F935333034_02ContractSignaturePageJuly232021.pdf
PDF 148 KB Posted
- Attached to
- Statewide Claims and Investigation Services
- Solicitation number
- ITN-00141
- Issued by
- Leon County, Florida
About this file
This document is a Contract Signature Page for a statewide claims and investigation services contract between the Florida Department of Financial Services and an unnamed contractor. The contract begins on May 13, 2022, or the date last signed, and can be renewed up to four (4) years. The Statement of Work, Price Response, and other attachments are incorporated by reference. The solicitation for this contract opportunity was issued as an Invitation to Negotiate (ITN) posted on the Vendor Bid System. The ITN included several addenda providing additional details and timeline updates, such as extending the deadline for vendors to submit questions.
The total price of the contract term and any renewal term are to be determined. There is no performance bond or other bond required. The contract manager for the Department is Jill Hancock, and the contractor's contract manager is unnamed. The contract will be subject to public records requirements and data security requirements as detailed in the addenda.
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Text version
Rev. 07/23/2021
DEPARTMENT OF FINANCIAL SERVICES
Contract Signature Page
Contract Title P.O. No. or Solicitation No., if any Contract Number Statewide Claims and Investigation Services 2122-01 ITN RM TBD
1. This Contract is entered into between the parties named below, located at the addresses which follow:
The Department of Financial Services, 200 East Gaines Street, Tallahassee, FL 32399
(hereinafter called the “Department”)
[Contractor’s Name, address] (hereinafter called the “Contractor”)
2. Contract to Begin: Date of Completion: Renewals:
May 13, 2022 or the date last signed below, whichever is later (“Effective Date”)
Up to four (4) years
3. Total Price of Contract Term: Total Price of Renewal Term: Total Price of Contract Term Plus Renewal Term:
TBD TBD TBD
4. Performance Bond, if any: Other Bonds, if any:
N/A N/A
5. Reference to Appropriation for Year 1 of the Contract (if the Contract is over $5 million pursuant to section 216.313, F.S.):
6. Department’s Contract Manager Contractor’s Contract Manager
Name:
Address:
Phone:
Jill Hancock 200 East Gaines Street, Tallahassee, FL 32399 850-413-4754
Name:
Address:
Phone:
7. The parties agree to comply with the terms and conditions of the following attachments which are hereby incorporated by reference:
Attachment 1: Standard Terms and Conditions Attachment 2: Statement of Work Attachment 3: Price Response Attachment 4: PUR 1000
8. The parties agree to comply with the terms and conditions of the following addenda which are hereby incorporated by reference:
Addendum A: Public Records Requirements Addendum B: Data Security Requirements Addendum C: Relevant Portions of Contractor’s Response
IN WITNESS WHEREOF, this Contract is being executed by the parties and will begin on the Effective Date.
CONTRACTOR
Contractor’s Name (if other than individual, state whether corporation, partnership, etc.)
By (Authorized Signature) Date Signed
Printed Name and Title of Person Signing
Department of Financial Services DEPARTMENT
By (Authorized Signature) Date Signed
Printed Name and Title of Person Signing
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