23222i_attachment-10-contractor_reseller_distributor_-infosheet_20210204.docx

41 KB Posted

Attached to
Personal Protective Equipment (PPE) and Related Items (Statewide)
Contract number
Not on record
Issued by
New York

About this file

Written by GovTribe AI ·

This document is a blank Contractor/Reseller/Distributor Information Sheet template for New York State Group 10150 contract covering Personal Protective Equipment (PPE) & Related Items. The form was revised on February 4, 2021, and serves as Attachment 10 for contract administration and ordering purposes. It is designed to collect comprehensive contact information from contractors and their authorized resellers/distributors, including company details, federal and NYS vendor identification numbers, and designated contacts for contract administration, sales/billing, and emergency situations.

The template provides sections for up to ten reseller/distributor entities and includes fields for minority, women, and service-disabled veteran-owned business enterprise (MWBE/SDVOB) certifications, as well as Small Business Enterprise (SBE) self-identification. Resellers can be authorized to take orders and receive payment, ship direct, or both, with provisions for noting any applicable restrictions. The document emphasizes that for authorized users to receive credit for utilizing MWBE resellers, those resellers must be permitted to both take orders and receive payment and must be registered in the state's SFS system with their own NYS Vendor ID number. All fields in this template document are currently blank, indicating it is a form to be completed by prospective contractors.

View the file

Other files

File Type Posted
23222i_appendix-c-01-17.docx DOCX document
23222i_Attachment01Pricing.xlsm XLSM spreadsheet
23222i_Attachment11.xlsm XLSM spreadsheet
23222i_attachment-04-insurance-requirements.docx DOCX document
1015023222ContractorInfo.pdf PDF
23222i_attachment-02-nys-required-certifications.docx DOCX document
1015023222ra.pdf PDF
23222i_attachment-05-bidder-information-questionnaire_20210204.xlsx XLSX spreadsheet
23222i_attachment-08-report-of-contract-usage.xlsx XLSX spreadsheet
23222i_attachment-03-encouraging-use-of-nys-business.docx DOCX document
23222i_appendix-d-fema-terms-and-conditions.docx DOCX document
23222i_attachment-09-manufacturercertificate.docx DOCX document
23222p5.pdf PDF
23222i_appendix-a-10-19.pdf PDF
23222i_appendix-b-04-16.pdf PDF
23222i_revised20210204.pdf PDF
1015023222p.pdf PDF
23222i_attachment-06-bidder-submission-checklist_20200204.xlsx XLSX spreadsheet
23222i_attachment-07-bidder-questions-form.xlsx XLSX spreadsheet
23222i_response-to-bidders-inquiries.pdf PDF
Show all 20

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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:
ds;akj
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 .