ATT E Bidder's Response Template.docx

Attachment E: BIDDER RESPONSE FORM This form is broken into seven sections:

Section 1. Bid Submittal Checklist Section;

Section 2. Bidder Responsiveness/Responsibility;

Section 3. Washington Small Business; OR Certified Washington Veteran-owned Business (VOB);

Section 4. EO 18-03 Response;

Section 5. Qualifications;

Section 6. Technical Response; and Section 7. Quotation/Cost Proposal.

Bidders must respond to all questions in the order and in the expandable space provided. If a question requires Bidder to submit additional documents, please attach them to this document and label them clearly as part of your response to this ATTACHMENT E.

This section identifies the bid submittals that must be provided to the Department of Health, to constitute a responsive bid. The submittals must be delivered as set forth below. Bids that do not include the submittals identified below may be rejected as nonresponsive. In addition, a bidder’s failure to complete any submittal as instructed may result in the bid being rejected. Bidders may not provide unsolicited materials. For any supplemental materials expressly required by the Department of Health in writing, bidders must identify such supplemental materials with the bidder’s name.

THIS COLUMN IS FOR EVALUATION PURPOSES ONLY

ATTACHMENT A - Bid Submission Letter and Bidders Profile This document is required bidder information for contract administration purposes.

Complete as instructed and submit it with the bid.

NOT SCORED

Included Yes |_| No |_|

ATTACHMENT C - Bidder Certifications. This document is the Bidder’s Certification.

Complete the certification, along with any exceptions or required explanations, and submit it with the bid to Enterprise Services.

Note: The Certification must be complete. Where there are choices, the bidder must check a box. The certification must be signed and submitted by a duly authorized representative for the bidder.

NOT SCORED

Included Yes |_| No |_|

ATTACHMENT D - 2 General Terms and Conditions Change Request Form This document is a required bid submittal IF bidder has business concerns with the Contract attached as ATTACHMENT D-1 General Terms and Conditions If so, bidder must complete

NOT SCORED

Included Yes |_| No |_|

Included Yes |_| No |_|

ATTACHMENT B-1 Bidder’s Diverse Business Inclusion Plan – Subcontractors This document is a required bid submittal IF bidder intends to utilize subcontractors if awarded a Contract. If so, the bidder must complete as instructed and submit it with the bid to DOH.

NOT SCORED

Included Yes |_| No |_|

Bid Responsiveness.

DOH will review bids to determine whether the bid is complete, signed, legible, in compliance with the requirements specified in this Competitive Solicitation.

Pass |_| Fail |_|

Bid Responsibility DOH will determine whether the bidder is a responsible bidder. DOH will consider the following elements:

· Bidder’s ability, capacity, and skill to perform the contract or provide the service required;

· Bidder’s character, integrity, reputation, judgment, experience, and efficiency;

· Bidder’s ability to perform the contract within the time specified;

· Bidder’s performance quality pertaining to previous contracts or services;

· Bidder’s compliance with laws relating to the contract or services;

· Whether, within the three-year period immediately preceding the date of the Competitive Solicitation, bidder has been determined by a final and binding citation and notice of assessment issued by the Washington State Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction to have willfully violated, as defined in RCW 49.48.082, any provision of chapter 49.46, 49.48, or 49.52 RCW; and

· Such other information as may be secured having a bearing on the decision to award the Contract.

See RCW 39.26.160(2)(a)-(g). In addition, DOH may consider the following:

· Financial Information: DOH may request financial statements, credit ratings, references, record of past performance, clarification of bidder’s bid, on-site inspection of bidder's or subcontractor's facilities, or other information as necessary to determine bidder’s capacity to perform and the enforceability of bidder’s contractual commitments. Failure to respond to these requests may result in a bid being rejected as non-responsive.

· References: DOH reserves the right to use references to confirm satisfactory customer service, performance, satisfaction with service/product, knowledge of products/service/industry and timeliness. Any negative or unsatisfactory reference can be reason for rejecting a bidder as non-responsible.

