MANUFACTURER CERTIFICATION Form3.pdf
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- Attached to
- RQ24-008 Bridge Maintenance Material Region 9
- Solicitation number
- 2119139
- Issued by
- Broome County, New York
About this file
This is a Manufacturer's Certification Form from the New York State Department of Transportation's Administrative Services Division - Purchasing Unit. The form is required to be completed by manufacturers and submitted with bidders' offers as part of the qualification process for an Invitation for Bid (IFB). The form requires manufacturers to certify three key elements: whether the bidder is an authorized dealer, their agreement to supply all quantities ordered under any resulting state contract, and certification that their products meet the IFB requirements.
The form requires detailed contact information from both the bidder and manufacturer, including company names, addresses, phone numbers, fax numbers, and email addresses. The manufacturer must provide an authorized signature, printed name, title, and date to attest to the validity of their responses. The form is dated 6/14 and requires listing of specific products/components to which the certification applies, though no specific products are pre-listed on the form.
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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 .