Response Form A~10.docx

RESPONSE FORM A - BID RESPONSE SHEET

21-DOC-1000-Timeclock Maintenance

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. 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.

File name: Response Form_A_[your company name] Response description: Response Form A

File name:Wnty_[your company name] Response description: Warranty Information

File name: SCF_[your company name] Response description: Standard Contract Form

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

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

Recalls. Describe in detail your company’s procedure for recalls. (You may attach policy and place see attached below) Use the box below for the answer

Return Policy. Describe in detail your company’s written return policy. (You may attach policy and place see attached below) Use the box below for the answer

Warranties (Manufacture, Extended & Service). State your company’s warranties that your company is submitting a response. (you may attach policy and place see attached below) Use the box below for the answer

Technical Support. Please provide toll-free technical support telephone line number and any additional information pertaining to technical support.

Use the box below for the answer

Installation. Please provide any services disruptions and special requirements. (You may attach policy and place see attached below Limit: 1 page.

Use the box below for the answer

Pricing. Please detail you pricing below. Pricing will be firm for the initial period. Any price increases must take place at the time of renewal.

Use this column for the answer: Rates

Subcontractor Disclosure. Please copy and paste additional copies of the table below for more subcontractors. Each subcontractor is subject to individual SST approval.

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)

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

4.14 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 contract award may result in termination of an awarded contract.

Signed electronically Authorized officer name:

Title:

Date:

Supplier Diversity Program (SDP) Plan Commitment SDP Plan Form #1 (To be submitted with Bid Response)

Contract/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.

Part I Bidder/Contractor Information (Required)

Business Name:

Contact Name:

Part II Financial Commitment (Required)

Provide a specific percentage committed (as a percentage of Bidder/Contractor sales derived from this contract for the life of the contract) to be spent with all certified SDP Partners that the Bidder will propose if awarded a Contract. Please note that prime bidders who are SDO-certified must also submit an SDP Plan Form.

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).

Supplier Diversity Program (SDP) Plan - Declaration of SDP Partner(s) SDP Plan Form #2

Contract/RFR Document Number: .

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 and SDVOBE 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)

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:

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

Part III Under the pains and penalties of perjury I certify that the information provided on this form is accurate. (Required)

Date:

Supplier Diversity Program (SDP) Resources:

· Lists of M/WBEs, M/WNPOs, VBEs and SDVOBEs 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.

· The Operational Services Division offers trainings on compliance with the SDP Plan requirements. Registration information for upcoming trainings can be found on the Supplier Diversity Program Trainings webpage.

Massachusetts Department of Correction Volunteer and Contractor Training and Acknowledgement of Prison Rape Elimination Act (PREA) - Attachment IV

I have been informed of and understand each of the following specific items about the PRISON RAPE ELIMINATION ACT (PREA) of 2003 listed below:

(2)

The Department has zero tolerance toward all forms of sexual abuse and sexual harassment and is committed to preventing, detecting, and responding to such conduct as outlined in 103 DOC 519 - SEXUALLY ABUSIVE BEHAVIOR PREVENTION AND INTERVENTION POLICY. The Department embraces the standards set forth by the National Prison Rape Elimination Commission and the American Correction Association for all state correctional jurisdictions.

(4)

Sexual misconduct between an employee/volunteer or contractor and an inmate is forbidden and may result in discipline up to and including termination and referring for prosecution Department employees, contractors, volunteers and inmates who engage in sexually abusive behavior. Sexual misconduct can consist of conversations, gestures, or correspondence of a sexual nature. This includes demeaning references to gender or sexual preference, or sexually suggestive or derogatory comments about body or clothing, or obscene language or gestures. Sexual misconduct also includes voyeurism which is an invasion of an inmate’s privacy by peering at an inmate in private situations outside of those required by supervisory or security policies and procedures.

(5)

I have a duty to report any sexual misconduct between an employee, volunteer or contractor and an inmate that I observe or have reason to believe occurred and must report it to the Shift Commander as required. If I fail to do so and such is proven pursuant to policy, there could be disciplinary action up to and including termination and/or criminal action.

BUSINESS REFERENCE FORM

Bidder:

RFR Name/Title:

RFR Number:

The bidder must provide (indicate a number) __________ business references.

