2-Attachment B-1 - Offer Form.docx
DOCX document 29 KB Posted
- Attached to
- Family Advocacy Center Counseling
- Solicitation number
- 263631
- Issued by
- Pinal County, Arizona
About this file
This is an Offer Form (Attachment B-1) for a Pinal County, Arizona solicitation for trauma therapy services at Public Health Family Advocacy Centers. The form is designed for qualified contractors to submit offers to provide on-site and/or virtual counseling sessions to clients who have experienced domestic violence, child neglect and abuse, sexual violence, and crime victimization. The contractor must be a licensed professional with demonstrated experience serving trauma survivors. The offer form requires submission of the company name, authorized signatory information, responder contact details, and web address and communication information, along with the dated version of the offer being submitted.
The form includes mandatory certifications that the responder must affirm by signature, including compliance with federal and Arizona employment discrimination laws (Federal Executive Order 11246 and Arizona Executive Order 2009-9), prohibition on providing economic opportunities or gifts to public servants, compliance with Arizona information technology accessibility standards (A.R.S. 41-3532), compliance with forced labor prohibitions regarding Uyghur labor in Chinese manufacturing (A.R.S. 35-394), and confirmation that the responder is not debarred from government contracting at any level. False statements on the form will void the offer and any resulting contract and may subject the responder to legal penalties.
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Other files
| File | Type | Posted |
|---|---|---|
| 10-Attachment C-1 - Federal Grant Contract Terms.docx | DOCX document | |
| 7-Attachment A - Scope of Work (SOW).docx | DOCX document | |
| 9-Attachment C - Draft Contract.docx | DOCX document | |
| 6-263631SOQ Family Advocacy Center Counseling (OPEN FIRST).docx | DOCX document | |
| 5-Attachment C-2 - Business Associate Agreement.docx | DOCX document | |
| 4-Attachment B-3 - Conformance Statements.docx | DOCX document | |
| 8-Attachment B - Submission Instructions.docx | DOCX document | |
| 1-Attachment B-4 - Supplier Contact Information.docx | DOCX document | |
| 3-Attachment B-2 - Addendum Acknowledgement Form.docx | DOCX document |
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Text version
Attachment B-1 Offer Form
Submission of Offer: Undersigned hereby offers and agrees to provide goods and/or services in compliance with the solicitation and the offer, which is as indicated by the latest dated version below:
Offer Date:
| X | ||
| Responder Company Name | Signature of Person Authorized to Sign Offer |
| Address | Printed Name and Title |
| City, State, Zip | Responder Contact Name and Title |
| Web Address | Contact Email Address | Contact Phone # |
Certification: By signature in the Offer section above, the Responder certifies:
1. The Responder shall not discriminate against any employee or applicant for employment in violation of Federal Executive Order 11246, Arizona State Executive Order 2009-9 or A.R.S. §§ 41−1461 through 1465.
2. The Responder has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted offer. Failure to provide a valid signature affirming the stipulations required by this clause will result in rejection of the offer. Signing the offer with a false statement will void the offer, any resulting contract, and may be subject to legal penalties under law.
3. The Responder certifies compliance with A.R.S. § 41-3532 when offering electronics or information technology products, services, or maintenance.
4. The Responder certifies compliance with A.R.S. § 35-394 prohibiting the use of forced labor by Responder or its contractors or subcontractors of ethnic Uyghurs in the People’s Republic of China in any goods produced in service of this contract.
5. The Responder is not debarred from, or otherwise prohibited from participating in any contract awarded by federal, state, or local government.
Att. B-1 #263631SOQ, Page 1 image1.png
File details come from the government source that posted it. Updated .