Summary of Required Form Exhibit 6

This is a required form exhibit for a Request for Statement of Qualifications (ROSQ) issued by the County of Los Angeles, Department of Mental Health, seeking qualified vendors to provide eating disorders services and electroconvulsive treatment services on an as-needed basis. The procurement targets acute inpatient care, specialized follow-up residential treatment center services, partial hospitalization programs, and intensive outpatient programs for children, adolescents, and adults diagnosed with eating disorders, as well as electroconvulsive treatment services. The respondents must demonstrate qualifications across multiple service modalities and populations. The document establishes the formal requirements and certifications that prospective contractors must complete and submit as part of their qualification statements to be considered for master agreement consideration with the County.

The exhibit specifies the required forms, declarations, and exhibits that all respondents must provide with their statements of qualifications, including compliance certifications, business entity information, and any applicable exclusions or restrictions. Prospective vendors must meet specified criteria regarding licensure, accreditation, experience, and operational capacity to deliver services across the designated service levels. The master agreements resulting from this ROSQ will operate on an as-needed basis, allowing the County flexibility in engaging qualified providers for eating disorders and electroconvulsive treatment services as demand dictates.