41NHA-S3848-Vendor-Information-Response.pdf

This is a Vendor Information Response form required for submission by the Nevada State Purchasing Division on behalf of the Nevada Health Authority for a Non-Emergency Transportation (NET) Brokerage Services contract opportunity. The form serves as a standardized document that all vendors and their subcontractors must complete and include with their proposals. The form captures essential vendor identification information including company name, contact details, address, telephone and email information, and a designated contact person for questions and contract negotiations.

The form requires vendors to provide comprehensive company profile information, demonstrate appropriate Nevada business licensing and registration as a foreign corporation if applicable pursuant to Nevada Revised Statutes, and disclose any prior experience with State of Nevada agencies. Vendors must also disclose employment relationships with current or former Nevada state employees who will perform work under the contract, and declare any significant prior or ongoing contractual failures, breaches, litigation, or claims that have occurred within the past six years that may affect performance capability. Additionally, vendors must identify the individual authorized to bind the organization and provide authorization information for payment via procurement card. The form requires complete disclosure of all relevant vendor qualifications and potential conflicts of interest to ensure transparency in the procurement process.