Bidder Mandatory Submission Form.docx
DOCX document 14 KB Posted
- Attached to
- Exam Services
- Solicitation number
- BD-15-1027-DOI01-DOI01-00000003921
- Issued by
- Suffolk County, Massachusetts
About this file
The document is a Bidder Mandatory Submission Form for a consultant contract opportunity with the Commonwealth of Massachusetts. The form requires bidders to disclose any additional income from the Commonwealth, persons with financial interest in the contract or bidder, and key personnel assigned to the contract. The related state and local contract opportunity is to provide licensing exam and continuing education goods and services to the MA Division of Insurance for the licensure of insurance producers and other license types.
The form indicates that this is a consultant contract opportunity within HH, NN, and UU object classes. Bidders must complete the form and provide resumes or statements of qualifications for any key personnel to be assigned to the contract. The form must be signed by an authorized signatory for the bidder, certifying the accuracy of the information under pains and penalties of perjury.
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Text version
CONSULTANT CONTRACTOR MANDATORY SUBMISSION FORM
COMPLETE THE FOLLOWING ONLY FOR CONSULTANT CONTRACTS
(Within HH and NN and UU Object Classes)
Bidder: ________________________________________________________________________ RFR Name/Title: ________________________________________________________________ RFR Number: # _________________________________________________________________
Additional Income Disclosure. Pursuant to the provisions of M.G.L. c. 29, s. 29A, the following amounts represent any contracts, grants or other income due from the Commonwealth of Massachusetts, including any political subdivision or public authority, during the period of a contract. You may attach additional sheets as necessary.
|_| Please check if N/A.
Disclosure of Persons with Financial Interest (other than the bidder). Pursuant to the provisions of M.G.L. c. 29, s 29A and c. 7A, s. 6, the following individuals have a financial interest in a contract and/or with more than one percent (1%) interest in the capital stock of the contractor. You may attach additional sheets as necessary.
Key Personnel. Attach a resume or statement of qualifications for all key personnel specifically named in bidder's response to be assigned to the performance of a contract.
The information submitted herein is certified by the bidder to be accurate under the pains and penalties of perjury.
Signature of Authorized Signatory for Bidder: __________________________________________________ Title of Authorized Signatory for Bidder: _____________________________________________________ Date: __________________________________________________________
Updated 11/1/05
File details come from the government source that posted it. Updated .