CTR079466_Contractor_Quote.pdf

CTR079466

Upon Signature

Attachment B: Notices, Correspondence & Payments

REQUEST FOR QUOTATION No.: BPM007097

SPECIMEN TESTING

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Avenue, Suite 530

Phoenix, AZ 85007

Notices, Correspondence and Payments to the Contractor shall be sent to:

(Print and complete the information below and attach to your Bid in the offer info and docs tab.)

RecoveryTrek LLC

Mr. Kirk Cizerle

440 Monticello Ave., Ste. 100

Norfolk, Virginia 23510

(757) 754-5475

Kirk@recoverytrek.com

Great Support

(757) 943-9800 greatsupport@recoverytrek.com

Contractor:

Attention:

Address:

City, State, Zip:

Telephone:

Email:

Customer Service:

Telephone:

Email:

Attachment C: Forced Labor of Ethnic Uyghurs Ban REQUEST FOR QUOTATION No.: BPM007097

SPECIMEN TESTING

ARIZONA DEPARTMENT OF

HEALTH SERVICES

OFFICE OF PROCUREMENT

150 N 18th Avenue, Suite 530

Phoenix, AZ 85007

Forced Labor of Ethnic Uyghurs Ban Please note that if any of the following apply to the Contractor, then the Offeror shall select the “Exempt Contractor” option below:

● Contractor is a sole proprietorship;

● Contractor has fewer than ten (10) employees; OR

● Contractor is a non-profit organization.

Pursuant to A.R.S. § 35-394, written certification is required to show that the company entering into a contract with a public entity does not use the forced labor, or any goods or services produced by the forced labor, of ethnic Uyghurs in the People's Republic of China.

Under A.R.S. § 35-394:

1. "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company or other entity or business association, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has ten or more full-time employees.

2. "Public entity" means this State, a political subdivision of this State or an agency, board, commission or department of this State or a political subdivision of this State.

In compliance with A.R.S. §§ 35-394 et seq., all offerors must select one of the following:

X The Company submitting this Offer does not use, and agrees not to use during the term of the contract, any of the following:

● Forced labor of ethnic Uyghurs in the People’s Republic of China;

● Any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China; or

● Any Contractors, Subcontractors, or suppliers that use the forced labor or any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China.

☐ The Company submitting this Offer does participate in use of Forced Uyghurs Labor as described in A.R.S. § 35-394.

☐ Exempt Contractor

Indicate which of the following statements applies to the Contractor (may be more than one):

☐ Contractor is a sole proprietorship;

☐ Contractor has fewer than ten (10) employees; and/or ☐ Contractor is a non-profit organization.

RecoveryTrek LLC Company Name Signature of person authorized to sign

440 Monticello Ave., Ste. 100

Kirk Cizerle

Address Printed name and Title

Norfolk, Virginia 23510 kirk@recoverytrek.com (757) 754-5475

City, State, ZIP Contact email address Contact phone number

ATTACHMENT D: Proposed Subcontractors ARIZONA DEPARTMENT

REQUEST FOR QUOTATION

No.: BPM0007097

OF HEALTH SERVICES

150 N. 18th Avenue, Suite 530

Phoenix, Arizona 85007

SPECIMEN TESTING

Contractor Name: RecoveryTrek LLC

Check “NO” if you WILL NOT subcontract any portion of the Work and will therefore be performing all of the Work with your own personnel.

If you WILL subcontract any portion of the Work, check “YES” below and list the name(s) of persons or companies you propose to use as Subcontractors.

1. Fill in the information for each significant Subcontractor – indicate the type of work the Subcontractor will perform under the Contract and their approximate percentage of the total Contract work;

2. Provide copies of relevant certifications each person or firm possesses attached to this form; AND

3. Provide a description of quality assurance (QA) and quality control (QC) measures that you will use to ensure that

Subcontractor’s work meets the Contract requirements.

State may demand additional information about proposed Subcontractors as a precondition of Award.

No. Name and contact information Small Business Work to be performed and QA/QC measures %

1. [Name]

[Contact information] Yes or No

[Work to be performed]

[QA/QC measures] X

2. [Name]

[Contact information] Yes or No

[Work to be performed]

[QA/QC measures] X

3. [Name]

[Contact information] Yes or No

[Work to be performed]

[QA/QC measures] X

4. [Name]

[Contact information] Yes or No

[Work to be performed]

[QA/QC measures] X

5. [Name]

[Contact information] Yes or No

[Work to be performed]

[QA/QC measures] X

NO, the Bidder WILL NOT subcontract any portion of the Work.X

YES, the Bidder WILL use the Subcontractors listed below:☐

Code Field type Label Qty Order Unit Delivery Date Unit Price Amount Delivery Date_1 I1_1 Required Item Fixed rate for drug and alcohol testing. 54 54