3-HSS-26-013 - Personal Attendant Services - Attachment 2 - Non-Collusion Statement.docx
DOCX document 134 KB Posted
- Attached to
- PERSONAL ATTENDANT SERVICES (PAS) State and local contract opportunity
- Solicitation number
- HSS-26-013
- Issued by
- Delaware
About this file
This document is a Non-Collusion Statement for a contract (No. HSS-26-013) issued by the Delaware Health and Social Services Division of Services for Aging and Adults with Physical Disabilities for Personal Attendant Services. The solicitation has a response deadline of 11/26/2025 at 1:00 PM EST, and requires vendors to certify they have not engaged in any collusive bidding practices. The contract is for providing personal attendant services (PAS) that support individuals with disabilities in performing daily living activities, including assistance with bathing, dressing, personal hygiene, meal preparation, shopping, housekeeping, transportation, and communication.
The document includes provisions for vendor classification, with optional certifications for Minority Business Enterprise (MBE), Woman Business Enterprise (WBE), Disadvantaged Business Enterprise (DBE), Veteran Owned Business Enterprise (VOBE), and Service-Disabled Veteran Owned Business Enterprise (SDVOBE). Vendors must disclose any federal, state, or local government suspensions or debarments within the past five years. The form requires detailed vendor information, including company name, authorized representative, contact details, and a signature from an individual legally authorized to enter into a formal contract with the State of Delaware.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 2-HSS-26-013 - Personal Attendant Services - Attachment 1 - No Proposal reply Form.docx | DOCX document | |
| 5-HSS-26-013 - Personal Attendant Services - Attachment 4 - Confidential Information Form.docx | DOCX document | |
| 1-HSS-26-013 - Personal Attendant Services - Final.docx | DOCX document | |
| 4-HSS-26-013 - Personal Attendant Services - Attachment 3 - Exceptions Form.docx | DOCX document | |
| 6-HSS-26-013 - Personal Attendant Services - Attachment 5 - Business References Form.docx | DOCX document | |
| 7-HSS-26-013 - Personal Attendant Services - Attachment 6 - Subcontractor Information Form.docx | DOCX document | |
| 8-HSS-26-013 - Personal Attendant Services - Appendix D - Templates - PSA, BAA, DTI TCs.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-26-013 |
| CONTRACT TITLE: | Personal Attendant Services |
DEADLINE TO RESPOND: 11/26/2025 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
File details come from the government source that posted it. Updated .