REQ SDP Form - Standard RFRs -Supplier Diversity Program updated 11-1-19.docx
DOCX document 50 KB Posted
- Attached to
- RFR201230 Cardiac Holter Monitoring Services
- Solicitation number
- BD-20-1031-LSH00-LSH01-46429
- Issued by
- Massachusetts
About this file
This document is a Supplier Diversity Program (SDP) Plan Commitment & Declaration of SDP Partner(s) form for a state and local contract opportunity. The form must be completed and submitted within 30 days of contract execution. It requires the prime bidder to provide the name of their business, contact information, and commit to a specific percentage of the contract value that will be spent with certified SDP partners such as Minority/Women-Owned Business Enterprises (M/WBEs), Veteran Business Enterprises (VBEs), Service-Disabled Veteran-Owned Business Enterprises (SDVOBEs), Disability-Owned Business Enterprises (DOBEs), and LGBT Business Enterprises (LGBTBEs). The prime bidder must identify the specific SDP partners they plan to utilize and the functions those partners will perform.
The related state and local contract opportunity is for Cardiac Holter Monitoring Services, issued by the State of Massachusetts. No other details about the specific contract opportunity are provided in this document.
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Text version
Supplier Diversity Program (SDP) Plan Commitment & Declaration of SDP Partner(s) (Form to be submitted with quote)
Contract/RFR Document Number: Click here to enter text.
Instructions: Completing all parts of this form is mandatory. Please read all sections of the Bid related to the SDP. Complete one form and submit within a period of up to 30 days (or as stated in RFR) of Contract Execution. See SDP Resources information below to assist in partnering with certified businesses.
Important: Prime bidders that are certified as an M/WBE, M/WNPO, VBE, SDVOBE, DOBE or LGBTBE must also submit an SDP Plan Form and may not list themselves or their affiliates as SDP Partners.
Part I Contractor Information and Annual Financial Commitment (Required)
| Business Name: Click here to enter text. |
| Contact Name: Click here to enter text. |
| Phone #: Click here to enter phone number. |
| Email address: Click here to enter email address. |
Part II Annual Financial Commitment (Required)
Provide a specific final percentage of Bidder/Contractor sales derived from this contract to be spent with all certified SDP Partners on a Massachusetts fiscal year (July 1-June 30) basis.
Final Annual SDP Percentage Committed for Life of Contract:
Click here to enter percentage.%
Part III Contractor’s SDP Partners (Required) (Fill in Applicable Lines; Insert Additional Rows as Needed)
| Planned SDP Partner Company Name |
| Check Planned SDP Partner’s Certification(s) |
| Certifying Organization |
| Functions to be Performed by the Partner (optional unless otherwise stated in the RFR) |
| Click here to enter text. | Choose an item. | Choose an item. | Click here to enter text. |
| Click here to enter text. | Choose an item. | Choose an item. | Click here to enter text. |
| Click here to enter text. | Choose an item. | Choose an item. | Click here to enter text. |
| Click here to enter text. | Choose an item. | Choose an item. | Click here to enter text. |
Supplier Diversity Program (SDP) Resources:
· Lists of M/WBEs, M/WNPOs, VBEs, SDVOBEs, DOBEs and LGBTBEs certified or verified by the Supplier Diversity Office (SDO) are located at www.mass.gov/sdo.
· Resources to assist Prime Bidders in finding potential Certified Partners can be found at www.mass.gov/sdp.
Revised: October 31, 2018(DPH)
Page | 2
File details come from the government source that posted it. Updated .