08_-_OMESformCP076.pdf
PDF 293 KB Posted
- Solicitation number
- EV00000828
- Issued by
- Oklahoma County, Oklahoma
About this file
This is a Responding Bidder Information form (OMES Form CP076) used by the Office of Management and Enterprise Services (OMES), Central Purchasing Division, on behalf of the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS). The form pertains to Solicitation EV00000828 for the Discharge Transitional Living Program, which seeks qualified service providers to assist individuals discharged into homelessness from psychiatric hospitals in Oklahoma County. The program aims to provide immediate independent housing, intensive recovery support services, community mental health treatment connections, and assistance in obtaining permanent independent housing for discharged individuals.
The form requires bidders to provide general company information, contact details, and FEIN/SSN, along with several certifications and disclosures. Bidders must certify their compliance with Oklahoma workers' compensation insurance requirements or provide documentation of exemption status, register with the Oklahoma Secretary of State prior to contract award or provide exemption documentation, and disclose whether they are engaged in any boycott of Israeli goods or services. The form also includes provisions for service-disabled veteran business enterprises to claim certification status with appropriate documentation. Authorized representatives must sign and date the completed form before submission with the bid response.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 02-_Attachment_A_Agency_Purpose.docx | DOCX document | |
| 07_-_OMESForm_CP004.pdf | ||
| 04_-_Attachment_G_Federal_Terms.docx | DOCX document | |
| 03_-_Attachment_B_General_Terms.docx | DOCX document | |
| 06_-_Exhibit_02_Cost_Template.xlsx | XLSX spreadsheet | |
| 05_-_Exhibit_01_Bidder_Response_Worksheet.xlsx | XLSX spreadsheet | |
| 01_-_Bidders_Instructions.docx | DOCX document |
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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 #
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: EV00000828 |
| 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 .