1-BPM007426_Attachment_A.pdf

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Avenue, Suite 280

Phoenix, AZ 85007

Attachment A: Offer and Acceptance No.: BPM007

SUBMISSION OF OFFER: The undersigned hereby offers and agrees to provide Substance Use Consulting Services in compliance with all terms, conditions, specifications, and amendments in the Solicitation and any written exceptions in the Offer indicated by the latest dated version below:

Offeror company name Signature of person authorized to sign Offer Date

Address Printed name and Title

City, State, ZIP Contact name and Title

By checking this box, Offeror is certifying that it is exempt from the requirements regarding the forced labor of ethnic Uyghurs because of one of the following: Contractor is a Sole proprietorship, has fewer than ten (10) employees; or is a non-profit organization.

Contact email address Contact phone number

CERTIFICATION: By signature in the above, Offeror certifies that it:

1. Will not discriminate against any employee or applicant for employment in violation of any Federal anti-discrimination laws, rules, regulations or executive orders,, [Arizona]

State Executive Orders 2023-09, 2023-01, 2009-09 or A.R.S. §§ 41-1461 through 41-1465;

2. Has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or

Service to a public servant in connection with the submitted offer. Failure to provide a valid signature affirming the stipulations required by this clause will result in rejection of the Offer. Signing the Offer with a false statement will void the Offer, any resulting contract, and may be subject to legal penalties under law;

3. Complies with A.R.S. § 18-132 when offering electronics or information technology products, Services, or maintenance;

4. Did not and will not involve collusion or other anti-competitive practices;

5. Is not debarred from, or otherwise prohibited from, participating in any contract awarded by federal, state, or local government; and

6. It is____/is NOT____a small business with less than 100 employees or has gross revenues of $4 million or less.

7. Does not participate in the use of forced labor of ethnic Uyghurs as described in A.R.S. § 35-394. (Unless exempt)

ACCEPTANCE OF OFFER

The offer is hereby accepted.

The Contractor is now bound to sell the Materials or Services listed by the attached Contract and based upon the Solicitation, including all terms, conditions, specifications, amendments, etc., and the Contractor’s Offer as accepted by the State.

The Contract shall henceforth be referred to as Contract No.

The effective date of the Contract is

The Contractor is cautioned not to commence any billable work or to provide any Material or Service under this Contract until Contractor receives purchase order, contract release document, or written notice to proceed.

State of Arizona Awarded this day of 20

Chief Procurement Officer Procurement officer signature

Zoho Sign Document ID: 32F53AEC-IJ7SZUMN_6LEQZGCSU7QYBRFR8ZN11EVQS1UR7JBSIA