Att J - Attestation Form-RTP.docx
DOCX document 43 KB Posted
- Attached to
- ISPHN Med Repack and Preventative MaintenanceBid Documents State and local contract opportunity
- Solicitation number
- 26-86417
- Issued by
- Vanderburgh County, Indiana
About this file
This is an Attestation Form (Attachment J) for a state and local contract opportunity administered by the State of Indiana, specifically through the Indiana Department of Administration (IDOA). The form serves as a mandatory submission requirement for respondents to confirm completion and submission of all required proposal components, including pricing (Section 1.10), executive summary (Section 3.2), and various supporting attachments such as the Indiana Veteran Owned Small Business form, Indiana Economic Impact statement, cost proposal in Excel format, business proposal, and technical proposal. Respondents must designate an Internal Response Manager who will serve as the dedicated contact for state correspondence related to the solicitation and must attest to having read and met all specified requirements outlined in the solicitation sections.
The form requires respondents to confirm their understanding of mandatory submissions, ability to supply required products or services, acceptance of contract terms and clauses, and eligibility for the Buy Indiana Initiative if applicable. Respondents must identify any confidential or redacted documents and specify the statutory exemptions under the Access to Public Records Act (APRA) that justify confidentiality, including detailed rationale and statutory exception references for each document. The form also provides space for optional additional attachments and includes provisions for alternative contract language submissions through legal representation. The document version is dated July 11, 2024, and establishes the compliance framework through which respondents demonstrate their qualifications and adherence to all solicitation requirements.
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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 Respondent additional attachments (OPTIONAL)
More rows may be inserted if necessary
| Filename |
| RFP Attachment Reference |
2 v.07112024
File details come from the government source that posted it. Updated .