8-DHHS26051 Submission Instructions.docx
DOCX document 24 KB Posted
- Attached to
- Optometry Services at USH
- Solicitation number
- DHHS26051
- Issued by
- Utah
About this file
This document contains submission instructions for a solicitation issued by the Utah Department of Human Services (DHHS) for optometry services at Utah State Hospital. The contract is intended to provide optometric medicine services to patients at the facility. The solicitation requires vendors to submit specific documentation to be considered for award, though no explicit response deadline, bid opening date, or contract term is specified in this instruction document.
Vendors must submit an IRS Form W-9 (unless currently holding a DHHS contract), a conflict of interest disclosure form, a current Utah optometric license, proof of a doctorate of optometry degree, a resume documenting at least five years of optometric experience and at least one year of direct experience working with the mentally ill, and a completed cost proposal form. The submission instructions emphasize that DHHS will review only documents explicitly requested in the solicitation and will not consider additional unsolicited materials.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 3-Form 1 IRS Form W-9.pdf | ||
| 6-Form 2a Conflict of Interest Disclosure Statement.pdf | ||
| 1-DHHS26051 IFB Optometry Services at USH.docx | DOCX document | |
| 2-DHHS26051 Optometry Services SOW Final.docx | DOCX document | |
| 5-DHHS26051 Cost Proposal Form.doc | DOC document | |
| 4-Form 2b Conflict of Interest Certification UGE.pdf | ||
| 7-DHHS Client Service Terms.docx | DOCX document |
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Text version
DHHS26051 Optometry Services at USH Document Submission Instructions
Responses should contain only documentation requested in this solicitation. DHHS will not review information submitted by a vendor that is not requested in this solicitation.
Response Content & Checklist
| · |
| Submit the documents specified below. Complete forms as instructed. Vendors are encouraged to use this table as a checklist to ensure that responses are complete. |
1. Form #1: IRS Form W-9 This form is not required if you currently hold any contract(s) with DHHS. Complete the form with the legal name of the business entity or individual applying for this solicitation.
2. Form #2a: Conflict of Interest Disclosure Statement
OR
Form #2b: Governmental Entity Conflict of Interest Certification (for government agencies, political subdivisions, municipalities, public schools, etc.)
3. A current and valid license to practice optometric medicine issued by the State of Utah, Division of Occupational and Professional Licensing.
4. A doctorate of optometry degree from an optometric school.
5. A resume and documentation demonstrating that the Offeror meets the minimum requirements of a) at least five years experience working as an optometrist; and b) at least one year of working directly with the mentally ill.
6. A completed DHHS26051 Cost Proposal Form.
Submission Instructions Page 1 of 1
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