Loading...
HomeMy WebLinkAboutAgreement_General_5/12/2022_Best LightingBEST LIGHTING SUPPLY APPLICATION FOR CREDIT CARD BUSINESS ACCOUNT BUSINESS CONTACT INFORMATION mini Company name: Village of Tequesta Phone:561-768-0482 Fax: Registered company address: 345 Tequesta Dr. city: Tequesta Email: E-mail: jmccorkle@tequesta.org State: FL ZIP Code: 33469 []Sole proprietorship []Partnership Corporation ❑Other: BUSINESS/TRADE Company name: TD Bank Address: 2130 Centre Park city: West Palm Beach State: FL ZIP Code: 27703 Phone: 561-838-2245 Fax: E-mail: Type of account: CREDIT CARD • • Name: Village of Tequesta Public Works Billing Address: T 136 Bridge Road city: Tequesta State FL ZIP: 33455 Phone: 561-768-0482 Type of Card: ®Visa ❑Mastercard Card Number: 4715 2900 0770 0227 Exp Date 11/23 Verification Code- 836 * \\REQUIRED// Verification code is the 3 digits on the back of the card in the signature panel. Charge by Invoice (initial) -Name must be exactly as it appears on card- -Address must be exactly as it appears on billing statement- -Special order items are not returnable nor refundable - Jeremy Allen Digitally signed by Jeremy Allen X late: 202203.03 10:43:38 -05'00' Signature of Card Owner Notes: 1. By signing this authorization form, you are authorizing Best Lighting Supply to charge this card without a signature on the Credit Card Receipt. The signature on this form is valid as the signature on the Credit Card Receipt. 2. All Invoice are to be paid when material arrives or ships from Manufacturer. 3. Special Orders require a deposit from 50-100% depending on the Manufacturer. 4. All lines must be completely filled out and signed by card owner before this form will be accepted. PHONE # 561-881-1550 FAX # 561-296-4132 smaheu@bestlightingsupply.com t► , r- -- - - - - 1387 N. Killian Drive Lake Park, FL 33403 JRL Phone: (561) 881-1530 Supply Fax: (561) 881-15M vfhotssale distributors CREDIT APPLICATION 1 561- or Village of Tequesta 345 Tequesta Drive FL 33469 BILLINCI ADOFWS tit ddteroM drur obO.sl ARE BILLS PAID OYES 136 Bridge Road, Tequesta, FL 33469 1 IACALW ONO 64 Government w s a SOLO PROPPIETOR O CORPORATION Nt NISM or ESTIMATED MONTHLY PERSON TO CONTACT: SUSINESS euaXi:1 Q IS: EMPLOYOOB 99 BEST LIONnNOPURCHO-SES Janet McCorkle 1 GOWNED OlItErnED OWNERS (IF APPLICANT IS A SOLE PROPRIETORSHIP OR PARTNERSHIP OFFICERS (IF A CORPORATION) NAME Jeremy Allen TITLE Village Manager HOME ADDRESS HOME PHONE NO. NAME TITLE HOME ADDRESS HOME PHONE NO. NAME TITLE HOME ADDRESS HOME PHONE NO. BANK OR SAVINGS AND LOAN ASSOCIATIONSIS) NAME TD Bank 0CHEMNo ACCOUNT NO. ADDRESS- 2139 Centre Park West Drive 0SAvuloS ACCOUNT NO. West Palm Beach, FL 33409 0 LOAN BMAPICE APPLICANTS PRINCIPAL SUPPLIERS ARE (UST AT LEAST THREE). NAME ADDRESS PHONE AMOUNT OWING Advantage Bundling 2228 Page Road Ste 103 Durham, NC 27703 866-283-3546 NAME AOORESS PHONE AMOUNTOWN0 Terracon Services P.O. Box 2766, Jupiter, FL 33468 NAME ADDRESS PHONE AR40W OWNG Pubtix Super Market P.O. Box 32009, Lakeland, FL 33802 877-333.7585 NAME ADDRESS PHONE AMOUNT OWING Pemonnel authorized to make charge NAME POSfTON NAME POSrTON NAME POSrTIDN Has applicant or any of its owners, principals, partners. officer or directors ever Ned a voluntary Patten In bankruptcy, been adjudged bankrupt or made an assignment for the benefit of creditors? ❑ YES W NO Are tame Owed by applicant to any taxing authority delinquent? 0 YES W NO Has a tax pan or civil suit boon Ned against applicant or any owner. principal. partner. officer or director within the past six years? D YES 13 NO Is applicant or any owner. princlpaL partner. officer, or director, a guarantor or endorser of debts or notes owed by otners? If any of the above questions are answered YES, please attach explanation. ❑ YES 13 NO Is material purchased for resale D YES O NO If yes, Rorida Bales Tax Number: TO BEST LtOHTpto SUPPLY: For the purpose ol establishing. and tram time to Orne rawrifisg business craA wIM e44 Lighting Supply. fbo axrdsusltpneQ uppilload makes am representation Wrote and hovby aur"tres Bad Llghtbg Supply to Colas L from any swAce at any Ilms. as cram and 0nan el itiorrta0on couuI ,a appawrd I fogaiias. a applicant if a oopmatim. dro uhdsm4ned onbw aSo efArafres Bed Lighting Supply to dCtatri tiro sane ktons -, conee+ning hh2berAersu as ah ft&ftW for the purpose M i FUM inducing Sod I.Igfnbtg ftPPIY m app M said ttakrass credit. Applicant represents and warrants that an inlomtation given herein Is complete, true and Correct App6cmtl agrees to all Best Uglr&V Supply standard terms and Conditions and H approved lor ae8t pledges prompt poyment of traatoes ion sooadarrce with such terms arid condbona. It any Such obrigatiosw