Vendor Information Sheet. The vendor information sheet completed with an original signature by an individual authorized to bind the organization must be included in this section.
Vendor Information Sheet xlsx 2 This form is mandatory to fill in and sign by every vendor who submits quotation Yes No ☐ ☐ On behalf of the Supplier, I further represent and warrant that the Supplier undertakes to comply with the Code of Conduct, available at xxxxx://xxx.xxxx.xxx/Public/CodeOfConduct. ☐ ☐ It is the responsibility of the Supplier to inform IOM immediately of any change to the information provided in this Declaration. ☐ ☐ On behalf of the Supplier, I certify that I am duly authorized to sign this Declaration and on behalf of the Supplier I agree to abide by the terms of this Declaration for the duration of any contract entered into between the Supplier and IOM. ☐ ☐ IOM reserves the right to terminate any contract between IOM and the Supplier, with immediate effect and without liability, in the event of any misrepresentation made by the Supplier in this Declaration. Signature: Name: Click or tap here to enter text. Title: Click or tap here to enter text. Date: Click or tap to enter a date. ANNEX 3: TECHNICAL AND FINANCIAL OFFER - SERVICES Bidders are requested to complete this form, sign it and return it as part of their quotation along with Annex 2 Quotation Submission Form. The Bidder shall fill in this form in accordance with the instructions indicated. No alterations to its format shall be permitted and no substitutions shall be accepted. Name of Bidder: Click or tap here to enter text. RFQ reference: Ng10-24-237 Date: Click or tap to enter a date. Technical Offer Provide the following: - a brief description of your qualification, capacity and expertise that is relevant to the Terms of Reference. - a brief methodology, approach and implementation plan; - team composition and CVs of key personnel Financial Offer Provide a lump sum for the provision of the services stated in the Terms of Reference of your technical offer. The lump- sum should include all costs of preparing and delivering the Services. All daily rates shall be based on an eight-hour working day. Currency of Quotation: Nigeria Naira Ref Description of Deliverables Unit of Measure Qty Price (Naira) 1 Albumin/ Creatinine Ratio Per Test 1 2 AFP (Alpha fetoprotein) Per Test 1 3 Albumin Per Test 1 4 BHCG Qualitative Per Test 1 5 Calcium Per Test 1 6 Chloride Per Test 1 7 Creatinine clearance Per Test 1 8 eGFR Per Test 1 9 ELECTROLYTES Per Test 1 10 FBC/CBC (Full/Complete Blood Count) Per Test 1 11 GeneXpert MTB/RIF Per Test 1
Vendor Information Sheet. Please enter your Tax ID here: Name of SPA Teacher Requesting Vendor: Vendor/Company Name: Email: Type of Service Offered (please be specific) Primary Phone Number: Primary/Alternative Contact Persons Alternate Phone Number: Website Address (if applicable): Fax Number: Mailing Address (Number & Street), City, State, Zip: XXXXXX'S CONTACT BILLING INFORMATION Checks made payable to: (This name must be indicated on the W-9) Billing Contact: Billing Phone: Billing Address: Billing Email: PLEASE COMPLETE, SIGN & RETURN copies of the following: •Vendor Information Sheet •Purchase Order Contract Terms •Process and Procedures Overview Page •Employer Fingerprinting Clearance Form •LiveScan Fingerprint Form (DOJ)- Completed by LiveScan Operator •W-9Form •Proof of Liability Insurance with Suncoast Preparatory Academy listed as the insured/certificate holder •Description of Services Offered •CV or Resume (including references) to establish qualifications If any required information or supporting documentation is missing or filled out incorrectly, SPA will attempt to assist in clarifying which items are still outstanding. If there are any changes in the vendor's contact information, SPA must be informed in writing within 30 calendar days via email/fax or regular mail. By signing below, you understand and agree to the above conditions for becoming an approved vendor for SPA. Signature Date
Vendor Information Sheet. Please enter your Tax ID here: Name of SPA Teacher Requesting Vendor: Vendor/Company Name: Email: Type of Service Offered (please be specific) Primary Phone Number: Primary/Alternative Contact Persons Alternate Phone Number: Website Address (if applicable): Fax Number: Mailing Address (Number & Street), City, State, Zip: XXXXXX'S CONTACT BILLING INFORMATION Checks made payable to: (This name must be indicated on the W-9) Billing Contact: Billing Phone: Billing Address: Billing Email: PLEASE COMPLETE, SIGN & RETURN copies of the following: •Vendor Information Sheet •Purchase Order Contract Terms •Process and Procedures Overview Page •Employer Fingerprinting Clearance Form •LiveScan Fingerprint Form (DOJ)- Completed by LiveScan Operator •W-9Form •Proof of Liability Insurance with Suncoast Preparatory Academy listed as the insured/certificate holder •Description of Services Offered •CV or Resume (including references) to establish qualifications If any required information or supporting documentation is missing or filled out incorrectly, SPA will attempt to assist in clarifying which items are still outstanding. If there are any changes in the vendor's contact information, SPA must be informed in writing within 30 calendar days via email/fax or regular mail. By signing below, you understand and agree to the above conditions for becoming an approved vendor for SPA. Signature Date P urchase Order Contract Terms The vendor providing services will be referred to as "Vendor" and Suncoast Preparatory Academy will be referred to as 'SPA" • The Vendor agrees that they will NOT begin services without a PO issued from SPA. The Vendor agrees not to increase their fees during the 2021-2022 school year. • The Vendor agrees that SPA will only pay the price for the number of classes listed on the PO. All Vendors are responsible for reconciling POs with their invoices. • The Vendor agrees that they are not authorized to provide any services that are inconsistent with a PO and acknowledges that SPA will not pay for any services that are not explicitly identified in a PO or in excess of the PO. • The Vendor agrees that they will not provide services that are sectarian or denominational and that SPA will not pay for such services because it is a public charter school using taxpayer money. The Vendor agrees that payment will only be issued after services have actually been performed. • The Vendor agrees that they will submit a completed and detailed invoice with student attendan...
Vendor Information Sheet. This must be submitted with your contract. List items for which you will need electricity: List the length of your trailer and which direction your trailer needs to face to serve. Any other information that might be helpful list here:
