attachment-13-contractor_dealer_distributor-information.docx

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Attached to
Firearms, Ammunition, and Less Lethal Products (Statewide)
Contract number
Not on record
Issued by
New York

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Written by GovTribe AI ·

This document is Attachment 13 of a New York State statewide contract vehicle for Group 35200 covering Firearms, Ammunition, and Less Lethal Products. It is administered by the New York State Office of General Services (OGS) and serves as a template form for contractors, dealers, and distributors participating in this statewide contract to submit and update their business information for ordering and contract administration purposes.

The form requires contractors to provide comprehensive company information including business name, address, Federal Tax ID, and NYS Vendor ID, along with designated contacts for contract administration, sales and billing, emergency services, and invoicing. Contractors must identify all associated locations, subsidiaries, dealers, and distributors authorized to fulfill orders under the contract. For entities with Minority- and Women-owned Business Enterprise (MWBE) or Service-Disabled Veteran-Owned Business (SDVOB) certifications, dealers and distributors must be registered in the Statewide Financial System (SFS) with their own NYS Vendor ID to receive applicable credits. The form accommodates multiple dealer/distributor entries with individual contact information, certifications, authorization levels (including "Take Orders AND Receive Payment" or "Ship Direct" capabilities), and any applicable restrictions. Contractors are required to submit updated forms to OGS whenever a dealer or distributor is added or removed from the contract, and must simultaneously submit completed MWBE 100 forms when adding or removing MWBE-certified resellers.

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GROUP 35200 – Firearms, Ammunition, and Less Lethal Products (Statewide) Page 1 of 4

ATTACHMENT 13

CONTRACTOR/DEALER/DISTRIBUTOR INFORMATION

(for ordering and contract administration purposes)

NOTE: Contractors MUST submit an updated form to OGS EVERY TIME a Distributor/Dealer is added or removed. If a contract has Minority- and/or Women-owned Business Enterprise (MWBE) participation goals, in addition to this form, Contractors MUST submit to OGS a completed MWBE 100 form EVERY TIME they add or remove a reseller that has been certified by NYS as an MWBE.

The MWBE 100 form is available under the “Commodity & Service Contracts” section at: https://ogs.ny.gov/mwbe/forms

CONTRACTOR/COMPANY INFORMATION

Company Business Name:
D/B/A – Doing Business As (if applicable):
Address:
Company Website:
Federal Tax ID #:
NYS Vendor ID #:

CONTRACT ADMINISTRATION

Contract Administrator Name:
Title:

Address (if different from above):

Email:
Phone:
Toll Free Phone:

SALES/BILLING (if different from above)

Contact Name:
Title:
Address:
Email:
Phone:
Toll Free Phone:
Business Hours (Specify M-F, Sat, Sun):

EMERGENCIES

Contact Name:
Title:
Address:
Email:
Phone:
Cell Phone:

INVOICING

Entity information that will appear on invoices, for orders placed directly with the Contractor, if different from Contractor/Company information above.

Invoicing Entity Company Name:
Federal Tax ID #:
NYS Vendor ID #:

Is payment made to the above Entity/Federal ID#?

Note: If yes, the invoicing entity NYS Vendor ID MUST be referenced on Purchase Orders ☐ Yes ☐ No

Contractor locations, subsidiaries, and/or Dealers/Distributors for the Contract are listed below. In order for an Authorized User to obtain MWBE or SDVOB credit, the applicable MWBE or SDVOB Dealer/ Distributor MUST be allowed to "Take Orders AND Receive Payment" and be entered into SFS with their own NYS Vendor ID #. An MWBE Dealer/ Distributor that is noted as a “Broker” in the “Restrictions Applicable to this Reseller” field has been identified as a broker in the NYS Directory of Certified Firms located at https://ny.newnycontracts.com, and the Contractor and the Authorized User will receive only a 25% MWBE credit for its utilization.

