Att J - Attestation Form.docx
DOCX document 46 KB Posted
- Attached to
- RFS 26-87982 IVH Hospice CareBid Documents
- Solicitation number
- RFS 26-87982
- Issued by
- Marion County, Indiana
About this file
This is an Attestation Form (Attachment J) for a state and local contract opportunity issued by the State of Indiana, specifically related to RFS 26-87982. The form serves as a mandatory submission document that requires respondents to confirm completion and submission of all required sections and attachments, including an Executive Summary (Section 3.2), Business Proposal (Attachment E), and Technical Proposal (Attachment F). Respondents must designate an Internal Response Manager who will serve as the dedicated contact for state correspondence. The form requires attestation regarding the respondent's ability and desire to supply required products or services, confirmation that legal representation has reviewed contract terms and clauses, and disclosure of any subcontractors beyond those submitted in Attachment A1.
The form includes provisions for the Buy Indiana Initiative certification, allowing respondents to claim preference points if validated within the Buy IN Designation List at the time of the Sourcing Event Submission Date. Section 1.10 Pricing and Section 3.2 Attachment D (Cost Proposal) are omitted for RFS 26-87982, indicating this is not a price-based solicitation. Respondents must identify and submit any confidential or redacted documents in Section 4.0, providing the applicable statutory APRA exemption references and detailed rationales. The form also requires documentation of subcontractors in Section 5.0, with executed contracts or Letters of Agreement required for each subcontractor identified. The document version is dated 07112024.
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Other files
| File | Type | Posted |
|---|---|---|
| Att K - SOW Template.docx | DOCX document | |
| Att G - Q&A Template.xlsx | XLSX spreadsheet | |
| Att I - Pre-proposal Network Form.docx | DOCX document | |
| Att B - Sample Contract.docx | DOCX document | |
| Att H - Reference Check Form.docx | DOCX document | |
| RFS 26-87982 Main Document.pdf | ||
| Att L - Infrastructure Overview.docx | DOCX document | |
| Att C - Indiana Economic Impact Form.xls | XLS spreadsheet | |
| Att M - Artificial Intelligence.docx | DOCX document | |
| Att F - Technical Proposal.docx | DOCX document | |
| Att E - Business Proposal.docx | DOCX document |
Show all 11
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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 |
| ☒ Omitted for RFS 26-87982 |
| Section 3.2 Executive Summary |
| ☐ Have completed, signed, and submitted |
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 or ☒ Omitted for RFS 26-87982
| Section 3.2 Attachment C: Indiana Economic Impact |
| ☐ Have read, completed, and submitted |
| Section 3.2 Attachment D: Cost Proposal (Excel Workbook) |
| ☒ Omitted for RFS 26-87982 |
| 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 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
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