2.3.7. Invest in MA Form.doc

DOC document 80 KB Posted

Attached to
RFQ 1701. Agent Location Hardware
Solicitation number
BD-17-1062-LOT-00001-00000009131
Issued by
Massachusetts

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Written by GovTribe AI ·

This document is the "Invest in Massachusetts Data Form" related to a state and local contract opportunity issued by the Massachusetts State Lottery Commission. The contract opportunity is for providing 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 provide information on whether at least 50% of the work-hours will be performed in Massachusetts, the number of jobs that will be created or preserved in Massachusetts as a result of the contract, and the specific locations in Massachusetts where those jobs will be located. Bidders who answer "Yes" to performing at least 50% of the work-hours in Massachusetts must certify this commitment, which will be an essential part of any resulting contract.

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INVEST IN MASSACHUSETTS DATA FORM

Instructions: Completing all parts of this form is mandatory unless directed otherwise. Please read instructions in the Invest in Massachusetts Attachment included with the solicitation.

For a complete list of certified vendors please go to http://www.somwba.state.ma.us/BusinessDirectory/BusinessDirectory.aspx .

Part I Bidder/Proposer Information

Business Name:

Full Address: number, street, and apt. or suite no., city, state, zip

Contact Name:
Phone # ( FORMTEXT

) - x Email address:

Part II Invest in Massachusetts Data (Please respond to the inquiries (1-3) listed below. If you answer “No” to Inquiry #1 of this Part II, then you are not required to complete Part III of this IMD Form).

f

1. Will at least 50% or more of the work-hours performed as a result of a contract arising out of this proposal be performed in Massachusetts? FORMCHECKBOX Yes FORMCHECKBOX No

2. If you responded “Yes” to Inquiry #1, how many of those jobs performed in Massachusetts will be created and/or preserved as a result of a contract arising out of this proposal?

3. If you responded “Yes” to Inquiry #1, where in Massachusetts will those jobs be located?

Part III Certification Based on your responses in Part II of the IMD Form, those Bidders/Proposers who have answered “Yes” to Inquiry #1 are required to certify the Bidder/Proposer’s commitment that 50% or more of the work-hours performed in connection with any contract arising out of the Bidder/Proposer’s RFR Response will be performed in Massachusetts. This certification must be signed by an individual authorized to bind the Bidder/Proposer firm. Additionally, this commitment will be an essential part of any contract awarded by the Treasury and will be written into any formal agreement.

f

I, Signed under the pains and penalties of perjury.

Print Name ► Authorized Signature ► ________________________________ Date ► f

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