T1778S Appendix B 4.28.23.docx

APPENDIX B

Bid Solicitation # 23DPP00889 T1778S - Communications/ Telecommunications Cable, Wire, and Associated Products- Supplemental Manufacturers/Distributors Certificate Note to Vendors {Bidders}: This “Manufacturers/Distributors Certificate” is to be removed and forwarded to the manufacturer by the distributor, completed and returned to the distributor by the manufacturer, and submitted to the State of NJ, Division of Purchase and Property, C/O the procurement specialist assigned to this contract.

Distributor Company Name:

Distributor Company Address:

The manufacturer/distributor executing this certificate by signing below does hereby attest to the accuracy and validity to the responses to the following questions:

1. Is the Distributor listed above an authorized dealer? Yes No

2. Do you as a manufacturer agree to supply to distributor with all quantities of products ordered pursuant to any resulting Blanket P.O. with the state? Yes No

3. Do you as a manufacturer certify that all pricing provided to the distributor is Manufacturer’s List Price or MSRP? Yes No

Manufacturer’s Company Name:

Manufacturer’s Address:

Telephone #:

Fax #:

Email Address:

Printed or Typed Copy of Signature

Signature of Authorized Manufacturing Representative Date