Attm. H - Invest in Massachusetts_Form~2.doc
DOC document 85 KB Posted
- Attached to
- RFR 2507 - Digital Window Signs
- Solicitation number
- BD-25-1062-LOT-LOTDO-110000
- Issued by
- Massachusetts
About this file
This is an Invest in Massachusetts Data Form required by the Massachusetts State Lottery Commission for RFR 2507 regarding digital window signs. The form requires bidders to provide business information and declare whether 50% or more of the work hours for the resulting contract will be performed in Massachusetts.
The form requires bidders to specify the number of jobs that will be created or preserved in Massachusetts and their locations if they commit to performing 50% or more of the work in-state. Bidders answering "yes" to the 50% work commitment must complete a certification section, signed under penalty of perjury by an authorized representative, which becomes an essential part of any resulting contract agreement.
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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.
For a complete list of certified vendors please go to http://www.somwba.state.ma.us/BusinessDirectory/BusinessDirectory.aspx .
Part I Bidder/Proposer Information
Business Name:
Full Address: number, street, and apt. or suite no., city, state, zip
| Contact Name: |
| Phone # ( FORMTEXT |
) - 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).
f
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? FORMCHECKBOX Yes FORMCHECKBOX 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.
f
I, Signed under the pains and penalties of perjury.
Print Name ► Authorized Signature ► ________________________________ Date ► f
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