3. Survey Tool RFB - Attachment B - Vendor Checklist - S-0637 DES-17.docx
DOCX document 39 KB Posted
- Attached to
- DHS Survey Tool
- Solicitation number
- S-0637 DES-17
- Issued by
- Wisconsin
About this file
This is a vendor checklist attachment for a Request for Bid (RFB) issued by the Wisconsin Department of Health Services (DHS) for a cloud-based enterprise survey tool. The checklist serves as a compliance verification document that vendors must complete and submit as part of their bid response. Vendors are required to acknowledge their compliance with all listed requirements by checking designated boxes, and omission of any required materials may result in bid rejection. The survey tool procurement seeks licensing for 150 users with Active Directory authentication integration using Secure Active Directory Federated Services (ADFS), with the solution to be cloud-based and vendor-supported while administered by DHS staff.
The vendor checklist mandates completion and submission of numerous supporting documents and forms, including the Request for Bid Cover Page (DOA-3070), Vendor Information Form (DOA-3477), Vendor Reference Form (DOA-3478), Vendor Agreement (DOA-3333), Certification Regarding Debarment and Suspension (F-01788), and financial statements. Vendors must also complete the Designation of Confidential and Proprietary Information Form (DOA-3027), provide a completed price sheet (Attachment A), acknowledge Wisconsin Standard Terms and Conditions (DOA-3054) and Supplemental Standard Terms and Conditions for Services (DOA-3681), and agree to provide temporary access to the survey tool upon request to allow DHS to validate compliance with mandatory specifications. All solicitation amendments, if applicable, must also be completed and signed as part of the bid submission.
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Other files
| File | Type | Posted |
|---|---|---|
| 2. Survey Tool RFB - Attachment A - Cost Sheet - S-0637 DES-17.xlsx | XLSX spreadsheet | |
| 1. Survey Tool RFB - S-0637 DES-17.pdf | ||
| 4. Survey Tool RFB - Attachment C - Solicitation Questions S-0637 DES-17.docx | DOCX document |
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Text version
DHS Survey Tool
Attachment B – Vendor checklist
Instructions: This form must be complete by marking the check boxes shown below. By marking these boxes, you are acknowledging compliance with these items. Omission of any required materials may result in the rejection of your Bid.
| Request for Bid Cover Page (DOA-3070) |
| ☐ Completed and Signed |
TAB 1
| Section 2 – Vendor Qualifications |
| ☐ Read and Agree |
TAB 2
| Section 3 – Mandatory Specifications |
| ☐ Read and Agree |
TAB 3
| Section 4 – Contract Terms and Conditions |
| ☐ Read and Agree or submitted point-by-point exceptions |
| · Wisconsin Standard Terms and Conditions (DOA-3054) |
| ☐ Read and Agree |
| · Supplemental Standard Terms and Conditions for Services (DOA-3681) |
| ☐ Read and Agree |
TAB 4
| Section 5 – Bid Procedure and Instructions |
| ☐ Read and Agree |
| · Upon request the vendor must provide temporary access to the survey tool to allow DHS to validate each mandatory specification. |
| ☐ Read and Agree |
TAB 5
Section 7 – Required Forms and Additional Documentation
| · Vendor Information Form (DOA-3477) |
| ☐ Completed |
| · Vendor Reference Form (DOA-3478) |
| ☐ Completed |
| · Vendor Agreement (DOA-3333) - see Section 1.6 |
| ☐ Completed |
| · Designation of Confidential and Proprietary Information Form (DOA-3027) |
| ☐ Completed |
| · Certification Regarding Debarment and Suspension (F-01788) |
| ☐ Completed |
| · Disclosure Statement – see Section 7.2 |
| ☐ Completed |
| · Financial Statements – see Section 7.3 |
| ☐ Completed |
| All Solicitation Amendments (if applicable) |
| ☐ Completed and Signed |
| Attachment A – Price Sheet |
| ☐ Completed |
| Attachment B – Bidder Checklist |
| ☐ Completed and Signed |
Vendor Name
Authorized Signature Date
S-0637 DES-17 Page 1 of 1
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