EVT0010692_-_Appendix_A_-_Character_Form.pdf
PDF 147 KB Posted
- Attached to
- Instant Lottery Tickets State and local contract opportunity
- Solicitation number
- EVT0010692
- Issued by
- Sedgwick County, Kansas
About this file
This is a Character and Financial Disclosure Form for vendors participating in a Kansas Lottery contract opportunity. The form requires vendors to provide essential business information including the company name, legal entity type, business address, telephone number, and any trade names or assumed names along with the states where those names are used. Vendors must also attach a copy of their latest financial statement as part of the disclosure requirements.
The form includes an authorization clause allowing the Kansas Lottery or its designee to conduct a comprehensive background investigation of the vendor using the information provided in the Character and Financial Forms and any other evidence obtained during the investigation to evaluate the criminal and financial/credit history of the business. The vendor must sign and date the form, providing printed name and title, and grants release of liability to all organizations, individuals, and agencies involved in furnishing background investigation information.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| EVT0010692_-_Appendix_D_-_Employee_Background.pdf | ||
| EVT0010692_-_Bid_Docuements.pdf | ||
| EVT0010692_-_Bid_Amendment_One_(1)_-_Extend_Q_A_Deadline.pdf | ||
| EVT0010692_-_Bid_Amendment_Three_(3)_-_Q_A.pdf | ||
| EVT0010692_-_Bid_Amendment_Two_(2)_-_Extend_Close_Date.pdf | ||
| EVT0010692_-_Appendix_C_-_Vendor_Background.pdf | ||
| EVT0010692_-_Cost_Sheet_Amended.pdf | ||
| EVT0010692_-_Event_Details.pdf | ||
| EVT0010692_-_Appendix_B_-_References.pdf | ||
| Instant_Lottery_Tickets.pdf | ||
| EVT0010692_-_Appendix_E_-_Performance_Bond.pdf | ||
| EVT0010692_-_Amendment_Four_(4)_-_Modificatons.pdf |
Show all 12
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Text version
Appendix A
Character and Financial Disclosure Form for All Vendors
THE VENDOR SHALL PROVIDE THE FOLLOWING INFORMATION:
1. Name of business:
2. Type of legal entity:
3. Address:
4. Telephone number:
5. (a) List any trade names or assumed names used:
(b) List all states where these names are used:
6. Attach a copy of vendor's latest financial statement.
I ______________________hereby authorize the Kansas Lottery or its designee to conduct a background investigation using the information contained in· the Character and Financial Forms attached to the RFP and such other evidence which may be found from said investigation to determine the criminal and financial/ credit history of the above-named business. I hereby release all organizations, individuals, agencies, and their employees and agents, from any liability that may result from their furnishing such information.
Signature and Date
Printed Name
Title
File details come from the government source that posted it. Updated .