3-HSS-26-026 Drug Court Diversion Services - Attachment 6 - Subcontractor Information Form.docx
DOCX document 126 KB Posted
- Attached to
- Syringe Services Program
- Solicitation number
- HSS-26-026
- Issued by
- Delaware
About this file
This document is a Subcontractor Information Form for the Delaware Health and Social Services (DHSS) Division of Substance Abuse and Mental Health, specifically for Contract No. HSS-26-026. The form is designed to capture detailed information about potential subcontractors, including their business classification status (such as Women Business Enterprise, Minority Business Enterprise, Disadvantaged Business Enterprise, and Veteran Owned Business Enterprise). The form requires vendors to provide comprehensive details about subcontractors, including their name, mailing address, description of work, and authorized signatory information.
The form is part of a broader solicitation for Syringe Services Program, which aims to provide harm reduction programming for people who use drugs (PWUD) and injection drug users (IDU). The context suggests this is part of Delaware's public health strategy to address HIV/AIDS, which affected 3,786 people in the state as of 2021. The document provides a template for vendors to disclose subcontractor information, emphasizing transparency and potentially promoting diversity and inclusion through the various business enterprise classifications that can be noted on the form.
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Other files
| File | Type | Posted |
|---|---|---|
| 8-HSS-26-026 - Attachment 3 - Exceptions Form.docx | DOCX document | |
| 6-HSS-26-026 - Statewide Syringe Services Program final 9.11.25.docx | DOCX document | |
| 4-HSS-26-026 Drug Court Diversion Services - Attachment 4 - Confidential Information Form.docx | DOCX document | |
| 2-HSS-26-026 Drug Court Diversion Services - Attachment 5 - Business References Form.docx | DOCX document | |
| 7-HSS-26-026- Attachment 2 - Non-Collusion Stmt.docx | DOCX document | |
| 1-Appendix - Budget Workbook.xlsx | XLSX spreadsheet | |
| 5-HSS-26-026 Appendix D - Templates Sample Agreements.docx | DOCX document |
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Text version
Delaware Health and Social Services
Division of Substance Abuse and Mental Health d
Delaware Health and Social Services
Division of Substance Abuse and Mental Health d
Attachment 6
SUBCONTRACTOR INFORMATION FORM
PART I – STATEMENT BY PROPOSING VENDOR
1. CONTRACT NO.
HSS-26-026
2. Proposing Vendor Name:
3. Mailing Address
4. SUBCONTRACTOR
a. NAME
4c. Company OSD Classification:
Certification Number: _____________________
b. Mailing Address:
4d. Women Business Enterprise |_| Yes |_| No 4e. Minority Business Enterprise |_| Yes |_| No 4f. Disadvantaged Business Enterprise |_| Yes |_| No 4g. Veteran Owned Business Enterprise |_| Yes |_| No 4h. Service Disabled Veteran Owned Business Enterprise |_| Yes |_| No
5. DESCRIPTION OF WORK BY SUBCONTRACTOR
6a. NAME OF PERSON SIGNING
| 7. BY (Signature) |
| 8. DATE SIGNED |
6b. TITLE OF PERSON SIGNING
PART II – ACKNOWLEDGEMENT BY SUBCONTRACTOR
9a. NAME OF PERSON SIGNING
| 10. BY (Signature) |
| 11. DATE SIGNED |
9b. TITLE OF PERSON SIGNING
* Use a separate form for each subcontractor image1.png image2.png
File details come from the government source that posted it. Updated .