MED53 Bidders Submission Checklist~1.doc

Bidders Submission Checklist MED53 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: MED53, Influenza Vaccine for the 2019 – 2020 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:

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– This RFR Bidders Check List

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– MED53 Bidders Price Sheet

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– Prompt Payment Discount (PPD) Form

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

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– Additional Environmentally Preferable Products/Practices (EPP) Form

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– Certificate of Non-Collusion No Submission Form, please scan and submit documents:

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– Certificate of Insurance listing Commonwealth of Massachusetts (usually ACCORD form from broker)

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– Emergency response plan, see Section C 4 of RFR Distributers Only No Submission Form, please scan and submit documents

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– 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