2._Bid_Submittal_Checklist_(CCHCS-MC-331).pdf
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- Solicitation number
- 0000031431
- Issued by
- California
About this file
The document is a Bid Submittal Checklist (CCHCS-MC-331) for a solicitation by the California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS) for Portable Diagnostic Sleep Testing Services, Bid Number SD23-00080. The solicitation requires bidders to submit various documents such as a Bid Rate Sheet, Bidder Certification, Equipment Specifications, Payee Data Record, Subcontractor/Consultant List, and other certifications and declarations. The bid submission deadline and other key dates are not provided. The contract term and potential renewal options are also not specified.
The checklist outlines the various corporate documents that may be required depending on the bidder's business entity type, such as Articles of Incorporation, Articles of Organization, Certificate of Limited Partnership, and Statement of Partnership Authority. The solicitation does not mention any pricing terms, set asides, incumbents, funding requirements or sources, or other salient commercial details.
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CCHCS-MC-331 – Bid Submittal Checklist Page 1 of 2
Bid Number: SD23-00080
BID SUBMITTAL CHECKLIST
SERVICE TYPE: PORTABLE DIAGNOSTIC SLEEP TESTING SERVICES
The checklist below is a summary of documents to be submitted based on requirements in the Invitation for Bid. This checklist should be returned with your bid. Place a check-mark or “X” next to each document being submitted to the State. An original signature is required on the document(s) where specified.
The company name identified on all documents submitted to the State (e.g., licenses, permits, certifications, and insurance) must be identical to the company name written on the Payee Data Record (STD 204). Failure to submit these documents in the manner prescribed may delay award of Agreements. For possible reasons for rejection of bids, please refer to the Notice to Prospective Bidders, Section 16. Cause for Rejection of Bid/Rescinding of Contract Award.
Bid Submittal Checklist (CCHCS-MC-331)
Bid Rate Sheet
Bidder Certification (CCHCS-MC-333)
Equipment Specifications, if applicable
Payee Data Record (STD 204)
Supplement Vendor Payee Data Record Form
Subcontractor/Consultant List (CCHCS-MC-391)
Disabled Veteran Business Enterprise (DVBE) Participation in Exempt Contracts (CCHCS-MC-1786)
Contractor Contact Information (CCHCS-MC-332)
Conflict of Interest Compliance Certificate (CCHCS-MC-412)
Commercially Useful Function (CUF) Certification Form (CCHCS-MC-345), if applicable
Contractor Certification Clauses (CCC 04/2017). Submit a copy of the first page with an original
Copy of valid California city or county business license (if applicable); or if a corporation located within the State of California, incorporation documents or letter from the California Secretary of State Certification of Good Standing; or if not a California business, an affidavit that business is in good standing with the state, province, or country in which business is headquartered.
CCHCS-MC-331 – Bid Submittal Checklist Page 2 of 2
Fictitious Name Permit, if applicable
Bid Number: SD23-00080
Non-Collusion Declaration (CCHCS-MC-379):
☐ Organizational Chart ☐ Identification of parent corporations in which Bidder has an interest ☐ Identification of existing financial relationships with other Contractors
Declaration of Capacity to Provide Services (CCHCS-MC-396)
Darfur Contracting Act (CCHCS-MC-394)
Iran Contracting Act (CCHCS-MC-323)
Conflict of Interest Compliance Certificate (CCHCS-MC-412)
California Civil Rights Laws Attachment (DGS OLS 04)
Contractor and Grantee Report on Compliance with Economic Sanctions in Response to Russia’s Actions in Ukraine
Based on business entity type, additional document(s) shall be submitted, when applicable.
Corporations ☐ Articles of Incorporation
(Board of Directors, President or Vice President, Secretary or Assistant Secretary)
Limited Liability Company (LLC) ☐ Articles of Organization
(LLC shall have one or more members, members shall have management duties, and if the company is to be managed by one or more managers and not by all members, the articles of organization shall contain a statement to that effect.)
Limited Partnership ☐ Certificate of Limited Partnership
(An entity having one or more general partners and one or more limited partners.)
General Partnership ☐ Statement of Partnership Authority
(The association of two or more persons to carry on as co-owners of a business for profit forms a partnership.)
Limited Liability Partnership ☐ Application to Register a Limited Liability Partnership
(The association of two or more persons to carry on as co-owners of a business for profit forms a partnership.)
| Bid Submittal Checklist CCHCSMC331: |
| Bid Rate Sheet: |
| Bidder Certification CCHCSMC333: |
| Equipment Specifications if applicable: |
| Payee Data Record STD 204: |
| Supplement Vendor Payee Data Record Form: |
| SubcontractorConsultant List CCHCSMC391: |
| Disabled Veteran Business Enterprise DVBE Participation in Exempt Contracts CCHCSMC1786: |
| Contractor Contact Information CCHCSMC332: |
| Conflict of Interest Compliance Certificate CCHCSMC412: |
| Commercially Useful Function CUF Certification Form CCHCSMC345 if applicable: |
| Contractor Certification Clauses CCC 042017 Submit a copy of the first page with an original: |
| Copy of valid California city or county business license if applicable or if a corporation located: |
| Fictitious Name Permit if applicable: |
| NonCollusion Declaration CCHCSMC379: |
| Organizational Chart: Off |
| Identification of parent corporations in which Bidder has an interest: Off |
| Identification of existing financial relationships with other Contractors: Off |
| Declaration of Capacity to Provide Services CCHCSMC396: |
| Darfur Contracting Act CCHCSMC394: |
| Iran Contracting Act CCHCSMC323: |
| Conflict of Interest Compliance Certificate CCHCSMC412_2: |
| California Civil Rights Laws Attachment DGS OLS 04: |
| Contractor and Grantee Report on Compliance with Economic Sanctions in Response to Russias: |
| Check Box1: Off |
| Articles of Incorporation: Off |
| Check Box2: Off |
| Check Box3: Off |
| Check Box4: Off |
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