07._OMESformCP076.pdf
PDF 399 KB Posted
- Attached to
- Housing and Employment Services
- Solicitation number
- EV00000835
- Issued by
- Oklahoma County, Oklahoma
About this file
This is an OMES Form CP076 Responding Bidder Information form for the State of Oklahoma Central Purchasing division related to Solicitation #EV00000835. The form is used to collect essential bidder information and certifications required for participation in the Youth Rapid Re-Housing Program, a service contract designed to assist individuals aged 18 to 24 years experiencing homelessness who have mental health or substance use disorders. The program aims to provide immediate short-term housing assistance coupled with intensive recovery support services, treatment connection, supported employment and education opportunities, family engagement, and sustained independent housing outcomes.
Bidders must complete and submit this certification form along with their proposal response and must provide specific documentation including: proof of Oklahoma Secretary of State registration or a signed exemption statement; a certificate of insurance demonstrating compliance with the Oklahoma Administrative Workers' Compensation Act or a signed exemption statement if applicable; and if claiming disabled veteran business enterprise status, appropriate federal certification of service-disabled veteran status, verification of 51% minimum ownership by service-disabled veterans, and documentation of management control by service-disabled veterans. Bidders must also certify whether they are engaged in any boycott of goods or services from Israel. The form requires complete bidder general information including FEIN/SSN, supplier ID, company name, contact information, and authorized signature with date.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 00._EV835_Agency-bid-instructions.docx | DOCX document | |
| 02._Attachment-B-general-terms.docx | DOCX document | |
| 01._Attachment-A-agency-purpose_.docx | DOCX document | |
| 08._omes-form-cp004.docx | DOCX document | |
| Amendment__1.EV835_VendorQ_A_.pdf | ||
| 06._Exhibit_-3Mandatory_Requirement_specifications.docx | DOCX document | |
| 04._Exhibit_1-Bidder_Response_Template.xlsx | XLSX spreadsheet | |
| 05._Exhibit_2-Cost_Template_Youth_RRH.xlsx | XLSX spreadsheet | |
| 03._Attachment-C-AgencyTerms_.pdf |
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Text version
OMES Form CP076 (11/2024) RESPONDING BIDDER INFORMATION | Page 1 of 1
Central Purchasing
RESPONDING BIDDER INFORMATION
You must submit a Certification for Competitive Bid and Contract along with the response to the solicitation.
1. SOLICITATION
Solicitation # EV00000835
2. BIDDER GENERAL INFORMATION
FEIN/SSN Supplier ID
Company name
3. BIDDER CONTACT INFORMATION
Address
Contact name Title
Email Phone Website Fax
4. BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL
Yes No
5. REGISTRATION WITH THE OKLAHOMA SECRETARY OF STATE
Yes Filing number:
No Prior to the contract award, the successful bidder is required to register with the Secretary of State or must attach a signed statement that provides specific details supporting the exemption the supplier is claiming (sos.ok.gov or 405- 521-3911).
6. WORKERS’ COMPENSATION INSURANCE COVERAGE
Bidder is required to provide a certificate of insurance showing proof of compliance with the Oklahoma Administrative Workers’ Compensation Act.
Yes Include a certificate of insurance with the bid.
No Exempt from the Administrative Workers’ Compensation Act pursuant to 85A O.S. § 2(18)(b)(1-11). (Attach a written, signed and dated statement on letterhead stating the reason for the exempt status. For frequently asked questions concerning workers’ compensation insurance, visit wcc.ok.gov.)
7. DISABLED VETERAN BUSINESS ENTERPRISE ACT
Yes I am a service-disabled veteran business as defined in 74 O.S. § 85.44E.
Include the following with the bid response:
1. Certification of service-disabled veteran status as verified by the appropriate federal agency.
2. Verification of not less than 51% ownership by one or more service-disabled veterans.
3. Verification of the control of the management and daily business operations by one or more service-disabled veterans.
No I do not meet the criteria as a service-disabled veteran business.
8. SIGNATURE
Authorized signature Date
Name Title https://www.sos.ok.gov/ https://www.wcc.ok.gov/
| Central Purchasing |
| RESPONDING BIDDER INFORMATION |
| Solicitation: |
| FEINSSN: |
| Supplier ID: |
| Company name: |
| Contact name: |
| Title: |
| Email: |
| Phone: |
| Website: |
| Fax: |
| 4 BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL: Off |
| Prior to the contract award the successful bidder is required to register with the Secretary of State or must attach a: Off |
| Compensation Act: Off |
| 7 DISABLED VETERAN BUSINESS ENTERPRISE ACT: Off |
| Date: |
| Name: |
| Title_2: |
| Filing number: |
| Address: |
File details come from the government source that posted it. Updated .