f-515_Event_No._18488_RFP_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 of the Sample Contract for additional pricing terms related to the Cost Proposal.

Responders must download and use the Exhibit D: Price Schedule attached to this Solicitation. The Price Schedule must be completed by the Responder and uploaded with the response. If pricing is not returned with your solicitation response, your response will be rejected. Failure to use the Price Schedule may be cause for rejection.

The State reserves the right to reject responses that do not supply sufficient line items.

Responders are required to offer services for all 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.

2. 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.

ATTACHMENT D: 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 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/

For assistance with this form, email the Minnesota Department of Human Rights Compliance.MDHR@state.mn.us

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

Comments:

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

__________Calendar Days after receipt of order (ARO)

4. Registered Dietician. Responders are to indicate whether they have a designated Registered Dietician that develops the menus.

☐ Yes ☐ No

Name:____________________________________

Certification(s): _______________________________

Rev. 9.01.2021

If the Responder answered “No” above, they must confirm that they have the capability to develop a menu that meets the dietary recommendations under the contract and submit 14 calendar days prior to meal delivery.

5. Responder Requirement Checklist. Responders are to confirm they can meet the required capabilities, as listed under section 2. Required Capabilities as listed in Exhibit C: Specifications, Duties, and Scope of Work showing the person or persons who will be working directly with this Contract. Failure to complete the requirement checklist may result in rejection of the response.

Required Capabilities Yes No

Experience – Minimum 1 year ☐ Yes ☐ No Serving Equipment ☐ Yes ☐ No Training ☐ Yes ☐ No Policy/Procedure Manual ☐ Yes ☐ No

5.1 Experience References. Responders are to provide current customer references that have received services within the last calendar year.

Service/Project Location/Address Contact Name Contact email/phone number

6. Responder License/Credentials. Responders are to confirm they have submitted copies of the mandatory licenses and certifications as listed under Section 6. License/Credential within Exhibit C: Specifications, Duties, and Scope of Work.

License/Credential Yes No Department of Health Inspection ☐ Yes ☐ No Dietary Manager’s Certificate ☐ Yes ☐ No Vendor License ☐ Yes ☐ No Certified Food Protection Manager Certificate

(CFPM)

☐ Yes ☐ No

Credential Verification for Registered Dietitian by the Commission on Dietetic Registration

☐ Yes ☐ No

7. Emergency Food Supply Menu Requirements. Regarding the Emergency Food Supply Menu requirements, the Responder understands the Emergency Food Supply requirements of the RFP/Solicitation as listed under Section

10.7 Emergency Food Supply within Exhibit C: Specifications, Duties, and Scope of Work. Can you meet this requirement?

☐ Yes ☐ No

If you answered no, you must provide a response below as to why you cannot meet this requirement and any alternative language for the State’s consideration.

Response: ______________________________________________________________________________________

8. Responder understands that it will be required to purchase and utilize the Academy of Nutrition and Dietetics’

Nutrition Care Manual for writing diet extensions. Do you agree to meet this requirement?

☐ Yes ☐ No

ATTACHMENT F: RESPONDER NARRATIVE

Responders must review Exhibit C: Specifications, Duties, and Scope of Work under the Sample Contract and Exhibits to understand the requirements of the solicitation and submit a response to the following narrative questions below.

When responding to the narrative questions, Responders must note the Contract requirements and provide a response describing their business’ capabilities in fulfilling the service obligations under the contract.

Responders must answer the narrative questions in the order they are listed below with the applicable numbering and title. The response to the narrative questions below can be answered within this document or submitted as a separate Microsoft Word file not to exceed ten (10) pages. A response longer than ten (10) pages may not be evaluated and may be cause for rejection.

Food Rotation. Responders must provide a detailed explanation on how their business plans to supply a food rotation to be approved by the site director prior to implementation. Responders should include information covering how they plan to address the rotation of food expiration dates and how they will replenish outdated inventory.

