IFB 1255 Attachment 1 - Bidder's Certified Statements LOCKED.docx
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- Solicitation number
- 2137191
- Issued by
- Clinton County, New York
About this file
This is a Bidder's Certified Statements form for Invitation for Bids (IFB) 1255 issued by the New York State Office of Children and Family Services (OCFS) to procure psychiatric services for youth in OCFS custody at four facilities: Brookwood Secure Center, Industry Secure Center, Taberg Residential Center, and Harriet Tubman Residential Center. The procurement seeks to award up to five contracts for psychiatric positions across these facilities, with Brookwood offering two positions at approximately 74 hours per month each (888 hours annually per position) and Industry Secure Center offering one position. Services are to be delivered in-person throughout the contract term, with OCFS retaining the right to request telepsychiatry services at its sole discretion during the service delivery period. Bidders must submit this mandatory form completed, signed, and certified as part of their bid response.
Minimum qualifications require bidders to possess a valid psychiatry license to practice medicine in New York State and be board-certified or board-eligible in general psychiatry by the American Board of Psychiatry and Neurology. Bidders must not be locum tenens vendors or staffing agencies and must agree to provide in-person services on the contract start date. Bidders must provide two rates—one for in-person services and one for telepsychiatry services—with telepsychiatry reimbursement occurring at the awarded remote rate if OCFS requests such services during the contract term. The certified statements form requires bidders to provide organizational information, identify authorized representatives and contracting personnel, disclose any individuals or organizations attempting to influence the procurement process, submit professional references using the prescribed attachment, and certify compliance with New York State procurement requirements including the Omnibus Procurement Act if the bid exceeds $1 million. Bids constitute firm, irrevocable offers valid for 365 days from submission.
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ATTACHMENT 1
BIDDER’S CERTIFIED STATEMENTS
Invitation for Bids (IFB) 1255 Psychiatric Services for Various Facilities
MANDATORY SUBMISSION: to be completed, signed, and included in the Bid
SECTION ONE: Information Regarding the Bidder
A. Provide the Bidder’s contact information and identification numbers.
Name:
Organization:
Address:
City, State, and ZIP Code:
Telephone Number (include area code):
Email Address:
Taxpayer Identification Number (REQUIRED):
NYS Vendor Identification Number, if available:
B. Provide the contact information of the bidder’s primary contact with OCFS regarding this bid.
Name:
Title:
Address:
City, State, and ZIP Code:
Telephone Number (include area code):
Email Address:
C. Provide the contact information of the person authorized to contractually bind the bidder, if different from (B).
Name:
Title:
Address:
City, State, and ZIP Code:
Telephone Number (include area code):
Email Address:
D.
In accordance with Procurement Lobbying Law, provide the name, address, telephone number, email address, place of principal employment, and occupation of any person authorized to represent the bidder. This requirement applies not only to bidder’s employees involved in the submission of the bid, but also to every individual or organization employed or designated by the bidder to attempt to influence the procurement process. If there is none, state that. This information must be updated if, after the deadline for submission of bids, the bidder retains an individual or organization to attempt to influence the procurement process. Indicate also whether the individual or organization has a financial interest in the procurement.
Name:
Title:
Address:
City, State, and ZIP Code:
Telephone Number (include area code):
Email Address:
Place of Principal Employment:
Occupation:
| This individual/organization has a financial interest in the procurement: |
| |_| Yes |_| No |
| No such individual/organization is authorized to represent the bidder: |
| |_| Yes |_| No |
SECTION TWO: Minimum Qualifications (See IFB Section 2.0 for additional information)
1. The bidder certifies that they possess a valid psychiatry license to practice medicine in New York State.
|_| Yes |_| No *
2. The bidder certifies they are board-certified or board-eligible in general psychiatry by the American Board of Psychiatry and Neurology.
|_| Yes |_| No *
3. The bidder certifies they will provide a minimum of three professional references that can verify the bidder’s qualifications to propose using Attachment 2 – References.
|_| Yes |_| No *
4. The bidder certifies that they are not a locum tenen vendor or staffing agency.
|_| Yes |_| No *
5. The bidder agrees to provide the requested services in-person on the contract start date.
|_| Yes |_| No *
SECTION THREE: Bidder’s Acknowledgement of Bid Requirements
| 1. The bid constitutes a firm and irrevocable offer for a period of 365 days from the date of submission to OCFS. |
| |_| Yes |_| No * |
| 2. By submission of a bid, the bidder agrees not to make any claims for or have a right to any damages because of any misrepresentations or misunderstanding of the specifications or because of any lack of information. |
| |_| Yes |_| No * |
| 3. The bidder certifies that all information provided in connection with its bid is true and accurate. |
| |_| Yes |_| No * |
| 4. The bidder acknowledges that, should any extraneous terms, alternative activities/work to be performed, added conditions, or exceptions be submitted within its bid, such extraneous terms, alternative activities/work to be performed, added conditions, or exceptions will not be considered by OCFS. |
| |_| Yes |_| No * |
| 5. The bidder has read, understands, and accepts all provisions of Appendix A – Standard Clauses for All New York State Contracts. Appendix A contains important information related to the contract to be entered into as a result of this IFB and will be incorporated, without change or amendment, into the contract entered into between OCFS and the selected Bidder. By submitting a response to this IFB, the Bidder agrees to comply with all the provisions of Appendix A. |
| |_| Yes |_| No * |
| 6. The bidder understands that bids that do not provide all the documents requested in IFB Section 3.2 Packaging of IFB Response and/or are not submitted in compliance with the instructions provided in IFB Section 3.1 Instructions for Bid Submission may be subject to rejection. |
| |_| Yes |_| No * |
| 7. The bidder certifies that, if the total bid amount is greater than $1 million, they have satisfied the requirements of the Omnibus Procurement Act of 1992 (Chapter 844 of the Laws of 1992, codified in State Finance Law § 139-i and Public Authorities Law § 2879(3)(n)–(p)). |
| |_| Yes |_| No |
| 8. The bidder certifies that no organization staff members that would provide these services are currently or have ever been a NYS agency employee OR the proposer has disclosed this information. If applicable, the proposer has included with the bid submission a signed statement with the NYS employee name(s) and the NYS agency(ies) they work for or previously worked for. |
| |_| Yes |_| No * |
* A Response of “No” to questions marked with an asterisk in Sections Two or Three will result in the disqualification of your bid.
SECTION FOUR: The bidder is (check as applicable)
|_| A New York State Certified Minority-owned Business Enterprise (MBE)
|_| A New York State Certified Women-owned Business Enterprise (WBE)
|_| A New York State Certified Minority- and Women-owned Business (MWBE)
|_| A New York State Certified Service-Disabled Veteran-Owned Business (SDVOB)
|_| A Small Business Enterprise (SBE) domiciled in New York State as defined and clarified by New York State Empire State Development – Small Business Division
|_| None of the above
SECTION FIVE: Information Regarding the Contract
Provide the contact information of the person authorized to receive notices regarding any contract resulting from this procurement.
Name:
Title:
Address:
City, State, and ZIP Code:
Telephone Number (include area code):
Email Address:
SECTION SIX: Signature Attestation (REQUIRED)
By signing below, I attest that I have express authority to sign these certified statements on behalf of the bidder and am authorized by law to bind the bidder contractually.
Signature:
Print Name:
Title:
Organization:
Date:
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