Attachment B - EOHHS-Required Bidder Certifications~1.docx
DOCX document 39 KB Posted
- Attached to
- 25EHSPMMHMESRFR: RFR for Member Experience Survey Administration, Analysis and Reporting
- Solicitation number
- BD-26-1039-EHS01-EHS01-118757
- Issued by
- Massachusetts
About this file
This document is an EOHHS-Required Bidder Certifications form for a Member Experience Survey Administration, Analysis, and Reporting contract. The certification requires bidders to confirm their qualifications, readiness, and compliance with federal statutes and regulations for conducting member experience surveys. Bidders must attest to their ability to begin performance by the specified date, maintain qualified personnel, and perform all required services at the proposed cost.
The certification covers multiple critical business aspects, including financial condition, potential conflicts of interest, and subcontractor relationships. Bidders must demonstrate sound financial condition, provide an unqualified audit opinion, confirm no outstanding liabilities or litigation, and commit to maintaining compliance throughout the contract term. The document requires signatures from both the Chief Executive Officer and Chief Financial Officer, who certify the accuracy of the information under penalties of perjury, with provisions for potential parent company guarantees and ongoing notification of any changes to the submitted statements.
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ATTACHMENT B
EOHHS-Required Bidder Certifications Completion of these Certifications is a required element of the Bidder’s Business Response as described in Section 5.2.F 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.
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 A by the date listed in Section 3.0 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.
The undersigned certifies that it is qualified to administer, analyze, and report on Member Experience Surveys in accordance with the requirements listed in the RFR, Attachment A, and as described below and will remain so qualified for the duration of the Contract including any optional extension periods.
The undersigned certifies that the Bidder and its subcontractors are now, and shall remain, for the duration of this Contract, including all extensions, in compliance with the federal statutes and regulations governing vendors for Member Experience Survey Administration, Analysis, and Reporting, and agrees that such compliance is a condition precedent to the award and continuation of this and/or any related contract(s).
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 4.2.D 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 4.2.D, any other information requested by EOHHS that, in EOHHS’s judgment, is relevant to the Bidder’s financial, legal, contractual, or other business interests. |
3. Acceptance of EOHHS Model Contract ☐ The undersigned certifies that the Bidder accepts all of the provisions in Attachment A, and its Attachments and Appendices, as well as the Commonwealth Terms and Conditions and Commonwealth of Massachusetts Standard Contract Form, in their entirety and without modification.
4. Key Personnel ☐ The undersigned certifies that the staff 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.
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. |
| ☐ | The undersigned certifies that each proposed subcontractor meets the requirements of the RFR and Attachment A. |
6. Financial Condition The undersigned certifies that the Bidder (On only the first two boxes below, please check the one that is applicable):
| ☐ | 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. |
7. 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 ________________, 2025 Signature of the Chief Executive Officer
Printed Name of Signatory
Date
Signed under the pains and penalties of perjury this ______day of ________________, 2025 Signature the Chief Financial Officer
Printed Name of Signatory
Date
EXHIBIT 1
CERTIFICATION OF SUBCONTRACTOR’S
Subcontractor Name:
Subcontractor Address:
Contact Person and Title:
Contact Telephone:
Contact Email Address:
The subcontractor attests that it meets the qualifications described in the RFR and Attachment A for subcontractors as described below:
I. Certification The undersigned certifies that the Subcontractor is now, and shall remain, for the duration of this Contract, including all extensions, in compliance with the federal statutes and regulations governing subcontractors vendors for Member Experience Survey Administration, Analysis, and Reporting, including the requirements set forth in the RFR and Attachment A.
Signed under the pains and penalties of perjury this ______day of ________________, 2025 Signature of Authorized Signatory
Printed Name and Title of Signatory
Date
Attachment B - EOHHS Required Bidder Certifications RFR for Member Experience Survey Administration, Analysis And Reporting
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