PO250008 Attach C Admin Response.docx

ATTACHMENT C - BIDDER RESPONSE TEMPLATE

ADMINISTRATIVE REQUIREMENTS RESPONSE (Pass/Fail)

RFQQ PR250008

Electronic Monitoring for Community Transition Services and Functional Family Parole

Instructions: Bidders must complete this template and attach the PDF to their emailed RFQQ Response. Please thoroughly read all instructions in the RFQQ before completing. All mandatory information must be provided for the Bidder to be responsive. Bidder may provide additional documentation as an additional Attachment; the documentation should be specified in this form. Also, please write your Business Name on the bottom of each page of this Response Template.

ADMINISTRATIVE REQUIREMENTS (Mandatory Pass/Fail)

Bidder Information:

Business Name:

Address:

Telephone:

Email of Legal Entity or Individual:

· No

Federal Tax Identifier Number:

WA State Uniform Business Identifier (UBI) Number:

Bidder confirms they meet the following qualifications:

1. Provide after-hours monitoring (5:00 pm PST to 8:00 am PST)

2. Provide wrist-worn devices

· Yes

· No

Contract History:

Has the Bidder’s performance on any contract unsatisfactory and resulted in a contract termination in the past five (5) years?

· Yes

· No

If yes, provide a list of those contracts terminated, and include the following:

· Other party’s Name

· Address

· Telephone Number

· Description of the Incident

· Bidder’s Position on the matter

State of Washington Employee(s):

If yes, provide the following information for each individual:

· Name

· Employing Agency

· Job Title while with the Agency

· Separation Date

Insurance Requirements:

Proprietary or Confidential Information:

If applicable, identify the Sections of the Response which the Bidder considers “Proprietary” or “Confidential” information:

(Optional) OMWBE Certification:

Is Bidder or Bidder’s subcontractor OMWBE Certified?

· Yes

If yes, Bidder’s OMWBE Certification #:

(Optional) Veteran Owned Business:

Is Bidder or Bidder’s subcontractor certified Veteran Owned Business?

· Yes

If yes, Bidder’s DVA Certification #:

(Optional) Small Business:

· No If yes, please be sure to sign and return Attachment B.1 Small Business Self-Certifications as part of your proposal.

Checklist of Mandatory Response Attachments:

· Completed and signed Bidders Certification and Assurances Form (Attachment B)

· Complete and Signed Small Business Self-Certification Form (Attachment B.1) if Bidder is a Self-Certified Small Business

· Completed and Signed Administrative Requirements (Attachment C; this document)

· Completed Technical and Management Response (Attachment C1)

· Completed Cost Proposal (Attachment C2)

· Scheduled Oral Presentation (Demo) with Purchasing Coordinator

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