41NHA-S3529 - Vendor-Information-Response.pdf

PDF 45 KB Posted

Attached to
Health Care Purchasing, Procurement & Market Analysis Services
Solicitation number
41NHA-S3529
Issued by
Nevada

About this file

This is a Vendor Information Response form used by the State of Nevada Purchasing Division for the Nevada Health Authority's Request for Qualifications (RFQ) for health care purchasing, procurement, and market analysis services. Vendors responding to this solicitation must complete the form to provide company contact information, details about a designated contact person for questions and contract negotiations, and company profile information. The RFQ seeks qualified consultants and consulting firms to establish a pool of up to three contract vendors providing expert services in health care procurement and purchasing for coverage programs, as well as actuarial and economic modeling services. Services will support Medicaid, the Public Employee Benefits Program, and the Exchange Marketplace. The RFQ was released on October 17, 2025, with proposals due by November 19, 2025, at 2:00 PM PST. The anticipated contract term is four years beginning in January 2026, structured on an as-needed basis with no guaranteed utilization.

Vendors must comply with multiple administrative and operational requirements outlined in the form, including Nevada business licensing and registration with the Secretary of State's Office as required under NRS 76 and NRS 80.010. Vendors are required to disclose any prior State of Nevada experience, current or former employment of state agency personnel, and any significant prior or ongoing contractual issues, contract breaches, or litigation involving the State of Nevada or other governmental entities within the past six years. Vendors must maintain rigorous insurance coverage, including Commercial General Liability of $2,000,000 aggregate and $1,000,000 per occurrence, Workers' Compensation, Employers' Liability, and Professional Liability coverage with insurers licensed in Nevada and rated at least A-VII by A.M. Best. The form requires vendors to identify individuals authorized to bind the organization and provide detailed cost schedules with hourly rates for consulting policy experts, actuaries, economists, and team members. No specific budget ranges, set-asides, or incumbent vendors are explicitly identified in the documentation.

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Text version

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:

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