40DHHS-S4080-Vendor-Information-Response.pdf

This is a Vendor Information Response form revised in April 2021 for the State of Nevada Department of Health and Human Services (40DHHS-S4080), applicable to the Water Well Repair contract opportunity. The form requires vendors and any subcontractors to provide comprehensive company contact information, including company name, street address, phone and email contact details, and a designated contact person for questions and contract negotiations. Vendors must also complete sections detailing overall company profile, licensing requirements, prior experience with Nevada state agencies, disclosure of current or former Nevada employees involved in contract performance, and any significant prior or ongoing contractual issues, breaches, or litigation with the State of Nevada or other public entities within the past six years.

The form emphasizes that selected vendors must register with the Nevada Secretary of State's Office as a foreign corporation if organized under another state's laws and obtain appropriate Nevada business licensing pursuant to NRS 76 prior to contract execution. Vendors are required to authorize payment through procurement card and identify the individual authorized to bind the organization, providing that individual's signature. The form serves as a standardized due diligence tool to verify vendor qualifications, legal standing, and contractual history before award, with no specific pricing terms, set-asides, or contract term information detailed within the response form itself.