5-Certification of Non-Debarment 03-14-24.pdf
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- Attached to
- Janitorial Services Staffing Augmentation
- Solicitation number
- 26-07128
- Issued by
- San Bernardino County, California
About this file
This Certification of Non-Debarment form, dated March 14, 2024, is a required submission for vendors bidding on Inland Empire Health Plan's (IEHP) Request for Proposal #26-07128 for Janitorial Services Staffing Augmentation in California. The document requires authorized firm representatives to attest that their organization is not excluded, ineligible, or terminated from participation in state or federal health care programs. The RFP seeks qualified vendors to provide temporary janitorial staffing across eight IEHP facility locations in Riverside and San Bernardino counties, with services including trash removal, restroom sanitation, floor care, surface disinfection, glass cleaning, and project-based work. Personnel must work both day shift (7:00 AM-6:00 PM) and swing shift (5:00 PM-1:30 AM) under IEHP's Environmental Services Supervisor direction. Questions are due by 5:00 p.m. PT on May 15, 2026, with proposals due by 2:00 p.m. PT on May 29, 2026. The initial contract term is one year with up to four optional one-year renewal periods at IEHP's discretion.
All assigned personnel must possess commercial janitorial experience and current California Janitorial Service Providers Registry registration per AB 1978, along with OSHA safety training, hazard communication certification, bloodborne pathogen protocols training, and chemical handling knowledge. IEHP provides all cleaning supplies, chemicals, equipment, and personal protective equipment; contractors must supply only labor. Pricing proposals must include fully inclusive blended hourly rates for Environmental Service Technician I and II positions, with separate overtime rates. Evaluation criteria allocate 65 points to scope and company qualifications, 30 points to pricing, and 5 points for local preference, with an additional 10 points possible for demonstrations or interviews. Bidders within Riverside or San Bernardino counties with a physical office and six-month operational history are eligible for five local preference points. All bidders must comply with non-discrimination provisions, conflict of interest restrictions, and provide certifications of non-debarment, non-collusion declarations, workers' compensation insurance evidence, commercial general liability coverage with minimum cyber liability insurance of $3 million, business licenses, W-9 forms, background checking procedures, references, organizational charts, and proof of three similar contracts awarded within the past three years.
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Certification of Non-Debarment 03-14-2024
CERTIFICATION
As an authorized representative of my Firm/Company/Sole Proprietorship, I hereby attest that my Firm/Company/Sole Proprietorship is not excluded, ineligible, or terminated from participation in State or Federal health care programs and does not appear on any of the following lists:
a. The Department of Health & Human Services (DHHS), Office of Inspector General (OIG), and List of Excluded Individuals and Entities (LEIE). Please visit https://exclusions.oig.hhs.gov.
b. General Services Administration (GSA), and the System for Award Management (SAM.gov). Please visit https://www.sam.gov.
c. California Department of Health Care Services (DHCS), and Medi-Cal Suspended and Ineligible Provider List (S&I List). Please visit http://files.medical.ca.gov/pubsdoco/SandILanding.asp.
d. Medicare Opt-Out List. Please visit https://data.cms.gov/dataset/Opt-Out- Affidavits/7yuw-754z.
I further attest that if selected, my Firm/Company/Sole Proprietorship will conduct regulatory sanction and exclusion screenings of subcontracted entities prior to engagement with said entities and monthly thereafter.
I understand that if my Firm/Company/Sole Proprietorship becomes excluded, ineligible, or terminated from participation in State and Federal health care programs, any contracts held with IEHP will be subject to immediate termination for cause.
RFP Name/Number:
Signature: Date:
Title of Agent/Officer:
"Execution hereof is certification that the undersigned has read and understands the terms and conditions hereof, and that the undersigned's principal is fully bound and committed."
https://exclusions.oig.hhs.gov/ https://www.sam.gov/ http://files.medical.ca.gov/pubsdoco/SandILanding.asp https://data.cms.gov/dataset/Opt-Out-Affidavits/7yuw-754z https://data.cms.gov/dataset/Opt-Out-Affidavits/7yuw-754z
| RFP NameNumber: |
| Date: |
| Title of AgentOfficer: |
| Signature2_es_:signer:signature: |
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