11._OMESformCP076.pdf
PDF 293 KB Posted
- Attached to
- DMH-Community Based Prevention Services
- Solicitation number
- EV00000945
- Issued by
- Hobart City, Oklahoma
About this file
This is an OMES Form CP076 Responding Bidder Information form used by the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) for solicitation EV00000945 regarding Community Based Prevention Services. The form serves as a certification document that must accompany a bidder's response to the contract opportunity. The solicitation seeks services to provide community-based prevention programs, including evidence-based practices and policies implemented at the local level by community coalitions to prevent substance use risk factors and related consequences. These prevention services will be coordinated with ODMHSAS field staff and other sector-based prevention initiatives across faith, family, workplace, higher education, school, and healthcare sectors as part of the department's strategic plan to prevent mental, emotional, and behavioral problems.
The form requires responding bidders to provide general company information, including FEIN/SSN, supplier ID, company name, and contact details. Bidders must certify their status regarding Israel boycotts, Secretary of State registration requirements, workers' compensation insurance coverage compliance, and disabled veteran business enterprise status. All responding bidders are required to submit a signed certification for competitive bid and contract along with their solicitation response. The form does not specify pricing terms, set-asides, incumbent information, response deadlines, or contract term details within this particular document; however, bidders must complete all applicable sections and provide supporting documentation as required by Oklahoma state regulations and the specific solicitation requirements.
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Text version
OMES Form CP076 (11/2024) RESPONDING BIDDER INFORMATION | Page 1 of 1
Central Purchasing
RESPONDING BIDDER INFORMATION
You must submit a Certification for Competitive Bid and Contract along with the response to the solicitation.
1. SOLICITATION
Solicitation #
2. BIDDER GENERAL INFORMATION
FEIN/SSN Supplier ID
Company name
3. BIDDER CONTACT INFORMATION
Address
Contact name Title
Email Phone Website Fax
4. BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL
Yes No
5. REGISTRATION WITH THE OKLAHOMA SECRETARY OF STATE
Yes Filing number:
No Prior to the contract award, the successful bidder is required to register with the Secretary of State or must attach a signed statement that provides specific details supporting the exemption the supplier is claiming (sos.ok.gov or 405- 521-3911).
6. WORKERS’ COMPENSATION INSURANCE COVERAGE
Bidder is required to provide a certificate of insurance showing proof of compliance with the Oklahoma Administrative Workers’ Compensation Act.
Yes Include a certificate of insurance with the bid.
No Exempt from the Administrative Workers’ Compensation Act pursuant to 85A O.S. § 2(18)(b)(1-11). (Attach a written, signed and dated statement on letterhead stating the reason for the exempt status. For frequently asked questions concerning workers’ compensation insurance, visit wcc.ok.gov.)
7. DISABLED VETERAN BUSINESS ENTERPRISE ACT
Yes I am a service-disabled veteran business as defined in 74 O.S. § 85.44E.
Include the following with the bid response:
1. Certification of service-disabled veteran status as verified by the appropriate federal agency.
2. Verification of not less than 51% ownership by one or more service-disabled veterans.
3. Verification of the control of the management and daily business operations by one or more service-disabled veterans.
No I do not meet the criteria as a service-disabled veteran business.
8. SIGNATURE
Authorized signature Date
Name Title https://www.sos.ok.gov/ https://www.wcc.ok.gov/
| Central Purchasing |
| RESPONDING BIDDER INFORMATION |
| Solicitation: EV00000945 |
| FEINSSN: |
| Supplier ID: |
| Company name: |
| Contact name: |
| Title: |
| Email: |
| Phone: |
| Website: |
| Fax: |
| 4 BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL: Off |
| Prior to the contract award the successful bidder is required to register with the Secretary of State or must attach a: Off |
| Compensation Act: Off |
| 7 DISABLED VETERAN BUSINESS ENTERPRISE ACT: Off |
| Date: |
| Name: |
| Title_2: |
| Filing number: |
| Address: |
File details come from the government source that posted it. Updated .