DEP.RFR.BWR.2017.15.LAB.SER.MSA.BID.RESP.FRM.5.4.17.docx

Bidder Response Form

Analytical Laboratory Services COMMBUYS Bid#: BD-17-1045-BWR00-BWR01-16001 Agency Document Number: BWR-2017-15 The following information is mandatory for this RFR (see RFR Section 7.1). Failure to provide the requested information may be cause for the bid to be deemed as non-responsive and may result in disqualification. Please note all boxes will expand to accommodate answers. Once completed, save the Word file (do not convert to PDF; must be submitted as a Word file) with the following name: “CompanyName_BidderResponseForm_RFR#" for submission.

1. Bidder General Information Company Name:

Company Address:

Company Phone Number:

Company Fax Number:

Company Internet Address:

2. Office Location Provide the address of the office from which this contract will be managed. In addition, list any other locations, including facility type, complete address and phone number. A separate document with this information may be provided.

Primary Location:

Other Locations:

3. Years in Business Provide the number of years in business prior to the close date of the solicitation. Along with your years in business, please provide your normal business hours.

Bidder Response

Number of years in business

Business hours/days

4. Industry Experience Provide a brief summary of your company’s experience in the industry.

5. Designated Contract Manager Provide a brief description of the designated contract manager’s experience that will be responsible for the overall management, reporting and ensuring adherence to the performance measures of this contract during normal business hours. This must include the name, address, phone number, fax number and E-mail address.

Contract Manager Name:

Business Address:

Business Phone:

Business Fax:

E-mail Address:

Brief Description of Contract Manager Experience:

6. Designated Reporting Contact Provide a primary contact for all reporting requirements under the contract.

Reporting Contact Name:

Business Phone:

E-mail Address:

7. Defaults or Bankruptcy Indicate whether your firm has filed for bankruptcy or defaulted on any contracts within the last five (5) years.

Describe any Bankruptcy within the last 5 years:

Describe any Defaults within the last 5 years:

8. Subcontractors Provide a brief summary of work by any subcontractor(s) that will be necessary and specify the type of service and area(s) of expertise that the subcontractor would perform. Bidders must also specify the subcontractor(s) qualifications to perform these services. Please note that all subcontractors are subject to approval by MassDEP in its sole discretion, pursuant to Article 9 of the Commonwealth’s Terms and Conditions.

Certification

I, ___________________________________, agree to all terms, conditions and requirements stated in this RFR. I realize failure to comply with any requirement of this RFR after contract award may result in termination of an awarded contract.

Signed electronically Authorized officer name:

Title:

Date:

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