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 .