3-RFI 03 Verification of Authorized Offeror Form.pdf

This is a Verification of Authorized Offeror Form issued by the Incorporated County of Los Alamos Procurement Division in Los Alamos, New Mexico, for use in response to a solicitation for SMART Recovery for Juveniles programming. The form serves to collect and verify information regarding the authorized officer of the selected offeror who will be responsible for obligating the contractor to provide services to the County. The document requires the submission of comprehensive organizational and individual contact information, including the authorized offeror's printed name, title, signature, the organization's legal name, state of incorporation, email address, mailing address, physical address, and telephone number. Additionally, the form requires submission of the organization's Federal Tax Identification Number, New Mexico Business Tax Identification Number if the organization is located in-state, and the contract manager's printed name, title, and email address.

The form provides no information regarding pricing terms, set asides, incumbent contractors, funding sources, or contract duration. As a verification document rather than a substantive procurement document, it functions solely as an administrative form to establish the authorized representative of the responding offeror and ensure proper contracting procedures. Offerors must complete all required fields accurately and have the authorized officer sign the form as part of their proposal submission for the juvenile-focused SMART Recovery services solicitation.