DEALER/DISTRIBUTOR INFORMATION

Company Business Name:
Address:
Federal Tax ID #:
NYS Vendor ID #:
Contact Name:
Title:
Email:
Hours of Availability:
Phone:

MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐ NYS Small Business Enterprise (self-identified)
Dealer/Distributor is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment ☐ Ship Direct
Restrictions Applicable to this Distributor/Dealer (if any):

DEALER/DISTRIBUTOR INFORMATION

Company Business Name:
Address:
Federal Tax ID #:
NYS Vendor ID #:
Contact Name:
Title:
Email:
Hours of Availability:
Phone:

MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐ NYS Small Business Enterprise (self-identified)
Dealer/Distributor is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment ☐ Ship Direct
Restrictions Applicable to this Distributor/Dealer (if any):

DEALER/DISTRIBUTOR INFORMATION

Company Business Name:
Address:
Federal Tax ID #:
NYS Vendor ID #:
Contact Name:
Title:
Email:
Hours of Availability:
Phone:

MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐ NYS Small Business Enterprise (self-identified)
Dealer/Distributor is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment ☐ Ship Direct
Restrictions Applicable to this Distributor/Dealer (if any):

DEALER/DISTRIBUTOR INFORMATION

Company Business Name:
Address:
Federal Tax ID #:
NYS Vendor ID #:
Contact Name:
Title:
Email:
Hours of Availability:
Phone:

MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐ NYS Small Business Enterprise (self-identified)
Dealer/Distributor is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment ☐ Ship Direct
Restrictions Applicable to this Distributor/Dealer (if any):

DEALER/DISTRIBUTOR INFORMATION

Company Business Name:
Address:
Federal Tax ID #:
NYS Vendor ID #:
Contact Name:
Title:
Email:
Hours of Availability:
Phone:

MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐ NYS Small Business Enterprise (self-identified)
Dealer/Distributor is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment ☐ Ship Direct
Restrictions Applicable to this Distributor/Dealer (if any):

DEALER/DISTRIBUTOR INFORMATION

Company Business Name:
Address:
Federal Tax ID #:
NYS Vendor ID #:
Contact Name:
Title:
Email:
Hours of Availability:
Phone:

MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐ NYS Small Business Enterprise (self-identified)
Dealer/Distributor is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment ☐ Ship Direct
Restrictions Applicable to this Distributor/Dealer (if any):

DEALER/DISTRIBUTOR INFORMATION

Company Business Name:
Address:
Federal Tax ID #:
NYS Vendor ID #:
Contact Name:
Title:
Email:
Hours of Availability:
Phone:

MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐ NYS Small Business Enterprise (self-identified)
Dealer/Distributor is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment ☐ Ship Direct
Restrictions Applicable to this Distributor/Dealer (if any):

DEALER/DISTRIBUTOR INFORMATION

Company Business Name:
Address:
Federal Tax ID #:
NYS Vendor ID #:
Contact Name:
Title:
Email:
Hours of Availability:
Phone:

MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐ NYS Small Business Enterprise (self-identified)
Dealer/Distributor is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment ☐ Ship Direct
Restrictions Applicable to this Distributor/Dealer (if any):

DEALER/DISTRIBUTOR INFORMATION

Company Business Name:
Address:
Federal Tax ID #:
NYS Vendor ID #:
Contact Name:
Title:
Email:
Hours of Availability:
Phone:

MWBE and/or SDVOB Certification:

☐ NYS Certified Women Owned ☐ NYS Certified Minority Owned ☐ SDVOB

SBE:
☐ NYS Small Business Enterprise (self-identified)
Dealer/Distributor is Authorized to: (check all that apply)
☐ Take Orders AND Receive Payment ☐ Ship Direct
Restrictions Applicable to this Distributor/Dealer (if any):

Attachment 13 – Contractor/Dealer/Distributor Information

File details come from the government source that posted it. Updated .