--� state:NL z�P a77�3 Account No.: Terms: Average Monthly Purchases: Trade Reference: ��s-� �}�y'�N(��L_(�.. Contact Name: Telephone: Address: Y�• t�C K I �-3 3� � c�cv: i�C��C�S State: 1 �C z�p: ��3�� Account No.: Terms: Average Monthly Purchases: Bank P.eference: ��\t S �Q��d(,lJu�� Concact Name: Telephone: � ,-�I Address: �(j S S'Gl�'1C� ��;4'1� ��` City: �r�1�1 'e�G� State:1�� Zip: G�� C�� Aceount Number�ae��>: My signature below authonzes the ahove bank to release[o PRIDE Enterprises the�nformation necessary[o evalua[e our applica[ion for credit purposes. Payment is due 30 days from invoice da[e.The und signed agr s that in he event of a dispute or collection efforts,the prevailing party shall be entitled to a[torney fees and costs.In addition,the undersi d consen to venue d jurisdic[ion to be vested with the courts located in Hillsborough County,Florida. LJc: - �� ' ��' �-- i, l ) �} `_ AuthorizedSignature:%� r' Name/Title:� I�/?uC- (f��(� Date: _ � � �l� Il�i � (��n��u �� r� t For credi[card orders,please conta Corpo te /R (813)324- 35/8739. � :Requests for credit limits over 52.000 require e(3) rade and one(1 ank reference. � �� Internal Use Only Credi�:\mounl Rcqucsird: Rtyuc��ed 13y: :\ppru�ctl B�: -- I �flPACT T !—� ROUGH INDUSTRY PUBLIC RECORDS. In accordance with Sec. 119.0701, Florida Statutes, CONTRACTOR must keep and maintain this Agreement and any other records associated therewith and that are associated with the performance of the work described in the Proposal or Bid. Upon request from the Village's custodian of public records, CONTRACTOR must provide the Village with copies of requested records, or allow such records to be inspected or copied, within a reasonable time in accordance with access and cost requirements of Chapter 119, Florida Statutes. A CONTRACTOR who fails to provide the public records to the Village, or fails to make them available for inspection or copying, within a reasonable time may be subject to attorney's fees and costs pursuant to Sec. 119.0701, Florida Stat�tes, and other penalties under Sec. 119.10, Florida Statutes. Further, CONTRACTOR shall ensure that any exempt or confidential records associated with this Agreement or associated with the performance of the work described in the Proposal or Bid are not disclosed except as authorized by law for the duration of the Agreement term, and following completion of the Agreement if the CONTRACTOR does not transfer the records to the Village. Finally, upon completion of the Agreement, CONTRACTOR shall transfer, at no cost to the Village, all public records in possession of the CONTRACTOR, or keep and maintain public records required by the Village. If the CONTRACTOR transfers all public records to the Village upon completion of the Agreement, the CONTRACTOR shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the CONTRACTOR keeps and maintains public records upon completion of the Agreement, the CONTRACTOR shall meet all applicable requirements for retaining public records. Records that are stored electronically must be provided to the VILLAGE, upon request from the Village's custodian of public records, in a format that is compatible with the Village's information technology systems. IF CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES,TO CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS AGREEMENT, PLEASE CONTACT THE VILLAGE CLERK, RECORDS CUSTODIAN FOR THE VILLAGE, AT (561) 768-0685, OR AT Imcwilliams@tequesta.or�, OR AT 345 TEQUESTA DRIVE, TEQUESTA, FLORIDA 33469. Palm Beach County Inspector General Pursuant to Article XII of the Palm Beach County Charter,the Office of the Inspector General has jurisdiction to investigate municipal matters, review and audit municipal contracts and other transactions, and make reports and recommendations to municipal governing bodies based on such audits, reviews, or investigations. All parties doing business with the Village shall fully cooperate with the inspector general in the exercise of the inspector general's functions, authority, and power. The inspector general has the power to take sworn statements, require the production of records, and to audit, monitor, investigate and inspect the activities of the Village, as well as contractors and lobbyists of the Village in order to detect, deter, prevent, and eradicate fraud, waste, mismanagement, misconduct, and abuses.