Att J - Attestation Form.docx
DOCX document 51 KB Posted
- Attached to
- ISPHN Pharmacy ManagementBid Documents State and local contract opportunity
- Solicitation number
- 26-84336
- Issued by
- Vanderburgh County, Indiana
About this file
This is an Attestation Form (Attachment J) for a state and local contract opportunity managed by the Indiana Department of Administration (IDOA). The form serves as a mandatory submission checklist requiring respondents to confirm completion and submission of all required proposal components, including the Executive Summary, pricing documentation, business and technical proposals, and various certification forms related to Minority and Women Business Enterprise (MWBE) status, Indiana Veteran Owned Small Business status, and Indiana Economic Impact assessments. Respondents must designate an Internal Response Manager as their dedicated contact for State correspondence and attest to having read and understood all mandatory requirements outlined in the solicitation.
The form requires respondents to confirm their understanding of contract terms, subcontractor documentation, confidentiality requirements, and Buy Indiana Initiative certification eligibility. Respondents must provide any documents or sections claimed as confidential or redacted under the Indiana Access to Public Records Act (APRA), including the specific statutory exception reference, rationale for exemption, and a separate redacted version of each document. The attestation also requires detailed information on all subcontractors not previously submitted in Attachments A or A1, including their names, functions to be performed, and evidence of executed contracts or letters of agreement. Optional additional attachments may be submitted by respondents and are subject to IDOA Procurement review and removal as deemed appropriate.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| RFP 26-84336 - Addendum 1.docx | DOCX document | |
| RFP 26-84336 Main Doc - Addendum 1.pdf | ||
| Att L - AI Technical Questions.docx | DOCX document | |
| Att I - Pre-proposal Network Form.docx | DOCX document | |
| Att D - Cost Proposal.xlsx | XLSX spreadsheet | |
| Att G - Q&A Template.xlsx | XLSX spreadsheet | |
| Att B - Sample Contract.docx | DOCX document | |
| Att C - Indiana Economic Impact Form.xls | XLS spreadsheet | |
| Att F - Technical Proposal.docx | DOCX document | |
| Att M - Infrastructure Overview.docx | DOCX document | |
| Att A1 - IVOSB.docx | DOCX document | |
| Att A - MWBE.docx | DOCX document | |
| RFP 26-84336 Main Document.pdf | ||
| Att H - Reference Check Form.docx | DOCX document | |
| Att K - Pharmacy Management Services SOW.docx | DOCX document | |
| Att E - Business Proposal.docx | DOCX document |
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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) Comment by IDOA Procurement: This can be removed in its entirety if IDOA considers it appropriate to do so.
| Filename |
| RFP Attachment Reference |
2 v.07112024
File details come from the government source that posted it. Updated .