Purchasing Services Click here
Instructions: Please review insurance requirements here .
If submitting a PDF version - please upload below.
By submitting this vendor application, you acknowledge that you have read and agree to the Canaveral Port Authority’s Terms and Conditions , which may be updated from time to time.
PROOF OF INSURANCE MUST ACCOMPANY ALL VENDOR APPLICATIONS AS REQUIRED UNDER THE GUIDELINES FOR INSURANCE COVERAGE REQUIREMENTS AND COVERAGE LIMITS.
**PLEASE FILL IN ALL INFORMATION ON FORM. MISSING INFORMATION MAY RESULT IN A DELAY IN PROCESSING APPLICATION**
Please Select Your Type of Business
Select
Service Provider
Supplier/Distributor
Manufacturer
Advertising/Media
Government Agency/Non- Profit
If you are a Service Provider, would services be provided on Port Property?
If you are a Supplier or Manufacturer, would you be making deliveries on Port Property?
Describe in detail the goods and/or services you company provides:
Upload completed W9, COI (if applicable) or PDF forms here: field is required
+
Upload completed W9, COI (if applicable) or PDF forms here: field is required field is required
Failure to include this information will delay the release of Purchase Orders
System Connectivity & Integration
Do you provide any hardware, software, IoT/OT devices, SaaS, or services that connect to, integrate with, or communicate with CPA systems, networks, cloud environments, or CPA vendors?
System Access
Does your organization require logical, administrative, remote, or physical access to CPA systems, networks, cloud environments, or facilities?
Data Handling
Upload Cybersecurity Liability Insurance
Upload Cybersecurity Liability Insurance field is required
Does your solution — including any vendor-owned or vendor-managed LTE or cellular-connected hardware — store, process, transmit, or impact CPA data or operations?
Operational Impact / LTE-Connected Devices
Will your organization store, process, transmit, or otherwise have access to CPA data, including personal, financial, operational, or security-sensitive information?
Remit to Address (Mailing Address where you would like payment sent)
Preferred Method of Communication
Physical Address
Preferred Method of Communication
Vendor Disclosure If any of the officers or principals of your company are employees of the Canaveral Port Authority and/or related to an employee or elected official of the Canaveral Port Authority in any capacity, please list their name(s) below:***KNOWINGLY WITHHOLDING THIS INFORMATION MAY RESULT IN VENDOR DISQUALIFICATION***
File Uploads
Upload completed W9, COI (if applicable) or PDF forms here:
+
Upload completed W9, COI (if applicable) or PDF forms here: field is required
The insurance requirement can be found
here .
Submit
