Att F - Attestation Form.docx
DOCX document 48 KB Posted
- Solicitation number
- 26-87805
- Issued by
- Indiana
About this file
This is an Attestation Form for a Negotiated Bid contract issued by the State of Indiana. The document serves as a comprehensive checklist requiring respondents to confirm their review, understanding, and submission of all mandatory bid components. Respondents must attest to having read and met pricing requirements per Section 1.9, understood mandatory contract terms and clauses per Section 2.2.6, completed and submitted the Executive Summary, Indiana Economic Impact form, Bid Cost Excel workbook, and the Attestation Form itself. Additionally, respondents must confirm submission of or exemption from the Confidential Information list, Minority and Women Business Enterprise certification (Attachment A), Indiana Veteran Owned Small Business certification (Attachment A1), Indiana Preferences form (Attachment G), and any subcontractor documentation. The form requires legal representation to either accept the sample contract language or submit alternative language with justification.
The Attestation Form includes sections for respondents to declare Indiana Veteran Owned Small Business (IVOSB) certification status, list any additional subcontractors not previously submitted with corresponding executed contracts or letters of agreement, propose alternative contract terms if applicable, and identify any confidential or redacted documents with accompanying statutory exemption justifications under Indiana's Access to Public Records Act (APRA). Respondents must provide detailed rationales for document confidentiality claims and submit separate redacted or confidential versions using specified filename formats. The form allows for expansion of sections as needed and permits optional submission of additional attachments beyond the mandatory requirements.
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Other files
| File | Type | Posted |
|---|---|---|
| NB 26-87805 Att E - QA.xlsx | XLSX spreadsheet | |
| NB Addendum template 26-87805.docx | DOCX document | |
| Att A - MWBE.docx | DOCX document | |
| Att H - Affidavit of Eligibility.docx | DOCX document | |
| Att C - Indiana Economic Impact Form.xls | XLS spreadsheet | |
| Att A1 - IVOSB.docx | DOCX document | |
| Att B - Sample Contract.docx | DOCX document | |
| Att E - Q&A Template.xlsx | XLSX spreadsheet | |
| Negotiated Bid Main Document 26-87805.docx | DOCX document | |
| Infrastructure Overview.docx | DOCX document | |
| Att D - Cost Proposal.xlsx | XLSX spreadsheet | |
| Artificial Intelligence - Technical Proposal Questions.docx | DOCX document | |
| Att G - Preferences.docx | DOCX document |
Show all 13
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Text version
ATTESTATION FORM
Negotiated Bid - Contract
ATTACHMENT F
Respondent Name:
1.0 Mandatory Submissions and Requirements: Disagreement with these items may result in the response being disqualified.
| Section 1.9 Pricing |
| ☐ Have read and meet this requirement |
| Section 2.2.6 Mandatory Contract Terms/Clauses |
| ☐ Have read and understand this section |
| Section 2.2 Executive Summary |
| ☐ Have completed, signed, and submitted |
| Section 3.2 Attachment C: Indiana Economic Impact |
| ☐ Have read, completed, and submitted |
| Section 2.3 Attachment D: Bid Cost (Excel Workbook) |
| ☐ Have completed and submitted |
| Section 2.4 Attachment F: Attestation Form |
| ☐ Have completed in its entirety and submitted |
2.0 Confirm mutual understanding and submission.
1.13 and 2.1 Confidential Information:
The complete list of Confidential and Redacted files is specified in section 4.0 of this attachment.
☐ Have read, and submitted or ☐ Have read, and does not apply to response
1.19 Attachment A: Minority and Women Business Enterprise form, IDOA provided certification letter and Subcontractor’s signed letter on company letterhead.
☐ Have completed, signed, and submitted
☐ Opting not to submit
1.20 Attachment A1: Indiana Veteran Owned Small Business form IDOA provided certification letter and Subcontractor’s signed letter on company letterhead.
☐ Have completed, signed, and submitted
| 2.2.1 Ability and Desire to Supply the Required Products or Services |
| ☐ Have read, and agree |
| 2.2.6 Contract Terms/Clauses |
| ☐ Confirm Respondent’s Legal Representation has read and accepts Sample Contract language. |
or ☐ Confirm Respondent’s Legal Representation has read and submitted alternative language per Section 6.0 of this attachment.
| 2.4.3 Attachment G: Indiana Preferences form |
| ☐ Have completed, and submitted |
2.4.4. Subcontractors
(Additional subcontractors/those not submitted in Attachment A/Attachment A1)
☐ Have read, agree, listed subcontractors in 5.0 of this attachment and submitted documents
☐ Have read, and does not apply to response
3.0 Claim clarification
| 1.20 Respondent is IVOSB certified |
| ☐ YES, claiming; Att A1, have completed, signed, and submitted |
☐ NO, not claiming
4.0 Confidential / Redacted File: confirm submission if applicable More rows may be inserted if necessary
Responses must include the following required information:
· List all documents or sections of documents, for which statutory exemption to APRA;
· Specify which statutory exception of APRA applies for each document or section of the document;
· Provide a description explaining how the statutory exception to the APRA applies for each document or section of the document; and
· Provide a separate redacted or confidential, whichever is applicable, version of the document. File name should use the following format:
· (Insert bid #) _ (insert Att letter) _CONFIDENTIAL
· (Insert bid #) _ (insert Att letter) _REDACTED
· More rows may be inserted if necessary
| Filename |
| Document Section |
| Document |
Page #
| Statutory exception reference |
| Rationale for application of the statute |
| Submitted |
5.0 Subcontractors per RFP 2.4.4 (additional subcontractors/those not submitted in Attachment A/Attachment A1)
| Subcontractor Name |
| Function to be performed |
| Document Submitted |
☐ Executed contract
☐ Letter of Agreement
☐ Executed contract
☐ Executed contract
☐ Executed contract
☐ Executed contract
☐ Executed contract
☐ Executed contract
6.0 Respondent Alternative Contract Terms/Clauses per Section 2.2.6.
| Attachment B, Section Reference |
| Alternative Proposed Language |
7.0 Respondent additional attachments (OPTIONAL)
| Filename |
| BID Attachment Reference |
File details come from the government source that posted it. Updated .