ATT_A Sample Bid_Sub Letter_ Bid_Profile.docx

ATTACHMENT A - BID SUBMISSION LETTER

Date Name Address of Bidder’s Principal Place of Business Telephone Number Fax Number Email Address Name of Contract Person, if different from Bidder Name

Re: Response Submission for DOH Competitive Solicitation RFQQ DOH#24-029C Care-a-Van Mobile Services Dear Sir or Madam:

1. Enclosed please find the Proposal of _______________ (Bidder) with respect to the above Competitive Solicitation. This Proposal includes this Letter ( Attachment A ) and Bidders Profile, as set forth in the Solicitation Document. In addition to these completed Attachment s, the response includes the following additional materials (if any): _____________________________________________________

2. I am authorized to submit this Proposal on behalf of Bidder, to make representations on behalf of Bidder and to commit Bidder contractually.

3. I have read the Solicitation Document and Sample Contract. In submitting this Proposal, Bidder accepts all terms and conditions stated in the Solicitation Document, including those set forth in the following amendments which Bidder has downloaded (please complete, indicating if no amendments were issued):

___No Amendments were issued with respect to this DOH#24-029C Care-a-Van Mobile Services

4. Bidder represents that it meets all minimum qualifications set forth in this DOH Competitive Solicitation and is capable, willing, and able to perform the services described in the DOH Competitive Solicitation within the time frames set forth for performance.

5. By my signature below, I certify that all statements and information provided in Bidder’s Response are true and complete.

Sincerely, (Signature)

Typed Name and Title of Bidder or Authorized Representative Attachment A - Bidder’s Bid Submission Letter and Bidder’s Profile DOH#24-029C Care-a-Van Mobile Services 10/1/2023

ATTACHMENT A– BIDDER’S PROFILE

Bidder:

Type/print full legal name of Bidder

BIDDER INFORMATION

Legal name of Bidder:

Address of Bidder:

Note: This must match information from Bidder’s Washington Business License.

Business Name

Address

City, State, Zip Code

Bidder’s Washington State Department of Revenue Registration Number/Unified Business Identifier (UBI) Number:

Note: A nine-digit UBI number is assigned to each registered businesses in Washington.

Taxpayer Identification No. (TIN):

Note: Your TIN will be either a number issued by the IRS (e.g., Employer Identification Number, Federal Tax Identification Number) or a number issued by the Social Security Administration (i.e., your Social Security Number). If your TIN is an SSN, state that fact, but do NOT provide the SSN.

Is your firm certified as a minority or woman owned business with the Washington State Office of Minority & Women’s Business Enterprises (OMWBE)?

Yes |_| No |_| If yes, provide Bidder’s OMWBE certification no.:

Is your firm a self-identified Washington Small Business?

Note: See Attachment C – Bidder’s Certification for criteria to qualify as a Washington Small Business Note: Regardless of size, a qualifying business must be owned and operated independently from all other businesses. In regard to size, the gross revenue thresholds, as reported on Bidder’s tax returns, are as follows:

· Microbusiness: Annual gross revenue of less than one million dollars.

· Minibusiness: Annual gross revenue of more than one million dollars, but less than three million dollars.

· Small Business: Annual gross revenue of less than seven million dollars over each of the three prior consecutive years.

Yes |_| No |_| If yes, provide the location for Bidder’s principal place of business:

If yes, what is your business size (based on annual gross revenue)?

Is your firm certified as a Veteran-Owned Business with the Washington State Department of Veteran Affairs?

Note: See Attachment C – Bidder’s Certification for criteria to qualify as a Certified Veteran-Owned Business.

Yes |_| No |_| If yes, provide Bidder’s WDVA certification no.

CONTRACT MANAGEMENT POINTS OF CONTACT

Authorized Representative Name:

Email:

Phone:

Contract Administrator Name:

Email:

Phone:

Complete if using subcontractors.

SUB CONTACTOR

REFERENCES

Provide a minimum of three (3) commercial or government references for which bidder has delivered goods and/or services similar in scope as described in the Competitive Solicitation.

REFERENCE 1

Company Name:

Contact:

Phone:

Email:

REFERENCE 2

Company Name:

Contact:

Phone:

Email:

REFERENCE 3

Company Name:

Contact:

Phone:

Email:

* Attachment A- Bid Submission Letter and Bidder’s Profile must be completed, signed and returned in its entirety to the Solicitation Coordinator at: Bids@doh.wa.gov image1.jpeg