Pass |_| Fail |_|

Answer (page numbers):

Are you a Washington Small Business as defined under RCW 39.26.010?

According to Chapter 39.26.010 RCW, to qualify as a Washington Small Business, Bidder must meet three (3) requirements:

a. Location. Bidder’s principal office/place of business must be located in and identified as being in the State of Washington. A principal office or principal place of business is a firm’s headquarters where business decisions are made and the location for the firm’s books and records as well as the firm’s senior management personnel.

b. Size. Bidder must be owned and operated independently from all other businesses and have either: (a) fifty (50) or fewer employees; or (b) gross revenue of less than seven million dollars ($7,000,000) annually as reported on Bidder’s federal income tax return, or its return filed with the Washington State Department of Revenue over the previous three consecutive years.

c. WEBS Certification. Bidder must have self-identified its Washington Small Business status in Washington’s Electronic Business Solution (WEBS).

OR

Are you a Certified Washington Veteran-Owned Business as defined under RCW 43.60A.190?

According to Chapter 43.60A.190 RCW, to qualify as a Certified Washington Veteran-Owned Business, Bidder must meet Four (4) requirements:

a. 51% Ownership. Bidder must be at least fifty-one percent (51%) owned and controlled by:

1. A veteran as defined as every person who at the time he or she seeks certification has received a discharge with an honorable characterization or received a discharge for medical reasons with an honorable record, where applicable, and who has served in at least one of the capacities listed in RCW 41.04.007;

2. A person who is in receipt of disability compensation or pension from the department of veteran’s affairs; or

3. An active or reserve member in any branch of the armed forces of the United States, including the national guard, coast guard, and armed forces reserves.

b. Washington Incorporation/Location. The bidder must be either an entity that is incorporated in the state of Washington as a Washington domestic corporation or, if not incorporated, an entity whose principal place of business is located within the State of Washington.

c. WEBS Certification. Bidder must have certified its Veteran-Owned business status in Washington’s Electronic Business Solution (WEBS).

d. WDVA Certification. Bidder must have provided certification documentation to the Washington Department of Veterans’ Affairs WDVA) and be certified by WDVA and listed as such on WDVA’s website (WDVA – Veteran-Owned Businesses).

5 Points

EO

Are your employees required to sign, as a condition of employment, a mandatory individual arbitration clause and/or a class or collective action waiver?

Please Note: Points for this question will be awarded to bidders who respond that they do not require these clauses and waivers. If you certify here that your employees are NOT required to sign these clauses and waivers as a condition of employment, and you are the successful bidder, a term will be added to your contract certifying this response and requiring notification to DOH if you later require your employees to agree to these clauses or waivers during the term of the contract.

5 Points

ANSWER: Yes |_| No |_|

Competitive Solicitation RFQQ DOH#24-029C Care-a-Van Mobile Services ATTACHMENT E Bidder Response Form Bidder Name _____________________

ATTACHMENT E – BIDDER RESPONSE FORM

10/1/2023

MANDATORY

MAXIMUM TOTAL POINTS

THIS COLUMN IS FOR EVALUATION PURPOSES ONLY

1. What is the geographic location(s) and # of patients?

1. What type of clinic (private, community, tribal, etc.)?

ANSWER:

ANSWER:

ANSWER:

ANSWER:

ANSWER:

ANSWER:

The Technical Proposal must contain a comprehensive description of services including the following elements:

MAXIMUM TOTAL POINTS

THIS COLUMN IS FOR EVALUATION PURPOSES ONLY

ANSWER:

ANSWER:

ANSWER:

ANSWER:

· tracking clinics served,

· staff hours, and number staff available at each clinic; and

· Vaccinations provided

ANSWER:

ANSWER:

Bidders must break down overall costs as follows:

Administrative costs, including but not limited to staffing, administrative supplies and other costs associated with the bid.

ANSWER: TOTAL MAXIMUM BID AMOUNT:

FOR ALLOCATED COST DETAIL, ATTACH A SEPARATE SPREADSHEET OR DESCRIBE DETAILS BELOW b

ANSWER: