Vendor Information Sheet.pdf
PDF 27 KB Posted
- Attached to
- Medical & Related Services
- Solicitation number
- 99SWC-S107
- Issued by
- Churchill County, Nevada
About this file
This document is a Vendor Information Sheet for a Request for Quotation (RFQ) issued by the state of Nevada. The Vendor Information Sheet requests the vendor to provide their company name, address, contact information, and the name and title of the individual authorized to bind the organization. The related state and local contract opportunity is for Medical & Related Services within the state of Nevada.
The Vendor Information Sheet is required to be included in Section III of the Technical Statement of Qualifications (SOQ) proposal by the vendor. The information provided in Sections V1 through V6 will be used for the development of the contract. Vendors must type or print their responses and include the completed Vendor Information Sheet in their proposal submission.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment B Submission Letter.pdf | ||
| RFQ 99SWC-S107 Medical and Related Services.docx | DOCX document | |
| Attachment D Contract~1.docx | DOCX document | |
| Section 3 Background Information Sheet~3.pdf | ||
| ATTACHMENT F Certification Regarding Lobbying~1.docx | DOCX document | |
| Attachment C Professional Qualification.pdf | ||
| Attachment E Insurance~1.docx | DOCX document | |
| List of Services updated 4-25-18.docx | DOCX document | |
| Attachment A 99SWC-S107.docx | DOCX document | |
| Attachment H Sample Work Order~1.doc | DOC document |
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Text version
VENDOR INFORMATION SHEET FOR RFQ: ________________
Vendor Shall:
A) Provide all requested information in the space provided next to each numbered question.
The information provided in Sections V1 through V6 shall be used for development of the contract;
B) Type or print responses; and
C) Include this Vendor Information Sheet in Section III of the Technical SOQ proposal.
V1 Company Name
V2 Street Address
V3 City, State, ZIP
V4 Telephone Number Area Code: Number: Extension:
V5 Facsimile Number
V6 Toll Free Number
V7
Contact Person for Questions / Contract Negotiations, including address if different than above
Name:
Title:
Address:
Email Address:
V8 Telephone Number for Contact Person
V9 Facsimile Number for Contact Person
V10 Name of Individual Authorized to Bind the Organization
Name: Title:
V11 Signature (Individual shall be legally authorized to bind the vendor per NRS
333.337) Signature: Date:
| Company Name: |
| Street Address: |
| City State ZIP: |
| Area Code: |
| Number: |
| Extension: |
| Area Code_2: |
| Number_2: |
| Extension_2: |
| Area Code_3: |
| Number_3: |
| Extension_3: |
| Area Code_4: |
| Number_4: |
| Extension_4: |
| Area Code_5: |
| Number_5: |
| Extension_5: |
| Name_2: |
| Title_2: |
| Date: |
| RFQ Number: |
| Email Address: |
| Address: |
| Title: |
| Name: |
File details come from the government source that posted it. Updated .