THE OCEAN COUNTY UTILITIES AUTHORITY P.O. Box “P” Bayville, New Jersey 08721 Fax: 732-269-8440 l Tel: 732-269-4500 www.ocua.com

VENDOR APPLICATION PLEASE COMPLETE AND FAX TO OCUA VENDOR #_____________________

COMPANY NAME (FORMAL)

COMPANY PRESIDENT / CEO

SALES REPRESENTATIVE

EMAIL ADDRESS - SALES REPRESENTATIVE

MAILING ADDRESS

CITY

STATE

ZIP

REMITTANCE ADDRESS

CITY

STATE

ZIP

PHONE NO. ( )

TOLL FREE NO. ( )

FAX NO. ( )

COMPANY WEB SITE

FEDERAL TAX I.D. NO. (not resale no.)

NOTE: Failure to provide your Federal Tax I.D. number may result in an Internal Revenue Service imposed penalty per Internal Revenue Service Code Section 3406(a)(1).

TYPE OF ORGANIZATION o INDIVIDUAL: ___________________________________ Name of Owner o CORPORATION: ________________________________ State of Corporation o PARTNERSHIP : o General o Limited o NON-PROFIT AGENCY

NOTICE TO ALL VENDORS DO YOU HAVE A “BUSINESS REGISTRATION CERTIFICATE” FROM THE STATE OF NEW JERSEY? o NO o YES If Yes, Please attach a copy to this application ____________________________________________________________________________________________________________________ WILL YOU ACCEPT OUR PURCHASE ORDER o NO o YES MINIMUM ORDER AMOUNT $________________________________

ALL VENDORS MUST COMPLETE THIS SECTION. 1. Have you ever been bonded? o Yes o No If yes, Name of Bonding Company: _________________________________________________ 2. Have you ever had a bond revoked? o Yes o No If yes, state briefly why: ____________________________________________________ 3. Is there any litigation pending against you? o Yes o No If yes, briefly state why: ____________________________________________ (Be prepared to provide this office with your attorney’s name, case number, and the status of the litigation 4. Is your inventory stocked in the State of New Jersey? o Yes o No If no, where is it stocked? _______________________________

The undersigned swears under penalty of perjury that the foregoing statements are true and correct and that they include all material information necessary to identify and explain the operations of this firm as well as the ownership thereof. Any material misrepresentation will be grounds for terminating any purchase orders or contracts which may be awarded and for initiating action under federal or state laws concerning false statements.

Name (Please Print)

Full Title

Signature Date

Please select Commodity Code(s) from the attached OCSD Commodity Code List. Do not select codes for which you currently do not supply goods or services.
If you choose multiple Commodity Codes, you are required to select ONE Primary Code category (i.e. 0400-Chemicals or 2100-Mechanical Equipment).	PRIMARY CODE: _______________ Multiple Commodities o Yes o No

NOTE: Three (3) consecutive no bids to formal bid/RFP requests will result in your company’s removal from our vendor bid list.

