Appendix_A_-_Minimum_Qualifications_Checklist.docx

Attachment A – Minimum Qualifications Checklist Complete this form and attach it to your agency’s Proposal

Minimum Qualifications

Proposals will be accepted only from agencies that meet the following required qualifications. Please check box if your agency meets these qualifications:

1. Proposer is legally authorized to conduct business in the State of California. Attach completed W9 signed in blue ink.* ☐ Yes ☐ No *Response required

2. Neither the proposer nor its principals and/or named subcontractors are identified on the list of federally debarred, suspended or other excluded parties located at https://sam.gov/content/exclusions.* ☐ Yes ☐ No *Response required

3. Proposer has a minimum of three (3) years of experience within the last five (5) years immediately preceding the issuance of this RFP in providing in-person safety net or similar services in San Mateo County. * ☐ Yes ☐ No *Response required

4. Proposer is able and willing to enter into an agreement with the County using the County’s Standard Terms and Conditions as shown in Appendix C - Standard Agreement Template and Attachments. Attach red-lined version to request changes. Changes are subject to County Counsel review and will be finalized during negotiations.* ☐ Yes, with no edits.

☐ Yes, with edits (see attached red-lined version).

*Response required

Name of Agency: Click or tap here to enter text.

Address: Click or tap here to enter text.

Required Registration

5. Please confirm your firm is registered with System and Award Management (SAM). SAM.gov* Comment by Jessica Silverberg: P&C- is this correct? It seems like there are 2 questions meshed into 1 here- agreement to county terms and conditions, and SAM.gov. seems like this should be 2 separate questions. Comment by Jessica Silverberg: P&C- also- the question on the terms and conditions is not worded that clearly. I think in past versions, the response options were clearer- something like- agree to terms and conditions, or we are proposing the attached changes. Please revise to be clearer- if departments are allowed to make changes to this section Comment by Sherman Gee: This is from the central procurement RFP template and they change it frequently. We can edit to separate into two questions and clarify Comment by Chris Ratana: P&C - I take this as OK to leave? Comment by Khalia Parish: Edited per Jessica’s suggestion.

☐ Yes ☐ No *Response required

6. What is the registered Business Name and Unique Entity ID (UEI) No.?*

· UEI number can be obtained by registering your business through SAM.GOV.

· Should you be in the process of obtaining your UEI number, please enter the digits ‘123’ temporarily for your response below in order to proceed with proposal. This temporary number should be replaced with the correct registration number for submission of the proposal.

*Response required

Registered as Business Name

Unique Entity ID: Business Number:

Proposer is required to be in good standing with https://sam.gov/SAM.

I, Insert Name, am a Insert Title at Insert Agency and am authorized to execute this Certification on its behalf.

I certify that the foregoing information is true and correct as of the date of this Certificate.

Signature: ______________________________

Date: Click or tap to enter a date.