Att J - Attestation Formv2.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, issued by the Indiana Department of Administration on behalf of the Family and Social Services Administration Division of Mental Health & Addiction. The form serves as a mandatory submission checklist requiring respondents to confirm completion and submission of all required proposal components, including pricing (Section 1.10), executive summary, veteran-owned small business certification documentation, economic impact analysis, cost proposal in Excel format, business proposal, technical proposal, and confidentiality agreements. Respondents must attest to their ability to supply required products and services, confirm legal representation review of contract terms or submission of alternative language, identify any additional subcontractors beyond those listed in Attachment A, and declare whether they are claiming Buy Indiana Initiative certification status. The RFP solicitation period extends to September 16, 2026 at 3:00 p.m. Eastern Time, with a pre-proposal conference scheduled for August 26, 2026 from 9:30 a.m. to 11:30 a.m. at the Indiana Government Center South. The contract term is four years with two optional one-year renewals for a potential six-year total engagement.
The attestation form requires respondents to designate an internal response manager as the dedicated contact for state correspondence and establish a single point of contact email address for all solicitation-related communications. Respondents must identify any documents or sections of documents for which statutory exemption under the Access to Public Records Act (APRA) is claimed, specifying the applicable exemption and providing both redacted and confidential versions as appropriate. The form includes sections for listing additional subcontractors not submitted in Attachment A, with requirements for executed contracts or letters of agreement for each subcontractor. An Indiana Veteran Owned Small Business participation goal of 3% has been established for this solicitation. The form accommodates optional additional respondent attachments and provides structured space for documenting all required submissions, maintaining compliance with the mandatory submission requirements specified in Section 1.0 of the attestation form.
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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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