REQ - Supplier Diversity Program Form~17.doc

DOC document 73 KB Posted

Attached to
RFR_164716 Philips Brilliance 64 channel CT scanner upgrade
Solicitation number
BD-16-1031-LSH00-LSH01-00000007045
Issued by
Suffolk County, Massachusetts

About this file

This document is a Supplier Diversity Program (SDP) Plan Commitment & Declaration of SDP Partner(s) form related to a state and local contract opportunity in Massachusetts. The form requires the prime bidder to identify any Minority Business Enterprises (MBE), Women Business Enterprises (WBE), and Service-Disabled Veteran-Owned Business Enterprises (SDVOBE) that will be used as SDP partners for the life of the contract. The prime bidder must commit to a percentage of the contract value that will be awarded to these SDP partners. The form provides instructions, certification details, and contact information for accessing SDP resources to assist in finding potential partners.

The related state and local contract opportunity is for a Philips Brilliance 64 channel CT scanner upgrade. The contract is being issued by the state of Massachusetts. No other details about the specific products, services, quantities, response due dates, award dates, or contract term are provided in the given documentation.

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Text version

Supplier Diversity Program (SDP) Plan Commitment & Declaration of SDP Partner(s)

(To be submitted with Bid Response)

RFR Document Number:

Instructions: Completing all parts of this form is mandatory. Please read instructions in the SDP section of the solicitation. Complete one form and submit with Bid. An SDP partner must be identified before a contract can be executed. See SDP and SDVOBE Resource information below to assist in partnering with certified businesses.

Part I Contractor Information (Required)

Business Name:
Contact Name:
Phone # ( FORMTEXT

Email address:

Please note that prime bidders who are SDO-certified must also submit an SDP Plan Form and may not list themselves as an SDP Partner. Check any of the following that are applicable to the Bidder:

Minority-owned Business Enterprise (MBE); Certification Expiration Date (If applicable):

Women-owned Business Enterprise (WBE); Certification Expiration Date (If applicable):

Service-Disabled Veteran-owned Business Enterprise (SDVOBE); Certification Expiration Date (If applicable):

Identify Business Opportunities for SDP Partners (Optional):

SDP Percentage Committed for Life of Contract:

Part II Contractor’s SDP Partners (Required)(Fill in Applicable Lines; Insert Additional Rows as Needed)

SDP Partner’s Company Name

SDP Partner’s Contact Person’s Email Address*
Check SDP Partner’s Certification(s)**
@ .
MBE

WBE

SDVOBE

@ .
MBE
@ .
MBE
@ .
MBE

WBE

SDVOBE

FORMTEXT

@ .
MBE

*The Supplier Diversity Office and contracting Department reserve the right to contact SDP Partners at any time to request that they attest to the amounts reported to have been paid to them by the Contractor.

** SDP Partner Certification Acronyms: MBE = Minority-owned Business Enterprise; WBE = Women-owned Business Enterprise; SDVOBE = Service-Disabled Veteran-owned Business Enterprise.

*** Certification Status can be checked on the Supplier Diversity Program Webpage (www.mass.gov/sdp).

Supplier Diversity Program (SDP) Resources:

· Resources available to assist Prime Bidders in finding potential Minority Business Enterprises (MBE) and Women Business Enterprises (WBE) partners can be found on the Supplier Diversity Program Webpage (www.mass.gov/sdp).

· Resources available to assist Prime Bidders in finding potential Service-Disabled Veteran-Owned Business Enterprise (SDVOBE) partners can be found on the Supplier Diversity Office Webpage (www.mass.gov/sdo).

· The Supplier Diversity Program offers training on the SDP Plan requirements. The dates of upcoming trainings can be found on the OSD Training & Outreach Webpage. In addition, the SDP Webinar can be located on the Supplier Diversity Program Webpage (www.mass.gov/sdp).

· The Supplier Diversity Business Directory can be found at https://www.sdo.osd.state.ma.us/BusinessDirectory/BusinessDirectory.aspx Page | 2

File details come from the government source that posted it. Updated .