4-HSS-24-049A - Congregate Nutrition Home Delivered Nutrition Services- Non-Collusion Statement -Attachment 2.pdf
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- Solicitation number
- HSS-24-049A
- Issued by
- Delaware
About this file
This is a Non-Collusion Statement attachment for Contract No. HSS-24-049A issued by the State of Delaware, Delaware Health and Social Services, Division of Services for Aging & Adults with Physical Disabilities. The contract pertains to Congregate & Home-Delivered Nutrition Services, which provide meals and related nutrition services to older Americans in both congregate settings and to homebound individuals. Congregate Nutrition Services include food and nutrient delivery, nutrition education, nutrition counseling, and other nutrition services designed to support the health and well-being of older adults while facilitating social engagement and volunteer opportunities. Home-Delivered Nutrition Services specifically serve homebound older individuals and function as a primary access point for other home and community-based services. The deadline to respond to this solicitation is March 31, 2026, at 4:30 PM EST.
The Non-Collusion Statement certifies that the vendor has not engaged in any agreement, collusion, or action that restrains free competitive bidding and confirms that the vendor is not a sub-contractor to another vendor also submitting a primary proposal. The form requires submission by an authorized representative legally able to bind the organization into a contract with the State of Delaware. Vendors must disclose company classifications including certification status 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). Additionally, vendors must affirm whether their firm, any affiliate, predecessor entity, or key personnel have been subject to federal, state, or local government suspension or debarment within the past five years.
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Text version
STATE OF DELAWARE
DELAWARE HEALTH AND SOCIAL SERVICES
DIVISION OF SERVICES FOR AGING & ADULTS
WITH PHYSICAL DISABILITIES
Attachment 2 - NON-COLLUSION STATEMENT
CONTRACT NO.: HSS-24-049A
CONTRACT TITLE: Congregate & Home-Delivered Nutrition services DEADLINE TO RESPOND: March 31, 2026, at 4:30 PM EST
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 & 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 & Adults with Physical Disabilities
COMPANY NAME __________________________________________________________________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?
Corporation
Partnership
Individual
STATE OF DELAWARE
DELAWARE HEALTH AND SOCIAL SERVICES
DIVISION OF SERVICES FOR AGING & ADULTS
WITH PHYSICAL DISABILITIES
YES NO if yes, please explain
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