Att J - Attestation Form.docx
DOCX document 45 KB Posted
- Attached to
- Staff AugBid Documents State and local contract opportunity
- Solicitation number
- RFP 25-81223
- Issued by
- Vanderburgh County, Indiana
About this file
This document is an Attestation Form from the Indiana Department of Administration (IDOA) for a state procurement solicitation. The form requires detailed confirmation of a respondent's compliance with various mandatory submission requirements, including completed attachments for pricing, executive summary, minority and women business enterprise documentation, Indiana veteran-owned small business forms, economic impact statements, cost proposals, business proposals, and technical proposals. Respondents must confirm their understanding of confidential information protocols, ability to supply required products or services, contract terms, and subcontractor arrangements.
The form includes optional claims for the Buy Indiana Initiative, which can potentially award points if the respondent is certified as an Indiana company. Respondents must also provide detailed information about any confidential or redacted documents, specifying statutory exemptions and rationales for each. The form allows for listing additional subcontractors beyond initial submissions, requiring executed contracts or letters of agreement for each. The document appears to be part of a comprehensive procurement process that emphasizes local economic impact, diversity in business participation, and thorough documentation of a vendor's capabilities and compliance.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| RFP 25-81223 ISPHN Staff Augmentation v4.pdf | ||
| Addendum 3.pdf | ||
| Clarification 1.docx | DOCX document | |
| RFP 25-81223 ISPHN Staff Augmentation v3.pdf | ||
| Att I - Pre Proposal Networking Opportunities Responses.zip | ZIP file | |
| Addendum 2.pdf | ||
| Addendum 1.pdf | ||
| RFP 25-81223 ISPHN Staff Augmentation v2.pdf | ||
| Att I - Pre-proposal Network Form.docx | DOCX document | |
| Att A - MWBE.docx | DOCX document | |
| Att A1 - IVOSB.docx | DOCX document | |
| Att D - Cost Proposal Template.xlsx | XLSX spreadsheet | |
| Att E - Business Proposal.docx | DOCX document | |
| Att G - Q&A.xlsx | XLSX spreadsheet | |
| Att H - Reference Check.docx | DOCX document | |
| Att L - State Duties and Responsibilities.pdf | ||
| Att B - Sample Contract.docx | DOCX document | |
| Att C - Indiana Economic Impact Form.xls | XLS spreadsheet | |
| Att F - Technical Proposal.docx | DOCX document | |
| Att K - Job Profiles.zip | ZIP file | |
| RFP 25-81223 ISPHN Staff Augmentation.pdf |
Show all 21
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Text version
ATTESTATION FORM
ATTACHMENT J
Respondent Name:
Respondent’s Internal Response Manager’s Name:
This person will be the dedicated contact to receive State correspondence specific to this solicitation.
Respondent’s Internal Response Manager’s Email Address:
1.0 Mandatory Submissions and Requirements: Disagreement with these items may result in the response being disqualified.
| Attachment J: Attestation Form |
| ☐ Have completed in its entirety and submitted |
| Section 1.10 Pricing |
| ☐ Have read and meet this requirement |
| Section 3.2 Executive Summary |
| ☐ Have completed, signed, and submitted |
Section 3.2 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 or ☐ Opting not to submit
Section 3.2 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
☐ Opting not to submit
| Section 3.2 Attachment C: Indiana Economic Impact |
| ☐ Have read, completed, and submitted |
| Section 3.2 Attachment D: Cost Proposal (Excel Workbook) |
| ☐ Have completed and submitted |
| Section 3.2 Attachment E: Business Proposal |
| ☐ Have completed and submitted |
| Section 3.2 Attachment F: Technical Proposal |
| ☐ Have completed and submitted |
2.0 Confirm mutual understanding and submission.
1.15 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
☐ Have read, and does not apply to response
| 2.2.1 Ability and Desire to Supply the Required Products or Services |
| ☐ Have read, and agree |
| 2.3.6 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 Attachment E.
2.6.3. 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
| 2.6.2 Buy Indiana Initiative/Indiana Company |
| ☐ YES claiming (points only awarded if certification is finalized per Buy Indiana registry* at time of Sourcing Event Submission Date) |
*Validated by Respondent within Buy IN Designation List at https://www.in.gov/idoa/procurement/supplier-resource-center/programs-and-preferences/buy-indiana/
☐ 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 rfp #) _ (insert Att letter) _CONFIDENTIAL
· (insert rfp #) _ (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 2.6.3 (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 additional attachments (OPTIONAL)
| Filename |
| RFP Attachment Reference |
2 v.07112024
File details come from the government source that posted it. Updated .