Attachment #1 - Respondent Information Form.docx
DOCX document 62 KB Posted
- Solicitation number
- RFP-185-2515-2026
- Issued by
- Polk County, Des Moines City, Iowa
About this file
This document is an Attachment #1 Respondent Information Form for the Iowa Health Information Network (Health Information Exchange) procurement by Iowa Health and Human Services (HHS). The form requires potential vendors to provide detailed company information for a solicitation seeking a Health Information Exchange infrastructure and services solution that enables secure, efficient, and interoperable health data exchange across Iowa.
The form captures comprehensive business details including legal business name, parent corporation information, business entity type, contact information, employee count, years in business, tax identification numbers, and registration status in Iowa. The document indicates that subcontractors may be utilized, with a requirement to submit an additional Subcontractor Disclosure Form for each proposed subcontractor. The procurement appears focused on selecting a vendor to provide advanced health information technology infrastructure that can facilitate seamless data sharing among healthcare providers within the state of Iowa.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment #2 - Subcontractor Disclosure Form.docx | DOCX document | |
| RFP-185-2515-2026 Health Information Network (Health Information Exchange).pdf | ||
| 1305844-event.pdf | ||
| Attachment #4 - IHIN Cost Proposal.xlsx | XLSX spreadsheet | |
| Attachment #5 - Sample Contract.docx | DOCX document |
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Text version
Attachment #1: Respondent Information Form
Primary Contact Information (an individual who can address issues re: this Proposal)
Name:
Address:
Tel:
Fax:
E-mail:
Respondent Detail
Business Legal Name (“Respondent”):
“Doing Business As” names, assumed names, or other operating names:
Parent Corporation Name and Address of Headquarters, if any:
Form of Business Entity (i.e., corp., partnership, LLC, etc.):
State of Incorporation/organization:
Primary Address:
Phone:
Local Address (if any):
Addresses of Major Offices and other facilities that may contribute to performance under this RFP/Contract:
Number of Employees:
Number of Years in Business:
Primary Focus of Business:
Federal Tax ID:
UEI #:
If the Respondent is currently registered to do business in Iowa, provide the Date of Registration:
Do you plan on using subcontractors if awarded this Contract? {If “YES,” submit Attachment 2 - Subcontractor Disclosure Form for each proposed subcontractor.}
File details come from the government source that posted it. Updated .