23222i_attachment-10-contractor_reseller_distributor_-infosheet_20210204.docx

41 KB Posted

Attached to
Personal Protective Equipment (PPE) and Related Items (Statewide)
Contract number
23222
Issued by
New York

About this file

Written by GovTribe AI ·

This document is a Contractor/Reseller/Distributor Information Sheet for Group 10150, specifically related to Personal Protective Equipment (PPE) and Related Items, issued by a state procurement agency (likely New York State). The form is designed for ordering and contract administration purposes, providing a template for contractors, companies, and resellers to input their detailed contact information, including company names, addresses, federal and state vendor IDs, and key personnel contact details.

The document includes sections for capturing information about multiple potential resellers and distributors, with options to identify Minority and Women-owned Business Enterprise (MWBE) certifications, Service-Disabled Veteran-Owned Business (SDVOB) status, and Small Business Enterprise (SBE) self-identification. Resellers can be authorized to take orders, receive payments, and ship directly, with the ability to note any specific restrictions. A key provision indicates that for authorized users to obtain credit for MWBE resellers, those resellers must be able to take orders and receive payments and be entered into the state's financial system with their own vendor ID.

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23222i_attachment-09-manufacturercertificate.docx DOCX document
23222i_revised20210204.pdf PDF
23222i_attachment-02-nys-required-certifications.docx DOCX document
23222i_attachment-03-encouraging-use-of-nys-business.docx DOCX document
23222i_response-to-bidders-inquiries.pdf PDF
1015023222ra.pdf PDF
23222i_attachment-06-bidder-submission-checklist_20200204.xlsx XLSX spreadsheet
23222i_attachment-07-bidder-questions-form.xlsx XLSX spreadsheet
23222i_appendix-b-04-16.pdf PDF
23222i_attachment-08-report-of-contract-usage.xlsx XLSX spreadsheet
23222i_Attachment01Pricing.xlsm XLSM spreadsheet
23222i_appendix-a-10-19.pdf PDF
23222i_attachment-04-insurance-requirements.docx DOCX document
23222i_Attachment11.xlsm XLSM spreadsheet
23222p5.pdf PDF
1015023222ContractorInfo.pdf PDF
23222i_appendix-c-01-17.docx DOCX document
23222i_attachment-05-bidder-information-questionnaire_20210204.xlsx XLSX spreadsheet
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GROUP 10150 – Personal Protective Equipment (PPE) & Related Items Page 1 of 4

ATTACHMENT 10

Contractor/Reseller/Distributor Information Sheet (Revised 2/4/21)

(for ordering and contract administration purposes)

CONTRACTOR/COMPANY INFORMATION

Company Name:
Click or tap here to enter text.
Address (from first page of bid):
Click or tap here to enter text.
Company Website:
Click or tap here to enter text.
Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:
Click or tap here to enter text.
Contract Administrator Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
Toll Free Phone:
Click or tap here to enter text.

SALES/BILLING (if different from above)

Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Address:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
Toll Free Phone:
Click or tap here to enter text.

EMERGENCIES

Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Address:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
Cell Phone:
Click or tap here to enter text.

RESELLER/DISTRIBUTOR INFORMATION

Company Name:
Click or tap here to enter text.
Address:
Click or tap here to enter text.
Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:
Click or tap here to enter text.
Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Hours of Availability:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment * ☐ Ship Direct
Restrictions Applicable to this Reseller (if any):
Click or tap here to enter text.

RESELLER/DISTRIBUTOR INFORMATION

Company Name:

Click or tap here to enter text.

Address:
Click or tap here to enter text.
Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:
Click or tap here to enter text.
Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Hours of Availability:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment * ☐ Ship Direct
Restrictions Applicable to this Reseller (if any):
Click or tap here to enter text.

RESELLER/DISTRIBUTOR INFORMATION

Company Name:

Click or tap here to enter text.

Address:
Click or tap here to enter text.
Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:
Click or tap here to enter text.
Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Hours of Availability:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment * ☐ Ship Direct
Restrictions Applicable to this Reseller (if any):
Click or tap here to enter text.

RESELLER/DISTRIBUTOR INFORMATION

Company Name:
Click or tap here to enter text.
Address:
Click or tap here to enter text.
Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:

Click or tap here to enter text.

Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Hours of Availability:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment * ☐ Ship Direct
Restrictions Applicable to this Reseller (if any):
Click or tap here to enter text.

RESELLER/DISTRIBUTOR INFORMATION

Company Name:
Click or tap here to enter text.
Address:
Click or tap here to enter text.
Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:
Click or tap here to enter text.
Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Hours of Availability:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment * ☐ Ship Direct
Restrictions Applicable to this Reseller (if any):
Click or tap here to enter text.

RESELLER/DISTRIBUTOR INFORMATION

Company Name:
Click or tap here to enter text.
Address:
Click or tap here to enter text.
Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:
Click or tap here to enter text.
Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Hours of Availability:

Click or tap here to enter text.

Phone:
Click or tap here to enter text.
MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment * ☐ Ship Direct
Restrictions Applicable to this Reseller (if any):
Click or tap here to enter text.

RESELLER/DISTRIBUTOR INFORMATION

Company Name:
Click or tap here to enter text.
Address:
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Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:
Click or tap here to enter text.
Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:

Click or tap here to enter text.

Hours of Availability:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment * ☐ Ship Direct
Restrictions Applicable to this Reseller (if any):
Click or tap here to enter text.

RESELLER/DISTRIBUTOR INFORMATION

Company Name:
Click or tap here to enter text.
Address:
Click or tap here to enter text.
Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:
Click or tap here to enter text.
Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Hours of Availability:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment * ☐ Ship Direct
Restrictions Applicable to this Reseller (if any):
Click or tap here to enter text.

RESELLER/DISTRIBUTOR INFORMATION

Company Name:
Click or tap here to enter text.
Address:
Click or tap here to enter text.
Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:
Click or tap here to enter text.
Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Hours of Availability:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment * ☐ Ship Direct
Restrictions Applicable to this Reseller (if any):
Click or tap here to enter text.

RESELLER/DISTRIBUTOR INFORMATION

Company Name:
Click or tap here to enter text.
Address:
Click or tap here to enter text.
Federal ID #:
Click or tap here to enter text.
NYS Vendor ID #:
Click or tap here to enter text.
Contact Name:
Click or tap here to enter text.
Title:
Click or tap here to enter text.
Email:
Click or tap here to enter text.
Hours of Availability:
Click or tap here to enter text.
Phone:
Click or tap here to enter text.
MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐NYS Small Business Enterprise (self-identified)
Reseller is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment * ☐ Ship Direct
Restrictions Applicable to this Reseller (if any):
Click or tap here to enter text.

*In order for an Authorized User to obtain credit for Reseller(s) being MWBE, Reseller(s) MUST be allowed to “Take Orders AND Receive Payment” and be entered into SFS with their own NYS Vendor ID #.

23222i_Attachment10_ Contractor and Reseller Information

File details come from the government source that posted it. Updated .