83979 Att J - Attestation Form.docx
DOCX document 45 KB Posted
- Attached to
- Therapy ServicesBid Documents State and local contract opportunity
- Solicitation number
- 25-83979
- Issued by
- Indiana
About this file
This document is an Attestation Form (Attachment J) for a state procurement opportunity, likely in Indiana, involving the Indiana Department of Administration (IDOA). The form serves as a comprehensive compliance checklist for respondents to confirm their understanding and submission of various required documents, including pricing, executive summary, minority and women business enterprise forms, veteran-owned small business documentation, economic impact statement, cost proposal, business proposal, and technical proposal. Respondents must carefully complete each section and confirm their ability to supply required products or services, with potential consequences of disqualification for incomplete or non-compliant submissions.
The document emphasizes several key compliance and preference elements, including the Buy Indiana Initiative, which offers potential points for Indiana-certified companies. Respondents must validate their status through the Buy Indiana registry and may need to submit confidential or redacted documents with specific formatting. The form also allows for listing additional subcontractors beyond initial attachments and provides optional sections for supplementary attachments. Notably, the form requires legal representation to review and accept or propose alternative contract language, and mandates detailed documentation for any confidential information claims, referencing specific statutory exemptions to the Access to Public Records Act (APRA).
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Addendum 1.docx | DOCX document | |
| RFP Boilerplate Documentv2.pdf | ||
| 83979 Att G - Q & A Template Response-.xlsx | XLSX spreadsheet | |
| 79415 Pre-Proposal Conference Slides.pptx | PPTX presentation | |
| 83979 Att A - MWBE.docx | DOCX document | |
| 83979 Att A1 - IVOSB.docx | DOCX document | |
| 83979 Att I - Pre-proposal Network Form.docx | DOCX document | |
| 83979 Att K - Artificial Intelligence Questions.docx | DOCX document | |
| 83979 Att L - Infrastructure Overview.docx | DOCX document | |
| 83979 Att C - Indiana Economic Impact Form.xls | XLS spreadsheet | |
| 83979 Att H - Reference Check Form.docx | DOCX document | |
| RFP Boilerplate Documentv1.pdf | ||
| 83979 Att B - Sample Contract.docx | DOCX document | |
| 83979 Att D Cost Proposal (1).xlsx | XLSX spreadsheet | |
| 83979 Att E - Business Proposal.docx | DOCX document | |
| 83979 Att F Technical Proposal (1).docx | DOCX document | |
| 83979 Att G - Q&A Template.xlsx | XLSX spreadsheet |
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Text version
ATTESTATION FORM
ATTACHMENT J
Respondent Name:
Respondent’s Internal Response Manager’s Name:
This person will be the dedicated contact to receive State correspondence specific to this solicitation.
Respondent’s Internal Response Manager’s Email Address:
1.0 Mandatory Submissions and Requirements: Disagreement with these items may result in the response being disqualified.
| Attachment J: Attestation Form |
| ☐ Have completed in its entirety and submitted |
| Section 1.10 Pricing |
| ☐ Have read and meet this requirement |
| Section 3.2 Executive Summary |
| ☐ Have completed, signed, and submitted |
Section 3.2 Attachment A: Minority and Women Business Enterprise form, IDOA provided certification letter and Subcontractor’s signed letter on company letterhead.
☐ Have completed, signed, and submitted or ☐ Opting not to submit
Section 3.2 Attachment A1: Indiana Veteran Owned Small Business form IDOA provided certification letter and Subcontractor’s signed letter on company letterhead.
☐ Have completed, signed, and submitted
☐ Opting not to submit
| Section 3.2 Attachment C: Indiana Economic Impact |
| ☐ Have read, completed, and submitted |
| Section 3.2 Attachment D: Cost Proposal (Excel Workbook) |
| ☐ Have completed and submitted |
| Section 3.2 Attachment E: Business Proposal |
| ☐ Have completed and submitted |
| Section 3.2 Attachment F: Technical Proposal |
| ☐ Have completed and submitted |
2.0 Confirm mutual understanding and submission.
1.15 and 2.1 Confidential Information:
The complete list of Confidential and Redacted files is specified in section 4.0 of this attachment.
☐ Have read, and submitted
☐ Have read, and does not apply to response
| 2.2.1 Ability and Desire to Supply the Required Products or Services |
| ☐ Have read, and agree |
| 2.3.6 Contract Terms/Clauses |
| ☐ Confirm Respondent’s Legal Representation has read and accepts Sample Contract language. |
or ☐ Confirm Respondent’s Legal Representation has read, and submitted alternative language per Attachment E.
2.6.3. Subcontractors
(Additional subcontractors/those not submitted in Attachment A/Attachment A1)
☐ Have read, agree, listed subcontractors in 5.0 of this attachment and submitted documents
☐ Have read, and does not apply to response
3.0 Claim clarification
| 2.6.2 Buy Indiana Initiative/Indiana Company |
| ☐ YES claiming (points only awarded if certification is finalized per Buy Indiana registry* at time of Sourcing Event Submission Date) |
*Validated by Respondent within Buy IN Designation List at https://www.in.gov/idoa/procurement/supplier-resource-center/programs-and-preferences/buy-indiana/
☐ NO, not claiming
4.0 Confidential / Redacted File: confirm submission if applicable More rows may be inserted if necessary
Responses must include the following required information:
· List all documents or sections of documents, for which statutory exemption to APRA;
· Specify which statutory exception of APRA applies for each document or section of the document;
· Provide a description explaining how the statutory exception to the APRA applies for each document or section of the document; and
· Provide a separate redacted or confidential, whichever is applicable, version of the document. File name should use the following format:
· (insert rfp #) _ (insert Att letter) _CONFIDENTIAL
· (insert rfp #) _ (insert Att letter) _REDACTED
· More rows may be inserted if necessary
| Filename |
| Document Section |
| Document |
Page #
| Statutory exception reference |
| Rationale for application of the statute |
| Submitted |
5.0 Subcontractors per RFP 2.6.3 (additional subcontractors/those not submitted in Attachment A/Attachment A1)
| Subcontractor Name |
| Function to be performed |
| Document Submitted |
☐ Executed contract
☐ Letter of Agreement
☐ Executed contract
☐ Executed contract
☐ Executed contract
☐ Executed contract
☐ Executed contract
☐ Executed contract
6.0 Respondent additional attachments (OPTIONAL)
| Filename |
| RFP Attachment Reference |
2 v.07112024
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