1-DHHS26256 Submission Instructions.docx

DOCX document 24 KB Posted

Attached to
Podiatry Services at Utah State Hosptial
Solicitation number
DHHS26156
Issued by
Utah

About this file

This is a submission instructions document for the Department of Human and Health Services (DHHS) in Utah regarding a contract opportunity to provide podiatry services at Utah State Hospital. The solicitation requires vendors to submit documentation demonstrating qualifications to deliver podiatric medical services to hospital patients. Specific submission requirements include proof of a current and valid license to practice podiatric medicine from the State of Utah Division of Occupational and Professional Licensing, a Doctorate of Podiatric Medicine degree from an accredited podiatric medical school, and a resume with supporting documentation showing at least five years of experience working as a podiatrist and at least one year of direct experience working with individuals with mental illness.

Vendors must submit a completed DHHS26051 Cost Proposal Form along with either a Conflict of Interest Disclosure Statement or a Governmental Entity Conflict of Interest Certification depending on entity type. IRS Form W-9 is required unless the vendor currently holds an existing contract with DHHS. The solicitation does not specify pricing terms, set-aside provisions, contract duration, renewal options, response deadlines, or funding amounts. DHHS will only review documentation specifically requested in the solicitation and will not consider extraneous information submitted by vendors.

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Other files

File Type Posted
2-DHHS BAA.pdf PDF
6-Form 2b Conflict of Interest Certification UGE.pdf PDF
3-DHHS26256 SOW Podiatry Services at USH.docx DOCX document
9-DHHS26256 Cost Proposal Form.doc DOC document
4-DHHS26256 Podiatry IFB.docx DOCX document
7-Form 2a Conflict of Interest Disclosure Statement.pdf PDF
5-Form 1 IRS Form W-9.pdf PDF
8-DHHS Client Service Terms.docx DOCX document

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Text version

DHHS26256 Podiatry Services at USH Document Submission Instructions

Responses should contain only documentation requested in this solicitation. DHHS will not review information submitted by a vendor that is not requested in this solicitation.

Response Content & Checklist

·
Submit the documents specified below. Complete forms as instructed. Vendors are encouraged to use this table as a checklist to ensure that responses are complete.

1. Form #1: IRS Form W-9 This form is not required if you currently hold any contract(s) with DHHS. Complete the form with the legal name of the business entity or individual applying for this solicitation.

2. Form #2a: Conflict of Interest Disclosure Statement

OR

Form #2b: Governmental Entity Conflict of Interest Certification (for government agencies, political subdivisions, municipalities, public schools, etc.)

3. A current and valid license to practice podiatric medicine issued by the State of Utah, Division of Occupational and Professional Licensing.

4. A Doctorate of Podiatric (DPM) degree from a podiatric medical school.

5. A resume and documentation demonstrating that the Offeror meets the minimum requirements of a) at least five years experience working as an Podiatrist; and b) at least one year of working directly with the mentally ill.

6. A completed DHHS26051 Cost Proposal Form.

Submission Instructions Page 1 of 1

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