consltfm.doc
DOC document 28 KB Posted
- Solicitation number
- BD-18-1018-DAC01-DAC01-26421
- Issued by
- Massachusetts
About this file
The document provided is a Consultant Contractor Mandatory Submission Form for a state and local contract opportunity. The form requires the bidder to disclose any additional income from the Commonwealth of Massachusetts, as well as any individuals with a financial interest in the contract and the key personnel to be assigned. The related state and local contract opportunity is for an Abuse Reporting Hotline Answering and Processing Service in the state of Massachusetts. The form does not provide details on the project overview, quantities, response dates, award dates, or contract term.
The document focuses on the required disclosures and certifications for the bidder. It does not contain information on pricing terms, set asides, incumbents, funding requirements, or other salient details about the contract opportunity.
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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.
FORMCHECKBOX
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.
FORMCHECKBOX
Please check if N/A.
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.
FORMCHECKBOX
Please check if N/A.
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
Sensitivity level - low
File details come from the government source that posted it. Updated .