9-DHHS26065 Submission Instructions.docx
DOCX document 24 KB Posted
- Attached to
- Optometry Services at Utah State Hospital
- Solicitation number
- DHHS26065
- Issued by
- Salt Lake County, Salt Lake City, Utah
About this file
This document contains submission instructions for a state and local contract opportunity issued by the Utah Department of Human Services (DHHS) for optometry services at Utah State Hospital. The solicitation seeks a qualified optometrist to provide optometric services, with no specific quantities, response dates, due dates, site visits, bidder's meetings, award dates, or contract term information provided in this instruction document.
Vendors must submit the following documentation: IRS Form W-9 (unless currently holding a DHHS contract), a conflict of interest disclosure form, a current and valid Utah state optometric license, a doctorate of optometry degree, a resume with documentation demonstrating at least five years of experience as an optometrist and at least one year of direct experience working with the mentally ill, and a completed DHHS26065 Cost Proposal Form. The solicitation emphasizes that only requested documentation will be reviewed, and vendors should use the provided checklist to ensure complete submissions.
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Other files
| File | Type | Posted |
|---|---|---|
| 6-AAA DHHS BAA Template 8.14.2023.docx | DOCX document | |
| 1-DHHS26065 IFB Optometry Services at USH.docx | DOCX document | |
| 7-Form 2a Conflict of Interest Disclosure Statement.pdf | ||
| 3-DHHS26065 Optometry Services SOW Final.docx | DOCX document | |
| 4-DHHS26065 Cost Proposal Form.doc | DOC document | |
| 2-Form 1 IRS Form W-9.pdf | ||
| 5-Form 2b Conflict of Interest Certification UGE.pdf | ||
| 8-DHHS Client Service Terms.docx | DOCX document |
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Text version
DHHS26065 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 DHHS26065 Cost Proposal Form.
Submission Instructions Page 1 of 1
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