Response Form A Optical~8.docx

RESPONSE FORM A - BID RESPONSE SHEET

18-IND-7548-Optical

Before submitting this and all other forms associated with this solicitation, all Bidders are advised to check the solicitation record on www.COMMBUYS.com for the final versions of all forms.

All Bidders must complete and return this Attachment with their response in order to be considered responsive. Completing every section of this document fully is mandatory unless instructions for specific questions state otherwise.

Company name

Street address, city, state, zip

Main phone number

Toll-free phone number

Fax number

Website

Name, Title

Phone number

Fax

Email

Name, Title

Phone number (working hours)

Phone number (non-working hours)

Fax

Email

Section 2. Bid Information

2.1 Indicate in which Category/Items your company is bidding:

Section 3- Checklist of Required Documentation Omission of required information or documentation may be grounds for Bidder disqualification. To ensure accurate review of your submission, please follow the file naming conventions and use the provided wording for the “Response Description” field.

Cost Sheets/Pricing See Section 3.5.2 of the RFR Complete electronically and submit with response.

Certificates or Letters of OEM Certification See Section 3.1.1 of the RFR Combine in one file and submit with response.

Samples See Section 3.2.7 of the RFR Receive samples by October 22, 2017 at 2:00 PM via mail to:

Tiffany Myers 50 Maple Street, Suite 3 Milford, MA 01757

Certificates of Insurance See Section 3.3.9 of the RFR Combine in one file and submit with response.

Service Maintenance Agreement See Section 3.3.7 of the RFR Combine in one file and submit with response.

Section 4- Company Information

4.2 Basic Information

Use this column for the answer or attach additional documentation

Number of years in business prior to the due date of this solicitation

Has the company had a previous Tax ID? What was the company’s past name?

Was this the result of a merger or acquisition? Please define with the dates of this circumstance.

Number of years in business offering each category that your company is submitting a response.

Corporate Headquarters location.

Business hours/days

4.4 Administrative Capability

Maintaining a contractual relationship with MassCor will require all Contractors to establish systems that would enable them to track and report contract activities on a quarterly basis even if no business is done under the contract. The penalty for non-compliance with this requirement is contract suspension or termination. By clicking the boxes below, the Bidder certifies that it has the required administrative capability to supply the following information on a quarterly basis.

|_| Quarterly reporting of spending with Supplier Diversity Program (SDP) Partners |_| Quarterly reporting of billing.

Yes

No

4.5 Financial Stability

Litigation, Penalties, Pending Actions, Enforcement Actions, or Bankruptcy: The bidder shall submit a description of any and all investigations, indictments or pending litigation by any federal, state or local jurisdiction relating to the bidder, any officer, director, partner or member thereof, any affiliate or any related company. A list of all criminal convictions within the last five years relating to the bidder, any officer, director, partner or member thereof, any affiliate or any related entity. A list of all civil penalties, judgments, consent decrees and other sanctions within the last five years, as a result of any violation of any law, rule, regulation or ordinance in connection with its business activities relating to the bidder, any officer, director, partner or member thereof, any affiliate or any related entity. A list of all actions occurring within the last five years which have resulted in revocation or suspension of any permit or authority to do business in any jurisdiction relating to the submitting entity, any officer, director, partner or member thereof, any affiliate or any related entity. A list of all actions occurring within the last five years that have resulted in the barring from public bidding relating to the bidder, an officer, director, partner or member thereof, any affiliate or any related entity. A list of all pending actions and enforcement actions, including OSHA violations. A list of all bankruptcy and other similar proceedings within the past five years relating to the bidder, any officer, director, partner or member thereof, any affiliate or any related entity.

Defaults: The bidder shall provide a description, in detail, of any situation in which the bidder’s firm (either alone or as part of a joint venture), or a subsidiary of the bidder’s firm, defaulted or was deemed to be in noncompliance of any contractual obligations, explaining the situation, its outcome and all other relevant facts associated with the event described. Please also provide the name, title and telephone number of the principal manager of the contract user who asserted the event of default or noncompliance.

Other Adverse Situations: The bidder shall provide a description of any present facts known to the bidder that might reasonably be expected to affect adversely either its ability to perform any aspect of the agreement or the viability of any affiliated entity that might reasonably be expected to supply financial support.

Use this column for the answer

Describe any Litigation, Penalties, or Bankruptcy

Describe any Defaults

Describe any other Adverse Conditions

Describe any actions, pending actions, enforcement actions or violations

4.6 Insurance. Describe your company’s liability (general and auto), property, personal injury and worker’s compensation insurance, including the limits, in the box below. Submit certified copies of insurance, see Section 3 of Response Form A.

General liability

Auto

Pollution

Property

Personal injury

Worker’s compensation

Company name

Street address, city, state, zip

Main phone number

Toll-free phone number

Fax number

Website

Products / Services this Subcontractor intends to provide under the Contract (if approved)

5.14 Discounts Available

Please describe any and all discounts offered by your company, as follows:

Prompt Pay Discounts (PPD) All Prompt Pay Discounts are to be reflected on the Prompt Pay Discount Form, page 13 of this document.

Special Purchases All Special Purchases are to be defined below.

Use the box below for the answer

Additional Discounts Available Any additional discounts available are to be defined below.

Use the box below for the answer

5.14 Price Benchmarking

Please describe any price agreements you may have with the U.S. Federal Government (e.g. General Services Administration), national public purchasing cooperatives (e.g. US Communities, NJPA, etc.), local purchasing cooperatives (e.g. chemical buying consortiums), or other states or large public organizations within the Commonwealth of Massachusetts. How does the pricing proposed by your company under this contract compare to pricing offered under agreements with above-mentioned organizations. Limit: 1 page.

Use this column for the answer

If Yes, name the organization(s) supplied under that contract:

If Yes, please compare the pricing offered under that contract with the pricing proposed to the Commonwealth in response to that solicitation:

If Yes, name the organization(s) supplied under that contract:

If Yes, please compare the pricing offered under that contract with the pricing proposed to the Commonwealth in response to that solicitation:

If Yes, name the organization(s) supplied under that contract:

If Yes, please compare the pricing offered under that contract with the pricing proposed to the Commonwealth in response to that solicitation:

If Yes, name the organization(s) supplied under that contract:

If Yes, please compare the pricing offered under that contract with the pricing proposed to the Commonwealth in response to that solicitation:

Certification

I , _____________________________________, agree to all terms, conditions and requirements stated in this RFR. I realize failure to comply with any requirement of this RFR after the contract award may result in a fine or termination of award on contract.

Contract Authorized Signatory Name:

Contract Authorized Signatory Title Date