2-Vendor Certification of Eligibility.pdf
PDF 88 KB Posted
- Solicitation number
- FDA20230301
- Issued by
- Harris County, Texas
About this file
This is a Vendor Certification of Eligibility form required by Harris County Hospital District d/b/a Harris Health System for participation in federal and state health care programs. The certification applies to vendors engaged for construction cost estimating services on an as-needed basis, which may include identifying cost factors, reading technical documents, preparing estimates, collaborating with design professionals, analyzing and adjusting estimates, recommending cost reduction strategies, and maintaining cost records for Harris Health construction projects encompassing hospitals, outpatient facilities, clinics, and specialty care centers.
Vendors and all their principals, including owners, officers, directors, employees, and key personnel, must certify that they are not listed on the General Services Administration's List of Parties Excluded from Federal Programs or the HHS/OIG List of Excluded Individuals/Entities. Harris Health screens all vendors upon engagement and annually thereafter against these exclusion lists. Vendors must immediately disclose to Harris Health's Corporate Compliance Office any placement on exclusion lists during the contract term and must report suspected violations of federal or state health care program requirements or Harris Health policies. Failure to comply with these requirements, including immediate termination of any principals placed on exclusion lists, will result in contract termination. Harris Health maintains a no-retribution, no-retaliation disclosure policy and provides a confidential hotline at 1-800-500-0333 for anonymous communications. The Corporate Compliance Office contact is (346) 426-1505.
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| 5-Service Agreement Template.docx | DOCX document | |
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| 8-FDA20260323 - Construction Cost Estimating Services for Harris Health.pdf | ||
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Text version
Attachment j
VENDOR CERTIFICATION OF ELIGIBILITY TO PARTICIPATE
IN FEDERAL AND STATE HEALTH CARE PROGRAMS
Background
The Harris County Hospital District d/b/a Harris Health System (“Harris Health”) participates in
Federal and State health care programs. As conditions of participation, neither Harris Health nor its vendors may be excluded from participation in any Federal or State health care program, and both Harris Health and its vendors must comply with all rules and regulations regarding the programs.
Harris Health screens all vendors upon engagement, and at least annually thereafter, against the
General Services Administration’s List of Parties Excluded from Federal Programs and the HHS/OIG List of Excluded Individuals/Entities (“LEIE/EPLS”) (collectively referred to as “exclusion lists”) to ensure that they are not listed on the exclusion lists. In addition, all vendors must disclose to Harris Health’s Corporate Compliance Office whether they or any of their owners, officers, directors, employees, or principals (collectively, “Principals”) are listed on the exclusion lists.
The contact information for Harris Health’s Corporate Compliance Office is:
Harris Health System Corporate Compliance Office
P.O. Box 300033 Houston, Texas 77230-0033
(346) 426-1505 (Phone)
Harris Health has a disclosure policy that emphasizes a no-retribution, no-retaliation policy and includes a reporting mechanism for anonymous communications for which confidentiality is maintained.
Harris Health has also arranged for a hotline service with an outside agency. The hotline’s phone number is 1-800-500-0333.
Certification
I hereby certify that neither the vendor who is listed below, nor any of its Principals, is on the exclusion lists. I further certify that the vendor will report immediately to Harris Health’s Corporate Compliance Office if either the vendor or any of its Principals becomes placed on the exclusion lists at any time in the future while the vendor is associated with Harris Health . I understand that if the vendor is now or subsequently become placed on the exclusion lists, Harris Health will terminate its contract(s) with vendor. I further understand that if the vendor fails to immediately terminate any of its Principals who become placed on the exclusion lists, Harris Health will terminate its contract(s) with vendor.
I further certify that the vendor understands that its Principals are expected to disclose or report to Harris Health’s Corporate Compliance Office, or other appropriate Harris Health designated individual, any suspected violation of any Federal or State health care program requirement or of Harris Health’s own policies and procedures.
Attachment j
Vendor Name
Address
City State Zip Code
Signature
Print Name
Title Phone Number
Email Address Date
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| VENDOR CERTIFICATION OF ELIGIBILITY TO PARTICIPATE |
| IN FEDERAL AND STATE HEALTH CARE PROGRAMS |
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