Bidders Response Form CISM Final.docx
DOCX document 729 KB Posted
- Attached to
- DFSJW DFS-CISM-2024 RFR
- Solicitation number
- BD-23-1021-DFS-DFS01-89508
- Issued by
- Massachusetts
About this file
This document is a Bidders Response Form for the Department of Fire Services (DFS) Critical Incident Stress Management (CISM) contract opportunity in the state of Massachusetts. The form requires bidders to provide their team/organization's contact information, including a 24/7 emergency phone number, team/organization director, and secondary contact. Bidders must also describe their qualifications, including whether they use the ICISF model as a standard of care and have a clinical director who is credentialed and licensed to practice as a mental health professional in Massachusetts. Bidders must submit proof of the clinical director's licensure and insurance with their bid response. The contract opportunity is identified as DFSJW DFS-CISM-2024 RFR, with the state ID of 65a95d78d947088ac30981f7 for the state of Massachusetts.
The form does not provide information on pricing terms, set asides, incumbents, funding requirements and sources, or any other salient details. Bidders must complete and submit the form with their bid response in CommBuys, the Massachusetts Procurement and Solicitation Management System.
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Other files
| File | Type | Posted |
|---|---|---|
| consig~35.doc | DOC document | |
| newEFT-form~14.pdf | ||
| newmass-w9~11.pdf | ||
| CISM Funding RFR 2024 Final.pdf | ||
| Attachment B - Request for Reimbursement Final.xlsx | XLSX spreadsheet | |
| Non Collusion Form~48.doc | DOC document | |
| Attachment A - Funding Application Form Final.xlsx | XLSX spreadsheet |
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Text version
Department of Fire Services Critical Incident Stress Management (CISM)
CISM BIDDER’S RESPONSE FORM
Bidders must complete the form below and submit with their bid response in CommBuys.
CONTACT INFORMATION
Team/Organization Name 24/7 Emergency Phone Number Team/Organization Director
| Director’s Mailing Address | City | State | Zip Code |
| Director’s Phone | Director’s Email |
Please note, the team director will be the primary contact for all correspondence with DFS.
Secondary Contact Contact’s Phone Contact’s Email
It is the bidder’s responsibility to provide the Department of Fire Services with updated contact information should any of the information above change.
QUALIFICATIONS
Please describe your team/organization and the CISM services you provide:
Does your team/organization use the ICISF model as a standard of care in providing support to emergency responders in Massachusetts? Yes No
Does your team/organization have a clinical director that is credentialed and licensed to practice as a mental health professional on their own in Massachusetts and who holds liability insurance to practice? Yes No
Clinician’s Name Please attach proof of licensure and insurance with your bid response.
If your team does not meet all of the qualifications above, please explain why in the space below. If you need additional space, please attach your explanation as a separate file.
REQUIRED SIGNATURE:
Designee must be noted on Contractor Authorized Signatory Form
Signature Date
Print Name & Title
CISM Bidder’s Response Form image1.jpeg
File details come from the government source that posted it. Updated .