Attachment 6 Required Bidder Certifications.doc

ATTACHMENT 6: RFR-Required Respondent Certifications

Completion of these Certifications is a required element of the Respondent’s Business Response as described in Section III of the RFR. Failure to submit this form may result in a Respondent’s response being rejected as non-responsive.

Exhibit 1 -- CERTIFICATION OF BIDDER’S QUALIFICATIONS AND CONTRACT READINESS

Name of Respondent:

(hereinafter, “Respondent”) Authorized Signatory’s Name:

Title: ___________________________________________________________________ By my signature on this Attachment 6: Exhibit 1, I certify that the information below, and any attached statement that I have provided, has been reviewed and signed by me, and is true, accurate, and complete, to the best of my knowledge. I understand that I sign under the pains and penalties of perjury, and may be subject to civil penalties or criminal prosecution for any falsification, omission, or concealment of any material fact contained herein.

1. Contract Readiness The undersigned certifies:

· That it will be ready to provide by execution of the Agreement or within 8 weeks of the execution of the Agreement, whichever is later, all services described in the Agreement in their entirety and without modification, for the term of the Agreement, in accordance with the timeframes and specifications described therein; and

· Its commitment to perform all requirements specified in the Agreement over the term of the Agreement, and any renewals thereof.

2. Debarment or Suspension

· The respondent certifies that neither the respondent nor its principals, subcontractors, or affiliates are presently, nor have they been in the past five years, debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in any program or procurement process by any governmental entity or public program.

3. Signature Signature and date stamps, or the signature of anyone other than the provider/fiscal agent, or in the case of a legal entity, person legally authorized to sign on behalf of the entity, are not acceptable.

Signed under the pains and penalties of perjury this ______day of ________________, 2017 Signature

Printed Name of Authorized Signatory

Title of Authorized Signatory

Date

Exhibit 2: Certification of Key Personnel

Name of Bidder:

Certification:

The undersigned certifies that the Key Personnel identified in the Bidder’s response are employees, consultants, or under obligation to the Bidder such that they will be available to work on this project according to the proposed project plan, and that they shall not be reassigned without the prior written approval of EOHHS.

Signature

Print Name of Signatory

Title

Date

Exhibit 3: Certification with Regard to Financial Condition

Name of Bidder: _________________________________________________________

Certification:

A check in the box to the right of each item indicates an affirmative response to the certification.

If one or more of the above boxes are not checked, please explain in the space provided below or attach a clearly labeled separate sheet.

Signature

Print Name of Signatory

Title

Date Exhibit 4: Certification with Regard to Subcontractors

Name of Bidder:

Certification:

The undersigned acknowledges its understanding that it will not be relieved of any legal obligations under any Contract resulting from this RFR as a result of any contracts with subcontractors, that it shall be fully responsible for the subcontractor’s performance, and that all subcontracts and other agreements or arrangements for reimbursement will be in writing and will contain terms required by and consistent with all terms and conditions of the Contract.

Signature

Print Name of Signatory

Title

Date

Exhibit 5: Certification of Non-Collusion The undersigned certifies under penalties of perjury that this bid or response has been made and submitted in good faith and without collusion or fraud with any other person. As used in this certification, the word “person” shall mean any natural person, business, partnership, corporation, union, committee, club, or other organization, entity, or group of individuals.

(Name of person signing Response)

(Name of business)