Att F - Attestation Form.docx
DOCX document 48 KB Posted
- Solicitation number
- 26-87563
- Issued by
- Jasper County, Indiana
About this file
This is an Attestation Form for a negotiated bid contract with the State of Indiana, Department of Administration (IDOA). The document serves as a compliance checklist requiring respondents to confirm receipt, understanding, and submission of all mandatory contract documents and requirements. Key mandatory submissions include the Executive Summary (Attachment B), Indiana Economic Impact form (Attachment C), Bid Cost Excel Workbook (Attachment D), and this Attestation Form itself (Attachment F). Respondents must also address optional submissions including the Minority and Women Business Enterprise form (Attachment A) and Indiana Veteran Owned Small Business form (Attachment A1), confirm their ability to supply required products or services, and declare acceptance or propose alternatives to sample contract terms and clauses outlined in Section 2.2.6. The form requires respondents to identify any subcontractors beyond those listed in Attachments A and A1, specify their functions, and submit executed contracts or letters of agreement for each subcontractor relationship.
The attestation process includes provisions for claiming Indiana Veteran Owned Small Business (IVOSB) certification status and optional submission of an Indiana Preferences form (Attachment G). Respondents must declare whether they are claiming IVOSB certification and provide appropriate supporting documentation from IDOA if applicable. The form includes detailed requirements for identifying confidential or redacted information subject to statutory exemptions under Indiana's Access to Public Records Act (APRA), including specification of applicable statutory exceptions, rationale for exemption application, and submission of appropriately marked confidential or redacted versions of affected documents. Any alternative contract language proposed by respondents must be documented in Section 6.0 of the attestation form, with all optional additional attachments clearly identified with corresponding bid attachment references.
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Other files
| File | Type | Posted |
|---|---|---|
| Att D - Cost Proposal Template.xlsx | XLSX spreadsheet | |
| Att G - Preferences.docx | DOCX document | |
| Att H - Affidavit of Eligibility.docx | DOCX document | |
| Negotiated Bid Main Document 26-87563.docx | DOCX document | |
| Att A - MWBE.docx | DOCX document | |
| Att C - Indiana Economic Impact Form.xls | XLS spreadsheet | |
| Att B - Sample Contract (the new one).docx | DOCX document | |
| Artificial Intelligence - Technical Proposal Questions.docx | DOCX document | |
| Vallonia_State_Tree_Nursery_Fumigation.pdf | ||
| Att A1 - IVOSB.docx | DOCX document | |
| Att E - Q&A Template.xlsx | XLSX spreadsheet | |
| Infrastructure Overview.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 .