4-GFE Docs.xlsx

XLSX spreadsheet 197 KB Posted

Attached to
Medical Navigation Program
Solicitation number
RFP260124
Issued by
Bath County, Kentucky

About this file

This file comprises Good Faith Efforts (GFE) documentation forms required by Louisville Metro Government for the Medical Navigation Program, a 911 Medical Call Diversion Program seeking to redirect low-acuity medical calls from Emergency Medical Services to appropriate alternative care pathways. The program will triage callers meeting defined criteria through medical professionals via phone and develop individualized care pathways, which may include in-home instructions, referrals to appropriate medical facilities, primary care provider contact, telehealth services, and arranged transportation. Bidders must complete and submit the GFE forms with their bid documents on Bonfire, allowing the Human Relations Commission to review the documentation. The forms must be submitted in their entirety; incomplete submissions will be rejected.

The GFE documentation requires bidders to disclose their subcontracting and self-performance work plans, along with detailed subcontractor information including legal business names, contact persons, addresses, federal tax identification numbers, and email addresses. Louisville Metro Government has established minority, female, and historically disadvantaged business enterprise (MFHBE) participation goals, including a 15 percent Minority Business Enterprise (MBE) goal, 5 percent Female Business Enterprise (FBE) goal, and 0.5 percent Historically Disadvantaged Business Enterprise (HBE) goal. Bidders must document their good faith efforts to solicit quotes from certified MFHBE subcontractors and suppliers, including evidence of contact attempts, quotes received, quote amounts as percentages of the total bid, and reasons for accepting or rejecting quotes. Additional documentation supporting good faith efforts must be attached. All forms require signature by a company official and must be submitted to the Louisville Metro Human Relations Commission at 745 W. Main Street, Suite 251, Louisville, Kentucky 40202.

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Other files

File Type Posted
5-Vendor Information.pdf PDF
7-Submission Instructions - RFP260124.pdf PDF
3-Ban the Box Compliance Checklist.pdf PDF
1-RFP260124 Specifications.pdf PDF
6-W9.pdf PDF
2-Acknowledgements Preferences.pdf PDF

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Text version

GFE 1

LOUISVILLE METRO GOVERNMENTTHIS FORM MUST BE COMPLETED IN ITS ENTIRETY
GOOD FAITH EFFORTS ("GFE')FAILURE TO DO SO, THIS FORM WILL BE REJECTED
SUBCONTRACTOR AND SELF-PERFORM WORK LIST
DUE WITH BID DOCUMENTS ON BONFIRE. ALLOW HRC TO VIEW DOCUMENT.
Bidder Name:Total Bid Amount:
MBEFBEHBELocal VendorEmail Address:
Bid Number:Project Name:
For more information about this form contact Louisville Metro Human Relations Commission • 745 W. Main Street, Suite 251 • Louisville, KY 40202 • 502-574-3631 phone • 502- 574-4332 TDD
DIVISIONS OF WORK (BIDDER WILL SELF-PERFORM)DIVISIONS OF WORK (UNDETERMINED WHO WILL PERFORM)
ALL (CHECK HERE IF YOU ARE NOT SUBCONTRACTING ANY WORK)

SUBCONTRACTOR INFORMATION

LEGAL BUSINESS NAME

CONTACT PERSON'S NAMELOCAL VENDOR SUPPLIER
DIVISION OF WORKSUB AMOUNT% of Total BidCERTIFIED SUBCONTRACTOR
STREET ADDRESSCITYSTZIPFederal Tax ID #Email AddressSUPPLIERMBE GOAL (15%)FBE GOAL (5%)HBE GOAL (.5%)

Total

Signature of Company Official:Office Use Only
Printed Name:Form Status:
Complete
Date:Incomplete (reason form was rejected)
Signature missing
Subcontractor information not completed
Bidder information not completed
Divison of work section not completed

&"Arial,Bold"&12Form GFE-1

GFE 2

LOUISVILLE METRO GOVERNMENT
GOOD FAITH EFFORTS ("GFE")
MFHBE SUBCONTRACTOR GFE LOG
DUE WITH BID DOCUMENTS ON BONFIRE. ALLOW HRC TO VIEW DOCUMENT.
Bidder Name:Bid Total:
Bid Number:Project:
Fax or mail this form to Louisville Metro Human Relations Commission • 745 W. Main Street, Suite 251 • Louisville, KY 40202 502-574-3631 phone • 502-

574-3577 fax • 502- 574-4332 TDD

NAME OF MFHBEREQUESTBID ACTIVITY
SUBCONTRACTORS/SUPPLIERS CONTACTEDDIVISION OF WORKFOR QUOTES
(A t t a c h)No ResponseQuote
Received (Attach)Quote Amount% of Bid TotalQuote UsedQuote RejectedReason for Rejection

Other Good Faith Efforts (Attach Supporting Documentation)

Signature of Company Official:
Printed Name:Date:

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