Rivers Casino Pittsburgh | Vendor Information A. Vendor Name and Address:Vendor Name(Required)DBA (if applicable)Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Remit Address if different from above: Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country B. Contact Information:First(Required)Last(Required)Phone(Required)FaxEmail Address(Required) C. Business Information:Does your Business have a license with the Pennsylvania Gaming Control Board (PGCB)?(Required) Yes No If yes, which one? Notification Registration Certification Publicly Traded Would there be any reason for the PGCB to deny you a Vendor License?(Required) Yes No Please state the number of years your business has provided Goods or Services (round to nearest year)(Required)What type of Goods or Services will you provide to the Casino ? Please all that apply:(Required) ATM /Svc Accounting Services Ad/Pub/Print Apparel & Accessories Architect/Engineer Svc Armored Car Art Sup/Svc Audio/Visual Equipment Auto/Auto Products Banking Beverages Catering Chemical Services Communications Computer/Supplies/Svc Construction Manager Educational Svc Entertainment Exterminating Floor Cover Floral & Services Food Furniture & Fixtures General Contractor HVAC Hardware Hotel Insurance Int Design Janitorial / Mtn Jewelry & Gift Items Junket Enterprises Kitchen Equi Landscaping Laundry/Dry Cleaning Legal Services Linen & Uniform Suppliers Liquor & Wine Regulated Maint & Supplies Maufactures Sales Mgmt Service Misc Supplies Natl/Local Prof Assocs. Office Related Equip Paper/Textile/Supplies Photography Plumbing/Electric Svc Prof/Tech Services Professional Sports Team Promo Org Protect/Safety Related Svc Recreation Refuse Haulers Security & Surveillance Shipping Signs/Banner Sports Events & Misc Subcontract TV/Radio/Newpaper Telecom Service Providers Temporary help services Tobacco Transport Travel Svc Utilities Vending Mach/Supplies Other Other Good or ServiceD. Vendor Minority Status and Declaration:It is the policy of the Rivers Casino Pittsburgh to encourage meaningful participation of the Minority owned and or Woman owned business sources whenever possible to provide useful and acceptable quality services or materials at competitive prices. In order for your business to be considered for Minority Status, you must provide a copy of your Minority Certification Form.Does your business qualify as a minority and/or woman owned ? Yes No Check applicable item(s) below:WBE - must have fifty one percent (51%) woman ownership and the woman owner(s) must exercise independent day to day control of the business. WBE If yes, do you have the Certification Form?If yes, do you have the Certification Form? Yes No MBE - must have fifty one percent (51%) minority ownership and the minority owner(s) must exercise independent day to day control of the business. The term MINORITY includes African American, Hispanic American, Native/Alaskan American, Asian American. MBE If yes, do you have the Certification Form?If yes, do you have the Certification Form? Yes No By signing below, I hereby certify that the information provided is true, complete and accurate to the best of my knowledge and belief.Type Your Name(Required)Today's Date(Required) MM slash DD slash YYYY Signature(Required)
