HealthTechSolutions_Offer_and_Acceptance.pdf

Request for Proposal Solicitation No.

BPM001998

Data Management Services

Arizona Department of Administration

State Procurement Office 100 N 15th Ave., Suite 402

Phoenix, AZ 85007

Attachment 1

Offer and Acceptance Form

SUBMISSION OF OFFER: Undersigned hereby offers and agrees to provide Workers' Compensation Cost Containment, Claim Management and Administration Services in compliance with the Solicitation indicated above and our Offer indicated by the latest dated version below:

Initial 1. J 11/06/2019 FL Offer:

Date initial

2. Ix X 3. Ix X 4. X X

Revised date#1 initial date #1 initial date #1 initial

Offers: �IX 6. Ix 7. IxX X X date#4 initial date#S initial date#6 initial

Best and 8. I3/23/20 FL

Final Offer:

Date initial � n l

HealthTech Solutions, LLC X �Ul<M l<L. T \.-t:_ __,)

Offerer company name Signature of person authorized to sign Offer

2030 Hoover Blvd Franklin T. Lassiter, Chief Operating Officer

Address Printed name and title

Frankfort, KY 40601 Franklin T. Lassiter, Chief Operating Officer

City I State I ZIP Contact name and title frank@healthtechsolutions.com5o2-352-246o

Federal tax identifier (EIN or SSN) Contact Email Address Contact phone number

CERTIFICATION: By signature in the above, Offerer certifies that it:

1. will not discriminate against any employee or applicant for employment in violation of Federal Executive Order 11246, [Arizona] State Executive Order 2009-9 or A.R.S. §§ 41-1461 through 1465;

2. has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted offer. Failure to provide a valid signature affirming the stipulations required by this clause will result in rejection of the Offer. Signing the Offer with a false statement will void the Offer, any resulting contract, and may be subject to legal penalties under law:

3. complies with A.R.S. § 41-3532 when offering electronics or information technology products, services, or maintenance: and

4. is not debarred from, or otherwise prohibited from participating in any contract awarded by federal, state, or local government.

ACCEPTANCE OF OFFER: State hereby accepts the initial Offer, Revised Offer, or Best and Final Offer identified by the latest date and number at the top of this form (the Accepted Offer). Offerer is now bound (as Contractor) to carry out the Work under the attached Contract, of which the Accepted Offer forms a part. Contractor is cautioned not to commence any billable work or to provide any material or perform any service under the Contract until Contractor receives the applicable Order or written notice to proceed from Procurement Officer.

State's Contract No. is: ______ _

Procurement Officer Signature

PART 3 of the Solicitation Documents

Template version 4.0 (16-NOV-2018)

A v ailable

The effective date of the Contract is: ____ Contract awarded ___ _ o n I n e

Date Date

Procurement Officer Printed Name a t

SECTION 3-8: Offer Forms

APP . AZ . go v

II

CTR049577 05/04/2020 05/01/2020

Sabina B. Moore