MANUFACTURER CERTIFICATION Form.pdf
PDF 371 KB Posted
- Attached to
- 4 -Ton Asphalt Hot Box and Recycler
- Solicitation number
- 2135987
- Issued by
- Herkimer County, New York
About this file
This is a Manufacturer's Certification Form issued by the New York State Department of Transportation's Administrative Services Division - Purchasing Unit. The form is required to be completed by manufacturers of products or components being bid on in state procurement opportunities and must be submitted by the bidder as part of their bid response. The form serves to validate that the bidder is an authorized dealer of the manufacturer, that the manufacturer agrees to supply all quantities ordered under any resulting contract with the State, and that the listed products meet the requirements specified in the Invitation for Bid (IFB). The form requires the manufacturer to provide company name, address, telephone number, fax number, and email address, along with an authorized representative's signature, title, and date of execution.
The Manufacturer's Certification Form applies to the New York State Department of Transportation's procurement for 4-ton asphalt hot box and recycler units (RQ26-001), which is being pursued through discretionary purchasing authority under State Finance Law section 163(6). This procurement mechanism allows purchases without formal competitive bidding when sourcing from certified small businesses, minority and women-owned business enterprises (MBEs/WBEs), service-disabled veteran-owned business enterprises (SDVOBs), or vendors providing recycled or remanufactured commodities or technology. All communications and bid submissions must be directed to the designated contact persons: Jennifer Walter at (518) 457-9434 or Jennifer.Walter@dot.ny.gov (primary), or Relina Sosa at (518) 458-5192 or Relina.Sosa@dot.ny.gov (secondary). Communications through other channels may constitute impermissible contact under state procurement lobbying regulations and could result in vendor disqualification.
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Other files
| File | Type | Posted |
|---|---|---|
| SS-4-Ton-Hot-Box-Trailer.pdf | ||
| RQ26-001 Cost Proposal Worksheet.xlsx | XLSX spreadsheet | |
| Stock Exhibit (6-2023).pdf | ||
| PLL Form (04-24).pdf | ||
| EO16_certification.pdf | ||
| REQUEST FOR QUOTATION RQ26-001 - Final.pdf | ||
| Executive Order 177_Certification Form.pdf |
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Text version
(6/14)
Administrative Services Division - Purchasing Unit
NEW YORK STATE DEPARTMENT of TRANSPORTATION
MANUFACTURER’S CERTIFICATION FORM
INSTRUCTIONS TO BIDDERS:
This “Manufacturer’s Certification” is to be forwarded to the manufacturer by the bidder (if required by
IFB), completed by the manufacturer and returned to the bidder by the manufacturer, and submitted with the bidder’s offer. (See “QUALIFICATION OF BIDDER” clause).
BIDDER’S COMPANY NAME: ______________________________________________
STREET ADDRESS: _______________________________________________________
CITY, STATE ZIP: ________________________________________________________
List the Products/Components to which this Certificate applies: ___________________________________________
The manufacturer executing this certification by signature below does hereby attest to the accuracy and validity of the responses to the following questions:
1. Is the bidder listed above an authorized dealer? Yes No
2. Do you as a manufacturer agree to supply the bidder/dealer with all quantities of products ordered pursuant to any resulting contract with the State? Yes No
3. Do you as a manufacturer certify that product listed above meets the requirements stated in the IFB? Yes No
MANUFACTURER’S COMPANY NAME:
ADDRESS:
TELEPHONE NUMBER:
FAX NUMBER:
E-MAIL ADDRESS:
PRINTED OR TYPED COPY OF SIGNATURE
SIGNATURE OF AUTHORIZED DATE
MANUFACTURER’S REPRESENTATIVE
TITLE
Contract/Procurement
File details come from the government source that posted it. Updated .