15._CCHCS-MC-393-_SB_Sub_-Supplier_Ack.pdf
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- Attached to
- On-Site Dialysis Request for Proposal SD23-00097
- Solicitation number
- 0000032853
About this file
This document is a Small Business Subcontractor/Supplier Acknowledgement form related to a California Department of Corrections and Rehabilitation/California Correctional Health Care Services contract opportunity identified as Proposal Number SD23-00097 CCHCS-MC-393. The form confirms that the named subcontractor/supplier has agreed to be identified by the bidding firm as a proposed small business or microbusiness subcontractor or supplier for the agreement. The subcontractor acknowledges the total dollar value of their claimed participation and agrees to provide the specified subcontracted services, labor or supplies under the resulting contract if the bidding firm is awarded the contract. The subcontractor understands it is their sole responsibility to contact the bidding firm to learn if they were awarded the contract and to confirm the subcontract agreement.
The document does not provide details on pricing terms, set asides, incumbents, funding requirements, or other salient commercial information. It is focused solely on the acknowledgement and commitments from the identified subcontractor/supplier.
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Text version
Proposal Number: SD23-00097
CCHCS-MC-393 – Small Business Subcontractor/Supplier Acknowledgement Rev. 04/05/2018
Small Business Subcontractor/Supplier Acknowledgement
Name of Bidding Firm/Prime Contractor
Total Dollar Value of Subcontractor Use
This document confirms and acknowledges that the firm named below agreed to be identified by a bidding firm as a proposed small business or microbusiness subcontractor or supplier for a California Department of Corrections and Rehabilitation/California Correctional Health Care Services agreement.
Subcontractor acknowledgements:
a. The subcontracting firm named herein has committed to perform or provide services/labor or supplies equal to a percentage of the total bid/cost proposal price submitted by the bidding firm named above.
b. The subcontracting firm named herein acknowledges the total dollar value of claimed participation identified above.
c. The subcontracting firm named herein agrees to provide the following subcontracted services/labor or supplies under the resulting contract if the bidding firm named above receives the contract award:
Below and/or continued on an attachment is a brief description of the commercially useful function(s) that the subcontractor/supplier identified herein will provide or supply:
The subcontracting firm named herein understands it is its sole responsibility to contact the bidding firm named above to learn if the proposer was awarded the contract pursuant to the referenced bid number and to confirm its subcontract agreement. If the bidding firm named above receives an award based in part on non-small business subcontractor preference, the bidding firm/contractor is obligated to use each small and/or microbusiness subcontractor or supplier identified in its proposal unless a subcontractor substitution is requested after contract execution pursuant to Public Contract Code Section 4107 and California Code of Regulations, Title 2, Section 1896.10.
The person signing below certifies the information supplied on this form is true and accurate to the best of their knowledge and agrees to allow the State to confirm this information, if deemed necessary.
Name of Proposed Subcontractor/Supplier Date Signed
Signature of Subcontractor/Supplier Representative
Telephone Number Email Address (if applicable)
Printed/Typed Name Title
For State Use Only
Information Verified by Date
File details come from the government source that posted it. Updated .