26-02-0523_Manufacturer_Certification_Form.pdf
PDF 1 MB Posted
- Attached to
- First Responder Supplies and Equipment
- Solicitation number
- 26-02-0523
- Issued by
- Virginia
About this file
The document is a Manufacturer Certification Form for the Virginia Sheriffs' Association (VSA) First Responder Supplies and Equipment procurement opportunity (Bid 26-02-0523). The form is specifically designed for manufacturers participating in the 2025-2026 procurement program, with a bid period opening on May 1, 2025, and closing at 12 noon EST on May 23, 2025. The contract awards are scheduled for June 20, 2025, covering first responder supplies and equipment for jurisdictions in the Commonwealth of Virginia.
The certification form requires strict compliance, mandating that only authorized manufacturer employees complete the document, with dealers and representatives explicitly prohibited from executing the form. The form serves to verify that the vendor/bidder is either the manufacturer or an authorized dealer for a specific manufacturer in Virginia. Failure to submit this completed certification form with a bid response will result in automatic disqualification. The form requires detailed contact information, including manufacturer name, address, representative contact details, and requires a physical or timestamped signature from an authorized manufacturer representative.
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Text version
Manufacturer Certification Form
First Responder Supplies and Equipment Bid 26-02-0523
This form is to be completed for all manufacturers in which your company is bidding.
Vendor (Bidder):
PLEASE NOTE: This certification form must be executed by an authorized employee of the manufacturer ONLY. Dealers/Representatives are not authorized to execute this certification form on behalf of the manufacturer. The manufacturer must execute this certification form even if they are offering their own products. Failure to submit this certification form with your response as required shall result in the disqualification of the response.
The section below is to be completed by the manufacturer representative.
This is to certify that the above vendor/bidder is the manufacturer and/or a manufacturer’s authorized dealer for the following manufacturer in the Commonwealth of Virginia.
Manufacturer Name:
Address:
City, State, Zip:
Contact Information of Representative:
Office Phone: Mobile Phone:
E-mail:
Signature of Manufacturer Representative: Title:
Printed Name of Manufacturer Representative: Date:
Note: Signatures must be physical or timestamped.
| Vendor Bidder: |
| Manufacturer Name: |
| Address: |
| City State Zip: |
| Office Phone: |
| Mobile Phone: |
| Email: |
| Title: |
| Printed Name of Manufacturer Representative: |
| Date: |
| Signature1_es_:signer:signature: |
File details come from the government source that posted it. Updated .