Attachment D Required Bidder Certifications Form.doc

Request for Responses for COVID-19 Isolation and Recovery Site Services

Attachment D: Required Bidder Certifications Form Completion of these Certifications is a required element of the Bidder’s Business Response as described in Section 3.1.B 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 (Or Equivalent):

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 (Or Equivalent):

By my signature on the last page of this Bidder Certification document, I certify that the information below in numbered paragraph 5 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 all services and responsibilities described in the RFR and proposed by the Bidder in its Response by the Contract Start Date and that the Bidder is able to completely perform all services and responsibilities at the proposed costs and fees stated in the Bidder’s cost response and by the dates specified herein.

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 3.1 of the RFR, that such information is complete, truthful, and accurately reflects the Bidder’s business, and that the Bidder will provide, in accordance with such Section 3.1, any other information requested by EOHHS that, in EOHHS’ judgment, is relevant to the Bidder’s financial, legal, contractual, or other business interests.

3. Acceptance of Model Contract for Loan Repayment Program for Health and Human Service Professionals and Task Orders

· The undersigned certifies that the Bidder accepts all of the provisions of the RFR, including all attachments, as well as all provisions of the Commonwealth Terms and Conditions and Commonwealth of Massachusetts Standard Contract Form, in their entirety and without modification, except as otherwise agreed to by EOHHS.

4. 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 reimbursement will be in writing and will contain terms consistent with all terms and conditions of the Contract.

5. Financial Condition

· The undersigned certifies that The Bidder is in sound financial condition, and that it will have sufficient financial reserves to perform the requirements of this RFR prior to the execution of the Contract, if selected, and will obtain an unqualified audit opinion for the latest audit of its financial statements, if such unqualified audit opinion is requested by EOHHS 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.

6. 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.

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 ________________, 2022 Signature of the Chief Executive Officer (or equivalent title)

Printed Name of Signatory

Date

Signed under the pains and penalties of perjury this ______day of ________________, 2022 Signature the Chief Financial Officer (or equivalent title

Printed Name of Signatory

Date

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EOHHS Request for Responses for COVID-19 Isolation and Recovery Site Services

Required Bidder Certifications