Att J - Attestation Form.docx
DOCX document 46 KB Posted
- Attached to
- CMHW Case Management System (Tobi)Bid Documents
- Solicitation number
- RFP 26-86873
- Issued by
- Marion County, Indiana
About this file
This is an Attestation Form (Attachment J) for RFP 26-86873, a solicitation issued by an Indiana state agency. The form serves as a certification document requiring the respondent to confirm completion and submission of all mandatory requirements and attachments necessary for proposal evaluation. Respondents must designate an Internal Response Manager as the dedicated contact for state correspondence and attest to having completed, read, and submitted or opted out of various proposal components including pricing (Section 1.10), Executive Summary (Section 3.2), and supporting attachments such as the Indiana Veteran Owned Small Business form, Indiana Economic Impact statement, Cost Proposal (Excel Workbook), Business Proposal, and Technical Proposal. The form also requires confirmation that the respondent has read and understands all mandatory submission requirements, confidentiality provisions, ability to supply required products or services, contract terms and clauses, and subcontractor information.
The Attestation Form includes provisions for respondents to claim Buy Indiana Initiative/Indiana Company status if applicable and validated within the Buy IN Designation List, with points awarded only if certification is finalized by the Sourcing Event Submission Date. Respondents must identify any documents or sections requiring confidential or redacted treatment under the Access to Public Records Act (APRA), specify the applicable statutory exemption, provide rationale for the exemption, and submit appropriately designated redacted or confidential versions. The form accommodates listing additional subcontractors beyond those submitted in Attachment A, requiring executed contracts or letters of agreement for each subcontractor and their designated functions. Optional respondent attachments may be included with appropriate RFP Attachment references, and additional rows may be inserted as necessary to accommodate all required information and documentation.
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Text version
RFP 26-86873
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: 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. |
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
| 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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