5-Appendix D Letter of Tansmittal Form.pdf
PDF 178 KB Posted
- Attached to
- All Payers Claims Database State and local contract opportunity
- Solicitation number
- 26-665-3030-78227
- Issued by
- New Mexico
About this file
This document is a Letter of Transmittal Form for Request for Proposal (RFP) #26-665-3030-78227, which requires potential offerors to complete the form in its entirety. The form is designed to collect key organizational information and authorize specific individuals to represent the offeror in various capacities, including contractually obligating the organization, negotiating, and responding to queries. Failure to properly sign and submit this form will result in disqualification of the proposal.
The form requires detailed information including the offeror's name, mailing address, telephone number, federal and New Mexico business tax identification numbers. Additionally, the form asks offerors to indicate whether subcontractors or other entities will be involved in contract performance. By signing, the authorized representative attests to the accuracy of the provided information, accepts the RFP's conditions of procurement, acknowledges evaluation factors, and confirms receipt of any amendments to the RFP.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 2-Appendix A Acknowledgement of Receipt Form.pdf | ||
| 7-Appendix F Detailed Scope of Work.pdf | ||
| 1-26-665-3030-78227 All Payers Claims Database.pdf | ||
| 10-Appendix I System Hosting Evaluation Questionnaire.pdf | ||
| 3-Appendix B Campaign Contribution Disclosure Form.pdf | ||
| 4-Appendix C Draft Agreement.pdf | ||
| 9-Appendix H Information Technology Requirements.pdf | ||
| 6-Appendix E Organizational Reference Questionnaire.pdf | ||
| 8-Appendix G Cost Response Form.pdf | ||
| 11-Appendix J Client List Form.pdf | ||
| 12-Pre-Proposal Conference Link.pdf |
Show all 11
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Text version
APPENDIX D
LETTER OF TRANSMITTAL FORM
LETTER OF TRANSMITTAL FORM
Please complete this form in its entirety. Failure to sign and/or submit this form will result in the disqualification of Offeror’s proposal.
RFP#:26-665-3030-78227
1. Identify the following information for the submitting organization:
Offeror Name Mailing Address Telephone
FED TIN#
NM BTIN#
2. Identify the individual(s) authorized by the organization to (A) contractually obligate, (B) negotiate, and/or (C) clarify/respond to queries on behalf of this Offeror:
A Contractually Obligate
B Negotiate*
C Clarify/Respond to Queries*
Name Title E-mail Telephone
* If the individual identified in Column A also performs the functions identified in Columns B & C, then no response is required for those Columns. If separate individuals perform the functions in Columns B and/or C, they must be identified.
3. Will any subcontractor/s be used in the performance of any resultant contract? (Select one):
____ No.
____ Yes. Identify subcontractor/s: _______________________________________________
4. Will any other entity/-ies (such as a State Agency, reseller, etc., that is not a subcontractor identified in #3 above) be used in the performance of any resultant contract? (Select one) ____ No.
____ Yes. Identify entity/-ies: ___________________________________________________
By signing the form below, the Authorized Signatory attests to the accuracy and veracity of the information provided on this form, and explicitly acknowledges the following:
• On behalf of the submitting-organization identified in item #1, above, I accept the Conditions Governing the Procurement, as required in Section II.C.1. of this RFP;
• I concur that submission of our proposal constitutes acceptance of the Evaluation Factors contained in Section V of this RFP; and
• I acknowledge receipt of any and all amendments to this RFP, if any.
Sign: ________________________________________________ Date:
(Must be signed by the individual identified in item #2.A, above.)
File details come from the government source that posted it. Updated .