Att F - Attestation Form.docx
DOCX document 42 KB Posted
- Attached to
- Bulk FuelBid Documents
- Solicitation number
- 26-84724
- Issued by
- Vanderburgh County, Indiana
About this file
This document is an Attestation Form for a Negotiated Bid contract, likely for the state of Indiana based on references to Indiana Economic Impact and Indiana Veteran Owned Small Business (IVOSB) forms. The form requires respondents to confirm their understanding and compliance with various mandatory submission requirements, including sections on pricing, contract terms, executive summary, economic impact, bid costs, and confidential information.
The form provides options for respondents to claim Indiana Veteran Owned Small Business certification, submit minority and women business enterprise documentation, and list potential subcontractors. Respondents must also confirm their ability to supply required products or services, review contract terms, and potentially submit alternative contract language. The document includes sections for confidential/redacted file submissions, detailing statutory exemptions and rationales, and allows for optional additional attachments to the bid response.
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Other files
| File | Type | Posted |
|---|---|---|
| Vendor Questions - State Responses.xlsx | XLSX spreadsheet | |
| Att H - Affidavit of Eligibility.docx | DOCX document | |
| Att G - Preferences.docx | DOCX document | |
| Att A1 - IVOSB.docx | DOCX document | |
| Att D - Bid Cost Template.xlsx | XLSX spreadsheet | |
| Artificial Intelligence - Technical Proposal Questions.docx | DOCX document | |
| Negotiated Bid Main Document.pdf | ||
| Infrastructure Overview.docx | DOCX document | |
| Att B - Sample Contract.docx | DOCX document | |
| District Map.jpg | JPG image | |
| Att C - Indiana Economic Impact Form.xls | XLS spreadsheet | |
| Att E - Q&A Template.xlsx | XLSX spreadsheet | |
| Att A - MWBE.docx | DOCX document |
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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 .