2-DHHS25038 Attachment H Submission Checklist.docx
DOCX document 24 KB Posted
- Attached to
- Audiology Services
- Solicitation number
- DHHS25038
- Issued by
- Utah
About this file
This is a submission checklist for DHHS25038, a solicitation issued by the Utah Department of Human Services for audiology services at state correctional facilities. The contract requires vendors to provide all-inclusive audiology services to inmates at Utah State Correctional Facility (USCF) and Central Utah Correctional Facility (CUCF), including on-site hearing evaluations, fitting and maintenance of hearing aids, and minor repairs. Responses must be submitted through the Bonfire platform and contain only documentation requested in the solicitation, with DHHS declining to review unrequested information.
Vendors must submit a complete response package that includes either Attachment C(a) or C(b) regarding conflict of interest disclosure, Attachment D (W-9 form, unless the vendor currently holds a DHHS contract), Attachment E (Technical Response Form), Attachment G (Cost Proposal Sheet), proof of certification and professional licensing, and resume(s) demonstrating experience providing audiology services, specific experience at correctional facilities, and experience relevant to the technical response questionnaires. The checklist serves as a tool for vendors to ensure compliance with all submission requirements prior to uploading their documents into Bonfire.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 1-DHHS25038 Attachment A DHHS Client Service Terms.docx | DOCX document | |
| 10-DHHS25038 Attachment E Technical Response.docx | DOCX document | |
| 4-DHHS25038 Attachment C (b) Conflict of Interest Certification UGE.pdf | ||
| 3-DHHS25038 Attachment D W9.pdf | ||
| 7-DHHS25038 Request for Proposal.docx | DOCX document | |
| 6-DHHS25038 Attachment B Scope of Work.docx | DOCX document | |
| 8-DHHS25038 Attachment F Score Sheet.xlsx | XLSX spreadsheet | |
| 5-DHHS25038 Attachment C (a) Conflict of Interest Form.pdf | ||
| 9-DHHS25038 Attachment G Cost Proposal Sheet.xlsx | XLSX spreadsheet | |
| 11-DHHS25038 Attachment I CHS Addendum.docx | DOCX document |
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Text version
DHHS25038 Attachment H Submission Checklist
Submit your response by uploading your documents into Bonfire.
Responses should contain only documentation requested in this solicitation. DHHS will not review information submitted by a vendor that is not requested in this solicitation.
Response Content & Checklist
| · |
| Submit the documents specified below. Complete forms as instructed. Vendors are encouraged to use this table as a checklist to ensure that responses are complete. |
1. Attachment C (a): Conflict of Interest Disclosure Statement
OR
2. Attachment C (b): Governmental Entity Conflict of Interest Certification (for government agencies, political subdivisions, municipalities, public schools, etc.)
3. Attachment D: W-9 This form is not required if you currently hold any contract(s) with DHHS. Complete the form with the legal name of the business entity or individual applying for this solicitation.
4. Attachment E: Technical Response Form
5. Attachment G: Cost Proposal Sheet
6. Provide proof of Certification and Professional Licensing.
7. Resume(s) Provide resume(s) that shows:
a. Experience providing Audiology Services; and
b. Experience providing Audiology Services at a correctional facility.
c. Experience listed in the technical response questionnaires.
Submission Instructions Page 1 of 1
File details come from the government source that posted it. Updated .