OMESformCP076.pdf
PDF 286 KB Posted
- Attached to
- RFP for SBE Navigator
- Solicitation number
- EV00000966
- Issued by
- Oklahoma
About this file
This is a Responding Bidder Information form (OMES Form CP076) used by the Oklahoma Office of Management and Enterprise Services Central Purchasing division for the RFP to provide SBE Navigator Entity services on behalf of the Oklahoma Insurance Department. The solicitation seeks responses from potential suppliers to provide contract services for the SBE-FP Navigator Entity, which oversees individual Navigators and conducts education and outreach to help Oklahomans access health insurance through the State Based Exchange on the Federal Platform. Navigators assist consumers with applying for coverage and provide education on health care basics, plan options, and available financial assistance. The state reserves the right to award a single contract or multiple awards based on what is determined to be in the best interest of the State.
The form requires bidders to provide general company information including FEIN/SSN, Supplier ID, and company name, along with bidder contact information and website details. Bidders must certify their compliance status regarding boycotts of Israeli goods or services, registration with the Oklahoma Secretary of State, workers' compensation insurance coverage under the Oklahoma Administrative Workers' Compensation Act, and eligibility status under the Disabled Veteran Business Enterprise Act. All responses must include a signed Certification for Competitive Bid and Contract, and successful bidders are required to register with the Secretary of State prior to contract award unless claiming an exemption with supporting documentation.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit_2_-_Navigator_Program_Detailed_Budget.xlsx | XLSX spreadsheet | |
| Agency_Bidder_Instructions.pdf | ||
| Exhibit_5_-ThirdPartySupplierInfo_.xlsx | XLSX spreadsheet | |
| omes-form-cp004.docx | DOCX document | |
| Exhibit_3_-_Navigator_Business_Assessment.pdf | ||
| Exhibit_1_-ExecutiveSummaryWorksheet.xlsx | XLSX spreadsheet | |
| Attachment_A.pdf | ||
| Exhibit_6_-_SBE_Navigator_Entity_SOW.pdf | ||
| Attachment_B_-_General_Terms.docx | DOCX document | |
| Exhibit_4_-_Navigator_Program_Application_Form.pdf |
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Text version
OMES Form CP076 (11/2024) RESPONDING BIDDER INFORMATION | Page 1 of 1
Central Purchasing
RESPONDING BIDDER INFORMATION
You must submit a Certification for Competitive Bid and Contract along with the response to the solicitation.
1. SOLICITATION
Solicitation #
2. BIDDER GENERAL INFORMATION
FEIN/SSN Supplier ID
Company name
3. BIDDER CONTACT INFORMATION
Address
Contact name Title
Email Phone Website Fax
4. BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL
Yes No
5. REGISTRATION WITH THE OKLAHOMA SECRETARY OF STATE
Yes Filing number:
No Prior to the contract award, the successful bidder is required to register with the Secretary of State or must attach a signed statement that provides specific details supporting the exemption the supplier is claiming (sos.ok.gov or 405- 521-3911).
6. WORKERS’ COMPENSATION INSURANCE COVERAGE
Bidder is required to provide a certificate of insurance showing proof of compliance with the Oklahoma Administrative Workers’ Compensation Act.
Yes Include a certificate of insurance with the bid.
No Exempt from the Administrative Workers’ Compensation Act pursuant to 85A O.S. § 2(18)(b)(1-11). (Attach a written, signed and dated statement on letterhead stating the reason for the exempt status. For frequently asked questions concerning workers’ compensation insurance, visit wcc.ok.gov.)
7. DISABLED VETERAN BUSINESS ENTERPRISE ACT
Yes I am a service-disabled veteran business as defined in 74 O.S. § 85.44E.
Include the following with the bid response:
1. Certification of service-disabled veteran status as verified by the appropriate federal agency.
2. Verification of not less than 51% ownership by one or more service-disabled veterans.
3. Verification of the control of the management and daily business operations by one or more service-disabled veterans.
No I do not meet the criteria as a service-disabled veteran business.
8. SIGNATURE
Authorized signature Date
Name Title https://www.sos.ok.gov/ https://www.wcc.ok.gov/
| Central Purchasing |
| RESPONDING BIDDER INFORMATION |
| Solicitation: |
| FEINSSN: |
| Supplier ID: |
| Company name: |
| Contact name: |
| Title: |
| Email: |
| Phone: |
| Website: |
| Fax: |
| 4 BIDDER IS ENGAGED IN BOYCOTT OF GOODS OR SERVICES FROM ISRAEL: Off |
| Prior to the contract award the successful bidder is required to register with the Secretary of State or must attach a: Off |
| Compensation Act: Off |
| 7 DISABLED VETERAN BUSINESS ENTERPRISE ACT: Off |
| Date: |
| Name: |
| Title_2: |
| Filing number: |
| Address: |
File details come from the government source that posted it. Updated .