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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Other files
| File | Type | Posted |
|---|---|---|
| 11-Attachment 2 Non-Collusion Statement (2).docx | DOCX document | |
| 10-Attachment 7 Monthly Usage Report.docx | DOCX document | |
| 1-Prospective Vendor Questionaire.docx | DOCX document | |
| 7-Attachment 4 Confidential Information.docx | DOCX document | |
| 2-HSS 26-022 Event Space for State of Delaware Events.docx | DOCX document | |
| 4-Attachment 5 Business References.docx | DOCX document | |
| 9-Attachment 9 Office of Supplier Diversity Form.docx | DOCX document | |
| 8-Attachment 8 Sample Subcontracting (2nd tier) Quarterly Report.docx | DOCX document | |
| 5-Attachment 3 Exceptions Form.docx | DOCX document | |
| 3-Attachment 1 No Proposal Reply Form.docx | DOCX document |
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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 .