5-HSS-26-066 - AppC-Vendor Frms.xlsx

26 KB Posted

Attached to
CAREGIVER RESOURCE CENTERS
Solicitation number
HSS-26-066
Issued by
Delaware

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This file contains vendor forms and attachments for solicitation 5-HSS-26-066 issued by the State of Delaware, Office of Management and Budget, Government Support Services, in conjunction with the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) for Caregiver Resource Centers (CRC). The solicitation seeks to establish community-based access points that provide information, assistance, referrals, outreach, education, and access to services and assistive technologies supporting unpaid caregivers. The CRCs will serve as hubs within caregiver action networks, delivering person-centered services to help caregivers navigate their caregiving journeys throughout the continuum of care.

The vendor forms package includes required submissions for interested bidders: a Vendor Information Sheet requesting company details, diverse vendor certifications, contact information, and business capability statements; a Non-Collusion Statement requiring certification of fair competitive bidding practices and acceptance of solicitation terms; an Exceptions Form allowing vendors to propose minor modifications to terms and conditions; a Confidentiality Form for designating proprietary or trade secret information; a Business References section requiring minimum three references of similar scope; and a Subcontractor Form for vendors utilizing subcontractors, which must include subcontractor information, diverse certifications, work descriptions, and signatures from both the primary vendor and subcontractor. All vendor responses must be submitted in accordance with the State of Delaware's procurement procedures and public records requirements under 29 Del. C. Chapter 100.

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Other files

File Type Posted
7-HSS-26-066 - AppE-Budget Wkbk-CRC.xlsx XLSX spreadsheet
2-HSS-26-066 - CRC-AttA.docx DOCX document
3-HSS-26-066 - CRC-AttB.docx DOCX document
4-HSS-26-066 - CRC-AttC-OAAPS Mthly Rpt.xlsx XLSX spreadsheet
1-HSS-26-066 - CRC - Final.docx DOCX document
6-HSS-26-066 - AppD-Templates-PSA, BAA DTI TCs.docx DOCX document

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Attachment2Vendor Info Sheet

Vendor Information Sheet
Company Name
DBA (if Applicable)
Purchase Order Address
Website
Diverse Vendor Self-Identification
State Certified (select drop down of "Yes" or "No")If yes, which State(s):
Federal Certified (select drop down of "Yes" or "No")
Desginated ContactsPrimarySecondary
Contact Name
Role/Title
Phone Number
Email
Business Capability Statement
(Provide a short capability statement about your business and its capabilities and skills to advertise who you are and what you do.)

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Attachment3Non-Collusion Stmt

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 solicitation, and further certifies that it is not a
sub-contractor to another Vendor who also submitted a bid/proposal as a primary Vendor in
response to this solicitation submitted this date to the State of Delaware, Office of Management and
Budget, Government Support Services.
It is agreed by the undersigned Vendor that the signed submission of this bid/proposal represents,
subject to any express exceptions set forth on the Exception form, 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, Office of Management and
Budget, Government Support Services.
Company Name
DBA (if applicable)
Name of Authorized Representative
Title
Phone Number
Email Address
Company Address
Phone Number
Email Address
Tax ID Number
AFFIRMATION: Within the past five (5) 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?
Select "Yes" or "No" from the drop down menu
If yes, explain

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Attachment4Exceptions Form

Exceptions Form
Responding Vendors may elect to take minor exceptions to the terms and conditions of this solicitation.
All exceptions must be submitted below. Exceptions found elsewhere in the solicitation response will not be considered. Government Support Services maintains sole discretion to reject any exceptions.
Exceptions
Paragraph & Page # of DocumentCurrent Language stated in the documentProposed Alternative languageJustification for proposed changeState of Delaware's responseBidder's response

If addition space is needed, please copy the format of this worksheet and attach as an additional file in your submission

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Attachment5Confidentiality Form

Confidentiality Form
Responding vendor may elect to designate sections of their proposal as confidential, intellectual property, trade secrets, and other confidential business information. Vendor shall explain below how the redacted information is not “public record” as defined by 29 Del. C. § 10002. The State shall independently determine the validity of any vendor designation as set forth in this section. Any vendor submitting a bid/proposal herein expressly accepts the State’s absolute right and duty to independently assess the legal and factual validity of any information designated as confidential business information.
Confidential Information (select "Yes" or "No" on the dropdown)
Confidentiality and Proprietary Information

If addition space is needed, please copy the format of this worksheet and attach as an additional file in your submission

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Attachment 6Business References

Business References
List a minimum of three business references of similar size and scope.
Please do not list any State Employee(s) as a business reference. If Subcontractors are
identified, a minimum of three business references must also be provided for each
subcontractor.
Reference One
Contact Name
Contact Title
Business Name
Address
Email
Phone
Current Vendor?
Work Performed
Reference Two
Contact Name
Contact Title
Business Name
Address
Email
Phone
Current Vendor?
Work Performed
Reference Three
Contact Name
Contact Title
Business Name
Address
Email
Phone
Current Vendor?
Work Performed

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Attachment7Subcontractor Form

Subcontractor
Are you proposing the use of any subcontractors in the fulfillment of the requirements as outlined in the solicitation?
(Please select "Yes" or "No" in the drop down menu)
If yes, complete this form.
Responding Vendor Information
Company Name
DBA (if applicable)
Company Address
Subcontractor Information
Company Name
DBA (if applicable)
Company Address
Diverse Vendor Self-Identification
State CertifiedIf yes, which State(s):
Federal Certified
Description of Work by Subcontractor
Once completed, this form must be signed by both vendors.
Proposing VendorSubcontractor
Authorized Signature:Authorized Signature:
Name:Name:
Title:Title:
Date:Date:

DropDowns

YES
NO
YES - Vendor is providing any information they declare to be confidential or proprietary for the purpose of production under 29 Del. C. Ch. 100, Delaware Freedom of Information Act.
NO - Vendor is not providing any information they declare to be confidential or proprietary for the purpose of production under 29 Del. C. Ch. 100, Delaware Freedom of Information Act.
YES - Vendor is submitting exceptions for consideration.
NO - Vendor is not submitting any exceptions to the specifications, terms, or conditions found in this solicitation.

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