Affirmation_and_Disclosure_Form_5-20-24_fillable_form.pdfAffirmation_and_Disclosure_Form_5-20-24_fillable_form.pdf

This is an Affirmation and Disclosure Form related to an RFP issued by the Ohio Department of Health (ODH) Bureau of Maternal, Child, and Family Health for the Women, Infant and Children (WIC) Program. The form is designed for vendors to affirm and disclose relevant information as part of their proposal submission for the WIC Farmers' Market Nutrition Program (FMNP) eSolution Training & Support contract opportunity (BMCFH-SFY27-WIC FMNP). The form appears to be a fillable PDF document dated May 20, 2024, which vendors must complete and submit as part of their response to the RFP. The underlying contract opportunity seeks proposals for recruitment, training, and support services for farmers and farmers' markets participating in Ohio's electronic WIC FMNP, which is transitioning from paper vouchers to electronic benefits to increase participation and redemption rates among WIC participants seeking to purchase fresh, locally grown fruits and vegetables.

The specific pricing terms, contract duration, award date, and response deadline are not detailed in the form document itself. However, the procurement is part of Ohio's modernization initiative to align the WIC FMNP with the Ohio Senior Farmers' Market Nutrition Program's transition to e-benefits using the Homegrown online application platform. Vendors submitting proposals are required to complete the affirmation and disclosure form to certify their qualifications, business status, and compliance with applicable regulations and requirements for state and local contracting in Ohio.