Attachment B - Statement of Receipt Authority and Intent to Propose Form.doc
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- Solicitation number
- BD-17-1031-LSH00-LSH01-00000009641
- Issued by
- Suffolk County, Massachusetts
About this file
This document is an Intent to Propose Form for RFR 173024, a state contract opportunity issued by the State of Massachusetts for PACS with Voice Dictation & Image Sharing. The form requires interested bidders to indicate whether they plan to submit a proposal for Option A - PACS with Integrated Speech Recognition Dictation or Option B - Image Sharing Solution. Bidders must designate an authorized agent and provide their contact information, as well as list any representatives attending the pre-bid conference and site visits. The proposal response is due by 5PM on Wednesday, September 7, 2016.
The contract opportunity appears to be for the provision of a Picture Archiving and Communication System (PACS) with integrated speech recognition dictation and/or an image sharing solution. Bidders may choose to submit a proposal for one or both options. No further details are provided regarding quantities, award date, contract term, or pricing terms. The document does not indicate whether there are any set-asides, incumbents, or funding requirements and sources.
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Text version
Attachment B: Intent to Propose Form
RFR_173024
Attachment B: Statement of Receipt, Authority and Intent to Propose Form
Please return your response to Attachment B (this and the following page) via email to alison.macneil@state.ma.us or fax to Alison MacNeil at (617) 971-3854 by Wednesday, September 7, 2016 by 5PM. Directions for the meeting can be found at www.mass.gov/shattuckhospital.
Authorization
The individual submitting the Proposal represents and certifies as part of the Proposal that he/she is authorized to act as an agent for the agency responsible for this Proposal.
Independent Preparation of Proposal
Any proposal submitted in response to the RFR will be developed independently, without consultation, communication, or agreement for the purpose of restricting competition, to any matter relating to costs or terms with any other respondent or any representative of such respondent.
A. Statement of Receipt and Intent to Propose
Hereby acknowledges receipt of RFR
(Agency Name)
Print name
Authorized Signature
Title
Date
We plan to submit a proposal in response to the Shattuck Hospital RFR for PACS with Voice Dictation & Image Sharing (check all that apply):
Option A – PACS with Integrated Speech Recognition Dictation
Option B - Image Sharing Solution Please fill in Parts B and C.
B. Authority and Intent to Propose
Agencies must designate one point of contact for all proposal communications. Each bidder is responsible for notifying Shattuck Hospital of any change(s) to the point of contact.
Name of Authorized Agent:
Title of Authorized Agent:
Company Represented:
Initials of Authorized Agent:
Date:
RFR Contact:
Contact Address:
Contact Email:
Contact Phone:
C. Representatives Attending Pre-bid Conference and Tour
Number Attending Site Visits*
Attendee 1 - Name and Title
Telephone Number
Email Address
Attendee 2 - Name and Title
Telephone Number
Email Address
Attendee 3 - Name and Title
Telephone Number
Email Address
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