5-Attachment F -VENDOR CERTIFICATION OF ELIGIBILITY TO PARTICIPATE.pdf
PDF 287 KB Posted
- Solicitation number
- RFP 26/0004
- Issued by
- Harris County, Texas
About this file
This is a Vendor Certification of Eligibility document issued by Harris Health System (Harris County Hospital District) in Texas, establishing compliance requirements for vendors participating in federal and state health care programs. The document applies to the RFP 26/0004 for Inpatient Psychiatric Services, which seeks qualified vendors to provide inpatient behavioral health services for adult and adolescent patients beginning July 1, 2026, for a twelve-month term. Harris Health screens all vendors upon engagement and annually thereafter against the General Services Administration's List of Parties Excluded from Federal Programs and the HHS/OIG List of Excluded Individuals/Entities to ensure compliance with federal and state health care program participation requirements.
Vendors must certify that neither they nor any of their owners, officers, directors, employees, or principals are listed on exclusion lists, and must immediately report to Harris Health's Corporate Compliance Office if they or any principals become listed at any time during the contract term. Failure to comply with these requirements or to immediately terminate principals who become excluded will result in contract termination. Vendors must also disclose any suspected violations of federal or state health care program requirements or Harris Health policies to the Corporate Compliance Office or designated Harris Health representatives. Harris Health maintains a no-retribution, no-retaliation disclosure policy and provides an anonymous hotline service at 1-800-500-0333 for confidential reporting. The certification must be signed by an authorized vendor representative and submitted with contact information including name, title, address, phone number, email, and date.
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Other files
| File | Type | Posted |
|---|---|---|
| 2-Attachment C - HARRIS HEALTH GENERAL REQUIREMENTS.pdf | ||
| 10-RFP 26 0004 - SPECIFICATIONS AND SCOPE.docx | DOCX document | |
| 4-Attachment E - Subcontractor Listing Form.pdf | ||
| 3-Attachment D- Tax Residence Certification.pdf | ||
| 1-Attachment A - RFP and Addenda Acknowledgement.docx | DOCX document | |
| 7-Attachment G - Experience Form.docx | DOCX document | |
| 8-Attachment B - Minimum Requirements Checklist.xlsx | XLSX spreadsheet | |
| 9-Attachment H - Minimum Insurance Requirements.pdf | ||
| 6-Attachment B - Pricing Schedule.xlsx | XLSX spreadsheet |
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Text version
VENDOR CERTIFICATION OF ELIGIBILITY TO PARTICIPATE
IN FEDERAL AND STATE HEALTH CARE PROGRAMS
Background
The Harris County Hospital District d/b/a Harris Health System (“Harris Health”) participates in Federal and State health care programs. As conditions of participation, neither Harris Health nor its vendors may be excluded from participation in any Federal or State health care program, and both Harris Health and its vendors must comply with all rules and regulations regarding the programs.
Harris Health screens all vendors upon engagement, and at least annually thereafter, against the
General Services Administration’s List of Parties Excluded from Federal Programs and the HHS/OIG List of Excluded Individuals/Entities (“LEIE/EPLS”) (collectively referred to as “exclusion lists”) to ensure that they are not listed on the exclusion lists. In addition, all vendors must disclose to Harris Health’s Corporate
Compliance Office whether they or any of their owners, officers, directors, employees, or principals
(collectively, “Principals”) are listed on the exclusion lists.
The contact information for Harris Health’s Corporate Compliance Office is:
Harris Health System
Corporate Compliance Office
P.O. Box 300033 Houston, Texas 77230-0033
(713) 566-6461 (Phone)
Harris Health has a disclosure policy that emphasizes a no-retribution, no-retaliation policy and includes a reporting mechanism for anonymous communications for which confidentiality is maintained.
Harris Health has also arranged for a hotline service with an outside agency. The hotline’s phone number is 1-800-500-0333.
Certification
I hereby certify that neither the vendor who is listed below, nor any of its Principals, is on the exclusion lists. I further certify that the vendor will report immediately to Harris Health’s Corporate
Compliance Office if either the vendor or any of its Principals becomes placed on the exclusion lists at any time in the future while the vendor is associated with Harris Health . I understand that if the vendor is now or subsequently become placed on the exclusion lists, Harris Health will terminate its contract(s) with vendor. I further understand that if the vendor fails to immediately terminate any of its Principals who become placed on the exclusion lists, Harris Health will terminate its contract(s) with vendor.
I further certify that the vendor understands that its Principals are expected to disclose or report to
Harris Health’s Corporate Compliance Office, or other appropriate Harris Health designated individual, any suspected violation of any Federal or State health care program requirement or of Harris Health’s own policies and procedures.
Vendor Name
Address
City State Zip Code
Signature
Print Name
Title Phone Number
Email Address Date
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