1-Certificate of Non-Debarment.pdf

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Attached to
Printing Mailing and Fulfillment Services
Solicitation number
25-06629
Issued by
San Bernardino County, California

About this file

This is a Certification of Non-Debarment document dated March 14, 2024, submitted by vendors in response to an Inland Empire Health Plan (IEHP) request for qualified vendors to provide Printing, Mailing, and Fulfillment Services in California. The certification requires an authorized representative of the bidding firm to attest that the company is not excluded, ineligible, or terminated from participation in state or federal health care programs. The document specifies that vendors must verify their compliance status against multiple exclusion lists, including the Department of Health & Human Services Office of Inspector General List of Excluded Individuals and Entities (LEIE), the General Services Administration System for Award Management (SAM.gov), the California Department of Health Care Services Medi-Cal Suspended and Ineligible Provider List, and the Medicare Opt-Out List. Additionally, vendors commit to conducting regulatory sanction and exclusion screenings of any subcontracted entities prior to engagement and on a monthly basis thereafter.

The certification establishes that any selected vendor must maintain compliance throughout contract performance, with immediate termination for cause as a consequence of becoming excluded, ineligible, or terminated from state and federal health care programs. The document serves as a binding attestation by the authorized officer or agent of the vendor's firm, demonstrating the vendor's understanding of and commitment to the terms and conditions. This certification is a standard compliance requirement for IEHP contracts and must be executed and submitted as part of the bid package for Printing, Fulfillment, and Mailing Services for enrollee-facing materials.

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Text version

Certification of Non-Debarment 03-14-2024

CERTIFICATION

As an authorized representative of my Firm/Company/Sole Proprietorship, I hereby attest that my Firm/Company/Sole Proprietorship is not excluded, ineligible, or terminated from participation in State or Federal health care programs and does not appear on any of the following lists:

a. The Department of Health & Human Services (DHHS), Office of Inspector General (OIG), and List of Excluded Individuals and Entities (LEIE). Please visit https://exclusions.oig.hhs.gov.

b. General Services Administration (GSA), and the System for Award Management (SAM.gov). Please visit https://www.sam.gov.

c. California Department of Health Care Services (DHCS), and Medi-Cal Suspended and Ineligible Provider List (S&I List). Please visit http://files.medical.ca.gov/pubsdoco/SandILanding.asp.

d. Medicare Opt-Out List. Please visit https://data.cms.gov/dataset/Opt-Out- Affidavits/7yuw-754z.

I further attest that if selected, my Firm/Company/Sole Proprietorship will conduct regulatory sanction and exclusion screenings of subcontracted entities prior to engagement with said entities and monthly thereafter.

I understand that if my Firm/Company/Sole Proprietorship becomes excluded, ineligible, or terminated from participation in State and Federal health care programs, any contracts held with IEHP will be subject to immediate termination for cause.

RFP Name/Number:

Signature: Date:

Title of Agent/Officer:

"Execution hereof is certification that the undersigned has read and understands the terms and conditions hereof, and that the undersigned's principal is fully bound and committed."

File details come from the government source that posted it. Updated .