2.3.5. Consultant Contractor Mandatory Submission Form.doc
DOC document 31 KB Posted
- Attached to
- RFQ 1701. Agent Location Hardware
- Solicitation number
- BD-17-1062-LOT-00001-00000009131
- Issued by
- Massachusetts
About this file
The document is a Consultant Contractor Mandatory Submission Form related to a Request for Response (RFR) issued by the Massachusetts State Lottery Commission. The RFR is for Agent Location Hardware and associated peripherals including software to support an integration to the existing ProSys lottery host system and migration to an upgraded host platform. The form requires bidders to disclose any additional income from the Commonwealth of Massachusetts, as well as any persons with a financial interest in the contract or more than a 1% interest in the bidder's company. Bidders must also attach resumes or statements of qualifications for key personnel to be assigned to the contract.
The related state and local contract opportunity is for RFQ 1701 issued by the Massachusetts State Lottery Commission. The Commission is seeking qualification statements from companies interested in providing the specified hardware, software, and integration services. No other details about pricing, set asides, incumbents, funding sources, or contract terms are provided in the documentation.
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Text version
Consultant Contractor Mandatory Submission Form
COMPLETE THE FOLLOWING ONLY FOR CONSULTANT CONTRACTS
(Within HH and NN and UU Object Classes)
Bidder: ________________________________________________________________________
RFR Name/Title: ________________________________________________________________
RFR Number: # _________________________________________________________________
Additional Income Disclosure. Pursuant to the provisions of M.G.L. c. 29, s. 29A, the following amounts represent any contracts, grants or other income due from the Commonwealth of Massachusetts, including any political subdivision or public authority, during the period of a contract. You may attach additional sheets as necessary.
FORMCHECKBOX
Please check if N/A.
Disclosure of Persons with Financial Interest (other than the bidder). Pursuant to the provisions of M.G.L. c. 29, s 29A and c. 7A, s. 6, the following individuals have a financial interest in a contract and/or with more than one percent (1%) interest in the capital stock of the contractor. You may attach additional sheets as necessary.
FORMCHECKBOX
Please check if N/A.
Key Personnel. Attach a resume or statement of qualifications for all key personnel specifically named in bidder's response to be assigned to the performance of a contract.
FORMCHECKBOX
Please check if N/A.
The information submitted herein is certified by the bidder to be accurate under the pains and penalties of perjury.
Signature of Authorized Signatory for Bidder: __________________________________________________
Title of Authorized Signatory for Bidder: _____________________________________________________
Date: __________________________________________________________
Updated 11/1/05
Sensitivity level - low
File details come from the government source that posted it. Updated .