6-Form Vendor-Price-Matching-Opportunity 09.2021.pdf

North Carolina EO50 Price Matching Version Date: 09/2021

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ATTACHMENT H: VENDOR REQUEST FOR EO50 PRICE MATCHING

Solicitation #: __________________________

Vendor Name: __________________________

Pursuant to G.S. 143-59 and Executive Order No. 50 (2010), a North Carolina resident Vendor may receive the opportunity to obtain a contract award by agreeing to match the final price(s) of the lowest Vendor, if the lowest price is offered by a non-resident Vendor. This opportunity arises when a North Carolina resident Vendor offers a price that is within five percent (5%) or $10,000 (whichever is less) of the non-resident Vendor’s overall lowest price. Requesting a price matching opportunity below does not require a resident Vendor to match the lowest price in the event the Vendor qualifies for the opportunity.

The following sections shall be completed if a resident Vendor is requesting a price matching opportunity:

PART I – EO50: Resident Bidder Determination

Vendor shall check the applicable boxes below. In order to be considered for the price-matching opportunity under Executive Order #50 and G.S. 143-59(c)(1), Vendor must meet the definition of a “Resident Bidder.”

By submitting this form, the Vendor certifies that:

it has paid unemployment taxes to the State of North Carolina for the most recent quarter or annually and has specifically done so for the last such payment period.

it has paid income taxes to the State of North Carolina each calendar quarter, or otherwise annually, and has specifically done so for the last such payment period.

PART II – EO50

I certify that the Vendor’s principal place of business is located in North Carolina. Principal place of business is defined as the principal place from which the trade or business of the Vendor is directed or managed.

A. Provide address of principal place of business:

Street Address (no P.O. Box number)

City, State, Zip Code

Is the above address the location of Vendor’s overall headquarters? YES NO

If Vendor has a public website, provide the link/address:

North Carolina EO50 Price Matching Version Date: 09/2021

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NOTICE: The Price Matching Opportunity will only be given to a Vendor that fully completes this attachment (i.e., all information shall be provided, all supporting documents shall be attached, and signature from an authorized representative of the Vendor shall be provided) and demonstrates its qualification for the Price Matching Opportunity. A certification shall be submitted with each bid for which Vendor seeks a price matching opportunity.

Certification of ___________________________________________ (name of resident Vendor).

The undersigned hereby certifies that he or she has read this certification, that all information provided in Part I and Part II above is true and accurate and that he or she is an officer, member, partner, owner, or other such managing employee of the Vendor (the “Authorized Representative”) that is authorized to execute this certification and to bind the Vendor to the certifications, statements, and agreements herein.

Name of Authorized Representative: _______________________________________________

Signature: _______________________________________________

Title: _______________________________________________

Date: _______________________________________________

B. ATTACH A COPY OF VENDOR’S MOST RECENT FILINGS WITH THE NORTH CAROLINA

SECRETARY OF STATE (such as Vendor’s Certificate of Authority, Annual Report or such other filing that discloses a North Carolina business address for the Vendor).

OR (check the box below)

Vendor certifies that its business is not required to make filings with the North Carolina Secretary of State.

If the box is checked, state the reason why no filings are required:

ATTACHMENT H: VENDOR REQUEST FOR EO50 PRICE MATCHING