Event_16775_Attachments.pdf

Rev. July 2023

ATTACHMENT A: RESPONDER DECLARATIONS

The undersigned certifies, to the best of his or her knowledge and belief, that:

A. Response Contents. The information provided is true, correct, and reliable for purposes of evaluation for potential contract award. The submission of inaccurate or misleading information may be grounds for disqualification from the award as well as subject the Responder to suspension or debarment proceedings as well as other remedies available by law.

B. Authorized Signature. This Declaration is signed by the appropriate person(s), with the authority to contractually bind the Responder, as required by applicable articles, bylaws, resolutions, minutes, and ordinances.

C. Non-Collusion Certification.

1. The Proposal has been arrived at by the Responder independently and has been submitted without collusion and without any agreement, understanding or planned common course of action with any other vendor designed to limit fair or open competition; and

2. The contents of the Response have not been communicated by the Responder or its employees or agents to any person not an employee or agent of the Responder and will not be communicated to any other individual prior to the due date and time of this Solicitation. Any evidence of collusion among Responders in any form designed to defeat competitive responses will be reported to the Minnesota Attorney General for investigation and appropriate action.

D. Organizational Conflicts of Interest. To the best of Responder’s knowledge and belief, and except as otherwise disclosed, there are no relevant facts or circumstances which could give rise to an organizational conflict of interest.

An organizational conflict of interest exists when, because of existing or planned activities or because of relationships with other persons,

1. a vendor is unable or potentially unable to render impartial assistance or advice to the State;

2. the vendor’s objectivity in performing the contract work is or might be otherwise impaired; or

3. the vendor has an unfair competitive advantage.

If after award, an organizational conflict of interest is discovered, an immediate and full disclosure in writing must be made to the State’s Chief Procurement Officer which must include a description of the action which the contractor has taken or proposes to take to avoid or mitigate such conflicts. If an organizational conflict of interest is determined to exist, the State may, at its discretion, cancel the contract. In the event the Contractor was aware of an organizational conflict of interest prior to the award of the contract and did not disclose the conflict to OSP, the State may terminate the contract for default. Organizational conflicts of interest terms apply to any subcontractors for this work.

E. Certification Regarding Lobbying. For State of Minnesota Contracts and Grants over $100,000, the undersigned certifies, to the best of his or her knowledge and belief that:

1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, Disclosure Form to Report Lobbying in accordance with its instructions.

3. The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into and is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. 1352.

Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

F. Copyrighted Material Waiver. By signing its Response, the Responder certifies that it has obtained all necessary approvals for the reproduction and distribution of the contents of its response.

G. Diverse Spend Reporting. The Sample Contract contains a clause for Diverse Spend Reporting. When this clause applies, Contractor will be required to register in a free portal to report diverse spend.

Please see Diverse Spend Reporting Frequently Asked Questions for additional information.

By signing this form, Responder acknowledges and certifies compliance with all applicable requirements indicated above.

Company Name:

Signature:

Printed Name:

Title:

Date:

Phone Number:

Email Address:

https://osp.admin.mn.gov/sites/osp/files/2022-11/viva_diverse_spend_reporting_faq.pdf

ATTACHMENT B: EXCEPTIONS TO STATE’S TERMS AND CONDITIONS

The State presumes a responder agrees to the terms and conditions of this solicitation unless a responder takes specific exception to one or more of the conditions on this form.

The State reserves the right to reject, negotiate, or accept any exception listed to the State’s terms and conditions (including those found in the attached Sample Contract).

INSTRUCTIONS: A responder must explicitly list all exceptions to State’s terms and conditions, if any (including those found in the attached Sample Contract). Reference the clause number and page number of the State's term and condition for each of a responder’s exceptions. If no exceptions exist, state "NONE" specifically on the form below.

Whether or not exceptions are taken, the Responder must sign and date this form and submit it as part of their response. (Add additional pages if necessary.)

Clause and Page Number Suggested Change to Clause Explanation or Justification

By signing this form, I acknowledge that the above-named responder accepts, without qualification, all terms and conditions stated in this solicitation (including the sample contract) except those clearly outlined as exceptions above.

This acknowledgement includes acceptance of the section of the Sample Contract, Exhibit A, titled “Contractor’s Documents.”

Signature:

Printed Name:

Title:

Date:

ATTACHMENT C: COST DETAIL

1. Cost Proposal. Responders should review Exhibit D: Price Schedule of the Sample Contract for additional pricing terms related to the Cost Proposal. The pricing schedule has two (2) separate price worksheets for the cost of the typical, discounts proposed and the cost of installation.

Responders must download and use the Exhibit D Price Schedule attached to this Solicitation. Responders must respond to all two (2) tabs of the Price Schedule (Service Plan, Cost Plus Parts) and upload with your solicitation response. If pricing is not returned with your solicitation response, your response may be rejected. Failure to use Price Schedule may be cause for rejection. The State reserves the right to reject responses that do not supply sufficient line items. For the purposes of evaluation, if a responder leaves blank or enters "No Bid" into a line item blank the State may enter the highest price received from all responders for that line item.

