2-HSS-26-021B - AppC-Vendor Frms.xlsx
XLSX spreadsheet 34 KB Posted
- Attached to
- Home and Community based Services State and local contract opportunity
- Solicitation number
- HSS-26-021B
- Issued by
- Delaware
About this file
This file contains vendor forms and requirements for the State of Delaware, Division of Developmental Disabilities Services (DDDS), in connection with the Home and Community-Based Services contract opportunity (2-HSS-26-021B). The solicitation seeks vendors to provide multiple home and community-based services including assistive technology, behavior consultation, benefits counseling, career assessment, community participation, day habilitation, personal care, residential habilitation, respite care, supported employment, and supported living services to individuals with intellectual and developmental disabilities. The vendor forms package includes requirements for company information submission, non-collusion statements, exceptions forms, confidentiality designations, business references, and subcontractor identification. Vendors must provide a minimum of three business references of similar size and scope and cannot list state employees as references. If subcontractors are proposed, each must also provide a minimum of three business references.
Vendors must comply with the state's published fee-for-service rates for DDDS services, which are set annually on the DDDS website and are subject to change based on legislative appropriations; no rate negotiation is permitted as a condition of contract award. Vendors are required to certify non-collusion, disclose any federal, state, or local government suspension or debarment actions within the past five years, and identify diverse vendor certifications at both state and federal levels. The forms allow vendors to designate confidential or proprietary information and submit exceptions to solicitation terms, subject to the state's independent determination of validity. All authorized representatives signing submissions must have legal authority to enter the organization into formal contracts with the State of Delaware, Office of Management and Budget, Government Support Services.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 4-HSS 26-021B - AppE-Supplemental Questionnaire.docx | DOCX document | |
| 5-HSS 26-021B - AppF-FAQ.docx | DOCX document | |
| 3-HSS-26-021B - AppD-Templates PSA, BAA DTI TCs.docx | DOCX document | |
| 1-HSS-26-021B - Home and Community Based Svcs.docx | DOCX document |
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Text version
Attachment2Vendor Info Sheet
| Vendor Information Sheet | ||
| Company Name | ||
| DBA (if applicable) | ||
| Purchase Order Address | ||
| Website | ||
| Diverse Vendor Self-Identification | ||
| State Certified (select drop down of "Yes" or "No") | If yes, which State(s): | |
| Federal Certified (select drop down of "Yes" or "No") | ||
| Desginated Contacts | Primary | Secondary |
| Contact Name | ||
| Role/Title | ||
| Phone Number | ||
| Business Capability Statement | ||
| (Provide a short capability statement about your business and its capabilities and skills to advertise who you are and what you do.) |
&F&A &P
Attachment3Non-Collusion Stmt
| Non-Collusion Statement | |
| This is to certify that the undersigned Vendor has neither directly nor indirectly, entered into any agreement, participated in any collusion or otherwise taken any action in restraint of free competitive bidding in connection with this solicitation, and further certifies that it is not a sub-contractor to another Vendor who also submitted a bid/proposal as a primary Vendor in response to this solicitation submitted this date to the State of Delaware, Office of Management and Budget, Government Support Services. | |
| It is agreed by the undersigned Vendor that the signed submission of this bid/proposal represents, subject to any express exceptions set forth on the Exception form, the Vendor’s acceptance of the terms and conditions of this solicitation including all specifications and special provisions. | |
| NOTE: Signature of the authorized representative MUST be of an individual who legally may enter his/her organization into a formal contract with the State of Delaware, Office of Management and Budget, Government Support Services. | |
| Company Name | |
| DBA (if applicable) | |
| Name of Authorized Representative | |
| Title | |
| Phone Number | |
| Email Address | |
| Company Address | |
| Phone Number | |
| Email Address | |
| Tax ID Number | |
| AFFIRMATION: Within the past five (5) years, has your firm, any affiliate, any predecessor company or entity, owner, Director, officer, partner or proprietor been the subject of a Federal, State, Local government suspension or debarment? | |
| Select "Yes" or "No" from the drop down menu | |
| If yes, explain |
&F&A &P
Attachment4Exceptions Form
| Exceptions Form | |||||
| Responding Vendors may elect to take minor exceptions to the terms and conditions of this solicitation. All exceptions must be submitted below. Exceptions found elsewhere in the solicitation response will not be considered. Government Support Services maintains sole discretion to reject any exceptions. | |||||
| Exceptions | |||||
| Paragraph & Page # of Document | Current Language stated in the document | Proposed Alternative language | Justification for proposed change | State of Delaware's response | Bidder's response |
If addition space is needed, please copy the format of this worksheet and attach as an additional file in your submission
&F&A &P
Attachment5Confidentiality Form
| Confidentiality Form |
| Responding vendor may elect to designate sections of their proposal as confidential, intellectual property, trade secrets, and other confidential business information. Vendor shall explain below how the redacted information is not “public record” as defined by 29 Del. C. § 10002. The State shall independently determine the validity of any vendor designation as set forth in this section. Any vendor submitting a bid/proposal herein expressly accepts the State’s absolute right and duty to independently assess the legal and factual validity of any information designated as confidential business information. |
| Confidential Information (select "Yes" or "No" on the dropdown) |
| Confidentiality and Proprietary Information |
If addition space is needed, please copy the format of this worksheet and attach as an additional file in your submission
&F&A &P
Attachment 6Business References
| Business References |
| List a minimum of three business references of similar size and scope. Please do not list any State Employee(s) as a business reference. If Subcontractors are identified, a minimum of three business references must also be provided for each subcontractor. |
| Reference One |
| Contact Name |
| Contact Title |
| Business Name |
| Address |
| Phone |
| Current Vendor? |
| Work Performed |
| Reference Two |
| Contact Name |
| Contact Title |
| Business Name |
| Address |
| Phone |
| Current Vendor? |
| Work Performed |
| Reference Three |
| Contact Name |
| Contact Title |
| Business Name |
| Address |
| Phone |
| Current Vendor? |
| Work Performed |
&F&A &P
Attachment7Subcontractor Form
| Subcontractor Form | |
| Are you proposing the use of any subcontractors in the fulfillment of the requirements as outlined in the solicitation? (Please select "Yes" or "No" in the drop down meniu) | |
| If yes, complete this form. | |
| Responding Vendor Information | |
| Company Name | |
| DBA (if applicable) | |
| Company Address | |
| Subcontractor Information | |
| Company Name | |
| DBA (if applicable) | |
| Company Address | |
| Diverse Vendor Self-Identification | |
| State Certified | If yes, which State(s): |
| Federal Certified | |
| Description of Work by Subcontractor |
| Once completed, this form must be signed by both vendors. | |
| Proposing Vendor | Subcontractor |
| Authorized Signature: | Authorized Signature: |
| Name: | Name: |
| Title: | Title: |
| Date: | Date: |
DropDowns
| YES |
| NO |
| YES - Vendor is providing any information they declare to be confidential or proprietary for the purpose of production under 29 Del. C. Ch. 100, Delaware Freedom of Information Act. |
| NO - Vendor is not providing any information they declare to be confidential or proprietary for the purpose of production under 29 Del. C. Ch. 100, Delaware Freedom of Information Act. |
| YES - Vendor is submitting exceptions for consideration. |
| NO - Vendor is not submitting any exceptions to the specifications, terms, or conditions found in this solicitation. |
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