OMESFormCP076.pdf
PDF 299 KB Posted
- Solicitation number
- EV00000993
- Issued by
- Oklahoma
About this file
This is an OMES Form CP076 Responding Bidder Information form submitted to Oklahoma's Central Purchasing division for Solicitation EV00000993, which seeks consulting services for Community Paramedicine deployment strategies. The solicitation, issued by the Office of Management and Enterprise Services (OMES), requests responses from qualified suppliers to develop and implement deployment strategies for Community Paramedicine in Oklahoma, identify pathways to sustainable payment models, and potentially integrate these services with other Rural Health Transformation Program (RHTP) initiatives. The contract may be made available for use by state agencies and affiliates on an as-needed basis, though specific response deadlines, award dates, and contract term details are not provided in this particular form.
The form requires bidders to provide general company information, contact details, FEIN/SSN, and Supplier ID, along with certifications regarding workers' compensation insurance compliance and Oklahoma Secretary of State registration. Bidders must also declare whether they are engaged in boycotts of Israeli goods or services and whether they qualify as service-disabled veteran businesses under Oklahoma statute 74 O.S. § 85.44E. Workers' compensation insurance coverage is mandatory unless the bidder qualifies for an exemption under 85A O.S. § 2(18)(b)(1-11), which requires submission of a signed, dated written statement. Service-disabled veteran businesses must provide federal verification of status, proof of at least 51% ownership by service-disabled veterans, and documentation that service-disabled veterans control management and daily operations. No pricing information, set-asides, incumbent details, or funding amounts are specified in this bidder information form.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Bidder_Instructions.pdf | ||
| Exhibit_5_-_Expected_Deliverables.pdf | ||
| Attachment_A_-_Purpose.pdf | ||
| Exhibit_3a_-_Statewide_Pricing.xlsx | XLSX spreadsheet | |
| Attachment_G_-_Federal_Terms.docx | DOCX document | |
| Exhibit_3b_-_Agency_Cost_Budget.xlsx | XLSX spreadsheet | |
| Exhibit_4_-_Business_Reference.docx | DOCX document | |
| Exhibit_2_-_Technical_Response.pdf | ||
| Attachment_C_-_Statewide-Terms.docx | DOCX document | |
| Exhibit_1_-_Executive_Summary.pdf | ||
| Attachment_B_-_General-Terms.docx | DOCX document | |
| OMESFormCP004.pdf |
Show all 12
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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: EV00000993 |
| 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 .