	THE OCEAN COUNTY UTILITIES AUTHORITY COMMODITY CODES
0100 AUTO EQUIP, PARTS & ACCESSORIES 0101 o Auto & Truck Body Repair 0102 o Auto & Truck Dealers, Manufacturing 0103 o Auto & Truck Parts, Access., Service 0104 o Automotive Batteries 0105 o Boat Equipment, Repair, Parts 0106 o Boats and Boat Rental 0107 o Construction Equip. Dealers & Mfrs 0108 o Construction Equipment Rental 0109 o Electric Carts 0110 o Miscellaneous Auto 0111 o Service Station Equip, Parts, Repair 0112 o Tires, Tubes & Tire Service 0113 o Vehicle Rental 0114 o Other _________________________ 0200 FACILITY SVCS & REMODELLING MATERIALS / SUPPLIES 0201 o Accoustical Ceiling Tiles 0202 o Cabinetry 0203 o Doors 0204 o Misc. Hardware & Supplies 0205 o Roofing, Siding Materials 0206 o Tile, Installation, Repair 0207 o Tubs, Showers, Sinks, Toilets 0208 o Wall Coverings 0209 o Windows 0210 o Other _________________________ 0300 BUSINESS & PROPERTY SERVICES 0301 o Appraisers & Surveyors 0302 o Background Music 0303 o Collection Agencies 0304 o Easements/Rights-of-way 0305 o Flags, Flagpoles, Access. & Repair 0306 o Insurance, Risk Management 0307 o Mailing Lists and Labels 0308 o Meeting Rooms, Hotels 0309 o Temp Help Agency: Transcribe/Translate 0310 o Temporary Buildings, Sales 0311 o Other _________________________ 0400 CHEMICALS, WATER / WASTEWATER TREATMENT 0401 o Chlorine (Cl2) 0402 o Ferric Chloride (FeCl3) 0403 o Ferrous Chloride (FeCl2) 0404 o Hydrogen Peroxide (H2O2) 0405 o Hydrochloric Acid (HCI) = Muriatic 0406 o Magnesium Hydroxide (Mg(OH)2 ) 0407 o Peracetic Acid (PAA) = (Acetyl Peroxide) 0408 o Polymers 0409 o Sodium Bisulfite (NaHSO3) 0410 o Sodium Hypochlorite (NaOcCl) – Bleach 0411 o Sodium Hydroxide (NaOH) = Caustic 0412 o Natural Gas 0413 o Other _________________________ Note: Lab chemicals & gases are listed under Lab Supplies		0500 CLOTHING & LAUNDRY SERVICES 0501 o Gloves 0502 o Laundry Services 0503 o Other _________________________ 0504 o Repairs, Alterations, & Misc. Services 0505 o Safety Shoes 0506 o Uniform Dealers & Manufacturing 0600 COMPUTER HARDWARE & SOFTWARE 0601 o Communication Devices 0602 o Computer Printer Supplies (ribbons, paper) 0603 o Computer Printers 0604 o Computer Program /Maint. /Enhancements / Upgrades 0605 o Mid-range/Large Computer Peripherals 0606 o Mid-range/Large Computer Repair & Maint. 0607 o Mid-range/Large Computers /Accessories 0608 o Miscellaneous Computer Items 0609 o PC Hardware Components 0610 o PC Maintenance/Repair Service 0611 o PC Peripherals 0612 o PC Software 0613 o Personal Computers 0614 o Programming: SAP 0615 o Programming: ORACLE 0616 o Programming: Other __________________ 0617 o Programming: Systems 0618 o Other _________________________ 0700 CONCRETE & GLASS PRODUCTS 0701 o Asphalt & Related Products 0702 o Bagged Cement 0703 o Concrete Accessories & Tools 0704 o Concrete Forms 0705 o Concrete Pumper Rental 0706 o Glass Containers 0707 o Glass Dealers & Installation 0708 o Meter Boxes 0709 o Wet Cement 0710 o Other _________________________ 0800 CONSTRUCTION 0801 o Carpentry 0802 o Construction Management 0803 o Contractor, Acoustical 0804 o Contractor, Cement 0805 o Contractor, Demolition 0806 o Contractor, Earthmoving 0807 o Contractor, Electrical 0808 o Contractor, Elevator 0809 o Contractor, Fencing 0810 o Contractor, Flooring 0811 o Contractor, General 0812 o Contractor, HVAC 0813 o Contractor, Insulation 0814 o Contractor, Landscape & Tree 0815 o Contractor, Mechanical 0816 o Contractor, Painting 0817 o Contractor, Paving & Grading 0818 o Contractor, Pipeline 0819 o Contractor, Plumbing 0820 o Contractor, Roofing 0821 o Contractor, Structural 0822 o Other _________________________	0900 ELECTRICAL/ELECTRONIC EQUIP, PARTS & REPAIR 0901 o Appliance Parts, Repair 0902 o Batteries, Dry Cell 0903 o Electric Motors 0904 o Electrical/Electronic Equip Dealers 0905 o Electrical/Electronic Supplies 0906 o Generators, 12 KV 0907 o Generators, Portable 0908 o Lighting Equipment, Parts, Services 0909 o Metering Devices, Recorders, Charts 0910 o Water/Wastewater Monitoring Equipment 0911 o Conduits 0912 o Controls (Electrical) 0913 o Fittings (Electrical) 0914 o Fiber Optics 0915 o Instruments 0916 o Pneumatic 0917 o Switchgear 0918 o Other _________________________ 1000 FILTERS, NON-AUTOMOTIVE 1001 o Air Conditioning 1002 o Engine Filters 1003 o Liquid Filters 1004 o Machine Filters 1005 o Sewage Filters 1006 o Other _________________________ 1100 FOOD & BEVERAGE PRODUCTS 1101 o Bottled Water 1102 o Catering 1103 o Food Service & Kitchen Equipment 1104 o Food Service Management 1105 o General Merchandise 1106 o Grocery 1107 o Restaurants 1108 o Other _________________________ 1200 FURNITURE & FIXTURE REPAIR 1201 o Floor Coverings 1202 o Furniture Refinishing 1203 o Furniture: GF Business 1204 o Furniture: Hon 1205 o Metal Shelving 1206 o Office Furniture 1207 o Office Furniture Rental 1208 o Window Coverings 1209 o Other _________________________ 1300 HARDWARE & TOOLS 1301 o Fasteners 1302 o Grounds Maintenance Tools & Equip. 1303 o Hand Tools 1304 o Hose, miscellaneous 1305 o Ladders 1306 o Locks & Keys, Sales & Services 1307 o Material Handling Equipment 1308 o Misc. Plumbing/Hardware/Tools 1309 o Plumbing Fittings 1310 o Plumbing Supplies 1311 o Power Tools 1312 o Shop Supplies 1313 o Welding Equipment & Supplies 1314 o Wire Rope & Cable 1315 o Other _________________________

