Purchasing Division

Charlotte County Emergency Assistance Form
Purchasing Disaster Assistance Program

Charlotte County is setting up and revising a disaster assistance program in the event of an emergency, which would require outside assistance. It is estimated that this emergency assistance could be required for up to eight (8) weeks or until regular contracting procedures could be followed.

In the event your services would be required, response time is very critical. This outside support would be required within twelve (12) hours of notification. If your firm or agency would like to be included in Charlotte County Disaster Assistance Program, please complete the following on-line form.

Please check the appropriate classification(s) that your firm can supply. These supplies or services shall be directly owned and be provided by your company. Subcontractors available to your company shall not be included. Firms shall list if they are currently under contract to provide emergency assistance to any other agencies.  

All information will be kept on file and updated yearly in April or May. Please provide 24-hour contact person(s) and applicable telephone numbers. Any questions for clarification please contact the Purchasing Division at (941) 743-1370.

Charlotte County Emergency Assistance Form

	Fields in RED are required.
Business Name
Address
City
State
Zip
Business Phone
Fax Number
E-mail

Currently under contract with another agency for emergency assistance?

YesNo

If YES, please explain:
Emergency Contact Personnel
Name & Title 1
Home Address
Home Phone/Cell
Beeper/Cell
Name & Title 2
Home Address
Home Phone/Cell
Beeper/Cell
Name & Title 3
Home Address
Home Phone/Cell
Beeper/Cell
Name & Title 4
Home Address
Home Phone/Cell
Beeper/Cell
Emergency Classification List of Supplies & Services (check all that apply)