HSS26070-BRSTFDCOUN_appC.xlsx

XLSX spreadsheet 34 KB Posted

Attached to
WIC Breastfeeding Peer Counselor Services
Solicitation number
HSS26070-BRSTFDCOUN
Issued by
Delaware

About this file

This is a vendor submission form package for the State of Delaware, Office of Management and Budget, Government Support Services, in response to a WIC Breastfeeding Peer Counselor Services solicitation. The document comprises seven attachments that establish the required submission components for interested vendors, including vendor information sheets, non-collusion statements, exceptions forms, confidentiality designations, business references, and subcontractor disclosures. Vendors must complete all applicable forms and provide company details, contact information, a business capability statement, and proof of diverse vendor certification status at both state and federal levels. The submission package requires vendors to affirm they have not been subject to federal, state, or local government suspension or debarment within the past five years and to certify compliance with competitive bidding requirements and state terms and conditions.

The vendor submission forms require a minimum of three business references of similar size and scope, with specific guidance that state employees cannot serve as references. If subcontractors are proposed, each must also provide three business references and complete separate subcontractor forms signed by both the primary vendor and subcontractor. Vendors may designate proprietary information, trade secrets, and confidential business information as restricted from public record disclosure under Delaware Code Chapter 10002, though the state retains sole discretion to determine validity of such designations. Vendors may also submit exceptions to solicitation terms and conditions for state consideration, with all exceptions subject to government approval or rejection. The forms establish a standardized submission framework to ensure all competing vendors provide equivalent information for evaluation purposes.

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File Type Posted
HSS26070-BRSTFDCOUN_pr.pdf PDF
HSS26070-BRSTFDCOUN_appD.pdf PDF
HSS26070-BRSTFDCOUN_rfp.pdf PDF
HSS26070-BRSTFDCOUN_ad1.pdf PDF

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Attachment2Vendor Info Sheet

Vendor Information Sheet
Company Name
DBA (if applicable)
Purchase Order Address
Website
Diverse Vendor Self-Identification
State Certified (select drop down of "Yes" or "No")If yes, which State(s):
Federal Certified (select drop down of "Yes" or "No")
Desginated ContactsPrimarySecondary
Contact Name
Role/Title
Phone Number
Email
Business Capability Statement
(Provide a short capability statement about your business and its capabilities and skills to advertise who you are and what you do.)

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Attachment3Non-Collusion Stmt

Non-Collusion Statement
This is to certify that the undersigned Vendor has neither directly nor indirectly, entered into any agreement, participated in any collusion or otherwise taken any action in restraint of free competitive bidding in connection with this solicitation, and further certifies that it is not a sub-contractor to another Vendor who also submitted a bid/proposal as a primary Vendor in response to this solicitation submitted this date to the State of Delaware, Office of Management and Budget, Government Support Services.
It is agreed by the undersigned Vendor that the signed submission of this bid/proposal represents, subject to any express exceptions set forth on the Exception form, the Vendor’s acceptance of the terms and conditions of this solicitation including all specifications and special provisions.
NOTE: Signature of the authorized representative MUST be of an individual who legally may enter his/her organization into a formal contract with the State of Delaware, Office of Management and Budget, Government Support Services.
Company Name
DBA (if applicable)
Name of Authorized Representative
Title
Phone Number
Email Address
Company Address
Phone Number
Email Address
Tax ID Number
AFFIRMATION: Within the past five (5) years, has your firm, any affiliate, any predecessor company or entity, owner, Director, officer, partner or proprietor been the subject of a Federal, State, Local government suspension or debarment?
Select "Yes" or "No" from the drop down menu
If yes, explain

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Attachment4Exceptions Form

Exceptions Form
Responding Vendors may elect to take minor exceptions to the terms and conditions of this solicitation. All exceptions must be submitted below. Exceptions found elsewhere in the solicitation response will not be considered. Government Support Services maintains sole discretion to reject any exceptions.
Exceptions
Paragraph & Page # of DocumentCurrent Language stated in the documentProposed Alternative languageJustification for proposed changeState of Delaware's responseBidder's response

If addition space is needed, please copy the format of this worksheet and attach as an additional file in your submission

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Attachment5Confidentiality Form

Confidentiality Form
Responding vendor may elect to designate sections of their proposal as confidential, intellectual property, trade secrets, and other confidential business information. Vendor shall explain below how the redacted information is not “public record” as defined by 29 Del. C. § 10002. The State shall independently determine the validity of any vendor designation as set forth in this section. Any vendor submitting a bid/proposal herein expressly accepts the State’s absolute right and duty to independently assess the legal and factual validity of any information designated as confidential business information.
Confidential Information (select "Yes" or "No" on the dropdown)
Confidentiality and Proprietary Information

If addition space is needed, please copy the format of this worksheet and attach as an additional file in your submission

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Attachment 6Business References

Business References
List a minimum of three business references of similar size and scope. Please do not list any State Employee(s) as a business reference. If Subcontractors are identified, a minimum of three business references must also be provided for each subcontractor.
Reference One
Contact Name
Contact Title
Business Name
Address
Email
Phone
Current Vendor?
Work Performed
Reference Two
Contact Name
Contact Title
Business Name
Address
Email
Phone
Current Vendor?
Work Performed
Reference Three
Contact Name
Contact Title
Business Name
Address
Email
Phone
Current Vendor?
Work Performed

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Attachment7Subcontractor Form

Subcontractor Form
Are you proposing the use of any subcontractors in the fulfillment of the requirements as outlined in the solicitation? (Please select "Yes" or "No" in the drop down meniu)
If yes, complete this form.
Responding Vendor Information
Company Name
DBA (if applicable)
Company Address
Subcontractor Information
Company Name
DBA (if applicable)
Company Address
Diverse Vendor Self-Identification
State CertifiedIf yes, which State(s):
Federal Certified
Description of Work by Subcontractor
Once completed, this form must be signed by both vendors.
Proposing VendorSubcontractor
Authorized Signature:Authorized Signature:
Name:Name:
Title:Title:
Date:Date:

DropDowns

YES
NO
YES - Vendor is providing any information they declare to be confidential or proprietary for the purpose of production under 29 Del. C. Ch. 100, Delaware Freedom of Information Act.
NO - Vendor is not providing any information they declare to be confidential or proprietary for the purpose of production under 29 Del. C. Ch. 100, Delaware Freedom of Information Act.
YES - Vendor is submitting exceptions for consideration.
NO - Vendor is not submitting any exceptions to the specifications, terms, or conditions found in this solicitation.

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