41NHA-S4038-Vendor-Information-Response.pdf

This is a Vendor Information Response form for the Nevada Health Authority's Program of All Inclusive Care for the Elderly (PACE) request for proposal. The form serves as a standardized template that vendors and their subcontractors must complete and submit as part of their proposal responses. The document establishes mandatory vendor disclosure and qualification requirements for potential contractors seeking to work with the State of Nevada on this contract opportunity.

The form requires vendors to provide comprehensive company contact information, including company name, street address, city, state, zip code, telephone numbers, email address, and a designated contact person for questions and contract negotiations. Vendors must also complete company profile information, demonstrate appropriate licensing through the Nevada Secretary of State's Office as required under NRS 76 and NRS 80.010 for foreign corporations, and disclose any prior State of Nevada experience by identifying specific state agencies for whom work was performed. Additionally, vendors must disclose whether they employ or have employed any current or former State of Nevada agency employees within the past two years who would perform work on the contract. Vendors are required to disclose any significant prior or ongoing contract failures, breaches, civil or criminal litigation, or pending claims or litigation occurring within the past six years that may adversely affect their ability to perform. The form concludes with sections for payment authorization for procurement card use and signature authorization from an individual authorized to bind the organization.