Attach C1 Admin Response.docx

ATTACHMENT C1 - BIDDER RESPONSE TEMPLATE

ADMINISTRATIVE REQUIREMENTS RESPONSE (Pass/Fail)

RFQQ 25-DCYF-CW-096

Positive Indian Parenting

Instructions: Bidders must complete this template and attach the PDF to their emailed RFQQ Response. Please thoroughly read all instructions in the RFQQ before completing. All mandatory information must be provided for the Bidder to be responsive. Bidder may provide additional documentation as an additional Attachment; the documentation should be specified in this form. Also, please write your Business Name on the bottom of each page of this Response Template.

ADMINISTRATIVE REQUIREMENTS (Mandatory Pass/Fail)

Bidder Information:

Business Name:

Address:

Telephone:

Email of Legal Entity or Individual:

|_|No

Federal Tax Identifier Number:

WA State Uniform Business Identifier (UBI) Number:

|_|No

All Bidders must meet the following minimum qualifications:

· Must be licensed to do business in the state of Washington or provide a commitment that it will become licenses in Washington within thirty (30) days of being selected as the Apparent Successful Bidder (ASB).

· Must be a Federally Recognized Tribe serving Washington State Families or be a Recognized American Indian Organization or Native Serving Organization that can demonstrate cultural proximity to the AI/AN community.

· Must have experience offering Positive Indian Parenting or experience offering culturally responsive parent-education services to the AI/AN community.

|_|Yes |_|No

|_|No

|_|No

Key Personnel

Identify the key personnel you will utilize in performing this Contract, and their experience and qualifications.

Please include Org Chart and resumes of Key Personnel

Contract History:

Has the Bidder’s performance on any contract unsatisfactory and resulted in a contract termination in the past five (5) years?

|_|Yes |_|No

If yes, provide a list of those contracts terminated, and include the following:

· Other party’s Name

· Address

· Telephone Number

· Description of the Incident

· Bidder’s Position on the matter

State of Washington Employee(s):

|_|No

If yes, provide the following information for each individual:

· Name

· Employing Agency

· Job Title while with the Agency

· Separation Date

Insurance Requirements:

|_|No

Proprietary or Confidential Information:

If applicable, identify the Sections of the Response which the Bidder considers “Proprietary” or “Confidential” information:

(Optional) OMWBE Certification:

Is Bidder or Bidder’s subcontractor OMWBE Certified?

|_|Yes

If yes, Bidder’s OMWBE Certification #:

If Subcontractor(s) is OMWBE Certified, Subcontractor(s) names:

If yes, subcontractor(s) OMWBE Certification #:

(Optional) Veteran Owned Business:

Is Bidder or Bidder’s subcontractor certified Veteran Owned Business?

|_|Yes

If yes, Bidder’s DVA Certification #:

(Optional) Small Business:

If yes, please be sure to sign and return Attachment B.1 Small Business Self-Certifications as part of your proposal.

Checklist of Mandatory Response Attachments:

|_|Completed and signed Bidders Certification and Assurances Form (Attachment B)

|_|Complete and Signed Small Business Self-Certification Form (Attachment B.1) if Bidder is a Self-Certified Small Business

|_|Completed and Signed Administrative Requirements (Attachment C1; this document)

|_|Completed Technical Application

|_|Completed Budget Template

|_|Complete Diverse Business Inclusion Plan – Subcontractor Goals (Attachment D) if Bidder’s proposal includes any Subcontractors.

|_|Key Personnel Resumes/Org Chart

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