Attach C1 Administrative Response_YAC FINAL.docx

ATTACHMENT C1 - BIDDER RESPONSE TEMPLATE

ADMINISTRATIVE REQUIREMENTS RESPONSE (Pass/Fail)

RFP# 26-DCYF-OJJ-103

Youth Advisory Committee Coordination

Instructions: Bidders must complete this template and attach the PDF to their emailed RFP Response. Please thoroughly read all instructions in the RFP before completing. All mandatory information must be provided in order 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

Bidder Information:

|_| No

|_| No |_| N/A

|_| No |_| N/A

Contract History:

|_| 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

Bidder’s Exceptions:

|_| No

Insurance Requirements:

Proprietary or Confidential Information:

(Optional) OMWBE Certification:

Is Bidder or Bidder’s subcontractor OMWBE Certified?

|_| Yes

If yes, OMWBE Certification # ;

If Subcontractor is OMWBE Certified, Subcontractor’s Name

(Optional) Veteran Owned Business:

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

|_| Yes

If yes, DVA Certification # ;

If Subcontractor is DVA Certified, Subcontractor’s Name

(Optional) Small Business:

|_| No

If yes, please be sure return a sign Attachment B.1 Small Business Self-Certifications for each subcontractor as part of your proposal.

Checklist of Mandatory Response Attachments:

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

|_| Completed Administrative Response (Attachment C-1; this document)

|_| Completed Technical and Management Response (Attachment C-2)

|_| Three Required Letters of Support |_| Minimum of one (1) letter from a youth or young person. Acceptable forms of documentation include direct quotes, programming feedback or surveys, or a formal letter of support from a young person who has worked with the bidder or who has received services from the bidder.

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