THE OCEAN COUNTY UTILITIES AUTHORITY COMMODITY CODES

1400 HEALTH SERVICES 1401 o Chiropractic 1402 o Clinical Laboratory 1403 o Dental 1404 o Doctors & Clinics 1405 o Eyeglasses 1406 o Hospitals 1407 o Other _________________________ 1500 INTERNET SERVICES 1501 o ASP-Application Service Provider 1502 o CRM-Customer Relation Mgmt 1503 o Document Management 1504 o E-commerce provider 1505 o ERP-Enterprise Resource Planning 1506 o Internet Software 1507 o Other _________________________ 1600 JANITOR / HOUSEHOLD, SERVICE / SUPPLIES 1601 o Chemical Toilets/Septic Tank Service 1602 o Cleaning Equipment 1603 o Cleaning Services (Building) 1604 o Cleaning Services-Grounds 1605 o Household Goods 1606 o Industrial Chemicals, Degreasers 1607 o Janitorial Products 1608 o Parking Lot Cleaning, Stripping 1609 o Wiping Cloths and Papers 1610 o Other _________________________ 1700 LABORATORY SUPPLIES 1701 o General Supplies 1702 o Laboratory Chemicals 1703 o Laboratory Gases 1704 o Furniture 1705 o Glassware 1706 o Other _________________________ 1800 LABS – OUTSIDE 1801 o General Testing 1802 o High Resolution 1803 o Microbiology 1804 o Other _________________________ 1805 o Radioactive 1806 o Toxicity 1900 LUMBER & WOOD PRODUCTS 1901 o Landscape Wood Products 1902 o Lumber & Building Materials 1903 o Pallets 1904 o Wood Chips 1905 o Wood Markers, Stakes, Forms 1906 o Other _________________________ 2000 MAINTENANCE & SERVICE 2001 o Auto. Shop Equip. Maint. & Services 2002 o Computer Maint. & Services 2003 o Elevator Service & Repair 2004 o Machine Shop Equip. Maint. & Svcs 2005 o Office Equip. Maint. & Svc. (Typewriter, Calculator & Services) 2006 o Repro. Machinery Maint. & Services 2007 o Testing Equip. Maint. & Svc. 2008 o Industrial Gases 2009 o Other _________________________ 2100 MECHANICAL EQUIPMENT 2101 o Air Compressors 2102 o Air/Hydraulic Tools 2103 o Bearings, Belts, Hose & Fittings 2104 o Centrifuges

