26-03-0521_Manufacturer_Certification_Form.pdf
PDF 107 KB Posted
- Attached to
- First Responder Supplies and Equipment
- Solicitation number
- 26-03-0521
- Issued by
- North Carolina
About this file
The document is a Manufacturer Certification Form for the North Carolina Sheriffs' Association (NCSA) Cooperative Purchasing Programs, specifically for Bid 26-03-0521 covering First Responder Supplies and Equipment. The form is designed to be completed by manufacturers participating in the 2025-2026 procurement opportunity, with a bid period opening on April 22, 2025, and closing at 12 noon EST on May 21, 2025. Contracts are scheduled to be awarded on June 18, 2025.
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. Failure to submit the properly completed certification form will result in disqualification from the bidding process. The form requires detailed manufacturer information, including name, address, contact details, and an official signature, with a specific note that signatures must be physical or timestamped to validate the certification.
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Text version
Manufacturer Certification Form
First Responder Supplies and Equipment Bid 26-03-0521
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 State of North Carolina.
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 .