Vendor Information Response.pdf
PDF 26 KB Posted
- Attached to
- Actuarial Services State and local contract opportunity
- Solicitation number
- 40DHHS-S3339
- Issued by
- Clark County, Nevada
About this file
The document is a Vendor Information Response form, revised in April 2021, designed for vendors to complete and submit as part of a proposal process. The form requires detailed company contact information, including company name, street address, city, state, zip code, telephone numbers, toll-free numbers, and email address. It also requests specific contact information for the person responsible for questions and contract negotiations, including their name, title, address, email, and telephone contact details.
This standardized form appears to be a template for potential vendors to provide comprehensive contact and communication information when responding to a state or local contract opportunity. The form is structured to capture essential details that would be used in contract development if the vendor is awarded the contract. It is specifically noted that if a proposal includes subcontractors, this form must be completed for each subcontractor as well, indicating a thorough vetting process for all parties involved in a potential contract.
View the file
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Text version
VENDOR INFORMATION RESPONSE
Revised: April 2021 Page 1 of 4
Vendors shall complete and return this form in their proposal.
If the proposal includes subcontractors, form must be completed for each subcontractor as well.
1. 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.
Requested Information Response
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
Requested Information Response
Name:
Title:
Address:
City, State, Zip Code:
Email Address:
Telephone Number, including area code:
Toll Free Number, including area code:
| Confidentiality and Certification of Indemnification |
| Certification Regarding Lobbying |
| Vendor Information Response |
| 1. VENDOR CONTACT INFORMATION |
| 1.1 COMPANY NAME AND CONTACT INFORMATION: |
| 1.2 CONTACT PERSON FOR QUESTIONS/CONTRACT NEGOTIATIONS |
| 2. VENDOR INFORMATION |
| 2.1 Vendors shall provide an overall company profile in the following table: |
| 2.2 VENDOR LICENSING |
| 2.2.1 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 ... |
| 2.2.2 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 htt... |
| 2.3 STATE OF NEVADA EXPERIENCE |
| 2.3.1 If ‘Yes’, complete the following table for each State agency for whom the work was performed. |
| 2.3.2 Table can be duplicated for each contract being identified. |
| 2.4 CURRENT OR FORMER EMPLOYEE |
| 2.4.1 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 p... |
| 2.5 PRIOR OR ONGOING CONTRACTUAL ISSUES |
| 2.5.1 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 o... |
| 2.5.2 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. |
| 2.5.3 If ‘Yes’, please provide the information in the table below. |
| 2.5.4 Table can be duplicated for each issue being identified. |
| 3. PAYMENT AUTHORIZATION FOR USE OF PROCUREMENT CARD |
| 4. NAME OF INDIVIDUAL AUTHORIZED TO BIND THE ORGANIZATION |
| 4.1 SIGNATURE OF INDIVIDUAL AUTHORIZED TO BIND THE VENDOR |
| Company Name: |
| Company Email Address: |
| Contact Person Name: |
| Contact Person Title: |
| Contact Person Address: |
| Contact Person City, State, Zip Code: |
| Contact Person Email: |
| Contact Person Telephone: |
| Contact Person Toll Free (if applicable): |
| Company Address: |
| Company City State Zip Code: |
| Company Telephone: |
| Company Toll Free: |
File details come from the government source that posted it. Updated .