Attachment_J_Invest_in_MA_Data_Form.docx
DOCX document 98 KB Posted
- Attached to
- RFR LOT Number 1506 - MSLC - STRIPS
- Solicitation number
- BD-15-1062-LOT-00001-00000002534
- Issued by
- Norfolk County, Boston City, Massachusetts
About this file
The document provided is an Invest in Massachusetts Data Form, which is a mandatory part of a solicitation from the Massachusetts State Lottery Commission (MSLC) for a pool of qualified firms to provide zero coupon non-callable U.S. Government securities, commonly referred to as STRIPS (Separate Trading of Registered Interest and Principal of Securities), through a competitive offering process. The form requires bidders/proposers to indicate if at least 50% or more of the work hours performed under the resulting contract will be in Massachusetts, and to provide details on the number and location of jobs that will be created or preserved in the state as a result of the contract.
Bidders/proposers who answer "yes" to having at least 50% of the work hours performed in Massachusetts are required to certify their commitment to this in the form, which will be an essential part of any contract awarded. The solicitation is identified as RFR LOT Number 1506 and has a COMMBUYS Bid Number of BD-15-1062-LOT-00001-00000002534.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment-N-Conflict Interest.doc | DOC document | |
| RFQ STRIPS 1506~1.docx | DOCX document | |
| sdprplanform3reporting.xlsx | XLSX spreadsheet | |
| CommonwealthTermsConditions.doc | DOC document | |
| RFQ 1506 Response Template.docx | DOCX document | |
| Attachment_B_Standard_Contract.doc | DOC document | |
| Attachment_H_ContractorSignatoryForm.doc | DOC document | |
| Supplier_Diversity_Plan_From_2_Declaration_of_SDP_Partners.docx | DOCX document | |
| Supplier_Diversity_Plan_From_1_Commitment.docx | DOCX document | |
| newmass-w9.pdf | ||
| Attachment_M_MSLC_PersonalDataCetrification.doc | DOC document | |
| Attachment_E_TaxCompliance - Copy.doc | DOC document | |
| Attachment_L_Lottery_Disclosure_Statement~1.doc | DOC document | |
| Attachment_F_BusinessReferenceForm - Copy.doc | DOC document | |
| AttachmentJ1InvestinMAInstructio.doc | DOC document |
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Text version
INVEST IN MASSACHUSETTS DATA FORM
Instructions: Completing all parts of this form is mandatory unless directed otherwise. Please read instructions in the Invest in Massachusetts Attachment included with the solicitation.
Part I Bidder/Proposer Information
Business Name:
Full Address: number, street, and apt. or suite no., city, state, zip
Contact Name: Phone # ( ) - x Email address:
Part II Invest in Massachusetts Data (Please respond to the inquiries (1‐3) listed below. If you answer “No” to Inquiry #1 of this Part II, then you are not required to complete Part III of this IMD Form).
| 1. | Will at least 50% or more of the work‐hours performed as a result of a contract arising out of this proposal be performed in | |
| Massachusetts? | Yes | No |
2. If you responded “Yes” to Inquiry #1, how many of those jobs performed in Massachusetts will be created and/or preserved as a result of a contract arising out of this proposal?
3. If you responded “Yes” to Inquiry #1, where in Massachusetts will those jobs be located?
Part III Certification Based on your responses in Part II of the IMD Form, those Bidders/Proposers who have answered “Yes” to Inquiry #1 are required to certify the Bidder/Proposer’s commitment that 50% or more of the work‐hours performed in connection with any contract arising out of the Bidder/Proposer’s RFR Response will be performed in Massachusetts. This certification must be signed by an individual authorized to bind the Bidder/Proposer firm. Additionally, this commitment will be an essential part of any contract awarded by the Treasury and will be written into any formal agreement.
| I, | , hereby certify that the information contained in this IMD Form is true and accurate and |
| I hereby certify on behalf of | [Bidder/Proposer Name] that, if awarded the contract, 50% or more of the work‐hours performed in connection with any agreement arising out of the Bidder/Proposer’s RFR Response, will be performed in the Commonwealth of Massachusetts. |
Signed under the pains and penalties of perjury.
Print Name Title
RFR LOT # 1506
OPEN and ROLLING PRE-QUALIFICATION OF STRIPS/ANNUITY PARTICIPATING FIRMS COMMBUYS Bid Number: BD-15-1062-LOT-00001-00000002534 MSLC Document Number: RFQ LOT Number 1506
Authorized Signature
Date image1.jpeg
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