8-Subcontractor Information Form -Attachment 6.pdf

429 KB Posted

Attached to
Delaware's Spay & Neuter Program -System Enhancement Project
Solicitation number
HSS-26-034
Issued by
Delaware

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This document is a Subcontractor Information Form from the Delaware Health and Social Services, Division of Public Health, for Contract No. HSS-26-034 titled "Delaware's Spay & Neuter Program – System Enhancement Project". The form is designed to capture detailed information about potential subcontractors involved in the project, including their business classifications and roles.

The form provides spaces for vendors to indicate various business enterprise classifications, including Women Business Enterprise, Minority Business Enterprise, Disadvantaged Business Enterprise, Veteran Owned Business Enterprise, and Service-Disabled Veteran Owned Business Enterprise. It is structured in two parts: Part I for the proposing vendor's statement and Part II for subcontractor acknowledgement. The form requires detailed information such as subcontractor name, mailing address, and a description of work to be performed, with a note that a separate form should be used for each subcontractor.

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Other files

File Type Posted
4-Non-Collusion Statement -Attachment 2.pdf PDF
2-HSS 26 034 Appendix B - Scope of Service -.docx DOCX document
6-Confidential Information Form -Attachment 4.pdf PDF
9-HSS 26 034 Delawares Spay Neuter Program System Enhancement Project-RFP - Appendix D - Project Cost.docx DOCX document
1-HSS 26 034 Delawares Spay Neuter Program System Enhancement Project-RFP -R2.docx DOCX document
3-No Proposal Reply -Attachment 1.pdf PDF
5-Exception Form Report -Attachment 3.pdf PDF
7-Business Refernences -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-26-034

TITLE: Delaware’s Spay & Neuter Program – System Enhancement Project

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 .