ITB650 Antitubercular Medication - Cover Form.pdf
PDF 131 KB Posted
- Attached to
- Antitubercular Medications
- Solicitation number
- 650
- Issued by
- Idaho
About this file
This document is Attachment 3 (Cover Form) for Idaho's Antitubercular Medications Invitation to Bid (ITB 650). The cover form is a mandatory submission requirement that must be completed, signed, and uploaded to the IPRO system by all bidders. Bidders must provide company information including legal entity status, Tax Identification Number (EIN), and DUNS Number on company letterhead or with specified contact details. According to the related contract opportunity, proposals are due by February 24, 2025, approximately seven weeks after the January 3, 2025 posting date. The contract seeks to procure multiple antitubercular medications to address tuberculosis treatment needs across Idaho's healthcare system, with the procurement designed to potentially accommodate multiple vendors through tiered or segmented contract awards based on medication types and quantities.
The cover form requires bidders to certify compliance with numerous conditions including acceptance of ITB requirements (except for modifications noted on Attachment 2), equal employment regulations, and federal/state procurement eligibility. Bidders must affirm they are not suspended or debarred (verifiable at sam.gov), have not engaged prohibited marketing practices or paid contingent fees, employ only legally authorized workers, and agree their bid remains firm and binding for ninety calendar days from the bid opening date. While specific set-asides are not explicitly designated in the available documentation, the procurement follows standard state guidelines that may provide opportunities for minority-owned, women-owned, or small businesses. Precise budget ranges are not specified in this cover form, though state-level pharmaceutical contracts for tuberculosis treatment programs typically range from hundreds of thousands to several million dollars annually depending on population needs and medication complexity.
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Text version
ANTITUBERCULAR 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?
Is Bidder in compliance with applicable equal employment regulations?
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?
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, deduct from the offered price the amount of any such fee, commission, percentage, brokerage fee, gifts, or contingencies?
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.
Does the Bidder affirm that the Bid will be firm and binding for ninety (90) calendar days from the Bid opening date?
https://sam.gov/
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?
Signed By:
Printed Name:
Date:
| AntituberculAR Medications |
| ATTACHMENT 3 - COVER FORM |
File details come from the government source that posted it. Updated .