ITB538 Antituberculosis Medication - Cover Form.docx
DOCX document 17 KB Posted
- Attached to
- ANTITUBERCULOSIS MEDICATION
- Solicitation number
- 538
- Issued by
- Kootenai County, Idaho
About this file
This document is an Invitation to Bid (ITB) for Antituberculosis Medications issued by the state of Idaho. The ITB requires bidders to complete and submit the attached Cover Form, which includes information about the bidder's company, compliance with the ITB requirements, and various certifications. The ITB is for the procurement of antituberculosis medications, but does not provide any details about the specific quantities or types of medications being requested. The bid opening date is not specified in the document. The contract term and any renewal options are also not mentioned.
The Cover Form requires bidders to provide their tax identification number, DUNS number, and confirm their legal status and ability to contract. Bidders must also affirm their compliance with equal employment regulations, that they have not employed any unauthorized parties to secure the contract, and that they are not currently suspended or debarred from federal or state procurement programs. Additionally, bidders must warrant that they do not knowingly employ persons who cannot legally work in the United States, and that any misrepresentation in this regard may result in monetary penalties or contract termination.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| ITB538 Antituberculosis Medication.pdf | ||
| State of Idaho Standard Terms and Conditions_5-21.pdf | ||
| solicitation_instructions-Jan-2017.pdf | ||
| RFQ Event #100 Administration Document.docx | DOCX document | |
| ITB538 Response to Questions.pdf | ||
| ITB538 State Signature Page.pdf | ||
| Signature+Page.pdf | ||
| Standard-Terms-and-Conditions_May-2021.pdf | ||
| ITB538 Antituberculous Medication - Cost Matrix - Draft.xlsx | XLSX spreadsheet | |
| Exhibit A - Bid Schedule.xlsx | XLSX spreadsheet | |
| Insurance Requirements 2023.pdf | ||
| ITB538 TB Medication- Amendment 1.pdf | ||
| ITB538 Amendment 2 Ack Form.pdf | ||
| ITB538 TB Medication- Amendment 2.pdf | ||
| RFQ Event #144 Administration Document.docx | DOCX document | |
| ITB Event 563 Administrative Document.docx | DOCX document |
Show all 16
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Antituberculosis Medications
ATTACHMENT 3 - COVER FORM
Attachment 3, Cover Form must be completed, signed, and uploaded to the Supplier Attachments page in IPRO. Failure to complete and submit this form may result in your Bid being deemed non-responsive.
Instructions: The Bid must include a signed copy of this cover form. Copy and paste this form onto your company letterhead, or include the following information: Bidder’s company name, mailing address, phone number, fax number, e-mail address, and name of Bidder’s authorized signer. The Cover Form must include the ITB Number and Title and must be signed by an individual authorized to commit the Bidder to the contents of the Bid.
| Requirement |
| Response |
| Bidder’s corporate or other legal entity status |
| ☐ Corporation |
☐ Limited Liability Corporation (LLC) ☐ Limited Liability Partnership ☐Sole Proprietorship ☐ Other (specify)
Bidder’s Tax Identification Number
EIN:
Bidder’s DUNS Number
DUNS:
Is Bidder a legal entity with the legal right to contract?
☐ Yes ☐ No
Other than modifications/exceptions identified on Attachment 2, in compliance with Section 3 of this ITB, does Bidder accept, and is Bidder willing to comply with, the requirements of this ITB?
☐ Yes ☐ No
Is Bidder in compliance with applicable equal employment regulations?
☐ Yes ☐ No
Does Bidder affirm that it has not employed any company or person other than a bone fide employee working solely for the Bidder or a company regularly employed as its marketing agent, to solicit or secure the Contract, and that it has not paid or agreed to pay any company or person, other than a bone fide employee working solely for the Bidder or a company regularly employed by the Bidder as its marketing agent, any fee, commission, percentage, brokerage fee, gifts, or any other consideration contingent upon or resulting from the award of the Contract?
☐ Yes ☐ No
Does Bidder understand and agree that for breach or violation of the above term, the State has the right to annul the Contract without liability or, in its discretion, to deduct from the offered price the amount of any such fee, commission, percentage, brokerage fee, gifts, or contingencies?
☐ Yes ☐ No
Firm(s) and/or staff responsible for writing the Bid?
Names:
Does Bidder affirm that it is not currently suspended, debarred, or otherwise excluded from federal or state procurement and non-procurement programs?
Note: vendor information is available at https://sam.gov.
☐ Yes ☐ No
Does the Bidder affirm that the Bid will be firm and binding for ninety (90) calendar days from the Bid opening date?
☐ Yes ☐ No
| Does Bidder warrant that it does not knowingly and willfully employ persons who cannot legally work in this country; and that Bidder takes steps to verify that it does not hire persons who have entered our nation illegally or cannot legally work in the United States; and that any misrepresentation in this regard or any employment of persons who have entered our nation illegally or cannot legally work in the United States constitutes a material breach and will be cause for the imposition of monetary penalties up to five percent (5%) of the Bid price, per violation, and/or termination of the Contract? |
| ☐ Yes ☐ No |
Signed By:
Printed Name:
Date:
File details come from the government source that posted it. Updated .