Interested State Information Form - Procurement Assistance and Support Services Doc1428590914~3.pdf

Version 2022.11.22

Interested State Information Form Please complete this form if your state wishes to be identified as a potential Participating Entity (“Interested State”) in the Request for Proposals for the NASPO ValuePoint portfolio named below (the “RFP”). A confidential draft of the RFP has been shared with NASPO primary members for review. Comments and questions on the RFP draft, as well as a completed copy of this form, may be emailed to the NASPO ValuePoint contact identified below by the indicated due date.

Submission of this form does not commit any Interested State to execution of any Participating Addendum.

I. SOLICITATION INFORMATION.

A. Portfolio Name: _______________________________________________________ B. Lead State: _________________________ C. NASPO ValuePoint Contact Name: ___________________________________ D. NASPO ValuePoint Contact Email: ___________________________________ E. Form Due Date: _______________

II. STATE INFORMATION. Please provide the information below. Forms should be completed and submitted only with the approval of the state’s NASPO primary member or designee. If your state requires a signature from the primary member or designee to indicate approval, they may sign below.

A. State: _________________________ B. State Point of Contact Name: ___________________________________ C. State Point of Contact Title: ___________________________________ D. State Point of Contact Email: ___________________________________ E. NASPO Primary Member or Designee Name: ___________________________________ F. NASPO Primary Member or Designee Email: ___________________________________

NASPO Primary Member or Designee Signature (if required): _______________________________

III. ESTIMATED ANNUAL VOLUME. Please provide your state’s estimated annual volume of spend on products and services within the scope of the RFP, based on historical usage and/or anticipated future usage. The Total Estimated Annual Volume for each Interested State will be included in the RFP for informational purposes only.

Providing an estimate does not commit any Interested State to any minimum or maximum volume of spend.

A. Estimated Annual Volume for State-level Entities: ____________________ B. Estimated Annual Volume for Non-state-level Entities: ____________________ C. Total Estimated Annual Volume (sum of A and B): ____________________

IV. PARTICIPATING ADDENDUM TERMS AND CONDITIONS. Interested States may attach state-specific terms and conditions to this form for inclusion in the RFP as potential Participating Addendum terms and conditions. Terms and conditions provided by Interested States will be shared with vendors for informational purposes only and will not be incorporated into the Master Agreement or addressed or negotiated by the Lead State. Participation and the terms and conditions applicable to each Participating Entity will be determined by the Participating Entity following negotiation of a Participating Addendum with a Contractor.

Please check one of the below.

☐ My state is not providing terms and conditions for inclusion in the RFP.

☐ My state has attached state-specific terms and conditions to this form, or included state-specific terms and conditions below, for inclusion in the RFP.