Att J - Attestation Form.docx
DOCX document 40 KB Posted
- Solicitation number
- 26-85265
- Issued by
- Marion County, Indiana
About this file
This document is an Attestation Form (Attachment J) for a state procurement solicitation, likely for the state of Indiana based on references to IDOA (Indiana Department of Administration). The form requires respondents to confirm their compliance with various mandatory submission requirements, including completing sections related to pricing, executive summary, minority and women business enterprise documentation, economic impact, cost proposal, business proposal, and technical proposal.
The attestation form outlines critical submission elements such as confidential information handling, ability to supply required products or services, contract terms acceptance, and subcontractor details. Respondents must verify their understanding of each section, either by agreeing, submitting alternative documentation, or indicating the section does not apply to their response. The form also provides a mechanism for listing confidential or redacted documents with specific statutory exemption references, and allows for optional additional attachments to be included with the proposal.
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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 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)
☐ 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
Reserved
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) More rows may be inserted if necessary
| 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)
More rows may be inserted if necessary
| Filename |
| RFP Attachment Reference |
File details come from the government source that posted it. Updated .