2105 o Compost Equipment 2106 o Engines (Non-Automotive) 2107 o Environmental/Air Treatment Equip 2108 o HVAC Parts & Supplies 2109 o Machine Tools 2110 o Pumps and Pump Repair 2111 o Refrigeration Equipment 2112 o Small Engine Repair & Parts 2113 o Sub-assembly: Valves, Hydrants, Misc. Pipeline Material 2114 o Testing Equipment 2115 o Valve Actuators 2116 o Valve Parts & Repair 2117 o Valves, Gate & Butterfly 2118 o Valves, Other 2119 o Wastewater Treatment Equipment 2120 o Water Treatment Equipment 2121 o Industrial Bearings, Seals 2122 o Other _________________________ 2200 METAL PRODUCTS 2201 o Containers & Cans 2202 o Machining 2203 o Metal Dealers; Flat, Bars, Shapes 2204 o Metal Fabricators-Pipe Fitting 2205 o Metal Fencing Material, Hardware 2206 o Metal Plating, Casting, Finishing 2207 o Metal Tanks 2208 o Springs, Clips, & Wire Forms 2209 o Other _________________________ 2300 MISCELLANEOUS 2301 o Adhesives 2302 o Conservation Equipment 2303 o Disposal Services 2304 o Extermination, Service & Equipment 2305 o Fish & Fishing Supplies 2306 o Fisheries Equipment & Supplies 2307 o Hazardous Waste Disposal 2308 o Interim Clerical Assistance 2309 o JPA - Non District Funds 2310 o Motor Fuels, Oils & Greases 2311 o Paints, Coatings & Supplies 2312 o Plants & Landscape Supplies 2313 o Police Equipment 2314 o Recreation Equipment 2315 o Road Oil 2316 o Specialties/Engraving/ Plaques/ Trophies 2317 o Pool/Pond Maint. Supplies/Equip. 2318 o Testing & Sampling 2319 o Tree Trimming/Removal 2320 o Utilities; Install/Repair – PGE / ATT / Cable 2321 o Water Conservation Rebate Pgm 2322 o Other _________________________ 2400 OFFICE MACHINES, PARTS & REPAIRS 2401 o Appliances 2402 o Audio Visual Equip: Supplies & Svcs 2403 o Calculator Dlrs: Svcs, Parts & Supplies 2404 o Cameras, Equip: Svcs, Parts, & Supplies 2405 o Copy Machine Dlrs: Svc, Parts, Supplies 2406 o Drafting Equip: Svcs., Parts & Supplies 2407 o FAX Machines, Parts & Service 2408 o Laminating Equip, Parts & Supplies

2409 o Misc. Office Machinery 2410 o Repro. Equip: Svcs., Parts & Supplies 2411 o Surveying Equip: Parts, Svcs & Supplies 2412 o Typewriter Dlrs: Svcs, Parts & Supplies 2413 o Other _________________________ 2500 PAPER & OFFICE PRODUCTS 2501 o Art Supplies 2502 o Business Forms, Preprinted 2503 o Computer Papers/Cards 2504 o Cut Papers 2505 o Envelopes 2506 o Facsimile Paper, Supplies 2507 o ID Products (tags, badges, etc.) 2508 o Office Products, General 2509 o Packaging Material 2510 o Rubber Stamps, Daters, Numbering Machines 2511 o Other _________________________ 2600 PIPELINE MATERIALS 2601 o AC Pipe & Accessories 2602 o Brass Service Fittings 2603 o Cast Iron Pipe Fittings 2604 o Clay, Terra Cotta & Other Pipe 2605 o Copper Tubing 2606 o Corrosion Protection 2607 o Corrugated Pipe & Accessories 2608 o CPVC/Plastic Pipe & Accessories 2609 o Hydrants and Hydrant Parts 2610 o Insulation 2611 o Pipe Repair Material 2612 o Pipeline Tools & Equipment 2613 o Service Clamps 2614 o Steel Pipe & Fittings 2615 o Trench Plates/Shoring 2616 o Water Meters & Parts 2617 o Other _________________________ 2700 PRINTING & PUBLISHING 2701 o Advertising 2702 o Binding 2703 o Books 2704 o Duplicating 2705 o Editing 2706 o Educational Tapes & Cassettes 2707 o Films/Slides/Video Cassettes 2708 o Graphic Design 2709 o Laminating 2710 o Mailing Services 2711 o Micrographics 2712 o Newsletters and Pamphlets 2713 o Newspapers 2714 o Paintings, Rental or Purchase (Art) 2715 o Periodicals 2716 o Photographic Processing 2717 o Picture Framing 2718 o Printing 2719 o Promotional & Advertising Materials 2720 o Typesetting 2721 o Other _________________________

