Outpatient Services RFQ 23012-3 Checklist.pdf
PDF 167 KB Posted
- Attached to
- Statewide Outpatient Services
- Solicitation number
- 23012-3
- Issued by
- Alamosa County, Colorado
About this file
The document is a Request for Qualifications (RFQ) #23012-3 Checklist for Outpatient Services issued by the Colorado Judicial Department, specifically targeting Judicial Districts' Problem-Solving Courts (PSC) and Probation Department. The RFQ seeks to establish a list of qualified providers for outpatient services for adult and juvenile probationers, including treatment services in substance use, mental health, DUI, domestic violence, cognitive behavioral therapy, specialized treatment, and case management. The solicitation primarily focuses on serving the 3rd, 6th, 7th, 9th, 11th, 12th, 13th, 15th, 16th, 21st, 22nd, and 23rd Judicial Districts, though providers are not required to serve the entire state.
The checklist outlines mandatory submission requirements, including a cover letter, conflict of interest disclosure, business organization statement, non-collusion affidavit, pricing response, exceptions to agreement, acknowledgement and attestation statements for specific behavioral health services, list of subcontractors, vendor price sheet, and a current W-9. Providers must demonstrate compliance with relevant licensing and certification requirements from DORA, OBH, and DVOMB. The document emphasizes that respondents do not need to provide services in all areas to be eligible and must indicate unit costs for each service they offer.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Solicitation Terms and Conditions.pdf | ||
| Business Organization Statement.pdf | ||
| Form W-9 (rev. March 2024).pdf | ||
| Q&A Document 1.pdf | ||
| Exceptions to Agreement.pdf | ||
| Statewide Outpatient Services RFQ-3rd Round-Final .pdf | ||
| Exhibit G. Vendor Price Sheet -Round 3.xlsx | XLSX spreadsheet | |
| Q _ A from 2nd Round Outpatient Services.pdf | ||
| Exhibit F. List of Subcontractors.xlsx | XLSX spreadsheet | |
| Affidavit of Non-Collusion.pdf | ||
| 23012-3 Addendum 1.pdf |
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Outpatient Services RFQ #23012-3 Checklist
Please submit this form with your proposal.
Check when complete
Indicate page number(s) where information is located within proposal
Cover Letter providing all information in Section 3.B.
(See page 6 of the Request for Qualifications (RFQ))
Any conflicts of interest with the Colorado Judicial Department
Yes No
If yes, please check the box and indicate page within the proposal.
All information in Section 4
(See page 7 of the RFQ)
Completed and signed Business Organization Statement
(provided on Bidnet)
Completed and signed Affidavit of Non-Collusion
Exhibit C. Pricing Response Section
(See page 26 of the RFQ)
Exceptions to Agreement, if needed; (provided on Bidnet)
Were exceptions taken? Yes No
Exhibit E. Completed and signed Acknowledgement and Attestation Statement for any applicable services:
• Office of Behavioral Health (OBH) or new Behavioral Health Administration for Substance Abuse Disorder
• DORA License for level of service agency intends to provide
• Domestic Violence Offender Management Board (DVOMB) Official Acceptance Letter
(See page 28 of the RFQ)
Exhibit F. List of Subcontractors, if any
Exhibit G. Vendor Price Sheet in excel format (provided on Bidnet)
Provide the unit costs (hourly, each, class, etc.) for each service you provide within the document.
Completed and signed W-9 dated within the last 6 months
Is agency registered with the Colorado Secretary of State?
Yes No
If yes, please check the box and indicate page within the proposal.
| Cover Letter providing all information in Section 3B: |
| Cover Letter providing all information in Section 3B(See page 6 of the Request for Qualifications (RFQ)): |
| Indicate page number(s)where information islocated within proposal: |
| All information in Section 4(See page 7 of the RFQ): |
| Completed and signed Business Organization Statement(provided on Bidnet): |
| Completed and signed Affidavit of Non-Collusion(provided on Bidnet): |
| Exhibit C Pricing Response Section(See page 26 of the RFQ): |
| Indicate page number(s)where information islocated within proposal_1: |
| Exhibit E Completed and signed Acknowledgement andAttestation Statement for any applicable services:• Office of Behavioral Health (OBH) or new BehavioralHealth Administration for Substance Abuse Disorder• DORA License for level of service agency intends toprovide• Domestic Violence Offender Management Board (DVOMB)Official Acceptance Letter(See page 28 of the RFQ): |
| Exhibit F List of Subcontractors, if any(provided on Bidnet): |
| Exhibit G Vendor Price Sheet in excel format (provided on Bidnet)Provide the unit costs (hourly, each, class, etc) for each serviceyou provide within the document: |
| Completed and signed W-9 dated within the last 6 months: |
| Indicate page number(s)where information islocated within proposal_2: |
| Yes: Off |
| No: Off |
| Yes_1: Off |
| No_1: Off |
| Yes_2: Off |
| No_2: Off |
| complete: Off |
| No_3: Off |
| (See page 7 of the RFQ): Off |
| (provided on Bidnet): Off |
| (provided on Bidnet)_1: Off |
| (See page 26 of the RFQ): Off |
| No_4: Off |
| Attestation Statement for any applicable services: Off |
| (provided on Bidnet)_2: Off |
| Provide the unit costs (hourly, each, class, etc) for each service: Off |
| Completed and signed W-9 dated within the last 6 months_1: Off |
| No_5: Off |
File details come from the government source that posted it. Updated .