2-BPM006391 Attac G Subcontractors Kupplin.pdf
PDF 142 KB Posted
- Attached to
- Registry Staffing for the Arizona State Hospital
- Solicitation number
- BPM006391
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Subcontractor Disclosure Form (Attachment G) from the Arizona Department of Health Services (ADHS) for Request for Proposal No. BPM006391 regarding Registry Staffing Services for the Arizona State Hospital. The form is designed for offerors to declare whether they will subcontract any portion of the work or perform all services with their own personnel. Offerors selecting the subcontracting option must provide detailed information for each proposed subcontractor, including the subcontractor's name and contact information, the specific work to be performed, the approximate percentage of total contract work, small business designation status, and a comprehensive description of quality assurance and quality control measures to ensure subcontractor compliance with contract requirements. The proposal submission deadline was March 10, 2025, with services needed to supply approximately twenty Behavioral Health Technicians (BHTs) per shift on an as-needed basis to support the Arizona State Hospital's staffing requirements across all shifts.
The form indicates that ADHS reserves the right to demand additional information about proposed subcontractors as a precondition of award. Offerors must attach relevant certifications for each subcontractor and provide documentation of QA/QC oversight measures. The document reflects a template structure with spaces for up to five subcontractors, though one specific submission reference to "Kupplin Worldwide LLC" appears on the form. No explicit set-aside designations, incumbent contractor information, or detailed pricing terms are specified within this attachment; however, the broader solicitation anticipates multiple contract awards to ensure adequate candidate pool availability for the hospital's supplemental staffing needs in Maricopa County.
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Text version
ATTACHMENT G
Subcontractors
ARIZONA DEPARTMENT OF
HEALTH SERVICES
REQUEST FOR PROPOSAL
No.: BPM006391
150 North 18th Avenue, Suite 530 Phoenix, AZ 85007
REGISTRY STAFFING FOR THE ARIZONA
STATE HOSPITAL
Solicitation Attachment – Proposed Subcontractors | Revision No. 1 | Revised 11-22
Contractor Name: [Name]
Check “NO” if you WILL NOT subcontract any portion of the Work and will therefore be performing all of the Work with your own personnel.
☐ NO, the Offeror will not subcontract any portion of the Work.
If you WILL subcontract any portion of the Work, check “YES” below and list the name(s) of persons or companies you propose to use as Subcontractors.
1. Fill in the information for each significant Subcontractor – indicate the type of work the Subcontractor will perform under the
Contract and their approximate percentage of the total Contract work;
2. Provide copies of relevant certifications each person or firm possesses attached to this form; AND
3. Provide a description of quality assurance (QA) and quality control (QC) measures that you will use to ensure that
Subcontractor’s work meets the Contract requirements.
State may demand additional information about proposed Subcontractors as a precondition of Award.
☐ YES, the Offeror will use the Subcontractors listed below:
No. Name and contact information Small business Work to be performed and QA/QC measures %
1. [Name]
[Contact information]
Yes or
No
[Work to be performed]
[QA/QC measures]
X
2. [Name] or
3. [Name] or
4. [Name] or
5. [Name] or
Dell Typewritten text Kupplin Worldwide LLC
Dell Typewritten text
File details come from the government source that posted it. Updated .