Amended Form 1_RFP NO. DMS-2223-084.pdf

RFP No.: DMS-22/23-084 Amended Form 1: Group Term Life Insurance Page 1 of 2

AMENDED FORM 1: MANDATORY RESPONSIVENESS REQUIREMENTS

Respondent must complete this form by certifying compliance or assent with the following items.

The Department will not evaluate Proposals that do not meet the mandatory requirements listed below. A Proposal will be deemed non-responsive if it fails to contain (or with regard to Attachment D: Data Use Agreement if the Respondent has failed to timely submit prior to submitting a Proposal) the following:

SOLICITIATION

SECTION

REFERENCE

MANDATORY RESPONSIVENESS

REQUIREMENTS

PAGE # OF VENDOR

PROPOSAL

N/A The Respondent certifies the person submitting the Proposal is authorized to do so on the Respondent’s behalf.

N/A

N/A

The Respondent certifies that it accepts the Contract terms and conditions as stated in the RFP (including any addenda thereto), without qualification or exception.

N/A

N/A

The Respondent certifies that, if awarded a contract, it will perform, at a minimum, the tasks outlined in Attachment 2: Administrative Requirements, of the Draft Contract (Attachment A), and that it expressly accepts such requirements as written, without caveat, exceptions, conditions, or deviations.

N/A

N/A

The Respondent certifies that, if awarded a contract, it will perform all Services described in Attachment 3: Performance Guarantees, of the Draft Contract (Attachment A).

N/A

N/A The Respondent certifies its Proposal conforms to the Plan Designs specified in the Draft Contract (Attachment A).

N/A

N/A

The Respondent certifies it is in compliance with Section 9 of the PUR 1001 form, as modified by section 3.2 of the RFP, and the Respondent accepts the terms and conditions of this RFP, including all addendums and attachments, without qualification or exception.

N/A

N/A

The Respondent certifies that it is not on the Suspended Vendor List maintained pursuant to section 287.042(1)(a)-(b), F.S., and neither the Respondent nor any supplier, subcontractor, nor consultant included in its Proposal are on the Discriminatory, Convicted, or Antitrust Violator Vendor Lists specified in Section 7 of the PUR1001 form, as modified by section 3.2, Special Instructions, above.

N/A https://www.dms.myflorida.com/content/download/2934/11780

RFP No.: DMS-22/23-084 Amended Form 1: Group Term Life Insurance Page 2 of 2

N/A

The Respondent certifies that it is not listed on the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or the Scrutinized Companies that Boycott Israel List, or been engaged in business operations in Cuba or Syria, and is not participating in a boycott of Israel pursuant to section 287.135, F.S.

N/A

N/A

The Respondent certifies that it is in compliance with section 448.095(2)(a), F.S., and that within the last year (i.e., within the last three hundred sixty-five (365) days), it has not had a contract terminated under section 448.095(2)(c), F.S., by a public employer, as defined by section 448.095(1)(i), F.S.

N/A

N/A

The Respondent certifies that, if awarded a Contract, prior to Contract execution, it will provide the Department with a PDF file of its current and active registration with (or, if a foreign entity, its Certificate of Authority from) the Florida Department of State, Division of Corporation (http://www.sunbiz.org/); or, if exempt from registration, a statement to that effect noting the basis for the exemption.

N/A

3.6

The Respondent certifies that it has submitted Form 2 in accordance with the instructions contained therein, in this RFP, as well as any supporting documentation.

3.6

The Respondent certifies that it has submitted at least four (4) Form 4 references in accordance with the instructions contained therein, in this RFP, and in item 6, References, of Attachment F.

3.6 and 3.8

The Respondent certifies that it has submitted the Attachment B: Price Sheet in accordance with the instructions contained therein and in this RFP.

Signature below serves as the Respondent’s certification of the foregoing statements.

Respondent’s Name Signature of Authorized Representative

Date Print Name/Title http://www.sunbiz.org/