1-Certification of Non-Debarment 03-14-24.pdf
PDF 166 KB Posted
- Attached to
- Enterprise Reimagining Learning Systems State and local contract opportunity
- Solicitation number
- 25-06305
- Issued by
- San Bernardino County, California
About this file
This document is a Certification of Non-Debarment from Inland Empire Health Plan (IEHP) for a procurement process. The certification requires a firm/company/sole proprietorship to attest that they are not excluded, ineligible, or terminated from participation in State or Federal health care programs. The document mandates verification against four specific lists: the DHHS Office of Inspector General's List of Excluded Individuals and Entities (LEIE), the GSA's 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.
The certification requires the bidding entity to conduct monthly regulatory sanction and exclusion screenings of subcontracted entities, with a clear understanding that any exclusion, ineligibility, or termination from State and Federal health care programs will result in immediate contract termination with IEHP. The document is dated 03-14-2024 and includes space for the RFP name/number, signature, date, and title of the agent/officer, with a final clause stating that execution of the document certifies understanding of all terms and conditions.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 2-RFI 25-06305 Enterprise Reimagining Learning Systems Final POSTED.pdf |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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."
https://exclusions.oig.hhs.gov/ https://www.sam.gov/ http://files.medical.ca.gov/pubsdoco/SandILanding.asp https://data.cms.gov/dataset/Opt-Out-Affidavits/7yuw-754z https://data.cms.gov/dataset/Opt-Out-Affidavits/7yuw-754z
| RFP NameNumber: |
| Date: |
| Title of AgentOfficer: |
| Signature2_es_:signer:signature: |
File details come from the government source that posted it. Updated .