121963 O3 Public Support Ventures File 1 of 4.pdf
PDF 217 KB Posted
- Solicitation number
- 121962 O3
- Issued by
- Douglas County, Nebraska
About this file
This document is a Contractual Agreement Form for a state procurement opportunity involving the Nebraska Department of Labor (NDOL), specifically for a UI Call Center operated by Public Support Ventures (PSV). The form is a standard state solicitation document dated 24/06/2025, requiring manual or DocuSign signature, and includes provisions for vendor classification and potential preference considerations under Nebraska's Transparency in Government Procurement Act. The form certifies that the bidder is not owned by the Chinese Communist Party and provides detailed contact information for the vendor.
Public Support Ventures, located in Denver, Colorado, is submitting this bid with Sam Gilman (CEO) as the primary contact. The company has provided contact details including phone number (202) 841-3180 and email sam@cedproject.org, with Kirby Rising listed as the Director of Program Operations. The document allows for potential vendor preferences for resident disabled veterans, businesses in designated enterprise zones, or blind persons licensed by the Commission for the Blind & Visually Impaired. The final audit report indicates the document was created and signed electronically on 24-25 June 2025, with all necessary electronic signature tracking completed through Adobe Acrobat Sign.
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Text version
SPB Form 22 | RFP Template | Effective 12162024
CONTRACTUAL AGREEMENT FORM
By signing this Contractual Agreement Form, the bidder guarantees compliance with the provisions stated in this solicitation and agrees to the terms and conditions unless otherwise indicated in writing and certifies that bidder is not owned by the Chinese Communist Party.
THIS FORM MUST BE SIGNED MANUALLY IN INK OR BY DOCUSIGN
COMPANY:
ADDRESS:
PHONE:
EMAIL:
BIDDER NAME & TITLE:
SIGNATURE:
DATE:
VENDOR COMMUNICATION WITH THE STATE CONTACT INFORMATION
(IF DIFFERENT FROM ABOVE)
NAME:
TITLE:
PHONE:
EMAIL:
BIDDER MUST COMPLETE THE FOLLOWING
Per Nebraska’s Transparency in Government Procurement Act, Neb. Rev Stat § 73-603, DAS is required to collect statistical information regarding the number of contracts awarded to Nebraska Vendors. This information is for statistical purposes only and will not be considered for contract award purposes.
_____ NEBRASKA VENDOR AFFIDAVIT: Bidder hereby attests that bidder is a Nebraska Vendor.
“Nebraska Vendor” shall mean any bidder who has maintained a bona fide place of business and at least one employee within this state for at least the six (6) months immediately preceding the posting date of this Solicitation. All vendors who are not a Nebraska Vendor are considered Foreign Vendors under Neb. Rev Stat § 73-603 (c).
_____ I hereby certify that I am a Resident disabled veteran or business located in a designated enterprise zone in accordance with Neb. Rev. Stat. § 73-107 and wish to have preference, if applicable, considered in the award of this contract.
_____ I hereby certify that I am a blind person licensed by the Commission for the Blind & Visually Impaired in accordance with Neb. Rev. Stat. § 71-8611 and wish to have preference considered in the award of this contract.
Public Support Ventures
1600 N Downing St Floor 6, Denver, CO 80218
(202) 841-3180 sam@cedproject.org
Sam Gilman, CEO
Kirby Rising Director of Program Operations kirby.rising@cedproject.org
(303) 884-7447
24/06/2025
NDOL UI Call Center Agreement Form - PSV Final Audit Report 2025-06-25
Created: 2025-06-24
By: Caroline Clark (caroline.clark@cedproject.org)
Status: Signed
Transaction ID: CBJCHBCAABAAc-hkWwWZabHG-93ZPP-8rZOwG0jv44Jy
"NDOL UI Call Center Agreement Form - PSV" History Document created by Caroline Clark (caroline.clark@cedproject.org)
2025-06-24 - 2:17:13 PM GMT
Document emailed to Sam Gilman (sam@cedproject.org) for signature
2025-06-24 - 2:17:17 PM GMT
Email viewed by Sam Gilman (sam@cedproject.org)
2025-06-25 - 5:33:30 AM GMT
Document e-signed by Sam Gilman (sam@cedproject.org) Signature Date: 2025-06-25 - 5:33:40 AM GMT - Time Source: server
Agreement completed.
2025-06-25 - 5:33:40 AM GMT
| 2025-06-25T05:33:42+0000 | |
| Certified by Adobe Acrobat Sign |
File details come from the government source that posted it. Updated .