ATTACHMENT H - CERTIFICATION OF RECALL OR SAFETY ISSUES.docx
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- Solicitation number
- 36C10G26R0007
About this file
This is a Certification of Recall or Safety Issues form that vendors must complete and submit as part of their response to solicitation 36C10G26R0007 for NX EQ A-dec Dental Delivery Units and Chairs. The form requires the authorized company representative to certify on behalf of the vendor, identified by their Unique Entity Identifier (UEI), that the quoted medical equipment has no outstanding recalls, no known safety issues, complies with all relevant medical equipment regulations and standards, and has been thoroughly checked for compliance with safety and performance standards. The form must be signed by an authorized representative including their name, title, signature, and date.
Offerors are instructed to complete all fields in the certification form and ensure it is signed by an authorized company representative before submitting it along with their quote. Vendors are cautioned that any false or misleading information provided in this certification may result in disqualification from the solicitation process and other penalties as permitted by law. This certification is required by the Department of Veterans Affairs Strategic Acquisition Center Frederick for vendors responding to this solicitation for dental delivery equipment.
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Attachment H Certification of Recall or Safety Issues Instructions to Offerors:
1. Complete all fields in the certification form.
2. Ensure that the form is signed by an authorized representative of the company.
3. Submit the completed form along with your quote.
Certification of No Outstanding Recalls or Safety Issues Solicitation Number: 36C10G26R0007 Requirement for: NX EQ A-dec Dental Delivery Units and Chairs
Company Unique Entity Identifier (UEI): __________________________________________
Certification:
By signing below, I, the undersigned, certify on behalf of the company identified by the UEI above, the medical equipment quoted in response to the above-referenced solicitation:
1. Does not have any outstanding recalls.
2. Does not have any known safety issues.
3. Complies with all relevant regulations and standards for medical equipment.
4. Has been thoroughly checked for compliance with safety and performance standards.
I understand that any false or misleading information provided in this certification may result in disqualification from the solicitation process and other penalties as permitted by law.
Authorized Representative:
Name: __________________________________________ Title: __________________________________________ Signature: __________________________________________ Date: __________________________________________
File details come from the government source that posted it. Updated .