DCR 989A_Bidder Response Form Updated.docx

BIDDER RESPONSE FORM

DCR 989A, Animal Feed, Supplies, and Equipment

INSTRUCTIONS: Please complete this form electronically by typing directly into the boxes or clicking on checkboxes. Submission of a completed Bidder Response Form is MANDATORY. Be sure to read the instructions for each section carefully and thoroughly. Responses found to be incomplete may be disqualified or excluded from evaluation. If additional space is needed to answer any of the questions included on this Bidder Response Form, you may attach additional pages to complete your responses. However, please start answering all questions directly on this Bidder Response Form and only attach additional pages if extra space is needed. Be sure to label any attachments accordingly to correspond to specific questions on this Bidder Response Form.

Bidder/Company Name:

Full Legal Address:

Point of Contact Name:

Email Address:

Phone Number:

Number of Years in Business: Please check the box that applies to your company or organization:

Contract Management: Please use the spaces below to identify and provide contact information for the person at your company who will serve as Contract Manager and main point of contact for DCR:

Name:

Title:

Phone Number:

Email Address:

Office Location/Address:

Pricing: Bidders must provide a percentage discount off, the retail pricing specific to the products and services to be sold under this contract. A contract vendor may not lower/decrease their percentage discount during the life of the contract, unless unforeseen circumstances necessitate a request to change the percentage discount. Bidders may provide contract pricing in a separate document in the Attachment tab of this COMMBUYS bid.

Experience/Qualifications: Please use the space below to briefly describe your company’s capacity and qualifications to provide the goods and services outlined in the Request for Responses (RFR).

Experience Providing Similar Service(s): Please use the space below to identify one (1) current or experience providing services of a similar nature/scope as those outlined in the Request for Responses (RFR). The example provided must either be current or have taken place within the last five (5) years.

Description/Overview of Service(s) Provided:

Name of Entity Services were Provided to:

Contact Person:

Contact Person Phone Number:

Contact Person Email:

Date of Service:

General Liability Insurance: In order to be awarded a contract, all bidders must submit evidence of valid general liability insurance. Such evidence can be in the form of a certificate of coverage provided by the bidder’s insurance carrier.

Does your company have general liability insurance coverage?

|_| YES (please be sure to include evidence of coverage as an attachment to your COMMBUYS bid response) |_| NO (failure to provide evidence of general liability insurance coverage shall be grounds for disqualification)

Other Required Evaluation Materials & Forms: Bidders must also submit the following required materials and forms for evaluation, in the bid solicitation Attachment tab in COMMBUYS.

· This Bidder’s Response Form

· Prompt Payment Discount (PPD) Form

· Environmentally Preferable Products/Practices (EPP) Form

· Business Reference Form

· Other required documents

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:

Company Name:

Title:

Email Address:

Date:

Phone Number:

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