11-26139 Document Submission Checklist.xlsx

XLSX spreadsheet 10 KB Posted

Attached to
USDC Physical Therapy Services
Solicitation number
DHHS26139
Issued by
Utah

About this file

This is a document submission checklist for the Utah Department of Health and Human Services (DHHS) related to the procurement of physical therapy services at the Utah State Developmental Center (USDC). The contract solicitation, identified as 11-26139, seeks qualified physical therapy providers to deliver services to residents at the facility. Bidders are required to submit a comprehensive package of documentation to be considered for award, including completed data sheets, W-9 tax forms, conflict of interest disclosures, and business associate agreements to ensure compliance with healthcare regulations and organizational policies.

Prospective vendors must demonstrate specific qualifications and experience to be eligible for consideration. Required submissions include a current Physical Therapy or Physical Therapy Assistant license from the Utah Department of Occupational and Professional Licensing (DOPL), along with two separate resumes: one documenting at least three years of professional experience working with individuals who have developmental and cognitive disabilities with possible behavioral and physical issues, and another demonstrating specific experience providing physical therapy services to individuals with intellectual disabilities. Additionally, bidders must submit both a technical proposal and a cost proposal outlining their approach and pricing for delivering these specialized services to the developmentally disabled population served by the Utah State Developmental Center.

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Other files

File Type Posted
9-26139 Form 5 Technical Proposal.docx DOCX document
10-26139 Form 6 Cost Proposal.docx DOCX document
1-26139 RFP.docx DOCX document
6-26139 Form 2 W-9.pdf PDF
12-DHHS26139 Award Recommendation and Justification Statement.docx DOCX document
7-26139 Form 3 Conflict of Interest Disclosure Statement.pdf PDF
4-26139 Score Sheet.xls XLS spreadsheet
3-26139 DHHS Client Service Terms.docx DOCX document
2-26139 Scope of Work.docx DOCX document
8-26139 Form 4 Business Associate Agreement.pdf PDF
5-26139 Form 1 Data Sheet.pdf PDF
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Text version

Sheet1 DHHS26139 USDC Physical Therapy Services

Document Submission Checklist

Please submit the documents listed below.
Form 1 - Data Sheet
Form 2 - W-9
Form 3 - Conflict of Interest Disclosure Statement
Form 4 - Business Associate Agreement
Form 5 - Technical Proposal
Form 6 - Cost Proposal
Copy of current Physical Therapy or Physical Therapy Assistant Utah DOPL license
Resume demonstrating at least 3 years of professional experience working with individuals who have developmental and cognitive disabilities and possible behavioral and physical issues.
Resume demonstrating experience in providing physical therapy to individuals with intellectual disabilities.

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