41NHA-S3922-Vendor-Information-Response.pdf

This is a Vendor Information Response form developed by the Nevada Health Authority for use in responding to a Request for Proposal regarding Nevada Average Acquisition Cost. The form serves as a standardized template requiring vendors and any identified subcontractors to provide comprehensive company and contact information necessary for contract development and execution. Required submissions include primary company contact details, designated contact person information for questions and contract negotiations, overall company profile, vendor licensing status, and documentation of prior experience with State of Nevada agencies. Additionally, vendors must disclose any current or former State of Nevada employees performing work under the contract, along with any significant prior or ongoing contractual issues, breaches, or litigation involving the State of Nevada or other government entities occurring within the past six years that could adversely affect performance capabilities.

The form also requires vendors to authorize payment through procurement card usage, identify the individual authorized to bind the organization, and provide certification regarding lobbying activities and indemnification. Pursuant to Nevada Revised Statutes, out-of-state corporations must register with the Nevada Secretary of State's Office as foreign corporations prior to contract execution, and all selected vendors must obtain appropriate business licensing through the State of Nevada Secretary of State's Office before commencing work. The document is formatted to accommodate multiple subcontractors and allows for duplication of response tables to document each relevant contract, employment relationship, or contractual issue being identified.