Participant Vendor Dissatisfaction Form
Please use this form if a vendor is consistently at fault for any of the following and/or you would like to inform us of any dissatisfaction you experienced with a vendor. Please be assured the information you submit to us is confidential. We will notify you at an appropriate time when action is to be taken.
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Any fields noted with a
*
are required.
Your Information
Full Name
*
School District/Department/Program Name
*
Phone Number
*
E-mail Address
*
Vendor Information
Vendor Name
*
Address (City, State, Zip Code)
*
Purchase Order Number
Purchase Order Date
Details of Complication/Incident
Bid:
*
--Please Select--
Arts & Crafts Supplies
Athletic/Academic Supply and Equipment Reconditioning
Audio Visual Supplies & Equipment
Carpentry Services
Classroom Furniture
Curricular Paper
Custodial Supplies
Electrical Lamps
Tubes & Ballasts
Electrical Services
Fence Equipment
Accessories
Related Site-Work Improvements
Fine & Recycled Paper
Fire Extinguisher Maintenance
Fuel Oil
General Office Supplies
Glass Replacement
Hazardous Waste Removal and Disposal
HVAC Services
Inspection
Preventive Maintenance & Repair of Basketball Backstops
Inspection
Preventive Maintenance & Repair of Bleachers
Labels & Report Cards
Lead in Water Analysis
Microcomputers
Peripherals & Software
Music Supplies & Instruments
Musical Instrument Repairs
Paint & Paint Supplies
Painting Services
Phys. Ed/Athletic/First Aid Supplies
Plumbing Services
Recycling Collection
Science Supplies & Graphing Calculators
Security Services
Special Education Instructional Supplies
Stationery Supplies
Tank Testing
Repair & Cleaning
Technology Education
Third Party Administrator for Tax Sheltered Annuities
Other
ESBOCES Bid (Quote) Number:
List Item Number(s):
Nature of Dissatisfaction:
*
Delivery not made on order as promised
Delivery made to wrong destination
Unauthorized delivery made before issuance of order
Quality of commodity is inferior
Unsatisfactory workmanship in installation of commodity
Invoice price higher than authorized
Quantity delivered in excess of order
Delivery made at unsatisfactory hour
Improper method of delivery
Delivery in damaged condition
Unauthorized substitute delivered by vendor
Commodity lacks required inspection stamps
Weight received at variance with invoice
Quantity delivered less than ordered
Other - please specify
Has the vendor been contacted via telephone more than once?
Has the vendor been contacted via telephone more than once?
Yes
No
Is this information for Documentation purposes only?
Is this information for Documentation purposes only?
Yes
No
Description of item(s):
*
Department/Program Comments:
(Please be accurate, complete and factual, and in addition, indicate the manner in which you suggest your complaint be settled.)