2._Bid_Submittal_Checklist_(CCHCS-MC-331).pdf
PDF 96 KB Posted
- Attached to
- SD23-00088 Ocular Prosthetic Services (Region 4)
- Solicitation number
- 0000032627
- Issued by
- San Bernardino County, California
About this file
The document is a Bid Submittal Checklist for a Contract for Ocular Prosthesis Services and Devices issued by the California Correctional Health Care Services (CCHCS). The checklist outlines the required documents to be submitted by bidders, including the Bid Rate Sheet, Payee Data Record, Subcontractor List, Small Business Certifications, Conflict of Interest forms, and other relevant certifications and licenses. The bid number is SD23-00088, and the contract term and renewal options are not specified.
The checklist indicates that bids will be evaluated based on the requirements outlined in the Invitation for Bid, and failure to submit the required documents may result in the rejection of the bid or the rescinding of the contract award. The checklist also provides guidance on the format and consistency required for the company information across all submitted documents. Additional documentation may be required based on the business entity type of the bidder, such as Articles of Incorporation, Articles of Organization, or Statements of Partnership Authority.
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Text version
CCHCS-MC-331 – Bid Submittal Checklist Page 1 of 2
Bid Number: SD23-00088
BID SUBMITTAL CHECKLIST
SERVICE TYPE: OCULAR PROSTHESIS SERVICES AND DEVICES
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)
Non-Small Business Subcontractor Preference Request (CCHCS-MC-392)
Small Business Subcontractor/Supplier Acknowledgement (CCHCS-MC-393)
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: SD23-00088
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
GenAI Report and Factsheet (STD 1000)
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.)
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