7-Subcontractor Information Form -Attachment 6.pdf

343 KB Posted

Attached to
LABORATORY EQUIPMENT MAINTENANCE
Solicitation number
HSS-26-009
Issued by
New Castle County, Delaware

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This document is a Subcontractor Information Form from the Delaware Health and Social Services, Division of Public Health, associated with Contract No. HSS 26 009. The form is designed to capture detailed information about potential subcontractors, including their business classifications and work descriptions. The form is structured in two parts: Part I for the proposing vendor's statement and Part II for subcontractor acknowledgement.

The form includes checkboxes to identify various business enterprise classifications, such as Women Business Enterprise, Minority Business Enterprise, Disadvantaged Business Enterprise, Veteran Owned Business Enterprise, and Service-Disabled Veteran Owned Business Enterprise. It provides spaces for recording the subcontractor's name, mailing address, OSD classification certification number, and a description of work to be performed. The form is intended to be completed separately for each subcontractor, allowing for comprehensive documentation of all secondary vendors involved in the contract.

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8-HSS 26 009 Laboratory Equipment and Maintenance Appendix A - Equipment List (1).xlsx XLSX spreadsheet
5-Confidential Information Form -Attachment 4.pdf PDF
2-No Proposal Reply Form -Attachment 1.pdf PDF
3-Non Collusion Statement -Attachment 2.pdf PDF
1-HSS 26 009 LABORATORY EQUIPMENT MAINTENANCE -RFP.docx DOCX document
4-Exception Report Form -Attachment 3.pdf PDF
6-Business References -Attachment 5.pdf PDF

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Delaware Health and Social Services Division of Public Health

Attachment 6

SUBCONTRACTOR INFORMATION FORM

PART I – STATEMENT BY PROPOSING VENDOR

1. CONTRACT NO.

HSS 26 009

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

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