Emergency Food Supply. Responders must provide a detailed explanation on how their business plans to fulfill the Emergency Food Supply requirements in the event of an emergency, as listed in section 10.7 Emergency Food Supply within Exhibit C: Specifications, Duties, and Scope of Work.

Serving Equipment. Responders must provide a detailed explanation on how their business plans to provide all reusable and non-breakable trays and other serving equipment such as, plates, flatware, and other eating utensils, and any other paper supplies needed for food service. Responders should reference section 2.4 Serving Equipment within Exhibit C: Specifications, Duties, and Scope of Work when providing their response.

Sample Training Report. Responders must provide a detailed explanation on how their business handles employee training for those providing direct services to the Contract site. The training narrative should include but not be limited to Portion Control, Sanitation and Food Temperatures, Safe Food Handling, Hand Hygiene, Hazard Analysis and Critical Control Point (HACCP) regulations, Modified Diet, Health Insurance Portability and Accountability (HIPAA) Standards, Customer Service and Joint Commission Standards. Responders should reference section 2.5 Training within Exhibit C: Specifications, Duties, and Scope of Work when providing their response.

Quality Assurance and Performance Improvement. 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 9. Quality Assurance and Performance Improvement requirements under Exhibit C: Specifications, Duties and Scope of Work of the Sample Contract and Exhibits.

5.1 Performance Improvement Plan. Responders must provide a detailed explanation on how their business shall address developing and presenting to the site director a Quality Assurance and Performance Improvement Plan that includes but is not limited to (1) quality assurance indicators for safety and sanitation and conformance with the Academy of Nutrition and Dietetics standards, (2) patient or client satisfaction assessment and, (3) hospital or other program satisfaction.

5.2 Conflict Resolution. Responders must provide a detailed explanation on how their business shall address any potential conflict and how they will develop a mutually agreeable resolution plan.

Sample Policy/Procedure Manual. Responders must provide a Sample Policy/Procedure Manual that includes but is not limited to:

(1) availability of diet manual and therapeutic diet menus to meet patient’s nutritional needs

(2) frequency of meals served

(3) system for diet ordering and patient tray delivery or meal delivery

(4) accommodation of not-routine occurrence i.e. early meal service, changes in diet order, etc.

(5) guidelines for acceptable hygiene practices of food service personnel; and

(6) guidelines for kitchen sanitation. Responders should refer to 4. Policy/Procedure Manual under the Sample Contract and Exhibits.

Sample Reports. Responders are to provide the following sample reports:

7.1 Food Production Logs. Responders are to provide, at a minimum quarterly, a sample food production logs listing the amount of food used and number of meals prepared. Responders should reference section 8.1 Food Production Logs within Exhibit C: Specifications, Duties, and Scope of Work when providing samples.

Provide a sample showing the capability to meet the report described above.

7.2 Monthly Temperature Sheets. Responders are to provide a sample monthly temperature sheets for the following: refrigeration and freezers, temperature sheets for dishwasher or sanitizer log, if a dishwasher is not used, dry storage temperature sheets, and food temperature logs for both the Responder’s on-site temperatures and the temperatures taken at facility site. Responders should reference section 8.2 Monthly Temperature Sheets within Exhibit C: Specifications, Duties, and Scope of Work of the Sample Contract and Exhibits when providing samples.

Sample Menu. Responders are to provide a sample four (4) week menu plan. Responders should reference section

10.1 General Menu Requirements within Exhibit C: Specifications, Duties, and Scope of Work of the Sample Contract and Exhibits when providing samples. Responders should provide sample menu plans for both Regular and Modified Diets.

6. Business Information

8. Sample Menu. Responders are to provide a sample four (4) week menu plan. Responders should reference section 10.1 General Menu Requirements within Exhibit C: Specifications, Duties, and Scope of Work of the Sample Contract and Exhibits when providi...