Purchasing Services
399 Challenger Road Cape Canaveral, FL 32920
Phone: (321) 783-7831/Fax: (321) 868-2184
Email: 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**
Upload Completed COI field is required
Failure to include this information will delay the release of Purchase Orders
System Connectivity & Integration
System Access
Data Handling
Upload Cybersecurity Liability Insurance field is required
Operational Impact / LTE-Connected Devices
Remit to Address (Mailing Address where you would like payment sent)
Physical Address
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 (if applicable) or PDF forms here: field is required
The insurance requirement can be found
here.
