26BRS042 RFQ with Specifications.pdf

REQUEST FOR

QUOTATION

STO-93 Rev. 10/01

VENDOR:

INSTRUCTIONS

Please quote us your prices on the commodities listed below.

All prices must be F.O.B. Destination and you must show

Unit Price, Amount, and Total or bid may be rejected.

Since the State of Connecticut is exempt from the payment of Federal Excise Taxes and the Connecticut Sales Tax, do not include such taxes.

We reserve the right to reject in whole or in part any or all bids submitted.

The contractor agrees and warrants that in the performance of this contract he will not discriminate or permit discrimination against any person or group of persons on the grounds of race, color, religious creed, age, marital status, national origin, sex, sexual orientation, learning disability, mental retardation or physical disability, including, but not limited to, blindness, unless it is shown by such contractor that such disability prevents performance of the work involved, in any manner prohibited by the laws of the United State or of the State of Connecticut.

If the contractor agrees and warrants that he will make good faith efforts to employ minority business enterprises as subcontractors and suppliers of materials on such project. The contractor further agrees to provide the

Commission Human Rights and Opportunities with such information requested by the Commission concerning the employment practices and procedures of the contractor as related to the provisions of this section and section 46a-56. For the purposes of this section "minority business enterprise" means any subcontractor or supplier of materials fifty-one percent or more of the capital stock, if any, or assets of which is owned by a person or persons: (1) Who are active in the daily affairs of the enterprise; (2) who have the power to direct the management and policies of the enterprise; and (3) who are members of a minority, as such term is defined in subsection (a) of section 32-9n.

This is not an order. Fill in and return to STATE OF CONNECTICUT at the address shown below.

ISSUED BY (Agency) (Return bid attention of)

Aging and Disability Services/Bureau of Rehabilitation Services Torrey Morse

BID NO.

26BRS042

AGENCY ADDRESS

55 Farmington Avenue, 12th floor, Hartford, CT 06105

DATE ISSUED

Sept. 9, 2026 7 am SHIP PREPAID TO (ABOVE AGENCY AT ADDRESS SHOWN.) (Unless other address is entered here)

New Britain, CT

DATE AND TIME BID REQUIRED

Sept. 23, 2026 4 pm

SIGNED (For Agency)

Torrey Morse

TITLE

Education Consultant

TELEPHONE NO.

(860) 424-4865/(860)876-9602

DATE MATERIAL REQUIRED

60 days

ITEM

No.

DESCRIPTION – REQUEST FOR QUOTE PRESCRIPTION REQUIREMENTS

AMOUNT

VEHICLE MODIFICATION FOR A PERSON WITH A DISABILITY

2026 Dodge RAM 1500 Warlock Edition with Crew Cab – ESMC #7580 VIN#3C6SRFGPXT4186045 …Vehicle on HOLD not purchased See Specifications below

VENDOR REQUIREMENTS:

• MUST BE NMEDA/QAP CERTIFIED IN GOOD STANDING AT TIME OF BIDDING and

PROVIDE IN-STATE SERVICE.

• MAINTAIN A RECORD of STANDARDIZED SERVICE PROVISION AND CUSTOMER SERVICE SATISFACTION WITH DORS AGENCY STAFF, SUBCONTRACTORS and

CONSUMERS.

• THE AGENCY MAY TERMINATE SERVICES IN WHOLE OR IN PART WHENEVER THE

AGENCY MAKES THE DETERMINATION THAT SUCH TERMINATION IS IN THE BEST

INTEREST OF THE CONSUMER and STATE.

• Due to current industry Supply and Demand challenges Vendor must have vehicle on hand to Bid.

RETURN BID TO: Torrey Morse at the email address E-MAIL: DORS.quotes@ct.gov

PHONE#: (860) 876-9602

All vendors must provide explanation for any item, device or system which is not identical to that specified in the Vehicle Evaluation Report but considered equivalent by the vendor.

Address all questions regarding prescribed equipment prior to bidding.

**Bid number must be referenced on the subject line when submitting by email.**

Entry

Interior

Primary

Controls

Secondary

Controls

Preparations

TOTAL: $

To b QUOTATION NO. DATE SUBMITTED DELIVERY AS REQ'D ABOVE (Unless noted here)

Completed SIGNED

TITLE TELEPHONE NO. & EXTENSION CASH DISCOUNT PAYMENT

TERMS

______%______days, NET 45

DAYS

by bidder VENDOR FEIN/SSN ARE YOU INCORPORATED

YES NO

PURCHASE ORDER ADDRESS (If different from bidder's address above) mailto:DORS.quotes@ct.gov

CT BRS Bid Breakdown

For Vehicle Modification

Date

BRS Bid Number: 26BRS042

BRS Bid Total: $

VM Vendor Name and Address Customer

Department of Aging and Disability Services Bureau of Rehabilitation Services 55 Farmington Avenue, 12th Floor Hartford, CT 06105 Phone: 860-424-4840 or 860-876-9602 Attn: Torrey Morse DORS.quotes@ct.gov

Item Description & ESMC RX #’s Quan. Per Total

Subtotal $

Tax Rate $

Sales Tax $

Inbound Shipping $

Total $

Authorized Signature Date

Additional Info:

Special Notation Section:

mailto:DORS.quotes@ct.gov

Client BRS 7580

Manual WHEETCHAIRINFORMATION

AI.I. DIMENSIONS IN INCHES UNIESS NOTED

DateofAssessment 7lL6l26 Make : _quickie_ Model: _Nitrum SN

Year lssued: _2 years ago- Weight of chair

-15-lbs Cushion Thickness

-3.5"-Type of Footrests ()Split or (X )Continuous Additional Features ( ) Recline ( )TiltinSpace ( )Seat Elevate

( )Solid or ()Removable ( )Joystick -Right -teft

G

A2

T- I I I I I I I I I

I

B _T

I I F c E

D

K L G2 F2

E?

J

H

A

B c

52"

4U' F2

G2

H2

Ground to back 29" / Folding Back

H2t

COMMENTS

ffi,ffiI l-

F _26" I _L _

A2 c2

D2

E2 _23.5 "

BRS 7580 WHEELCHAIR.pdf

BRS 7580 VER BLANK.pdf