4-RFQ 04 Request for Preference Form.pdf

REQUEST FOR PREFERENCE

Incorporated County of Los Alamos Procurement Division

101 Camino Entrada, Building 3 Los Alamos, NM 87544

Version:20250501

Offeror Company Name:

Solicitation No.:

Solicitation Title:

Name and Title of the Person Completing this Form

In accordance with Incorporated County of Los Alamos (“County”) Code Section. 31-261(b) and NMSA 1978 Section 13-1-21 et al., if the chief purchasing officer determines preference is applicable to the solicitation, Offeror(s) must submit a written request for preference, with a valid copy of the applicable New Mexico state-issued preference certificate with its Proposal to qualify for the requested preference. If requesting local preference, Offeror(s) must also submit with its Proposal a current valid Los Alamos County Business License and must maintain its principal office and place of business in Los Alamos County to qualify for Local Business preference. County reserves the right, for any reason, to (1) verify the accuracy and validity of any information and documents submitted by Offerors prior to applying any preference factors; and (2) deny any request for preference if Offeror(s) have not met applicable requirements to qualify for any requested preference.

By checking the box(s) below and submitting this form with my Proposal, I certify the following statements are true and correct:

1) By requesting a preference type below, my company meets the definition for that preference type as defined in the regulations stated above;

2) I understand that a request for preference or preference-related documents or information cannot be submitted or modified after the solicitation closing date;

3) Preference factors will be applied as applicable in accordance with the most current County Code Section 31-261(b) and NMSA 1978 Section 13-1-21 et al., as may be modified from time to time.

Preference Requested Check all being requested

Preference Type As defined in Los Alamos Code Section 31-261(b) and NMSA 1978 Section 13-1-21

□ No Preference. I certify that I am not requesting any preference for this solicitation.

Local (Los Alamos) Business. I certify that my company is incorporated in New Mexico and my company’s principal office and place of business is in Los Alamos County.

□ Resident (New Mexico) Business

Version:20250501

□ Native American Resident Business with annual gross revenues of up to six million dollars ($6,000,000) in the preceding tax year

□ Native American Resident (New Mexico) Business

Resident Veteran Business with annual gross revenues of up to six million dollars ($6,000,000) in the preceding tax year

Native American Resident Veteran Business with annual gross revenues of up to six million dollars ($6,000,000) in the preceding tax year