Vendor Information Response.docx

VENDOR INFORMATION RESPONSE

VENDOR INFORMATION RESPONSE

Vendors shall complete and return this form in their proposal.

If the proposal includes subcontractors, form must be completed for each subcontractor as well.

VENDOR CONTACT INFORMATION

COMPANY NAME AND CONTACT INFORMATION:

The information provided in the table below shall be used for development of the contract, if awarded.

Company Name:

Company Street Address:

City, State, Zip Code:

Telephone Number, including area code:

Toll Free Number, including area code:

Email Address:

CONTACT PERSON FOR QUESTIONS/CONTRACT NEGOTIATIONS

Name:

Title:

Address:

City, State, Zip Code:

Email Address:

Telephone Number, including area code:

Toll Free Number, including area code:

VENDOR INFORMATION

Vendors shall provide an overall company profile in the following table:

Company Name:

Ownership (sole proprietor, partnership, etc.):

State of Incorporation:

Date of Incorporation:

# of years in business:

List of top officers:

Location of company headquarters, to include City and State:

Location(s) of the office that shall provide the services described in this RFP:

Number of employees locally with the expertise to support the requirements identified in this RFP:

Number of employees nationally with the expertise to support the requirements in this RFP:

Location(s) from which employees shall be assigned for this project:

VENDOR LICENSING

Please be advised: Pursuant to NRS 80.010, a corporation organized pursuant to the laws of another state shall register with the State of Nevada, Secretary of State’s Office as a foreign corporation before a contract can be executed between the State of Nevada and the awarded vendor, unless specifically exempted by NRS 80.015.

The selected vendor, prior to doing business in the State of Nevada, shall be appropriately licensed by the State of Nevada, Secretary of State’s Office pursuant to NRS 76. Information regarding the Nevada Business License can be located at http://nvsos.gov.

Nevada Business License Number:

Legal Entity Name:

No

If the answer is ‘No’, provide explanation below:

STATE OF NEVADA EXPERIENCE

No

If ‘Yes’, complete the following table for each State agency for whom the work was performed.

Table can be duplicated for each contract being identified.

State Agency Name:

State Agency Contact Name:

Dates Services Were Performed:

Type of Duties Performed:

Total Dollar Value of the Contract:

CURRENT OR FORMER EMPLOYEE

No

If ‘Yes’, please explain when the employee is planning to render services; i.e., while on annual leave, compensatory time, or on their own time?

If you employ (a) any person who is a current employee of an agency of the State of Nevada, or (b) any person who has been an employee of an agency of the State of Nevada within the past two (2) years, and if such person shall be performing or producing the services which you shall be contracted to provide under this contract, you shall disclose the identity of each such person in your response to this RFP, and specify the services that each person shall be expected to perform.

PRIOR OR ONGOING CONTRACTUAL ISSUES

Disclosure of any significant prior or ongoing contract failures, contract breaches, civil or criminal litigation in which the vendor has been alleged to be liable or held liable in a matter involving a contract with the State of Nevada or any other governmental entity.

Any pending claim or litigation occurring within the past six (6) years which may adversely affect the vendor’s ability to perform or fulfill its obligations if a contract is awarded as a result of this RFP shall also be disclosed.

No

If ‘Yes’, please provide the information in the table below.

Table can be duplicated for each issue being identified.

Date of alleged contract failure or breach:

Parties involved:

Description of the contract failure, contract breach, or litigation, including the products or services involved:

Amount in controversy:

Resolution or current status of the dispute:

Status of the litigation:

PAYMENT AUTHORIZATION FOR USE OF PROCUREMENT CARD

Using agencies may desire to use a Procurement Card as a method of payment to vendors.

PAYMENT AUTHORIZATION FOR USE OF PROCUREMENT CARD

No

NAME OF INDIVIDUAL AUTHORIZED TO BIND THE ORGANIZATION

Name:

Title:

SIGNATURE OF INDIVIDUAL AUTHORIZED TO BIND THE VENDOR

Individual shall be legally authorized to bind the vendor per NRS 333.337

Signature:

Date:

Revised: April 2021 Page 2 of 2