Form 1 - Vendor Acknowledgement.pdf
PDF 111 KB Posted
- Solicitation number
- RFP-11961
- Issued by
- Leon County, Florida
About this file
Form 1 - Vendor Acknowledgement is a standard procurement document from the Florida Division of Emergency Management (FDEM) for the Elevate Florida residential mitigation grant program. This form serves as a key component of the RFP-DEM-24-25-017 solicitation, requiring potential contractors to provide comprehensive vendor contact information, business details, and an authorized signature certifying compliance with the Request for Proposal (RFP) terms and conditions. The document is designed to capture critical vendor information including business entity type, DUNS and FEID numbers, contact details for primary and secondary representatives, and requires an authorized signature with the power to legally bind the respondent.
The form is part of a broader procurement seeking qualified contractors to provide inspection and assessment services across Florida's 67 counties, with a focus on residential mitigation projects. While the form itself does not specify pricing or detailed service requirements, it is an essential component of the solicitation process for a contract running through December 31, 2027, with proposal submissions due by 3:00 PM on March 31, 2025. The associated procurement aims to establish a pool of contractors who can perform structural assessments, geotechnical reports, elevation certificates, and construction inspections, with potential opportunities for diverse businesses including Certified Minority Business Enterprises (CMBE) and Women-Owned Businesses (WBE).
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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 (Digital)
Vendor Mailing Address:
City, State, Zip: *Authorized Signature (Printed), 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 RFP.
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:
| City State Zip: |
| 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: |
| Vendor Name: |
| Text3: |
| Text4: |
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