Vendor Information Response~4.docx

DOCX document 38 KB Posted

Attached to
Inmate Food Services
Solicitation number
44DOC-S1773
Issued by
Churchill County, Nevada

About this file

This document is a Vendor Information Response form for a state and local contract opportunity for Inmate Food Services in Nevada, specifically in Carson City. The vendor must provide contact information, company profile, licensing details, and experience with the State of Nevada. The vendor is also required to disclose any prior or ongoing contractual issues, as well as whether they will accept payment via procurement card. The contract opportunity involves providing inmate food services for the jurisdiction of Carson City.

The document does not provide specific details about the pricing terms, set asides, incumbents, funding sources, or other salient information related to the contract opportunity. The focus is on collecting vendor information and verifying compliance with state requirements.

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Text version

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.

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:

VENDOR INFORMATION

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

Question
Response

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.

Question
Response

Nevada Business License Number:

Legal Entity Name:

Is the Legal Entity Name the same name as vendor is Doing Business As (DBA)?
Yes

No

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

STATE OF NEVADA EXPERIENCE

Question
Response
Has the vendor ever been engaged under contract by any State of Nevada agency?
Yes

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.

Question
Response

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

Question
Response
Are you now or have you been within the last two (2) years an employee of the State of Nevada, or any of its agencies, departments, or divisions?
Yes

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.

Question
Response
Does any of the above apply to your company?
Yes

No

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

Table can be duplicated for each issue being identified.

Question
Response

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:

If the matter has resulted in a court case:
Court
Case Number

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

Question
Response
Please indicate if you will accept this method of payment?
Yes

No

NAME OF INDIVIDUAL AUTHORIZED TO BIND THE ORGANIZATION

Requested Information
Response

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

File details come from the government source that posted it. Updated .