Att I - Pre-proposal Network Form.docx

This is a Pre-Proposal Network Opportunities Form attachment for Request for Proposal 26-85938, issued by the Indiana Department of Mental Health and Addiction (DMHA) for a Community Behavioral Health Center (CCBHC) Center of Excellence initiative. The form is optional and designed to collect preliminary information from interested organizations prior to formal proposal submission. Respondents must complete the form by providing company name, MBE/WBE/IVOSB certification status if applicable, company address, contact name and title, telephone number, and email address. Completed forms must be submitted via email to rfp@idoa.in.gov with a subject line clearly identifying the RFP number, attachment reference, and submitting company name, as detailed in RFP Section 1.24.

No specific pricing terms, contract duration, award dates, or other substantive contract details are provided in this form document. The form serves solely as a preliminary intake mechanism to identify potential network participants and establish contact information for the CCBHC Center of Excellence project. The optional nature of the submission suggests this is a pre-qualification or expression of interest step rather than a binding commitment to bid.