65DPS-S3656-Vendor-Information-Response.pdf

This is a Vendor Information Response form issued by the State of Nevada, Department of Public Safety (65DPS-S3656), revised April 2021. The form serves as a standardized template that vendors must complete and submit as part of their proposal for state contract opportunities. Vendors are required to provide comprehensive company contact information, including company name, street address, city, state, zip code, telephone number, toll-free number, and email address. Additionally, vendors must identify a primary contact person for questions and contract negotiations, including that individual's name, title, address, email, and telephone numbers. The form applies to all vendors responding to the opportunity, and if a proposal includes subcontractors, the form must be completed for each subcontractor as well.

The form requires vendors to disclose an overall company profile and provide evidence of appropriate licensing in accordance with Nevada Revised Statutes (NRS 80.010 and NRS 76), including registration with the Nevada Secretary of State's Office for foreign corporations and Nevada business licensing prior to contract execution. Vendors must also disclose any prior experience with State of Nevada agencies and identify any current or former State of Nevada employees who will perform work on the contract. Additionally, vendors are required to disclose any significant prior or ongoing contract failures, breaches, civil or criminal litigation involving State of Nevada contracts or other government entities, and any pending claims or litigation within the past six years that may adversely affect performance capability. The form includes sections for payment authorization for procurement card use and requires signature authorization from an individual with binding authority for the organization.