Appendix D - Award Preference.docx
DOCX document 27 KB Posted
- Attached to
- Structured Settlement Services
- Solicitation number
- RFP-11641
- Issued by
- Leon County, Florida
About this file
This is an Award Preferences Form (Form 2425-01 RFP RM Appendix D) from the Florida Department of Financial Services, used to establish preference criteria in the event of a tie between respondents who receive identical highest scores for a structured settlement services contract. The form is specifically tied to a solicitation for structured settlement consulting services for Statewide Workers' Compensation and Liability claims under the Division of Risk Management's self-insurance program.
The form outlines five preference categories that respondents can qualify for: certified minority business enterprise status under Florida Statute 288.703, certified veteran business enterprise status under Florida Statute 295.187, implementation of a drug-free workplace program under Florida Statute 287.087, status as a foreign manufacturing company with a Florida factory employing over 200 Florida workers, or none of the above preferences. The form requires respondents to indicate their net worth and includes certification requirements with authorized signature, printed name, and date fields.
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Other files
| File | Type | Posted |
|---|---|---|
| Appendix B - Questions Template.xlsx | XLSX spreadsheet | |
| Att 6 - Mandatory Criteria Cert.docx | DOCX document | |
| 2425-01 RFP RM - Complete RFP.pdf | ||
| Appendix D - Award Preference.docx | DOCX document | |
| Appendix E - Contract Disputes.docx | DOCX document | |
| 2425-01 RFP RM - Complete RFP.pdf | ||
| Appendix E - Contract Disputes.docx | DOCX document | |
| Att 6 - Mandatory Criteria Cert.docx | DOCX document | |
| 2425-01 RFP RM - Addendum 1.pdf | ||
| Appendix B - Questions Template.xlsx | XLSX spreadsheet |
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Text version
DEPARTMENT OF FINANCIAL SERVICES
Award Preferences Form
2425-01 RFP RM
APPENDIX D
The Respondent’s responses on this form will only be used in the event one or more Respondents receive an identical highest score. If the Department discovers that any information on this form is false after the award to the Respondent is made, the Department reserves the right to terminate the Contract and hold the Respondent liable for costs associated with re-procurement.
1. Choose the responses that apply by checking the applicable box(es) below:
| |_| | Respondent is a certified minority business enterprise as defined in section 288.703, Florida Statutes, (F.S.). |
| |_| | Respondent is a certified veteran business enterprise as provided in section 295.187, F.S. |
| |_| | Respondent has implemented a drug-free workplace program in accordance with section 287.087, F.S. |
| |_| | Respondent is a foreign manufacturing company with a factory in Florida and employing over 200 employees working in Florida. |
| |_| | Respondent is not eligible for any of the above preferences. |
2. Complete the following statement:
Respondent has a net worth of .
As the person authorized to sign this form, I certify that the information provided above is accurate as to the Respondent.
Name of Respondent:
Signature: _________________________________________________________________
Printed Name: _________________________________________________________________
Date: _________________________________________________________________
Appendix D Rev. 9/28/22
File details come from the government source that posted it. Updated .