attachment-2-rfp-2026-nhvh-01-med.docx
DOCX document 54 KB Posted
- Attached to
- Medical Services
- Solicitation number
- RFP-2026-NHVH-01-MED
- Issued by
- Belknap County, New Hampshire
About this file
This is a transmittal letter and vendor information form for the New Hampshire Veterans Home's Request for Proposal (RFP) for mobile dental services. The solicitation requests vendors to provide dental services to residents of the New Hampshire Veterans Home over a five-year contract period. Specific services include primary care physician coverage at approximately 100 hours per month and medical director services at approximately 40 hours per month. The vendor response is effective for 180 days from the submission due date or until the contract effective date, whichever is later. The RFP requires vendors to provide three professional references, describe their organizational capabilities and relevant experience, address any potential conflicts of interest, and confirm they are not debarred from federal or state government work.
Pricing must be submitted on an hourly basis for each year of the five-year contract term, with separate rates for primary care physician and medical director positions. The actual hours are noted as approximate and not guaranteed. Vendors are authorized to receive third-party payments or direct payments from the New Hampshire Veterans Home for services rendered to residents above and beyond those covered under the base contract, specifically for residents with 70% or greater service connection status. The submission requires authorized signatures from individuals legally authorized to obligate the vendor, along with primary contact information for general matters and a designated fiscal contact for financial issues.
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Other files
| File | Type | Posted |
|---|---|---|
| attachment-3-rfp-2026-nhvh-01-med-scoring.pdf | ||
| attachment-1-rfp-2026-nhvh-01-med-0.pdf | ||
| addendum-1-rfp-2026-nhvh-01-med.pdf | ||
| rfp-2026-nhvh-01-med.pdf |
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Text version
New Hampshire Veterans Home Appendix B – Transmittal Letter and Vendor Information
TRANSMITTAL LETTER
Solicitation ID Number
Vendor Name
Vendor Address
Vendor Telephone
State of NH Vendor Code Number (required)
Date of Submission
To whom it may concern:
We hereby submit this response to the Solicitation referenced above, in complete accordance with all conditions and specifications set forth in the Solicitation.
We attest to the fact that:
1. The Vendor has read and fully understands this Solicitation and agrees to be bound by its terms, conditions, and requirements.
2. The Vendor fully understands and agrees to items listed in Section 2 – Special Provisions and Scope of Services and Appendix A - Form P-37 General Provisions and Standard Exhibits.
3. The Vendor’s Solicitation Response is effective for a period of 180 days from the Vendor Solicitation Response Due Date or until the Effective Date of any resulting Contract, whichever is later.
4. The prices, terms and conditions, and services in the Vendor’s Solicitation Response have been established without collusion with other vendors.
5. This document is signed by a person who is authorized to legally obligate the responding Vendor.
Further, in accordance with RSA 21-I:11-c, the undersigned Vendor certifies that neither the Vendor nor any of its subsidiaries, affiliates or principal officers is currently debarred from performing work on any project of the federal government or the government of any state.
Authorized Signature
Authorized Signature (printed)
Title
Telephone
1. Vendor Contact Information
Primary Point of Contact Individual who will serve as the Vendor’s primary contact for all other matters relating to the Solicitation.
Name
| 1.1. |
| Title |
| 1.2. |
| 1.3. |
| Telephone |
Fiscal Contact Individual who will serve as the Vendor’s primary contact for fiscal matters.
Name
Title
Telephone
2. Vendor References Provide the information requested below for three (3) individuals or organizations who have knowledge of your organization’s capability to deliver services applicable to this Solicitation. The Department may contact references at its discretion. A current Department employee will not be considered a valid reference.
Vendor Reference 1
Individual/Organization Name
Telephone
Description of Work Complete
Dates of Performance
Vendor Reference 2
Individual/Organization Name
Telephone
Description of Work Complete
Dates of Performance
Vendor Reference 3
Individual/Organization Name
Telephone
Description of Work Complete
Dates of Performance
3. Affiliations – Conflict of Interest
| Does your organization have any affiliations that might result in a conflict of interest in relation to this Solicitation? |
| Choose an item. |
a. If YES, explain the relationship(s) and how the affiliation(s) would not represent a conflict of interest.
4. Executive Summary
a. Provide a general company overview:
i. Describe the company’s management, organizational structure, and history; ownership and subsidiaries; company background and primary lines of business; headquarters and satellite locations; mission statement; and number of employees.
ii. Summarize the organization’s current project commitments, as well as major government and private sector clients.
iii. Describe any strengths considered to be assets to the organization and notable company accomplishments.
b. Provide an overview of the services the Vendor intends to provide.
i. Describe the organization’s understanding of the services requested in this solicitation and any problems anticipated in accomplishing the work.
ii. Describe the organization’s familiarity with the project elements, its solutions to the problems presented and knowledge of the requested services.
iii. Summarize how the organization is capable of effectively completing the services outlined in the solicitation, including 24/7 coverage details.
c. Bidders pricing response:
Bidder hereby offers to provide mobile dental services to the NHVH in accordance with all of the requirements of this bid at the following prices for the entire contract term.
Primary Care Physician
Year 1 hourly rate $ per hour x 100 hours per mth x 12 months = $
Year 2 hourly rate $ per hour x 100 hours per mth x 12 months = $
Year 3 hourly rate $ per hour x 100 hours per mth x 12 months = $
Year 4 hourly rate $ per hour x 100 hours per mth x 12 months = $
Year 5 hourly rate $ per hour x 100 hours per mth x 12 months = $
*Hours are based on approximate usage and are not guaranteed
Medical Director
Year 1 hourly rate $ per hour x 40 hours per mth x 12 months = $
Year 2 hourly rate $ per hour x 40 hours per mth x 12 months = $
Year 3 hourly rate $ per hour x 40 hours per mth x 12 months = $
Year 4 hourly rate $ per hour x 40 hours per mth x 12 months = $
Year 5 hourly rate $ per hour x 40 hours per mth x 12 months = $
*Hours are based on approximate usage and are not guaranteed
The contractor is also authorized to receive third party payments (or NHVH payment for 70%+ service connected prevailing residents) for services rendered to residents above and beyond that which is covered by this contract per the terms outlined in Section 4 of the RFP.
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