3-HSS-26-007 Emergency Response System - Attachment 2 - Non-Collusion Statement.docx
DOCX document 130 KB Posted
- Attached to
- Emergency Response Systems State and local contract opportunity
- Solicitation number
- HSS-26-007
- Issued by
- Delaware
About this file
This document is a Non-Collusion Statement for the Delaware Health and Social Services Division of Services for Aging and Adults with Physical Disabilities, related to Contract No. HSS-26-007 for Emergency Response Systems. The solicitation has a response deadline of October 30, 2025, at 1:00 PM EST, and seeks a vendor to provide an Electronic Response System (ERS) designed to promote safety for high-risk participants by enabling immediate emergency assistance through an electronic device that can signal a response center when help is needed.
The document includes provisions for vendor classification, with options to identify as a Minority Business Enterprise (MBE), Woman Business Enterprise (WBE), Disadvantaged Business Enterprise (DBE), Veteran Owned Business Enterprise (VOBE), or Service-Disabled Veteran Owned Business Enterprise (SDVOBE). Vendors are required to affirm their eligibility and disclose any federal, state, or local government suspensions or debarments within the past five years. The Non-Collusion Statement certifies that the vendor has not engaged in any collusive practices and represents the vendor's acceptance of the solicitation's terms and conditions, with the signature required to be from an authorized representative legally capable of entering into a formal contract with the state.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 1-HSS-26-007 Emergency Response System - FINAL REVISION.docx | DOCX document | |
| 7-HSS-26-007 Emergency Response System - Attachment 6 - Subcontactor Information Form.docx | DOCX document | |
| 2-HSS-26-007 Emergency Response System - Attachment 1 - Non Proposal Reply Form.docx | DOCX document | |
| 4-HSS-26-007 Emergency Response System - Attachment 3 - Exceptions Form.docx | DOCX document | |
| 6-HSS-26-007 Emergency Response System - Attachment 5 - Business References Form.docx | DOCX document | |
| 8-HSS-26-007 Emergency Response System - Appendix C - Templates for PSA, BAA and DTI TCs.docx | DOCX document | |
| 5-HSS-26-007 Emergency Response System - Attachment 4 - Confidential Information Form.docx | DOCX document |
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Text version
Delaware Health and Social Services
Division of Services for Aging and Adults with Physical Disabilities d
Attachment 2
| CONTRACT NO.: | HSS-26-007 |
| CONTRACT TITLE: | Emergency Response Systems |
DEADLINE TO RESPOND: 10/30/2025, at 1:00 PM EST
NON-COLLUSION STATEMENT
This is to certify that the undersigned Vendor has neither directly nor indirectly, entered into any agreement, participated in any collusion or otherwise taken any action in restraint of free competitive bidding in connection with this proposal, and further certifies that it is not a sub-contractor to another Vendor who also submitted a proposal as a primary Vendor in response to this solicitation submitted this date to the State of Delaware, Division of Services for Aging and Adults with Physical Disabilities.
It is agreed by the undersigned Vendor that the signed delivery of this bid represents, subject to any express exceptions set forth at Attachment 3, the Vendor’s acceptance of the terms and conditions of this solicitation including all specifications and special provisions.
NOTE: Signature of the authorized representative MUST be of an individual who legally may enter his/her organization into a formal contract with the State of Delaware, Division of Services for Aging and Adults with Physical Disabilities.
Corporation
Partnership
Individual
COMPANYNAME (Check one)
NAME OF AUTHORIZED REPRESENTATIVE
(Please type or print)
SIGNATURE TITLE
COMPANY ADDRESS
PHONE NUMBER FAX NUMBER
| EMAIL ADDRESS | ______________________________ | ||
| STATE OF DELAWARE | |||
| FEDERAL E.I. NUMBER | LICENSE NUMBER_____________________________ |
COMPANY CLASSIFICATIONS:
CERT. NO.: __________________
| Certification type(s) |
| Circle all that apply |
| Minority Business Enterprise (MBE) | |
| Yes | No |
| Woman Business Enterprise (WBE) | |
| Yes | No |
| Disadvantaged Business Enterprise (DBE) | |
| Yes | No |
| Veteran Owned Business Enterprise (VOBE) | |
| Yes | No |
| Service-Disabled Veteran Owned Business Enterprise (SDVOBE) | |
| Yes | No |
[The above table is for informational and statistical use only.]
PURCHASE ORDERS SHOULD BE SENT TO:
(COMPANY NAME)
ADDRESS
CONTACT
PHONE NUMBER FAX NUMBER
EMAIL ADDRESS
AFFIRMATION: Within the past five years, has your firm, any affiliate, any predecessor company or entity, owner, Director, officer, partner or proprietor been the subject of a Federal, State, Local government suspension or debarment?
YES NO if yes, please explain image1.png image2.png
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