THE OCEAN COUNTY UTILITIES AUTHORITY COMMODITY CODES

2800 PROFESSIONAL SERVICES & CONSULTANT 2801 o Aerial Photography 2802 o Archaeological 2803 o Architecture 2804 o Auctioneer 2805 o Audit & Account 2806 o Communications 2807 o Computer 2808 o Earthquake 2809 o Economic 2810 o Educational 2811 o Engineering 2812 o Environmental 2813 o Equal Employment Opportunity/ Affirmative Action Program 2814 o Financial 2815 o Fish & Wildlife 2816 o Food Service Consulting 2817 o Health & Safety 2818 o Interior Design 2819 o Labor Relations 2820 o Land Use 2821 o Landscape Architecture 2822 o Legal 2823 o Management 2824 o Marketing 2825 o Mechanical 2826 o Personnel 2827 o Photography 2828 o Planning 2829 o Public Relations 2830 o Recreation & Land Mgmt 2831 o Security 2832 o Traffic Management 2833 o Videotape Production Services 2834 o Wastewater 2835 o Water 2836 o Writers/Artists/ Cartoonists / Illustrators 2837 o Other _________________________ 2900 QUARRIED & MINED PRODUCTS 2901 o Backfill Materials 2902 o Decorative Landscape Materials 2903 o Filter Media 2904 o Rip Rap 2905 o Sand 2906 o Other _________________________ 3000 RECYCLING 3001 o Paper 3002 o Cardboard 3003 o Plastic 3004 o Other _________________________ 3100 RENTAL SERVICE FM&O 3101 o Backhoe 3102 o Boring 3103 o Compactor, Roller, Stomper 3104 o Concrete Sawing 3105 o Crane and Rigging 3106 o Diving 3107 o Dump Truck 3108 o Inspection 3109 o Other Trucking Services 3110 o Pressure washer 3111 o Sandblasting 3112 o Security 3113 o Street Sweeper 3114 o Towing

3115 o Trenching, Equipment & Supplies 3116 o Water Truck/Tank Truck 3117 o Welding 3118 o Other _________________________ 3200 RUBBER & PLASTIC PRODUCTS 3201 o Bags, Plastic, Fabric & Other 3202 o Hose, Gaskets, Rubber Goods 3203 o Plastic Bottles, Containers 3204 o Plastic Tanks 3205 o Plastics 3206 o Signs 3207 o Other _________________________ 3300 SAFETY & FIRST AID SUPPLIES / EQUIPMENT 3301 o Fire Protection Equipment 3302 o First Aid Box Refill Service 3303 o First Aid Supplies & Equipment 3304 o Health & Safety Products 3305 o Security Products 3306 o Security Services 3307 o Other _________________________ 3400 TELECOMMUNICATIONS 3401 o Cellular Service 3402 o Data Communication Equipment 3403 o Datacom Equipment Maint. & Repair 3404 o Microwave Equip 3405 o Microwave Equip Maint. & Repair 3406 o Pagers, Equipment 3407 o Pagers, Maintenance & Repair 3408 o Other _________________________ 3409 o Radio Communication Equip/Dealers 3410 o Radio Equipment Maint. & Repair 3411 o Telecommunications Support Equip. 3412 o Voice Communication Equipment 3413 o Voicecom Equipment Maint. & Repair 3500 TEMPORARY HELP 3501 o Administrative 3502 o Engineering 3503 o General 3504 o Information Technology 3505 o Laboratory 3506 o Other _________________________ 3600 TRAINING 3601 o Computer 3602 o Forklift 3603 o General 3604 o Industrial 3605 o Medical 3606 o Other _________________________ 3607 o Safety 3700 TRANSPORTATION & STORAGE SVCS 3701 o Airplanes & Helicopters 3702 o Couriers, Local 3703 o Freighting 3704 o Moving Services & Storage 3705 o Parcel/Package Delivery 3706 o Taxis, Buses 3707 o Travel Agencies 3708 o Other _________________________