MANUFACTURER CERTIFICATION Form.pdf
PDF 150 KB Posted
- Attached to
- Region 8 Traffic Signs
- Solicitation number
- 2138969
- Issued by
- New York
About this file
This is a Manufacturer's Certification Form issued by the New York State Department of Transportation, Administrative Services Division - Purchasing Unit, for use in conjunction with an Invitation for Bids (IFB) for Region 8 Traffic Signs. The form is completed by manufacturers to certify their authorization status and product compliance. Bidders are required to submit this form as part of their offer if mandated by the IFB documentation. The certification applies to traffic signs and related materials for procurement in Region 8, which encompasses Columbia, Dutchess, Putnam, Orange East, Orange West, and Ulster counties in New York.
The manufacturer must attest to three key certifications: confirmation that the bidder is an authorized dealer; agreement to supply all quantities of products ordered under any resulting contract with the State; and certification that the products meet all requirements specified in the IFB. The form requires completion by an authorized manufacturer's representative with signature, printed name, title, date, and contact information including company address, telephone number, fax number, and email address. No business enterprises have been awarded identical or substantially similar procurement contracts within the past five years. The procurement includes contracting goals for Service-Disabled Veteran-Owned Businesses (6.00%), Minority Business Enterprises (1.00%), and Women Business Enterprises (8.00%).
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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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