2-BPM006391 Attach G KR Young.pdf
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- 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 Subcontractors attachment form (Attachment G) for Request for Proposal No. BPM006391 issued by the Arizona Department of Health Services for Registry Staffing Services at the Arizona State Hospital. The solicitation seeks contractors to provide Behavioral Health Technicians (BHTs) and Registered Nurses (RNs) on an as-needed, if-needed basis, with the hospital's primary need being approximately twenty (20) Registry BHTs per shift across all shifts. Proposal responses were due by March 10, 2025, with services to be provided in Maricopa County, specifically within Phoenix City jurisdiction. The contract term and renewal options are not specified in this attachment document.
This attachment document functions as a declaration form requiring offerors to indicate whether they will subcontract any portion of the work or perform all work with their own personnel. If subcontracting is planned, offerors must list up to five proposed subcontractors with their contact information, identify whether each is a small business, specify the work to be performed with percentage allocations, and describe quality assurance and quality control measures for each subcontractor. Offerors must provide copies of relevant certifications for all proposed subcontractors. The document indicates that the State may demand additional information about proposed subcontractors as a precondition of award. No pricing terms, set-asides, incumbent vendors, or funding amounts are addressed in this particular attachment.
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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
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