44DOC-S3444 - Vendor-Information-Response.pdf

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Attached to
Pest Control Services
Solicitation number
44DOC-S3444
Issued by
Pershing County, Nevada

About this file

This document is a Vendor Information Response form, revised in April 2021, designed for vendors to complete and submit as part of a proposal process. The form is structured to collect comprehensive contact information for the proposing company and a designated contact person for questions and contract negotiations. It requires vendors to provide details such as company name, street address, city, state, zip code, telephone numbers, email address, and specific contact information for the individual who will handle inquiries and potential contract discussions. The form is intended to be completed by the primary vendor and any subcontractors involved in the proposal. It is a standardized template that allows for consistent information gathering to support contract development if the proposal is awarded.

The form does not contain specific pricing, funding sources, or project details, but serves as a critical administrative document for establishing communication channels and identifying key personnel for a potential contract. Vendors are instructed to complete all sections thoroughly, with the understanding that the information provided will be used for contract development purposes. The form is designed to be flexible, allowing for multiple vendors or subcontractors to be documented using the same template, which suggests a comprehensive and inclusive procurement approach.

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VENDOR INFORMATION RESPONSE

Revised: April 2021 Page 1 of 4

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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