2023 Attachment F Certification Requirements for Responsiveness.pdf
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- Attached to
- Accident and Sickness (CAMP) Insurance ITB
- Solicitation number
- ITB-03867
- Issued by
- Florida
About this file
This document is the Attachment F Certification Requirements for Responsiveness for ITB No 23-84131600 Accident and Sickness (CAMP) Insurance issued by the State of Florida Department of Management Services. The Attachment F outlines the certifications the bidder must provide including being in compliance with applicable state disclosure requirements, not being on suspended or convicted vendor lists, being registered to do business in Florida, and having the required insurance licenses and certificates of authority. The bidder also certifies that their key personnel have the required experience and that they have provided the requested pricing and insurer information. The bidder must sign the document to acknowledge and certify compliance with all of the listed responsiveness requirements.
The Attachment F is part of the solicitation process for the Accident and Sickness (CAMP) Insurance contract for the State of Florida. The contract term, renewal options, and other salient contract details are not provided in this attachment. The pricing terms, funding requirements, and other commercial details are also not included in this document, which focuses solely on the bidder's certification of compliance with the responsiveness requirements.
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Text version
ITB No 23-84131600-ITB
Accident and Sickness (CAMP) Attachment F
Certification Requirements for Responsiveness
The person submitting the Bid and its pricing certifies to being authorized by the Bidder to respond to this solicitation on the Bidder’s behalf.
The Bidder certifies it is in compliance with all applicable disclosure requirements set forth in section 286.101, F.S., and has not been deemed ineligible for a grant or contract funded by a state agency pursuant to section 286.101(7), F.S.
The Bidder certifies that the Bidder is not on the Suspended Vendor List maintained pursuant to section 287.042(1)(a) F.S., and 287.1351 F.S., and neither the Bidder nor any supplier, subcontractor, nor consultant included in its Bid are on the Convicted Vendor, Discriminatory Vendor, or Antitrust Violator Vendor Lists specified in Paragraphs 7 and 8 of the PUR1001 form, as modified by the Special Instructions section of the ITB.
The Bidder certifies that the Bidder is in compliance with Section 9 of the PUR1001 form, as modified by the Special Instructions section of the ITB.
The Bidder certifies that the Bidder is not on the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or the Scrutinized Companies that Boycott Israel List nor is it engaged in a boycott of Israel.
The Bidder certifies that if awarded a Contract, and prior to execution of a contract, it shall provide a PDF file of its current and active registration with the Florida Department of State, Division of Corporations, or, if exempt from registration, a statement to that effect noting the basis for the exemption. If Bidder is an out-of-state corporation, it certifies it will provide a Florida Certificate of Authority from the Florida Department of State, Division of Corporations prior to Contract execution.
Website: www.sunbiz.org.
NOTE: Foreign entities are required to obtain a Florida Certificate of Authority pursuant to applicable Florida Statutes from the Florida Department of State, Division of Corporations, to transact business in the State of Florida.
The Bidder certifies that the Bidder is in compliance with section 448.095(2)(a), F.S., and that within the last year (i.e., within the last 365 days), it has not had a contract terminated under section 448.095(2)(c), F.S., by a public employer, as defined by section 448.095(1)(i), F.S.
The Bidder certifies that the Broker’s key management personnel assigned to securing the Insurance Policy will maintain current and active insurance license(s) required to provide the services contemplated herein.
The Bidder certifies that the Bidder and the selected Insurer possess a valid and current certificate of authority to transact insurance, in accordance with section 624.404, Florida Statutes, or are an eligible surplus lines insurer in accordance with section 626.918, Florida Statutes.
The Bidder certifies that it and the selected Insurer each have 10 years of experience in the placement and account management of the insurance coverage described in this ITB.
The Bidder certifies it has provided the Department with pricing on Attachment B, Price Sheet.
The Bidder certifies it has provided the Department with the Insurer Quotation and AM Best Rating.
Signature below certifies that Bidder conforms with all Responsiveness Requirements listed above. Signature below further certifies acknowledgment of the Bidder’s ongoing duty to provide updates to the Procurement Officer should a change in Bidder’s circumstance render these certifications no longer true.
Bidder’s Name
Signature of Bidder’s Authorized Representative Date https://www.dms.myflorida.com/content/download/2934/11780 http://www.sunbiz.org/
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