Att J - Attestation Form.docx
DOCX document 45 KB Posted
- Solicitation number
- 26-87847
- Issued by
- Marion County, Indiana
About this file
This is an Attestation Form (Attachment J) for a state and local contract opportunity with the State of Indiana, specifically managed through the Indiana Department of Administration (IDOA). The form serves as a mandatory submission checklist that respondents must complete to confirm compliance with all requirements outlined in the solicitation. Key submission requirements include completion of pricing documentation (Section 1.10), an executive summary (Section 3.2), and several attachments addressing business qualifications, financial proposals, and technical capabilities. Respondents must also confirm they have read and agree to contract terms and clauses, acknowledge confidentiality requirements, and declare whether they are claiming Buy Indiana Initiative status for potential additional points in the evaluation process.
The attestation form requires respondents to designate an internal response manager as the dedicated contact for State correspondence and to document all mandatory submissions, optional attachments, and any subcontractors involved in performing the work. Respondents must identify any documents or sections requiring confidential or redacted treatment under the Access to Public Records Act (APRA) and provide the statutory exemption basis for such designations. The form includes sections for documenting subcontractor agreements, executed contracts or letters of agreement, and optional additional attachments. This form does not contain pricing terms, funding amounts, or contract duration information, as it is a procedural compliance document designed to ensure respondents meet all submission requirements and understand their obligations under the solicitation.
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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 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 ☐ 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. |
☐ Confirm Respondent’s Legal Representation has read, and submitted alternative language per Attachment E.
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 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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