6-Attachment 6 Subcontractor Information Form.docx

DOCX document 84 KB Posted

Attached to
VENUE FOR CONFERENCES AND COMMUNITY EVENTS
Solicitation number
HSS-26-022
Issued by
Delaware

About this file

This document is a Subcontractor Information Form from the Delaware Health and Social Services (DHSS) Division of Social Services for contract HSS-25-040. The form is designed to capture detailed information about potential subcontractors, including their business classification status (such as Women Business Enterprise, Minority Business Enterprise, Disadvantaged Business Enterprise, Veteran Owned Business Enterprise), contact details, and proposed work description. The form requires signatures from both the proposing vendor and the subcontractor, with spaces for authorized representatives to provide their names, titles, and dates of signing.

The form allows vendors to identify subcontractors and their specific business characteristics, which may be relevant for diversity, inclusion, or procurement preference considerations. While the form itself does not provide specific details about the associated contract's scope, it is part of a broader solicitation by DHSS for venues and services related to conferences, trainings, community forums, and engagement events across Delaware. The form's structure suggests a comprehensive approach to documenting subcontractor participation, with provisions for multiple subcontractors to be listed using separate forms.

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Text version

STATE OF DELAWARE

DELAWARE HEALTH AND SOCIAL SERVICES

DIVISION OF SOCIAL SERVICES

STATE OF DELAWARE

OFFICE OF THE SECRETARY - ADMINISTRATION

Attachment 6

SUBCONTRACTOR INFORMATION FORM

PART I – STATEMENT BY PROPOSING VENDOR

1. CONTRACT NO. HSS-25-040
2. Proposing Vendor Name:

3. Mailing Address

4. SUBCONTRACTOR

a. NAME

4c. Company OSD Classification:

Certification Number: _____________________

b. Mailing Address:

4d. Women Business Enterprise |_| Yes |_| No 4e. Minority Business Enterprise |_| Yes |_| No 4f. Disadvantaged Business Enterprise |_| Yes |_| No 4g. Veteran Owned Business Enterprise |_| Yes |_| No 4h. Service Disabled Veteran Owned Business Enterprise |_| Yes |_| No

5. DESCRIPTION OF WORK BY SUBCONTRACTOR

6a. NAME OF PERSON SIGNING

7. BY (Signature)
8. DATE SIGNED

6b. TITLE OF PERSON SIGNING

PART II – ACKNOWLEDGEMENT BY SUBCONTRACTOR

9a. NAME OF PERSON SIGNING

10. BY (Signature)
11. DATE SIGNED

9b. TITLE OF PERSON SIGNING

* Use a separate form for each subcontractor image1.png

File details come from the government source that posted it. Updated .