8-HSS-26-047 - BEHAVIORAL HEALTH NUTRITION SERVICES - Attachment 6 - Subcontractor Information Form.docx
DOCX document 126 KB Posted
- Attached to
- BEHAVIORAL HEALTH NUTRITION SERVICES
- Solicitation number
- HSS-26-047
- Issued by
- Delaware
About this file
This is a Subcontractor Information Form attachment for the Delaware Health and Social Services Division of Substance Abuse and Mental Health's Behavioral Health Nutrition Services procurement (Contract No. HSS-26-047). The form serves as a template for proposing vendors to identify and document any subcontractors they intend to utilize in delivering behavioral health nutrition services to individuals with serious mental illness and substance use disorders. The form requires vendors to provide subcontractor company information, including mailing address and relevant certifications, and requests a detailed description of the work the subcontractor will perform as part of the overall service delivery.
The form includes sections for certifying subcontractor business classifications, including Women Business Enterprise (WBE), Minority Business Enterprise (MBE), Disadvantaged Business Enterprise (DBE), Veteran Owned Business Enterprise (VOBE), and Service Disabled Veteran Owned Business Enterprise (SDVOBE) designations. Both the proposing vendor and the subcontractor must provide signed acknowledgments and authorizations on the form, with separate forms required for each subcontractor. This document is a standard procurement requirement designed to ensure transparency regarding supply chain composition and to facilitate tracking of utilization of certified business enterprises in state contracting.
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Other files
| File | Type | Posted |
|---|---|---|
| 6-HSS-26-047- Attachment 2 - Non-Collusion Stmt.docx | DOCX document | |
| 4-Appendix C- Budget Workbook-Nutrition RFP.xlsx | XLSX spreadsheet | |
| 3-Nutrition RFP-Appendix B SOW and Technical Requirements.docx | DOCX document | |
| 1-RFP HSS-26-047 BEHAVIORAL HEALTH NUTRITION SERVICES.docx | DOCX document | |
| 2-Appendix D-workplan-Nutrition.docx | DOCX document | |
| 9-HSS-26-047 - BEHAVIORAL HEALTH NUTRITION SERVICES- Attachment 5 - Business References Form.docx | DOCX document | |
| 5-HSS-26-047 - BEHAVIORAL HEALTH NUTRITION SERVICES Attachment 4 - Confidential Information Form.docx | DOCX document | |
| 7-HSS-26-047 - BEHAVIORAL HEALTH NUTRITION SERVICES- Exceptions Form.docx | DOCX document |
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Text version
Delaware Health and Social Services
Division of Substance Abuse and Mental Health d
Delaware Health and Social Services
Division of Substance Abuse and Mental Health d
Attachment 6
SUBCONTRACTOR INFORMATION FORM
PART I – STATEMENT BY PROPOSING VENDOR
1. CONTRACT NO.
HSS-26-047
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 .