Att F - Attestation Form.docx

DOCX document 47 KB Posted

Attached to
DNR AmmunitionBid Documents
Solicitation number
27-87904
Issued by
Indiana

About this file

This is an Attestation Form for a Negotiated Bid procurement managed by the State of Indiana. The form serves as a checklist for respondents to confirm compliance with mandatory submission requirements and mutual understanding of the procurement terms. Respondents must attest to having read and met pricing requirements, understood mandatory purchase order terms and conditions, completed and submitted the Executive Summary, provided the Indiana Economic Impact form, submitted the Bid Cost Excel workbook, and completed the Attestation Form itself. Additional optional submissions include the Indiana Veteran Owned Small Business certification form, Indiana Preferences form, and documentation for any subcontractors beyond those listed in the initial submission.

The form includes sections for respondents to declare whether they are claiming Indiana Veteran Owned Small Business (IVOSB) certification status and to list any additional subcontractors with their assigned functions and supporting documentation, which may include executed contracts or letters of agreement. Respondents may also attach optional supporting documentation as needed. The attestation process ensures that all bidders acknowledge they have reviewed and comply with the specified mandatory requirements, with disagreement or failure to meet these items potentially resulting in disqualification of the response.

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Other files

File Type Posted
Att G - Purchasing Preference Form.docx DOCX document
Att D - Cost Proposal Template.xlsx XLSX spreadsheet
Att I - Requirements.docx DOCX document
Att B - Sample Purchase Order T&C.docx DOCX document
Att A1 - IVOSB.docx DOCX document
Att E - Q&A Template.xlsx XLSX spreadsheet
Att H - Affidavit of Eligibility.docx DOCX document
Negotiated Bid Main Document (PURCHASE ORDER).docx DOCX document
Att C - Indiana Economic Impact Form.xlsx XLSX spreadsheet

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Text version

ATTESTATION FORM

Negotiated Bid - PO

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 PO Terms and Conditions
☐ Have read and understand this section
Section 2.2 Executive Summary
☐ Have completed, signed, and submitted
Section 2.4.1 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.

1.20 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 or ☐ Opting not to submit

2.2.1 Ability and Desire to Supply the Required Products or Services
☐ Have read, and agree
2.4.3 Attachment G: Indiana Preferences form
☐ Have completed, and submitted

☐ Opting not to submit

2.4.4. Subcontractors

(Additional subcontractors/those not submitted in 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 Subcontractors per PO 2.4.4 (additional subcontractors/those not submitted in Attachment A1) More rows may be inserted if necessary

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

5.0 Respondent additional attachments (OPTIONAL)

More rows may be inserted if necessary

Filename
Attachment Reference

File details come from the government source that posted it. Updated .