Bidder_s_Checklist.pdf
PDF 302 KB Posted
- Attached to
- 26LS0005 - Temporary Relief Physician Services
- Solicitation number
- 0000039962
- Issued by
- Los Angeles County, California
About this file
This is a Bidder's Checklist for State of California Solicitation Number 26LS0005, issued by the Department of Veterans Affairs for Temporary Relief Physician Services at the Veterans Home of California - Lancaster. The solicitation requires bidders to submit specified documentation and certifications as part of their bid response. The checklist serves as a summary of required submission documents based on the Invitation for Bid requirements and must be returned with the bid submission.
Bidders must submit the following documentation to be considered for award: Bidder Certification, Bid Rate Sheet, signed Payee Data Record (STD 204), Bidder Declaration (GSPD-05-105), Non-Collusion Declaration, Commercially Useful Function (CUF) Certification if applicable, Disabled Veteran Business Enterprise (DVBE) Declarations (DGS PD 843) if applicable, Iran Contracting Act compliance documentation if applicable, Darfur Contracting Act compliance documentation, California Civil Rights Laws compliance documentation, Contractor Certification Clauses (CCC-4/2017), valid California business licensing documentation or equivalent out-of-state business documentation, and a sample invoice. All company names must be identical across all submitted documents and match the name on the Payee Data Record. Failure to submit documents as prescribed may delay contract award.
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Text version
State of California Solicitation Number: 26LS0005 Department of Veterans Affairs
BIDDER’S CHECKLIST
Temporary Relief Physician Services
The checklist below is a summary of documents to be submitted based on requirements in the Invitation for Bid. This checklist should be returned with your bid. Place a check mark or “X” next to each document being submitted.
Signatures are required on the documents where specified.
The company name listed on all documents submitted (ex., licenses, permits, certifications, and insurance) must be identical to the company name on the Payee Data Record (STD 204). Failure to submit these documents in the manner prescribed may delay award of Agreements.
Bidder’s Checklist
Bidder Certification
Bid Rate Sheet
Signed Payee Data Record - STD 204
Bidder Declaration - GSPD-05-105
Non-Collusion Declaration
Commercially Useful Function (CUF) Certification, if applicable
Disabled Veteran Business Enterprise (DVBE) Declarations – DGS PD 843, if applicable
Iran, if applicable
Darfur Contracting Act
California Civil Rights Laws
Contractor Certification Clauses (CCC-4/2017) - The CCC-4/2017 can be found on the Internet at https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List- Folder/Standard-Contract-Language
Valid California city or county business license; or, if a corporation located within the State of California, incorporation documents or letter from the Secretary of State; or, if not a California business, an affidavit that business is in good standing with the State, Province, or Country in which business is headquartered.
Sample Invoice
File details come from the government source that posted it. Updated .