6-HSS-26-040 Non Collusion Statement -Attachment 2.pdf
PDF 367 KB Posted
- Solicitation number
- HSS-26-040
- Issued by
- Delaware
About this file
This is a Non-Collusion Statement form for the Delaware Health and Social Services Division of Public Health related to Contract No. HSS-26-040 for Delaware Statewide Birth to Three Early Intervention Services. The proposal deadline is February 23, 2026, at 1:00 PM EST/EDT. The form requires the vendor's authorized representative to certify that the organization has not engaged in collusion, participated in any agreement that restrains free competitive bidding, and is not a sub-contractor to another vendor who submitted a primary proposal. By signing and submitting the form, the vendor accepts all terms, conditions, specifications, and special provisions of the solicitation. The authorized signatory must be an individual with legal authority to enter the organization into a formal contract with the State of Delaware.
The form requires vendors to provide company information including name, authorized representative details, federal E.I. number, license number, and certification classifications such as 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. Vendors must also declare whether their firm, any affiliate, predecessor entity, owner, director, officer, partner, or proprietor has been subject to federal, state, or local government suspension or debarment within the past five years, with explanation required if applicable. The form includes sections for purchase order delivery information and contact details for the vendor's designated point of contact.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Delaware Health and Social Services Division of Public Health
Attachment 2
CONTRACT NO.: HSS-26-040
CONTRACT TITLE: Delaware Statewide Birth to Three Early Intervention Services DEADLINE TO RESPOND: February 23, 2026, at 1:00 PM EST/EDT
NON-COLLUSION STATEMENT (COMPLETE THIS FORM IN ITS ENTIRELY)
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 Public 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 Public Health.
COMPANYNAME (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
Corporation Partnership Individual
File details come from the government source that posted it. Updated .