DCR-858 BIDDER RESPONSE FORM.docx

BIDDER RESPONSE FORM

DCR-858 Health & Safety and Environmental & Compliance Certification & Training

THE INITIAL DEADLINE FOR SUBMITTING PROPOSALS IS MONDAY, DECEMBER 20, 2021 AT 11:59 PM (EST)

INSTRUCTIONS: Please complete this form electronically by typing directly into the GREY boxes. Be sure to read the instructions for each section carefully and thoroughly. Responses found to be incomplete may be disqualified or excluded from evaluation.

Bidder/Company Name:

Mailing Address:

(Street Address)

(City/Town)

(State)

(Zip Code)

Point of Contact Name:

Phone Number:

Email Address:

Please specify the number of years your company has been in business:

Ability to Provide Training Courses and Products: Please specify which of the training course and products listed below your company is able to provide (to check of a box, double-click on the box, then select “Checked” and click “Okay”):

Category 1: Health & Safety Certification & Training

|_| Community Water Safety

|_| Lifeguard Instructor Trainer

|_| Learn to Swim Levels 1>6

|_| Stop the Bleed

|_| Guard Start or similar product

|_| First Aid for Severe Trauma

|_| Lifeguard Training

|_| Wilderness and Remote First Aid

|_| Waterfront Lifeguarding

|_| Digital Training – Web-Based/Streaming/USB

|_| Lifeguard Management

|_| Instructors Manuals

|_| Water Safety Instructor

|_| Text Books

|_| Standard First Aid

|_| Marketing tools and resources

|_| Standard First Aid with CPR / AED - Adult

|_| Safety Brochures

|_| Standard First Aid with CPR / AED - Child

|_| Safety Posters

|_| CPR for the Professional Rescuer

|_| Swimming and Water Safety Books

|_| First Aid and CPR Instructor

|_| Learn to Swim Booklets and Instruction Guides

|_| Lifeguard Instructor

Category 2: Environmental & Compliance Certification & Training

ASBESTOS-RELATED CERTIFICATIONS & TRAININGS:

|_| Asbestos Project Monitor Refresher

OTHER CERTIFICATIONS & TRAININGS:

Company Experience Providing Similar Services: Please use the spaces below to describe your company’s experience providing services of a similar or equivalent nature to those outlined in the RFR. Specifically, provide examples that demonstrate your company’s experience with regard to conducting trainings. Bidders must provide at least one (1) example but are encouraged to provide three (3) examples.

EXPERIENCE 1:

Description of Service(s) Provided:

Length of Time Service(s) Provided:

Organization Services were Provided to:

Contact Name at Organization:

Phone Number for Contact Person:

EXPERIENCE 2:

Description of Service(s) Provided:

Length of Time Service(s) Provided:

Organization Services were Provided to:

Contact Name at Organization:

Phone Number for Contact Person:

EXPERIENCE 3:

Description of Service(s) Provided:

Length of Time Service(s) Provided:

Organization Services were Provided to:

Contact Name at Organization:

Phone Number for Contact Person:

Qualifications & Capacity to Provide Contract Services: Please describe your company’s ability, qualifications, and capacity to provide the services outlined in the RFR. Please include any specific capabilities or qualifications that demonstrate your company and/or your personnel’s ability to fulfill the types of services sought by DCR in the RFR.

Provision of Qualified Staff: Please use the spaces below to list all relevant staff at your company with the necessary qualifications to perform the services outlined in the RFR. Also, please use the space provided to describe their education, background, experience, and qualifications.

Staff Person 1:

Name:

Title/Position:

Education, Background, Experience, & Qualifications:

Staff Person 2:

Name:

Title/Position:

Education, Background, Experience, & Qualifications:

Staff Person 3:

Name:

Title/Position:

Education, Background, Experience, & Qualifications:

Staff Person 4:

Name:

Title/Position:

Education, Background, Experience, & Qualifications:

Geographic Service Areas: Please indicate which Massachusetts counties your company is able to provide service to (to check of a box, double-click on the box, then select “Checked” and click “Okay”):

If your company is not able to service the entire Commonwealth of Massachusetts, please indicate which counties you are able to provide service. A map of Massachusetts counties is provided on the last page of this Bidder Response Form.

Other Forms & Materials: Bidders must also submit the following forms & materials:

· Price Rate Sheet

· Training Catalog (if available/applicable)

· Prompt Payment Discount (PPD) Form – see Attachments Tab of the CommBuys bid solicitation

· Environmentally Preferable Products/Practices (EPP) Form – see Attachments Tab of the CommBuys bid solicitation

Affirmation: By entering my name and information below, I hereby affirm that I have read, agree to, and will abide by (if awarded a contract) all of the terms and conditions outlined in the Request for Responses (RFR) associated with this procurement and that the information provided in this Bidder Response Form is accurate and truthful.

Name

Title

Date

Company Name

Email Address

Phone Number

Company Address

City/Town

State

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