are not so paid when due the APPLICANT agrees to pay the sane. together with am domiages, Interest at 1.6% per month, bosses. costs, wiperiaea of cospctlon. Ogrd arpanso. court costa andattorrteysY toes. in botln trtal aid appesate taunts, paid or InamOd by said SELLER In andem oring to coned such ridobladness or my part thereof Date Business Name Village of Tequesta Signed By Jeremy Alien vcn U+ Q,LSoe^S" ewe. W Rfwh mta SA 011 APPLICANT: PLEASE COMPLETE REVERSE SIDE OF THIS FORM NOTE: If applicant Is requesting business credit from Best Lighting Supply In excess of $2,500.00 our credit policy requires certain financial information be provided relative to current operations and, if applicant is a corporation, financial information as to the officers. Best Lighting Supply assures applicant that all Such Information shag remain strictly confidential and used only for the purpose of deterntintrlg credit worthiness. A separate form financial statement may be substituted if available. If you need assistance in completing this information, please contact our credit department - FINANCIAL (NFARMATION Condition at Close of Blc>dltess ; 19_ ASSETS: PROFIT AND LOSS STATEMENT: Cash $ Net Sates 5 Inventory Less: Cost of Goods Sold Axt's Receivable Gross Profit E Equipment Less Operating Expenses Reel Estate Net Operating Profit 5 Other Assets Total Assets $ PERSONAL STATEMENT OF SIGNING OFFICER (co only if applicant is a corporation) LIABILITIES: .mplete Aocts Payable S As of 19 Notes Payable Cash 5 Notes Payable S Mortgages Stocks & Bonds Mortgages Other Liabilities Real Estate Other Liabilities Total Liabilities S Vehicles/equipment Total Liabilities Capilal/Net worth $ Other Assets Net Worth S (Total Assets Less Total Liabilities Total Assets 5 Annual Income t CONTINUING PERSONAL GUARANTEE State of Florida County of Palm Beach) In order to Induce Best Ughtng Supply, Lake Park, Florida (herein termed the SELLER") to extend cred ft from dme to time to (hereinafter termed the'BUYEFn as the BUYER may desire and the SELLER may grant, or to renew, extend or modfy In whole or In part any and afl Indebtedness and Ilability of every kind. nature and character new existing or which may hereafter most from BUYER to SELLER howsoever and whensoever seated, (herein termed the "UNDERSIGNED") each of them. Jointly and severally ll more than one bind themselves. their heirs, executors, administrators and successors and absolutely and uncondttlonaily agree to pay said SELLER and to Its endorsees, transferees, successors or other assigns of either this Instrument or any of the obligations secured hereby, according to their terms. If any such obligations are not so paid when due by the BUYER, the UNDERSIGNED will Immediately pay the same, together with all damages, losses, costs, expenses of collection, legal expense, court costs and allomeys' fees, In both trial and appellate courts, paid or Incurred by said SELLER in endeavoring to tolled such Indebtedness or any part thereof or In enforcing this Guaranty. This agreement contains the entire contract and there is no understanding that any person other tnan the UNDERSIGNED named above shall execute this agreement. This Guarantee shelf be governed by and construed In accordance with the laws of the State of Florida. WrrNESS the signature and seal of the UNDERSIGNED, this day of 19_ Sworn to and subscribed before me this day of , 19 NOTARY PUBUC By: My Commission expires: DO KOT WRiTH IN ONADED AREA BELOW FOR OFFICE tM.QKW CF EW APPROVAL APPROVAL DATE AMOUNT OF CREDIT ACCOI1Mr IMsBEA 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 Statutes, 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) 768-0440, OR AT Imcwilliams@teguesta.org, OR AT 345 TEQUESTA DRIVE, TEQUESTA, FLORIDA 33469. 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. "The Village of Tequesta strives to be an inclusive environment. As such, it is the Village's policy to comply with the requirements of Title II of the American with Disabilities Act of 1990 ("ADA") by ensuring that the Contractor's [ agreement /bid documents and specifications ] are accessible to individuals with disabilities. To comply with the ADA, the Contractor shall provide a written statement indicating that all [ agreement /bid documents and specifications], from Contractor, including files, images, graphics, text, audio, video, and multimedia, shall be provided in a format that ultimately conforms to the Level AA Success Criteria and Conformance Requirements of the Web Content Accessibility Guidelines 2.0 (Dec. 11, 2008) ("WCAG 2.0 Level AA"), published by the World Wide Web Consortium ("WK"), Web Accessibility Initiative ("WAI"), available at www.w3.org/TR/WCAG/."