Attachment 4 - Patient Assault Information Form

This attachment is a supplementary document supporting the State of Maine's Master Agreement for Sexual Assault Evidence Collection Kits procurement through the Department of Administrative and Financial Services, Office of State Procurement Services. The Patient Assault Information Form serves as a standardized data collection instrument for documenting critical information related to sexual assault cases. The form is designed for use by healthcare facilities, law enforcement agencies, and sexual assault crisis centers participating in the Master Agreement to consistently record patient information, assault circumstances, evidence collection details, and chain-of-custody data. Quotations for complete evidence collection kits, which must include this form as a standardized component, are due by May 6, 2026, at 4:00 p.m. Eastern Standard Time through the AdvantageME Vendor Self Service system. The anticipated contract term runs from June 1, 2026, through May 31, 2027, with four optional renewal periods extending through May 31, 2031, and the State anticipates procuring approximately 1,000 kits annually with delivery to the Maine State Police Crime Lab in Augusta on a FOB Destination basis.

Vendor pricing must remain firm for a minimum of one year from the initial contract period, with all kit components subject to Maine's forensic standards and law enforcement protocols. No specific set-aside designations or pricing restrictions are identified in the procurement documentation. The State of Maine is exempt from federal, state, and local taxes and will issue an exemption certificate at contract execution. Eligible participants in the Master Agreement include state police, municipal police departments, hospitals and healthcare facilities, and sexual assault crisis centers throughout Maine. Vendors must submit physical samples of complete kits for departmental evaluation prior to bid closing and provide comprehensive product data sheets in PDF format demonstrating compliance with all specifications outlined in the solicitation.