1.1 Price Schedule: Tab 1 - Service Plan. Responders should provide a cost for all the products requested in Exhibit D Price Schedule Tab 1: Service Plan. The submitted pricing under the requested Service Plans shall be a fixed price.

Responders are to consider all costs associated with providing service indicated in Exhibit C: Specifications, Duties, and Scope of work.

1.2 Price Schedule: Tab 2 – Cost Plus Parts. Responders must provide the cost of the products requested in Exhibit D Price Schedule Tab 2: Repair Parts. The submitted pricing under Repair Parts shall be Cost Plus. Cost is defined as the actual cost the Contractor pays the supplier for goods or services the State orders, minus any applicable taxes.

Only costs specifically detailed in the billing statement, quote, or invoice from the supplier will be subject to the cost-plus percentage detailed on Contract. If a quote is issued, the invoice price cannot exceed the quoted price.

The product purchase price from the supplier must be verifiable with a quote, billing statement, or invoice upon request from the State or Ordering Entity.

Alterations or Erasures. The State reserves the right to reject a response containing an alteration or erasure of any price used to determine the lowest responsible responder unless the alteration or erasure is done in a manner that is clear and authenticated by an authorized representative of the Responder. An acceptable way to make an alteration or erasure is to cross out the price, print the correction in ink adjacent to it, and have an authorized representative of the Responder initial and date that correction.

Workforce and Equal Pay Declaration Page

This form is required for all businesses executing government contracts under the following:

Select one:

☐ Businesses executing a contract with State or Metropolitan agencies in excess of $100,000 (Workforce Certificate) and if applicable $500,000 (Equal Pay Certificate)

☐ Businesses executing a contract with University of Minnesota for general obligation bond funded capital projects in excess of $100,000 (Workforce Certificate) and if applicable $500,000 (Equal Pay Certificate)

☐ Businesses executing a contract with Political Subdivisions for general obligation bond funded capital projects in excess of $250,000 (Workforce Certificate) and if applicable $1,000,000 (Equal Pay Certificate)

Select all that apply:

We are a Certificate holder:

☐ Workforce Certificate under the name: _________________________________________________________ ☐ Equal Pay Certificate under the name: __________________________________________________________

We are applying/have applied for the following certificate(s):

☐ Workforce Certificate Application date (MM/DD/YYYY): ____________________ ☐ Equal Pay Certificate Application date (MM/DD/YYYY): ____________________

We have not applied for one or both certificates:

☐ Our Company does not yet have a Workforce Certificate or Equal Pay Certificate. We acknowledge that a

Workforce and, if applicable, Equal Pay Certificate, or approved exemption by MDHR is required before a contract can be executed.

We are Exempt:

☐ We attest to MDHR that we have not employed 40 or more employees on a single day during the prior 12 months in Minnesota or the state in where we have our primary place of business. MDHR may request the names of our employees during the previous 12 months, the date of separation, if applicable, and the current employment status and count.

Business Information

Vendor/Supplier ID Business Name Name of Contracting Agency

Authorized Signatory Name Title Date

Signature Email Phone

For assistance with this form, email the Minnesota Department of Human Rights Compliance.MDHR@state.mn.us https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/ https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/ https://mn.gov/mdhr/certificates/workforce-certificate/ https://mn.gov/mdhr/certificates/equalpay/

ATTACHMENT E: ADDITIONAL INFORMATION

1. Contractor’s Contact Information. Provide the contact information for the representative responsible for the management of the contract and the representative receiving purchase orders.

Vendor’s Legal Name

Address

Contact Person (Contract)

Email Address

Telephone Number

Contact Person (PO Order)

Email Address

Telephone Number

2. Prompt Pay Discount. What prompt pay discounts do you offer? Select all that apply, if “other,” specify terms in the comment section below:

□ 1% in 30

□ 2% in 30

□ 3% in 30

□ 1% in 10, Net 30

□ 2% in 10, Net 30

□ 3% in 10, Net 30

□ 5% in 10, Net 30

□ Other

□ 1% in 15, Net 30

□ 2% in 15, Net 30

□ 3% in 15, Net 30

□ 1% in 20, Net 30

□ 2% in 20, Net 30

□ 3% in 20, Net 30

□ Net 30

3. Delivery Time Frame. Responder must enter a delivery time frame after receipt of order (ARO) in the space below.

___________Calendar Days after receipt of order (ARO) for Service Plans

___________Calendar Days after receipt of order(ARO) for Cost Plus Parts

4. Responder Requirement Checklist Responders are to review and confirm that they meet all the mandatory required capabilities under the contract as specified in 2. Required Capabilities under Exhibit C: Specifications, Duties, and Scope of Work stated below:

4.1 Responders are to confirm that they can meet the location access requirements as specified under 2.2 Location

Access under Exhibit C: Specifications, Duties, and Scope of Work.

☐Yes ☐No

Rev. 9.01.2021

4.2 Responders are to confirm that they can meet the minimum turnaround times as specified under 2.3 Service Turnaround Times under Exhibit C: Specifications, Duties, and Scope of Work.

