16. Supplier Diversity Plan Form for POS~1.xls
XLS spreadsheet 52 KB Posted
- Solicitation number
- BD-18-1022-DMH08-8220A-18593
- Issued by
- Massachusetts
About this file
This document is a Supplier Diversity Program (SDP) Form for Purchase of Service (POS) that is required for providers to be qualified to contract with Commonwealth Agencies in Massachusetts for POS services. The form must be submitted annually with the provider's Uniform Financial Report (UFR) and when responding to POS contract opportunities. The form collects information on the provider's total POS state expenditures, as well as their planned and current SDP partners, including the certification type, description of the business arrangement, and the committed and expended amounts. Providers certified by the Supplier Diversity Office (SDO) cannot list themselves as an SDP partner.
The form also references a related state and local contract opportunity, the "Respite Services - Master Agreement Request for Applications" issued by the Massachusetts Department of Mental Health (DMH). Through this RFA, DMH is seeking to establish a pool of qualified providers from which DMH Areas can purchase Site-Based Respite and/or Mobile Respite Services on an as-needed basis. DMH will enter into a Master Agreement with all qualified providers.
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SDP Spending Report
| Supplier Diversity Program (SDP) Form for Purchase of Service (POS) | ||||
| Completing all parts of this form is required in order for a provider to be qualified to contract with Commonwealth Agencies for POS services. | ||||
| This form is due annually with a provider's UFR Report and a copy of the completed form is to be submitted when responding to POS contract opportunities with an Executive Department. | ||||
| Submission for Fiscal Year | ||||
| Part I | Contractor Information (Required) | |||
| Business Name | Contact Name | Contact Email | Contact Phone | Fiscal Year Total POS State Expenditures |
| $ - 0 | ||||
| Part II | SDP Partner Information (Required) (Insert additional lines as needed) | |||
| Providers that are currently SDO Certified may not list themselves as a Partner in this section. | ||||
| Planned and Current SDP Partner(s) Company Name (as it appears on a list at www.mass.gov/sdo) | Certification Type (Choose One) | Description of Business Arrangement | Committed Amount in Current Fiscal Year | Expended Amount in Prior Fiscal Year |
| $ - 0 | $ - 0 | |||
| $ - 0 | $ - 0 | |||
| $ - 0 | $ - 0 | |||
| $ - 0 | $ - 0 | |||
| $ - 0 | $ - 0 | |||
| $ - 0 | $ - 0 | |||
| TOTAL | $ - 0 | $ - 0 | ||
| PERCENT (%) OF POS SPEND | 0% | |||
| Part III | Under the pains and penalties of perjury I certify that the information provided in this report is accurate. | |||
| Name | Supplier Diversity Certification Acronyms: | |||
| Title | MBE - Minority Business Enterprise | |||
| Phone | WBE - Woman Business Enterprise | |||
| M/WBE - Minority and Woman Business Enterprise | ||||
| Authorized Signature | SDVOBE - Service-Disabled Veteran-Owned Business Enterprise | |||
| (May be left blank if submitted electronically) | VBE - Veteran-Owned Business Enterprise | |||
| Date | M/NPO - Minority Non-Profit Organization | |||
| W/NPO - Women Non-Profit Organization | ||||
| Form revised: July 1, 2016 | M/W/NPO - Minority and Women Non-Profit Organization | |||
| DOBE - Disability-Owned Business Enterprise | ||||
| LGBTBE - Lesbian, Gay, Bisexual or Transgender Business Enterprise |
FORM INSTRUCTIONS
Overall Providers that hold POS contracts with Commonwealth departments are required to file a "Supplier Diversity Program (SDP) Form for Purchase of Service (POS)" each year and upload it with their Uniform Financial Report (UFR). This requirement includes Providers who have already been certified by the Supplier Diversity Office (SDO) as a Minority- and/or Women Business/Organization. Providers that are exempt from UFR filing requirements must submit the SDP form when they upload their exemption request. Providers responding to POS bids posted on COMMBUYS will be directed to submit the most recent completed copy of this form with their proposals/quotes.
Part I - Contractor Information Bidder/Contractor Information: Business name, contact name, phone number and email.
Fiscal Year Total POS State Expenditures can be found on the "POS Expenditure and Federal Funds Listing" posted by OSD on the provider’s UFR eFiling site.
Part II - Contractor's SDP Partner Information Planned or Current SDP Partner(s) must belong to any one or more of the following groups:
- MBE - Minority Business Enterprise, WBE - Woman Business Enterprise , or M/WBE - Minority and Woman Business Enterprise;
- M/NPO - Minority Non-Profit Organization, W/NPO - Women Non-Profit Organization, M/W/NPO - Minority and Women Non-Profit;
- SDVOBE - Service-Disabled Veteran-Owned Business Enterprise; and/or
- VBE - Veteran-Owned Business Enterprise Organization
Only partners listed on one of the "Directory of Certified Businesses" lists on www.mass.gov/sdo can be listed as partners on this form.
Providers certified by SDO may not list their own organization as an SDP partner.
Although currently not covered by SDP spending commitments, Providers may also inform the Commonwealth of their spending with partners certified as DOBE - Disability-Owned Business Enterprise, and LGBTBE - Lesbian, Gay, Bisexual or Transgender Business Enterprise.
Certification Type: Select the partner's certification type from the menu. For partners with multiple certification types, please select the one that is highest on the dropdown list.
Description of Business Relationship: Describe the business relationship/arrangement with the SDO Certified Partner (e.g. "providing transportation services").
Committed Amount in Current Fiscal Year : Enter the amount (as an exact dollar figure) your organization is committed to spend with SDP partner(s) during the current Fiscal Year. If you are filing a UFR for Fiscal Year 2016, the commitment would be for Fiscal Year 2017.
Expended Amount in Prior Fiscal Year: Enter the amount (as an exact dollar figure) that your organization expended with SDP partner(s) during the past fiscal year (UFR reporting year). If you are filing a UFR for Fiscal Year 2016, the commitment would be for Fiscal Year 2017.
Additional Resources
· More information about the Supplier Diversity Program (SDP) is available at www.mass.gov/sdp
· For a complete list of certified vendors refer to www.mass.gov/sdo
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