CREIGHTONUNIVERSITY

SUPPLIER INFORMATION SHEET

  1. How long has your Firm been providing services to the public?
  2. Describe briefly the services and capabilities of your Firm.
  3. What is the annual dollar amount of your largest account? How many accounts do you currently service which are similar in size to the University?
  4. Who will be directly responsible for the University's account?

Please provide a summary of this individual's training and experience including the
number of years with your Firm.

Please provide contact information, including e-mail address if applicable.

  1. Are you, your Firm, (including corporate board of directors or officers) or any of your employees currently excluded from participation in any federal or state funded program, including, but not limited to Medicare or Medicaid? If yes, please provide specific information regarding such exclusion.
  2. Are you, your Firm, (including corporate board of directors or officers) or any of your employees related to, alumni of, or in way connected to CreightonUniversity? If yes, provide specific information regarding the person(s) and their relationship to the University.
  3. Is your Firm currently involved in any litigation for goods or services that your Firm provides?
  4. Is your Firm currently for sale or involved in any transaction to expand or to become acquired by another organization? If so, please explain. Has your Firm been involved in any reorganization, acquisition, or merger within the last two (2) years? If so, please explain.
  5. Include a copy or have your agent send a copy of your most current insurance information. The University's minimum requirements are outlined below.

Insurance
Supplier shall secure and protect their Firm and the University from any liability, loss, or damage whatsoever for any injury, including death to any person or property whatsoever, in the performance of services or provision of supplies required by this Agreement. As a minimum, Supplier shall carry general public liability insurance and product liability insurance in a combined single limit amount not less than $1,000,000 per occurrence and $2,000,000 general aggregate; employer's liability and workmen's compensation insurance as may be required under the laws of the State of Nebraska. Fire, theft, vandalism, or malicious mischief insurance on the equipment and property of Supplier shall be Supplier's responsibility. Automobile public liability insurance will be required on all vehicles operated on the University properties. Supplier will provide Certificates of Insurance evidencing the insurance required under this provision, including “Waiver of Subrogation & Alternate Employer Endorsement” naming CreightonUniversity for worker's compensation coverage.

Are you a "Green" Supplier? Respond to the questions below as part of the registration process.

The most common thought of products are low or no VOC paint and finishes, energy-efficient windows, energy-efficient lighting, skylights to maximum lighting in the daytime, formaldehyde-free building materials, and Energy Star appliances. Think about how your firms services and/or products would make you a "Green" Supplier.

  1. Is your firm involved with learning as much as possible about being "green" to offer top-to-bottom and inside-to-out green building options? ____ NO ____ YES If yes, please list
  2. Does your firm have in place business practices that promote sustainability? ____ NO ____ YES If yes, please list.
  3. Is anyone in your firm now LEED accredited individual? ____ NO ____ YES If yes, please list
  4. Is anyone in your firm studying for the LEED AP exam or other green building certification programs - NARI, NKBA, NAHB, etc.? ____NO ____ YES If yes, please list

Revised 10/2011