Form 1 - Vendor Acknowledgement.pdf
PDF 85 KB Posted
- Attached to
- ITB-DEM-25-26-020 - WebEOC
- Solicitation number
- ITB-15570
- Issued by
- Leon County, Florida
About this file
This is a Vendor Acknowledgement Form for ITB-DEM-25-26-020, a solicitation issued by the Florida Division of Emergency Management for a comprehensive web-based emergency management tool. The form requires vendors to provide standard company information including vendor name, mailing address, DUNS number, FEID number, and business entity type. Vendors must designate an authorized representative with binding authority to execute the acknowledgement and certify compliance with the solicitation's Terms & Conditions. The form also requires identification of primary and secondary vendor contacts, including their names, titles, addresses, telephone numbers, fax numbers, and email addresses, with the expectation that these individuals will be available for telephone communication and meetings related to the solicitation schedule.
The Florida Division of Emergency Management is seeking qualified vendors to provide software, maintenance, and professional services based on the WebEOC platform to support statewide emergency management functions. Pricing and service details are outlined in Attachment B, the Price Sheet. Vendors submitting proposals must complete and sign this acknowledgement form as part of their response to demonstrate authorization to bind their organization and commitment to meeting all solicitation requirements.
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Text version
FORM 1
Vendor Acknowledgement
Vendor Name:
If a Fictitious Name is used include registered name (i.e. XYZ, Inc.
D/B/A ABC)
*Authorized Signature (Manual)
Vendor Mailing Address:
City, State, Zip: *Authorized Signature (Typed), Title
Phone Number:
*This individual must have the authority to bind the Respondent.
By signature on the Reply, Respondent certifies that it complies with the Terms &
Conditions of the RFQ.
Toll Free Number:
Email Address:
DUNS Number:
FEID Number:
Type of Business Entity (Corporation, LLC, partnership, etc.):
VENDOR CONTACTS: Provide the name, title, address, telephone number, and email address of the official contact and an alternate, if available. These individuals shall be available to be contacted by telephone or attend meetings as may be appropriate regarding the solicitation schedule.
Primary Contact:
Contact Name, Title:
Address:
Phone Number:
Fax Number:
Email Address:
Secondary Contact:
Contact Name, Title:
Address:
Phone Number:
Fax Number:
Email Address:
| Vendor Name: |
| Authorized Signature ManualVendor Mailing Address: |
| City State Zip: |
| Authorized Signature Typed Title: |
| Phone Number: |
| Toll Free Number: |
| Email Address: |
| DUNS Number: |
| FEID Number: |
| Type of Business Entity Corporation LLC partnership etc: |
| Primary Contact: |
| Contact Name Title: |
| Address: |
| Phone Number_2: |
| Fax Number: |
| Email Address_2: |
| Secondary Contact: |
| Contact Name Title_2: |
| Address_2: |
| Phone Number_3: |
| Fax Number_2: |
| Email Address_3: |
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