Att J - Attestation Form.docx
DOCX document 39 KB Posted
- Attached to
- Early Intervention Professional Development SystemBid Documents State and local contract opportunity
- Solicitation number
- RFP 25-84140
- Issued by
- Indiana
About this file
This document is an Attestation Form (Attachment J) from a state procurement process, likely in Indiana, related to a solicitation for products or services. The form serves as a comprehensive checklist for respondents to confirm their compliance with various mandatory submission requirements, including completed sections such as Pricing (1.10), Contract Terms/Clauses (2.3.6), Executive Summary (3.2), and multiple attachments including Minority and Women Business Enterprise forms, Indiana Veteran Owned Small Business documentation, Economic Impact statement, Cost Proposal, Business Proposal, and Technical Proposal.
The form includes provisions for claiming Buy Indiana Initiative points, submitting confidential/redacted documents with specific formatting requirements, and listing potential subcontractors. There are options for respondents to claim or opt out of certain certifications, submit alternative contract language, and provide detailed explanations for confidential information exemptions. The document appears designed to ensure thorough vendor compliance, transparency, and comprehensive proposal submission across multiple evaluation criteria, with specific emphasis on Indiana-based business participation and detailed documentation of proposed services and subcontractor relationships.
View the file
Other files for this state and local contract opportunity
Show all 22
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTESTATION FORM
ATTACHMENT J
Respondent Name:
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 2.3.6 Mandatory Contract Terms/Clauses |
| ☐ Have read and understand this section |
| 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.
2.6.4. 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
| 2.6.3 Buy Indiana Initiative/Indiana Company |
| ☐ YES claiming (points only awarded if finalized per Buy Indiana registry) |
☐ 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 2.6.4 (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 additional attachments (OPTIONAL)
| Filename |
| RFP Attachment Reference |
Pg 2
File details come from the government source that posted it. Updated .