MED50 Bidders Submission Checklist.doc

Bidders Submission Checklist MED50 Bidders must download and submit with their COMMBUYS online response a completed version of this RFR Checklist, including filling in all Bidder contact information and checking off (by double clicking each box below and in the pop-up selecting “checked”), thereby certifying completion and submission of each of the forms required by this RFR on COMMBUYS.

RFR Number: MED50, Entitled: Influenza Vaccine for the 2016 – 2017 Flu Season Bidder Contact Information (To be completed by Bidder):

· Bidder’s name (individual or company):

· Bidders Federal Tax ID (TIN)

· Bidder’s Address (Street, City/Town, state, zip):

· Bidders State of incorporation

· Bidders Mass VC # if known

· Bidders DUNS #

· Contract Manager Name & Title:

· Contract Manager Emergency Phone Number (24 Hours)

· Telephone number: Facsimile number:

· Email address:

· Website (Please note that it is the Bidder’s responsibility to inform the Contract Manager of any changes in their Bidder Contact Information by resubmitting this form with any changes during the RFR process or during the contract term, if awarded a contract.)

Required Forms – To check a box, double click the box and in the pop up select “checked”. By checking the box for each of the forms listed below, the Bidder is certifying that each of these forms has been completed, executed and submitted with their bid/response:

FORMCHECKBOX

– This RFR Bidders Check List

FORMCHECKBOX

– MED50 Bidders Price Sheet

FORMCHECKBOX

– Prompt Payment Discount (PPD) Form

FORMCHECKBOX

– Supplier Diversity Program (SDP) Plan Form #1 - note that % commitments are a % of all sales under the contract

FORMCHECKBOX

– Additional Environmentally Preferable Products/Practices (EPP) Form No Submission Form, please scan and submit documents:

Distributers Only No Submission Form, please scan and submit documents

FORMCHECKBOX

– Signed Statement from each manufacturer bid on their letterhead stating they will supply the distributer with the quantity on each line item the distributer is bidding to the Commonwealth Vendor Fair Participation - Bidders please check one of the boxes below, exhibiting is not a requirement to bid:

FORMCHECKBOX

– I will exhibit at the MASSbuys event

FORMCHECKBOX

– I do not plan to exhibit