40DHHS-S3545 - Vendor-Information-Response.pdf

This is a Vendor Information Response form for a State of Nevada, Department of Health and Human Services (DHHS) contract opportunity (40DHHS-S3545). The form is required to be completed and submitted by all vendors and subcontractors as part of their proposal response. The document outlines the essential information vendors must provide, including company contact details, contact person information for questions and contract negotiations, company profile, licensing status, and prior experience with State of Nevada agencies. The form also requires vendors to disclose any current or former State of Nevada employees who will perform work under the contract and to document any significant prior or ongoing contractual issues, breaches, or litigation involving the State of Nevada or other government entities.

The form establishes compliance requirements for doing business with the State of Nevada, including registration as a foreign corporation with the Secretary of State's Office pursuant to NRS 80.010 and obtaining appropriate licensure under NRS 76. Vendors must provide comprehensive disclosure of any contract failures, breaches, civil or criminal litigation, or pending claims occurring within the past six years that may adversely affect their ability to perform contract obligations. The form also designates authorization for payment using procurement cards and requires identification and signature of the individual authorized to bind the vendor organization. Revised in April 2021, this form serves as a standardized documentation instrument to establish vendor qualifications, experience, and compliance status prior to contract award.