Attachment 1 - Request for Qualification for Contractual Services Form.docx
DOCX document 41 KB Posted
- Attached to
- Interpreting & Translation Services
- Solicitation number
- 103325-O3
- Issued by
- Blaine County, Nebraska
About this file
This document is an Attachment 1 - Request for Qualification for Contractual Services Form for the State of Nebraska. It outlines the process for bidders to prequalify as contractors to provide interpreting and translation services for the Nebraska Department of Health and Human Services (DHHS). The services may include translation and/or interpretation for or on behalf of DHHS program clients and/or providers. The form requires bidders to provide their company information and certify whether they are a Nebraska contractor, a resident disabled veteran or business located in a designated enterprise zone, or a blind person licensed by the Commission for the Blind & Visually Impaired in order to be considered for any applicable preferences in the contract award.
The pricing terms, set asides, incumbent providers, funding requirements and sources, and award amounts are not specified in this document. The form indicates that the information collected regarding Nebraska contractors is for statistical purposes only and will not be considered for the contract award.
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Text version
Attachment 1 Request for Qualification for Contractual Services Form
BIDDER MUST COMPLETE THE FOLLOWING
By signing this Request for Qualification for Contractual Services form, the bidder guarantees compliance with the procedures stated in this Request for Qualification, and agrees to the terms and conditions unless otherwise indicated in writing and certifies that bidder maintains a drug free work place.
Per Nebraska’s Transparency in Government Procurement Act, Neb. Rev Stat § 73-603 DAS is required to collect statistical information regarding the number of contracts awarded to Nebraska Contractors. This information is for statistical purposes only and will not be considered for contract award purposes.
_____ NEBRASKA CONTRACTOR AFFIDAVIT: Bidder hereby attests that bidder is a Nebraska Contractor. “Nebraska Contractor” shall mean any bidder who has maintained a bona fide place of business and at least one employee within this state for at least the six (6) months immediately preceding the posting date of this RFQ.
______I hereby certify that I am a Resident disabled veteran or business located in a designated enterprise zone in accordance with Neb. Rev. Stat. § 73-107 and wish to have preference, if applicable, considered in the award of this contract.
_____ I hereby certify that I am a blind person licensed by the Commission for the Blind & Visually Impaired in accordance with Neb. Rev. Stat. §71-8611 and wish to have preference considered in the award of this contract.
FORM MUST BE SIGNED USING AN INDELIBLE METHOD (NOT ELECTRONICALLY)
INDIVIDUAL/FIRM NAME:
COMPLETE ADDRESS:
TELEPHONE NUMBER:
EMAIL ADDRESS:
DATE:
SIGNATURE:
TYPED NAME & TITLE OF SIGNER (FIRMS ONLY):
File details come from the government source that posted it. Updated .