4-HSS-26-028- Attachment 2 - Non-Collusion Stmt.docx
DOCX document 129 KB Posted
- Attached to
- PROMISE Mental Health Group Homes
- Solicitation number
- HSS-26-028
- Issued by
- Delaware
About this file
This document is a Non-Collusion Statement for a contract issued by the Delaware Health and Social Services Division of Substance Abuse and Mental Health for PROMISE Mental Health Group Homes. The solicitation has a response deadline of January 12, 2026, at 1:00 PM EST, and requires vendors to certify that they have not engaged in any collusive bidding practices. The document is a formal procurement form that vendors must complete to participate in the contract opportunity, with spaces for company details, classification, and authorized representative information.
The form includes optional business classification certifications such as 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 also affirm whether they have been subject to federal, state, or local government suspensions or debarments within the past five years. The document serves as an official attestation of the vendor's integrity and eligibility for the PROMISE Mental Health Group Homes contract in Delaware, requiring a signature from an authorized representative who can legally enter into a contract with the state.
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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 2
| CONTRACT NO.: | HSS-26-028 |
| CONTRACT TITLE: | PROMISE Mental Health Group Homes |
DEADLINE TO RESPOND: Due 01/12/2026, 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 Substance Abuse and Mental Health
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 Substance Abuse and Mental Health.
Corporation
Partnership
Individual
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?
YES NO if yes, please explain image1.png image2.png
File details come from the government source that posted it. Updated .