2 RFA Cover Sheet and Application Music DMHMUS-25-35~1.docx

DEPARTMENT OF MENTAL HEALTH

RFA COVER SHEET AND APPLICATION

RFR Number: BD-25-1022-DMH08-8210C-113384

RFR Title: Request For Application for Musical Instruments and Accessories Purchase Maintenance and Repairs Master Agreement

Bidder Information:

Name:

Address:

Tax Identification #: _________________________

Contact Person Name:

Contact Person Phone:

Contact Person Email:

Contact Person FAX:

SIGNATURE: (must be an individual authorized to negotiate for and execute the contract on behalf of the Bidder)

(Signature)

(Print Name)

(Title)

(Date)

Response Categories Check all that apply.

__ Item Purchases (to include service maintenance and repair)

__ Items Service Maintenance and/or Repair

Experience

___ Bidder has at least three (3) years of experience providing leasing, renting, servicing or outright purchase of washers and dryers to designated locations.

In the case of companies formed fewer than three (3) years prior to this date via merger, acquisition or some other means, the SST may consider the experience of all companies involved in the merger or acquisition.

___ Provide attachment describing details of exception to three-year requirement.

Instruments

Please list instruments that you are certified to repair:

INSTRUMENTS PURCHASE: Cost Plus _______% Markup (Delivery Included) Warranty: ______________________

REPLACEMENT PARTS: Cost Plus _______% Markup (Delivery Included) Warranty: ______________________

Service

LABOR $ Per hour per tech Normal Business Hours

RATES:

$ Per hour per tech Non-Business Hours

$ Per hour per tech Holidays

$ Per hour per tech Weekends

This price includes vendors pick up instruments cost from various sites, repair and return.

Please refer to the RFR for what is considered accepted hours for the above rates. Any exceptions must be approved by the RFR Procurement Team Leader before contract award.

WARRANTY:

Full warranty for parts and labor for a period of 3 years or manufacturer’s warranty, whichever is the greater. This period will begin on date of final acceptance signed off by the Department of Mental Health indicating that the instruments have been up and running in complete condition for a minimum of 30 days.

Application:

If bidders would like to add additional warranty terms to increase or add to the required warranty, enter that information here:

Please Enter the information below

LABOR WARRANTY:

RETURN POLICY:

___ Bidder Affirms the following regarding solvency and debarment:

Solvency Applicants must not be currently in bankruptcy or receivership or have been in bankruptcy and/or receivership within the last three (3) calendar years.

a. Applicants must have at least three (3) months of adequate reserves.

b. Applicants must have no outstanding liabilities to the Internal Revenue Service, the Massachusetts Department of Revenue. or any other government agencies.

c. Applicants must not be subject to any charges, complaints, or other claims now pending before any court, regulatory board, or government agency that could have an impact on their stability or ability to provide services under the RFR.

___ Debarment Applicants must not be subject to a federal or state debarment order. DMH cannot award a contract to a provider that is currently subject to a Massachusetts or federal debarment order.