MANUFACTURER CERTIFICATION Form.pdf
PDF 150 KB Posted
- Attached to
- Portable Screener & RC Tracked Skid Steer
- Solicitation number
- 2136583
- Issued by
- Richmond County, New York
About this file
This is a Manufacturer's Certification Form issued by the New York State Department of Transportation (NYSDOT) Administrative Services Division - Purchasing Unit in connection with the procurement of one Portable Screener and one RC Tracked Skid Steer for NYSDOT Region 6. The form serves as a required submission with a bidder's offer, whereby the manufacturer of the products must certify three key items: authorization of the bidder as a dealer, commitment to supply all ordered quantities under any resulting contract with the State, and confirmation that the listed products meet the requirements specified in the Invitation for Bid (IFB). Bidders must obtain the completed and signed certification from the manufacturer and submit it along with their proposal response to the NYSDOT Purchasing Office. Interested entities should contact the department via email at Purch-Assist@dot.ny.gov or by telephone at (518) 457-4401 to request the full bid package and be added to the bidder's list, referencing the solicitation number BA26-010 in their inquiry.
The form requires manufacturers to provide company information including name, address, telephone number, facsimile number, and email address, along with an authorized representative's printed signature, typed signature, and title. The certification applies specifically to the products or components being quoted by the bidder and must be executed by an authorized manufacturer's representative. No specific pricing, set-asides, funding amounts, or contract term details are outlined in the certification form itself; these details are contained within the full IFB document referenced throughout the procurement notice.
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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
| MANUFACTURER’S CERTIFICATION FORM |
| INSTRUCTIONS TO BIDDERS: |
| MANUFACTURER’S COMPANY NAME: |
| ADDRESS: |
| TELEPHONE NUMBER: |
| FAX NUMBER: |
| E-MAIL ADDRESS: |
| PRINTED OR TYPED COPY OF SIGNATURE |
| MANUFACTURER’S REPRESENTATIVE |
| TITLE |
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