5-HSS-26-035- Attachment 2 - Non-Collusion Stmt.docx
DOCX document 129 KB Posted
- Attached to
- Substance Use Disorder Services
- Solicitation number
- HSS-26-035
- Issued by
- Delaware
About this file
This is a Non-Collusion Statement attachment for a substance use disorder services contract issued by the Delaware Health and Social Services Division of Substance Abuse and Mental Health. The contract, identified as HSS-26-035, seeks proposals from qualified providers to operate a comprehensive range of substance use disorder services for uninsured and underinsured Delaware residents. The services must align with the American Society of Addiction Medicine (ASAM) Criteria and principles while addressing individuals' medical, social, and behavioral health needs, including substance use disorders with or without co-occurring mental health disorders. Proposals are due March 26, 2026, at 1:00 PM EST. The statement certifies that the bidding vendor has not engaged in collusion, agreements restraining competitive bidding, or conflicts of interest related to this solicitation.
The Non-Collusion Statement requires authorized representatives to provide company information, including name, address, contact details, Federal E.I. Number, and license number. Vendors must indicate their business classifications and certifications, including 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) status. The form also requires affirmation regarding any prior Federal, State, or Local government suspension or debarment of the firm, its affiliates, predecessor entities, or principal owners within the past five years. The signed statement represents the vendor's acceptance of all solicitation terms, conditions, specifications, and special provisions, subject to any exceptions noted in Attachment 3.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2-HSS-26-035 - Substance Use Diorder Services- Attachment 5 - Business References Form.docx | DOCX document | |
| 7-HSS-26-035 - Substance Use Diorder Services Attachment 4 - Confidential Information Form.docx | DOCX document | |
| 8-HSS-26-035 Substance Use Disorder Services.docx | DOCX document | |
| 1-HSS-26-035 - Substance Use Diorder Services - Attachment 6 - Subcontractor Information Form.docx | DOCX document | |
| 3-HSS-26-035 - Attachment 3 - Exceptions Form.docx | DOCX document | |
| 6-HSS-26-035 Appendix C BudgetTemplate SUPTRS.xls | XLS spreadsheet | |
| 4-HSS-26-035 Appendix D - Templates Sample Agreements.docx | DOCX document |
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Text version
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-26-035 |
| CONTRACT TITLE: | Substance Use Disorder Services |
DEADLINE TO RESPOND: Due 03/26/2026, 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
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