1-HSS-26-016- Attachment 2 - Non-Collusion Stmt.docx
DOCX document 126 KB Posted
- Attached to
- COMPREHENSIVE SUBSTANCE USE PRIMARY PREVENTION SERVICES FOR COMMUNITIES, ADULTS AND YOUTH
- Solicitation number
- HSS-26-016
- Issued by
- Delaware
About this file
This is a Non-Collusion Statement form for the Delaware Health and Social Services Division of Substance Abuse and Mental Health's Contract No. HSS-26-016, titled "Comprehensive Substance Use Primary Prevention Services for Communities, Adults and Youth." The form requires vendors to certify they have not engaged in collusive bidding practices and serves as their acceptance of the solicitation's terms and conditions. Proposals are due October 20, 2025, at 1:00 PM EST, and the form must be signed by an authorized representative legally empowered to enter into formal contracts with the State of Delaware.
The document includes sections for vendor information including company classification certifications for Minority Business Enterprise (MBE), Woman Business Enterprise (WBE), Disadvantaged Business Enterprise (DBE), Veteran Owned Business Enterprise (VOBE), and Service Disabled Veteran Owned Business Enterprise (SDVOBE), though these appear to be for informational and statistical purposes only. Vendors must provide company details, contact information, purchase order instructions, and affirm whether they have been subject to government suspension or debarment within the past five years. The form references Attachment 3 for any express exceptions to the acceptance of terms and conditions.
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Text version
Delaware Health and Social Services
Division of Substance Abuse and Mental Health d
Delaware Health and Social Services
Division of Substance Abuse and Mental Health d
Attachment 2
| CONTRACT NO.: | HSS-26-016 |
| CONTRACT TITLE: | Comprehensive Substance Use Primary Prevention Services for Communities, Adults and Youth |
DEADLINE TO RESPOND: Due 10/20/2025, at 1:00 PM EST
NON-COLLUSION STATEMENT
This is to certify that the undersigned Vendor has neither directly nor indirectly, entered into any agreement, participated in any collusion or otherwise taken any action in restraint of free competitive bidding in connection with this proposal, and further certifies that it is not a sub-contractor to another Vendor who also submitted a proposal as a primary Vendor in response to this solicitation submitted this date to the State of Delaware, Division of Substance Abuse and Mental Health
It is agreed by the undersigned Vendor that the signed delivery of this bid represents, subject to any express exceptions set forth at Attachment 3, the Vendor’s acceptance of the terms and conditions of this solicitation including all specifications and special provisions.
NOTE: Signature of the authorized representative MUST be of an individual who legally may enter his/her organization into a formal contract with the State of Delaware, Division of Substance Abuse and Mental Health.
Corporation
Partnership
Individual
COMPANY NAME __________________________________________________________________Check one)
NAME OF AUTHORIZED REPRESENTATIVE
(Please type or print)
SIGNATURE TITLE
COMPANY ADDRESS
PHONE NUMBER FAX NUMBER
| EMAIL ADDRESS | ______________________________ | ||
| STATE OF DELAWARE | |||
| FEDERAL E.I. NUMBER | LICENSE NUMBER_____________________________ |
COMPANY CLASSIFICATIONS:
CERT. NO.: __________________
| Certification type(s) |
| Circle all that apply |
| Minority Business Enterprise (MBE) | |
| Yes | No |
| Woman Business Enterprise (WBE) | |
| Yes | No |
| Disadvantaged Business Enterprise (DBE) | |
| Yes | No |
| Veteran Owned Business Enterprise (VOBE) | |
| Yes | No |
| Service Disabled Veteran Owned Business Enterprise (SDVOBE) | |
| Yes | No |
[The above table is for informational and statistical use only.]
PURCHASE ORDERS SHOULD BE SENT TO:
(COMPANY NAME)
ADDRESS
CONTACT
PHONE NUMBER FAX NUMBER
EMAIL ADDRESS
AFFIRMATION: Within the past five years, has your firm, any affiliate, any predecessor company or entity, owner, Director, officer, partner or proprietor been the subject of a Federal, State, Local government suspension or debarment?
YES NO if yes, please explain image1.png image2.png
File details come from the government source that posted it. Updated .