☐Yes ☐No

4.3 Responders are to confirm they can meet the expectations of establishing semi-annual and/or annual preventative maintenance programs for equipment as specified under 2.4 Service Plans under Exhibit C:

Specifications, Duties, and Scope of Work.

☐Yes ☐No

4.4 Responders are to confirm they are capable of setting up and providing reports for each facility under the contract that summarize the accuracy and functionality of all equipment within 90 days of the contract award as specified under 4. Reporting under Exhibit C: Specifications, Duties, and Scope of Work.

☐Yes ☐No

4.5 Site Visit Checklist.

Responders must conduct a site visit to review Attachment G: St. Peter Direct Care and Treatment Facility Equipment List. In the event of inconsistencies found when reviewing the equipment list onsite responders may submit updates to items noted within Attachment G: St. Peter Direct Care and Treatment Facility Equipment List for the State to review and update the solicitation document prior to the due date and time of the solicitation.

The following St. Peter Direct Care and Treatment Facility contact should be contacted to set up a time to visit the St. Peter Direct Care and Treatment Facility :

Becky Kurth Management Analyst 2 | Forensic Services State Operated Forensic Services Rebecca.Kurth@state.mn.us O: 507-985-2111

Site Location

Site Visit Complete

(X)

Date Visited

Response Submitted for Site (X)

DIRECT CARE AND TREATMENT FACILITY SITES

St. Peter Regional Treatment Center (RTC) mailto:Rebecca.Kurth@state.mn.us

ATTACHMENT F: RESPONDER NARRATIVE

Responders are to review Exhibit C: Specifications, Duties, and Scope of Work under the Sample Contract and Exhibits to understand the requirements of the solicitation and to accurately submit their responses to the following narrative questions.

When responding to the narrative questions Responders should note the requested information and provide a response describing their business’ capabilities in fulfilling the service obligations under the contract.

Responses to the narrative questions below can be answered within this document or submitted as a separate Microsoft Word file not to exceed five (5) pages. Responses longer than five (5) pages will not be evaluated and may be cause for rejection.

1. Maintenance Plan Proposal. The following narrative section is focused on the Responder’s service capabilities and is intended to confirm for the State that the Responder can meet the staffing and service requirements under the Sample Contract and Exhibits.

1.1 Maintenance Setup . Responders must provide a narrative on how their business shall address the initial service setup per state facility location to be serviced under the contract.

1.2 Administering and Maintenance. Responders must describe how their business will administer the maintenance and services requested under Exhibit C of the Sample Contract and Exhibits.

1.3 Service Tracking and Scheduling . Responders must provide a current or proposed solution that their business would utilize to track and schedule the required and on-demand maintenance under the contract as noted under Exhibit C: Specifications, Duties, and Scope of Work within the Sample Contract and Exhibits.

1.4 Staffing. Responders must provide the following information in the charts below: the names of current service technicians, any certifications they may hold, and the service locations (Exhibit C, 2.4 Facility Location) where they would be assigned to perform equipment service under the contract. While certifications are not required, responders should list any relevant certifications that their business’ technicians possess.

One chart is designated for staff assigned to Preventative Maintenance, while the second chart should be used to identify staff responsible for On-Demand Service.

Preventative Maintenance Staff Staff Certification(s)

On-Demand Staff (Normal hours) Staff Certification(s)

On-Demand Staff (Emergency hours) Staff Certifications(s)

2. Contract Reporting Solution. Responders are required to detail their approach to managing tracking, scheduling, and report generation for contract end users through the use of an offline computerized device. Equipment and/or device proposals would be required to meet the specifications found under 4. Reporting under Exhibit C of the Sample Contract and Exhibits to meet the requirements of the contract.

2.1 Non-network connected computerized device. Responders are to provide their proposed non-network connected computerized device solution and an overall description of its capabilities.

2.2 Tracking Service. Responders are to describe how their proposed solution will be able to track and schedule per state facility location for preventative maintenance required under the contract.

2.3 Parts Ordered. Responders are to describe how their proposed solution would be able to accurately order parts either due to being required under the preventative maintenance plan, due to an emergency or outside the warranty period for the equipment serviced under the contract.

2.4 Warranty and Equipment Life cycle. Responders are to describe how their proposed solution would address ensuring parts that would fall under the warranty of the OEM would be addressed to avoid additional costs and to assist in determining when equipment may be required to be replaced.

2.5 Sample reporting. Responders are to provide sample reports that may be representations or actual samples of existing capabilities that meet the requirements of 4. Reporting under Exhibit C: Specifications, Duties and Scope of Work of the Sample Contract and Exhibits. Responders are to provide the following sample reports:

2.5.1 Preventative Maintenance Report. This report should include relevant information tied to tracking either the annual or semi-annual maintenance, state facility location, and the date the equipment was serviced.

2.5.2 Parts Ordered Report. This report should include the state facility location, the equipment name, equipment category, if applicable the warranty, repair parts required to be replaced, the date the part was ordered, and the date of when the part was installed.

2.5.3 Equipment Lifecycle Report. This report should provide information to end users to understand the number of years left of the warranty, note the equipment category, the number of parts ordered under warranty and/or outside the warranty to assist in determining whether or not equipment should be replaced.