40DHHS-S3910-Vendor-Information-Response.pdf

PDF 97 KB Posted

Attached to
Food Services
Solicitation number
40DHHS-S3910
Issued by
Nevada

About this file

This is a Vendor Information Response form related to food services procurement for the Nevada Department of Health and Human Services (DHHS). The document applies to food service provision across multiple state facilities: Desert Regional Center, Northern Nevada Adult Mental Health Services, Lakes's Crossing Center, Southern Nevada Adult Mental Health Services, and both Northern and Southern Nevada Department of Child and Family Services locations. The scope encompasses meal planning, preparation, and service for patients and residents across these five distinct entities. The response form requests comprehensive vendor information including company background, qualifications, staffing capabilities, food safety certifications, and operational procedures necessary to support food services at these facilities.

The vendor information response requires detailed submission of organizational credentials, experience in institutional food service, documentation of food handling certifications, liability insurance details, and proposed operational methodologies. Vendors must demonstrate capacity to serve multiple facility types with varying patient populations and dietary requirements. The form functions as a qualification and capability assessment tool to ensure potential contractors possess the necessary experience, licensing, insurance coverage, and operational infrastructure to manage food services across the designated state facilities. Submission of complete and accurate vendor information is essential for consideration in the procurement process.

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40DHHS-S3910 - Cost Schedule.docx DOCX document
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VENDOR INFORMATION RESPONSE

Revised: April 2021 Page 1 of 1

Vendors shall complete and return this form in their proposal.

If the proposal includes subcontractors, form must be completed for each subcontractor as well.

1. VENDOR CONTACT INFORMATION

COMPANY NAME AND CONTACT INFORMATION:

The information provided in the table below shall be used for development of the contract, if awarded.

Requested Information Response

Company Name:

Company Street Address:

City, State, Zip Code:

Telephone Number, including area code:

Toll Free Number, including area code:

Email Address:

CONTACT PERSON FOR QUESTIONS/CONTRACT NEGOTIATIONS

Requested Information Response

Name:

Title:

Address:

City, State, Zip Code:

Email Address:

Telephone Number, including area code:

Toll Free Number, including area code:

Confidentiality and Certification of Indemnification
Certification Regarding Lobbying
Vendor Information Response
1. VENDOR CONTACT INFORMATION
1.1 COMPANY NAME AND CONTACT INFORMATION:
1.2 CONTACT PERSON FOR QUESTIONS/CONTRACT NEGOTIATIONS
2. VENDOR INFORMATION
2.1 Vendors shall provide an overall company profile in the following table:
2.2 VENDOR LICENSING
2.2.1 Please be advised: Pursuant to NRS 80.010, a corporation organized pursuant to the laws of another state shall register with the State of Nevada, Secretary of State’s Office as a foreign corporation before a contract can be executed between the ...
2.2.2 The selected vendor, prior to doing business in the State of Nevada, shall be appropriately licensed by the State of Nevada, Secretary of State’s Office pursuant to NRS 76. Information regarding the Nevada Business License can be located at htt...
2.3 STATE OF NEVADA EXPERIENCE
2.3.1 If ‘Yes’, complete the following table for each State agency for whom the work was performed.
2.3.2 Table can be duplicated for each contract being identified.
2.4 CURRENT OR FORMER EMPLOYEE
2.4.1 If you employ (a) any person who is a current employee of an agency of the State of Nevada, or (b) any person who has been an employee of an agency of the State of Nevada within the past two (2) years, and if such person shall be performing or p...
2.5 PRIOR OR ONGOING CONTRACTUAL ISSUES
2.5.1 Disclosure of any significant prior or ongoing contract failures, contract breaches, civil or criminal litigation in which the vendor has been alleged to be liable or held liable in a matter involving a contract with the State of Nevada or any o...
2.5.2 Any pending claim or litigation occurring within the past six (6) years which may adversely affect the vendor’s ability to perform or fulfill its obligations if a contract is awarded as a result of this RFP shall also be disclosed.
2.5.3 If ‘Yes’, please provide the information in the table below.
2.5.4 Table can be duplicated for each issue being identified.
3. PAYMENT AUTHORIZATION FOR USE OF PROCUREMENT CARD
4. NAME OF INDIVIDUAL AUTHORIZED TO BIND THE ORGANIZATION
4.1 SIGNATURE OF INDIVIDUAL AUTHORIZED TO BIND THE VENDOR
Company Name:
Company Email Address:
Contact Person Name:
Contact Person Title:
Contact Person Address:
Contact Person City, State, Zip Code:
Contact Person Email:
Contact Person Telephone:
Contact Person Toll Free (if applicable):
Company Address:
Company City State Zip Code:
Company Telephone:
Company Toll Free:

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