9-RFP 05 Verification of Authorized Offeror Form.pdf

This is a Verification of Authorized Offeror Form issued by the Incorporated County of Los Alamos Procurement Division in New Mexico for the Pharmacy Inspection Services solicitation. The form is designed to capture the authorized officer information from selected offerors who will be obligated to provide licensed pharmacist services for quarterly pharmaceutical inspections and oversight of drug handling and distribution to the County Emergency Medical Services, a division of the Los Alamos County Fire Department. The form requires offerors to submit the printed name, title, and signature of an authorized representative, along with the organization's legal name, state of incorporation, and contact information.

The form collects essential business and tax identification information from offerors, including federal tax identification number and New Mexico Business Tax ID Number (BTIN) for in-state located organizations. Additionally, offerors must provide complete mailing and physical addresses, telephone numbers, and email addresses, as well as designate a contract manager with printed name, title, and email contact information. This verification form serves as documentation that the submitting organization has reviewed the proposal conditions, scope of services, and deliverables for the solicitation and is authorized to enter into a binding agreement with the County.