7-HSS-26-017 - DHSS Strategic Plan Development - Attachment 6 - Subcontractor Information Form.docx
DOCX document 131 KB Posted
- Attached to
- DHSS STRATEGIC PLAN DEVELOPMENT State and local contract opportunity
- Solicitation number
- HSS-26-017
- Issued by
- Delaware
About this file
This Subcontractor Information Form is an attachment for a Delaware Health and Social Services strategic planning contract opportunity (HSS-26-017). The form serves as a required document for vendors to disclose subcontractor information when proposing for DHSS's comprehensive strategic plan development project, which includes conducting needs assessments, streamlining practices, optimizing resource allocation, developing a strategic framework, and creating implementation and monitoring plans. The project is scheduled to begin in November 2025 and conclude by August 2026.
DHSS has allocated up to $500,000 for this strategic planning initiative. The subcontractor form requires disclosure of company classification information including certifications for Women Business Enterprise, Minority Business Enterprise, Disadvantaged Business Enterprise, Veteran Owned Business Enterprise, and Service-Disabled Veteran Owned Business Enterprise status. The form includes sections for both the proposing vendor's statement and subcontractor acknowledgment, with signature requirements from authorized representatives of both parties. A separate form must be completed for each subcontractor involved in the proposal.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 2-HSS-26-017 - DHSS Strategic Plan Development - Attachment 1 - No Proposal Reply Form.docx | DOCX document | |
| 6-HSS-26-017 - DHSS Strategic Plan Development - Attachment 5 - Business References Form.docx | DOCX document | |
| 8-HSS-26-017 - DHSS Strategic Plan Development - Appendix C - Templates-PSA, BAA and DTI TCs.docx | DOCX document | |
| 1-HSS-26-017 - DHSS Strategic Plan Development - Final.docx | DOCX document | |
| 4-HSS-26-017 - DHSS Strategic Plan Development - Attachment 3 - Exceptions Form.docx | DOCX document | |
| 3-HSS-26-017 - DHSS Strategic Plan Development - Attachment 2 - Non-Collusion Statement.docx | DOCX document | |
| 5-HSS-26-017 - DHSS Strategic Plan Development - Attachment 4 - Confidential Information Form.docx | DOCX document |
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Text version
Delaware Health and Social Services
Office of the Secretary d
Delaware Health and Social Services
Office of the Secretary d
Attachment 6
SUBCONTRACTOR INFORMATION FORM
PART I – STATEMENT BY PROPOSING VENDOR
1. CONTRACT NO. HSS-26-017
TITLE: DHSS STRATEGIC PLAN DEVELOPMENT
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 image2.png
File details come from the government source that posted it. Updated .