7-Subcontractor Form -Attachment 6.pdf

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Attached to
ALLIANCE for ADOLESCENT PREGNANCY PREVENTION SERVICES
Solicitation number
HSS-26-008
Issued by
New Castle County, Delaware

About this file

This is a Subcontractor Information Form (Attachment 6) for the Delaware Health and Social Services Division of Public Health related to Contract HSS-26-008, the Alliance for Adolescent Pregnancy Prevention Services. The form is designed to be completed by proposing vendors to disclose subcontractor information and facilitate coordination of statewide adolescent pregnancy prevention initiatives across Delaware's three counties. The AAPP program, established in 1995, implements evidence-based curricula delivered by trained facilitators to reduce adolescent pregnancy, sexually transmitted disease, and HIV/AIDS rates in high-risk areas. The form requires vendors to provide the proposing vendor name and mailing address, subcontractor identification details, company classification information, and a description of work to be performed by each subcontractor, with separate forms required for each subcontractor engagement.

The form includes certification requirements for subcontractors and requests classification status across multiple categories including Women Business Enterprise, Minority Business Enterprise, Disadvantaged Business Enterprise, Veteran Owned Business Enterprise, and Service-Disabled Veteran Owned Business Enterprise designations. The form requires signatures and acknowledgment from both the proposing vendor and the subcontractor, indicating mutual agreement to the terms and conditions of the subcontracting arrangement. This documentation ensures transparency in subcontracting relationships and compliance with state procurement requirements for the adolescent pregnancy prevention services being delivered across New Castle, Kent, and Sussex Counties.

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Text version

Delaware Health and Social Services Division of Public Health

Attachment 6

SUBCONTRACTOR INFORMATION FORM

PART I – STATEMENT BY PROPOSING VENDOR

1. CONTRACT NO. HSS-26-008

TITLE: Alliance for Adolescent Pregnancy Prevention Services

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

10. BY (Signature) 11. DATE SIGNED

9b. TITLE OF PERSON

* Use a separate form for each subcontractor

File details come from the government source that posted it. Updated .