7-HSS-26-020 - Enhanced Communication - Attachment 6 - Subcontractor Information Form.docx

DOCX document 131 KB Posted

Attached to
ENHANCED COMMUNICATION State and local contract opportunity
Solicitation number
HSS-26-020
Issued by
Delaware

About this file

This document is a Subcontractor Information Form for the Delaware Health and Social Services Division of Developmental Disabilities (DDDS) related to the Enhanced Communication contract (HSS-26-020). The contract seeks to provide facilitated communication opportunities for Deaf service recipients receiving residential habilitation services, with a focus on supporting communication between service recipients, housemates, and staff. Additionally, the contract includes educational components for Direct Support Professionals (DSPs) about Deaf Culture and functional American Sign Language (ASL) vocabulary.

The form is designed to capture detailed information about potential subcontractors, including their business classifications such as Women Business Enterprise, Minority Business Enterprise, Disadvantaged Business Enterprise, Veteran Owned Business Enterprise, and Service-Disabled Veteran Owned Business Enterprise. While specific pricing terms are not detailed in this document, the contract emphasizes compliance with state and federal laws, with full service details available in Appendix B of the Scope of Work. The opportunity is specific to Delaware and aims to enhance communication support for individuals with developmental disabilities who are deaf.

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Text version

Delaware Health and Social Services

Division of Developmental Disabilities d

Delaware Health and Social Services

Division of Developmental Disabilities d

Attachment 6

SUBCONTRACTOR INFORMATION FORM

PART I – STATEMENT BY PROPOSING VENDOR

1. CONTRACT NO. HSS-26-020

TITLE: Enhanced Communication

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 .