Attachment 6 - RFR Required Bidder Certifications DME Preferred Supplier.doc

ATTACHMENT 6. RFR-Required Bidder Certifications

Completion of these Certifications is a required element of the Bidder’s Business Response as described in Section III.E.7 of the RFR. Failure to submit this form may result in a Bidder’s response being rejected as non-responsive.

Name of Bidder:

(hereinafter, “Bidder”) Chief Executive Officer:

By my signature on the last page of this Bidder Certification document, 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.

Chief Financial Officer:

By my signature on the last page of this Bidder Certification document, I certify that the information below in numbered paragraph 6 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.

A check in the box of each item, below, indicates an affirmative response to the certification. If one or more of the boxes are not checked, please provide an explanation on a clearly labeled separate sheet.

EXHIBIT 1

BIDDER’S QUALIFICATIONS AND CONTRACT READINESS

· The undersigned certifies that the Bidder will be ready to begin performance of responsibilities described in this RFR and in Attachment 5 by the date listed in Section VII of this RFR, and that the Bidder is able to perform all services and responsibilities at the cost stated in the Bidder’s cost response and by the dates specified in this RFR.

EXHIBIT 2

BIDDER’S INTERESTS

· The undersigned certifies that no Bidder interest will conflict in any manner or degree with the performance of services required under the Contract.

· The undersigned certifies that the Bidder has submitted all information required under Section III.E.4 of the RFR, that is complete, truthful, and accurately reflects the Bidder’s business, and that the Bidder will provide, in accordance with such Section III.E.4, any other information requested by EOHHS that, in EOHHS’s judgment, is relevant to the Bidder’s financial, legal, contractual, or other business interests.

EXHIBIT 3

ACCEPTANCE OF EOHHS MODEL CONTRACT FOR PREFERRED SUPPLIER

The undersigned certifies that the Bidder accepts all of the provisions in Attachment 5, EOHHS Model Contract, and its Attachments, as well as the Commonwealth Terms and Conditions and Commonwealth of Massachusetts Standard Contract Form, in their entirety and without modification.

EXHIBIT 4

KEY PERSONNEL

· The undersigned certifies that the Key Personnel identified in the Bidder’s response to the RFR are employees, consultants, or under obligation to the Bidder such that they will be available to work on this Contract as specified by the Bidder in its response and that they shall not be reassigned without the prior written approval of EOHHS.

EXHIBIT 5

SUBCONTRACTORS

· 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 partnership agreements, subcontracts, and other agreements or arrangements for payment will be in writing and will contain terms consistent with all terms and conditions of the Contract.

EXHIBIT 6

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.

EXHIBIT 7

DEBARMENT OR SUSPENSION

The Bidder certifies that neither the Bidder 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

EXHIBIT 8

FINANCIAL CONDITION

The undersigned certifies that the Bidder (please check one of the boxes below):

· is in sound financial condition and has sufficient financial reserves to perform the requirements of this RFR and has received an unqualified audit opinion for the latest audit of its financial statements. Specify the date of the last audit __________________; OR

· is in sound financial condition and will have sufficient financial reserves to perform the requirements of this RFR prior to the execution of the Contract, if selected, and will have received an unqualified audit opinion for the latest audit of its financial statements, prior to Contract execution.

· The undersigned certifies that the Bidder has no outstanding liabilities to the Internal Revenue Service or other government agencies.

· The undersigned certifies that the Bidder is not the subject of any current litigation or findings of non-compliance under federal or state law.

· The undersigned certifies that the Bidder has not been the subject of any past litigation or findings of non-compliance under federal or state law.

· The undersigned certifies that the Bidder is not aware of any circumstance materially and adversely affecting the Bidder’s financial condition that is not reported in the foregoing financial statements and that, to the best of his/her knowledge, the Bidder is not delinquent in the payment of any federal or state tax.

If applicable, the undersigned certifies the following with respect to its Bidder’s Parent Company, _______________ (“Parent”):

· The undersigned certifies that Parent is in sound financial condition and has received an unqualified audit opinion for the latest audit of its financial statements. Specify the date of the last audit ______;

· The undersigned certifies that Parent has no outstanding liabilities to the Internal Revenue Service or other government agencies.

· The undersigned certifies that Parent is not the subject of any current litigation or findings of non-compliance under federal or state law.

· The undersigned certifies that Parent has not been the subject of any past litigation or findings of non-compliance under federal or state law.

· The undersigned certifies that Parent will provide an unconditional guarantee, in a form acceptable to EOHHS, of all financial and other obligations under the Contract.

EXHIBIT 9

PRIVACY AND SECURITY CERTIFICATION

· The undersigned certifies that the Bidder will adhere to all applicable obligations regarding the protection of personal information, as defined in M.G.L. c. 93H, and personal data, as defined in M.G.L. c. 66A, owned or controlled by EOHHS that the Bidder may access in connection with its performance under the Contract.

EXHIBIT 10

CHANGES TO STATEMENTS

· The undersigned acknowledges the Bidder’s obligation to notify EOHHS of any changes in the statements made herein.

Signed under the pains and penalties of perjury this ______day of ________________, 2023 Signature of the Chief Executive Officer

Printed Name of Signatory

Date

Signed under the pains and penalties of perjury this ______day of ________________, 2012 Signature the Chief Financial Officer

Printed Name of Signatory

Date

EXHIBIT 11

CERTIFICATION OF SUBCONTRACTOR’S INDEPENDENCE

(if applicable)

Subcontractor Name:

Subcontractor Address:

Contact Person and Title:

Contact Telephone:

Contact Email Address:

Signed under the pains and penalties of perjury this ______day of ________________, 2023 Signature of Authorized Signatory

Printed Name and Title of Signatory

Date

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EOHHS Required Bidder Certifications

EOHHS RFR for a Preferred Supplier for DME Incontinence Products