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.

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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 .