Appendix A - Proposal Cover Sheet.docx
DOCX document 18 KB Posted
- Attached to
- Workers' Compensation Security Fund Counsel
- Solicitation number
- OGC-2024-06
- Issued by
- Adams County, Pennsylvania
About this file
This document is the Proposal Cover Sheet for a Request for Proposals (RFP) issued by the Commonwealth of Pennsylvania Office of General Counsel under RFP# OGC-2024-06 for legal services related to the Workers' Compensation Security Fund. The selected law firms will provide representation to defend workers' compensation claims arising from insolvent insurance companies that did business in Pennsylvania, including practice before workers' compensation judges, the Workers' Compensation Appeal Board, and appellate courts. This engagement may also include other general legal work as designated by the Chief Counsel of the Pennsylvania Insurance Department, the Security Fund, or the Governor's Office of General Counsel. The Commonwealth will make a limited multiple award to the highest evaluated law firms based on the criteria in the RFP.
The RFP requires the submission of multiple documents, including a Technical Submittal, Small Diverse Business Participation Submittal, Veteran Business Enterprise Participation Submittal, Cost Submittal, and Law Firm Diversity Submittal. The RFP is issued pursuant to Executive Order 2015-2 and the Commonwealth Procurement Code, and covers work in Dauphin County and Harrisburg City.
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Text version
APPENDIX A - PROPOSAL COVER SHEET
COMMONWEALTH OF PENNSYLVANIA
Office of General Counsel
RFP# OGC-2024-06
Submitted in five separately attached submittals is the proposal of the Offeror identified below for the above-referenced RFP:
Law Firm Information:
Offeror Name
Offeror Mailing Address
Offeror Website
Offeror Contact Person
Offeror’s Phone Number
Offeror’s Facsimile Number
Offeror’s E-Mail Address
Offeror Federal ID Number
Offeror SAP/SRM Vendor Number
Submittals Separately Attached:
Technical Submittal
Small Diverse Business Participation Submittal
Veteran Business Enterprise Participation Submittal
Cost Submittal
Law Firm Diversity Submittal
Signature
Signature of an official authorized to bind the Offeror to the provisions contained in the Offeror’s proposal:
Printed Name
Title
FAILURE TO COMPLETE, SIGN AND RETURN THIS FORM WITH THE OFFEROR’S PROPOSAL MAY RESULT IN THE REJECTION OF THE OFFEROR’S PROPOSAL A - 1
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