Att J - Attestation Form.docx
DOCX document 46 KB Posted
- Solicitation number
- RFP 26-87488
- Issued by
- Tippecanoe County, Indiana
About this file
This is an attestation form document related to a state and local contract opportunity. The form serves as a certification mechanism for vendors or contractors to attest to specific compliance requirements, qualifications, or representations regarding their business operations and eligibility to participate in government contracting. The document establishes a formal declaration process wherein signatories confirm adherence to regulatory standards, business practices, and contractual obligations. The attestation form typically requires authorized representatives to verify information under penalty of perjury, thereby creating a binding legal commitment to the accuracy of stated claims and the contractor's capacity to fulfill contract requirements.
The specific attestation requirements, compliance criteria, and certification standards contained within this form are essential components of the procurement process, ensuring that only qualified and compliant vendors proceed with contract negotiations and award consideration. Attestation forms of this nature commonly address areas such as business registration status, insurance coverage, safety compliance, non-discrimination policies, conflict of interest disclosures, and other mandatory certifications required by the contracting jurisdiction. The completion and submission of this attestation form represents a prerequisite step in the vendor qualification and selection process, with false attestations subject to legal remedies and potential debarment from future government contracting opportunities.
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Other files
| File | Type | Posted |
|---|---|---|
| Vendor Networking Opportunities List.xlsx | XLSX spreadsheet | |
| Att G - Q&A Template.xlsx | XLSX spreadsheet | |
| RFP 26-87488 IVH EHR Main Document.docx | DOCX document | |
| Att L - AI - Technical Proposal Questions.docx | DOCX document | |
| Att A - IVOSB.docx | DOCX document | |
| Att F- Technical Proposalv2.docx | DOCX document | |
| Att N - Resource Usage Matrix.xlsx | XLSX spreadsheet | |
| Att H - Reference Check Form.docx | DOCX document | |
| Att B - Sample Contract.docx | DOCX document | |
| Att B3 - IOT-SaaS.docx | DOCX document | |
| Att B1 - IOT-IaaS.docx | DOCX document | |
| Att B2 - IOT-PaaS.docx | DOCX document | |
| Att E - Business Proposal.docx | DOCX document | |
| Att D - Cost Proposalv.2.xlsx | XLSX spreadsheet | |
| Att C - Indiana Economic Impact Form.xlsx | XLSX spreadsheet | |
| Att I - Pre-proposal Network Form.docx | DOCX document | |
| Att M - Infrastructure Overview.docx | DOCX document | |
| Att K - Scope of Workv2.docx | DOCX document |
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Text version
ATTESTATION FORM
ATTACHMENT J – RFP 26-87488
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 A)
| 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
File details come from the government source that posted it. Updated .