4-RFP 05 Verification of Authorized Offeror Form.pdf

PDF 696 KB Posted

Attached to
Employee Vision Benefits
Solicitation number
RFP26-68
Issued by
Los Alamos County, New Mexico

About this file

This is a Verification of Authorized Offeror Form related to Los Alamos County's request for qualified offerors to provide fully-insured Vision Insurance Benefit Coverage to county employees in New Mexico. The form serves as a certification document requiring offerors to verify their authorization and eligibility to submit proposals for this employee vision benefits contract. The document establishes the formal submission requirements and offeror qualifications necessary to participate in the competitive bidding process for providing vision insurance benefits to the county's workforce.

The form functions as a prerequisite verification document that offerors must complete and submit as part of their proposal package. By executing this form, offerors certify their legal authority to conduct business in New Mexico and their ability to provide the requested fully-insured vision insurance coverage. The form ensures that only qualified and authorized insurance providers can participate in the procurement process and that all submissions meet the baseline eligibility requirements established by Los Alamos County for this benefits procurement.

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Text version

VERIFICATION OF AUTHORIZED

OFFEROR

Incorporated County of Los Alamos

Procurement Division 101 Camino Entrada, Building 3

Los Alamos, NM 87544

Version: 20250318

This form provides the Incorporated County of Los Alamos (“County”) with the name and information of the authorized officer who can obligate the selected Offeror in providing the services to the County.

Having read the Proposal conditions and examined the scope of services and deliverables for this solicitation, this Proposal is hereby submitted by:

Solicitation No.

Solicitation Title

Printed Name of Authorized Offeror

Title of Authorized Offeror

Signature of Authorized Offeror

Organization’s Legal Name

State of Incorporation

Email Address

Mailing Address (City, State, Zip)

Physical Address (City, State, Zip)

Telephone No.

Federal Tax I.D. No.

NM BTIN (if located in-stated)

Contract Manager Printed Name, Title, and Email

Solicitation No:
Solicitation Title:
Printed Name of Authorized Offeror:
Title of Authorized Offeror:
Signature of Authorized Offeror:
Organizations Legal Name:
State of Incorporation:
Email Address:
Mailing Address City State Zip:
Physical Address City State Zip:
Telephone No:
Federal Tax ID No:
NM BTIN if located instated:
Contract Manager Printed Name Title and Email:

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