Reference name:_____________________________________ Contact:

Address: ________________________________________________ Phone: # ( ) Fax/Internet address:

Description and date(s) of commodities and services provided:

Reference name: _______________________________________Contact:

Address: _______________________________________________ Phone: # ( ) Fax/Internet address:

Description and date(s) of commodities and services provided:

Reference name: ______________________________________ Contact:

Address: _______________________________________________ Phone: # ( ) Fax/Internet address:

Description and date(s) of commodities and services provided:

References will be contacted to confirm the bidder’s abilities and qualifications as stated in the bidder’s response. The department may deem the bidder’s response unresponsive if a reference is not obtainable from a listed reference after reasonable attempts.

ADDITIONAL ENVIRONMENTALLY PREFERABLE PRODUCTS / PRACTICES

Bidder Company Name: ___________________________________________________ Date: _______________ In line with the Commonwealth’s efforts to promote products and practices which reduce our impact on the environment and human health, Bidders are encouraged provide information regarding their environmentally preferable/sustainable business practices as they relate to this contract wherever possible.

Bidders who can demonstrate such initiatives in their RFR submission (referencing, but not limited to, the items listed below) will be eligible to receive evaluation points.

In order to receive evaluation points, Bidders must complete this form and submit it with their RFR Response.

Bidders must submit appropriate documentation to support the items for which the Bidder indicated a “Yes” and present this documentation in the proper sequence of this Attachment.

1. Packaging

packaging take-back services, or shipping carton return

If yes, use the box below to enter a description of the practices being followed. The box below will expand to accommodate the information being entered.

2. Business Practices / Operations / Manufacturing

If yes, use the box below to enter a description of the practices being followed. The box below will expand to accommodate the information being entered.

3. Certifications

Certification, C2C Protocol, Responsible Care Codes of Practice or other similar standards ____ Third Party product certifications such as Green Seal, Scientific Certification Systems, Smartwood, etc.

If yes, bidders must submit copies of the certificates obtained.

4. Other Environmental Criteria Bidders are encouraged to respond to criteria specifically indicated in this RFR as “desirable environmental criteria” (and attach the appropriate documentation) to receive consideration in the evaluation.

If yes, use the box below to enter a description of the practices being followed. The box below will expand to accommodate the information being entered.

Purpose of the Form

ADDITIONAL ENVIRONMENTALLY PREFERABLE PRODUCTS / PRACTICES

The ADDITIONAL ENVIRONMENTALLY PREFERABLE PRODUCTS / PRACTICES form is a standard evaluation tool included with virtually all The Department Requests for Response (RFR) that will result in a Contract. It applies to the operations of the Bidder (not any manufacturer or other company represented buy the Bidder).

Purpose of the Form The primary purpose for incorporating this language into RFRs is to encourage potential Bidders to adopt business practices that foster a sustainable approach to conducting their operations. Such an approach may include one that has a reduced impact on the environment or public health, such as, but not limited to, creating less waste by using less packaging; eliminating the use substances and/or materials that are considered toxic during the manufacturing process, at time of product use, or upon disposal; or utilizing vehicles in the delivery fleet that operate on alternative fuels for the purpose of reducing air pollution and greenhouse gas emissions.

Other purposes for the form that may be beneficial to the Bidder include:

· The form alerts Bidders to the fact that the Commonwealth considers such initiatives part of the “best value” of a procurement.

· The form provides Bidders with an opportunity to receive “preference” in the evaluation phase of the RFR for the environmental initiatives they have instituted. It is important for Bidders to provide a statement (or other documentation) along with their response to substantiate or better explain how those initiatives are implemented in their operations in order to receive a preference or points…

Guidance on Completing the Form

1) Packaging – Many forms of corrugated containers now contain 60% or more post-consumer recycled content and are comparable in cost; in addition, several alternatives to using polystyrene as a packaging cushion are now available. Bidders should check with their box manufacturers to learn about the recycled content they use and include information about that in their RFR Response. Companies are also encouraged to research the EPP alternative products and practices indicated on the form and convert to their use wherever possible.

2) Business Operations – This section refers to things the Bidder does within their own operations to create a smaller “environmental footprint” in the marketplace by reducing the impact of their operations through energy conservation, waste and toxics reduction and other sustainable practices.

3) Training and Education – If Bidders offer a product or service that involves an environmentally preferable component and they train their staff to inform customers of these features, such training should be mentioned in conjunction with this form to receive credit. If Bidders provide materials (brochures, info on websites, etc.) on the environmental attributes of their products/services, they can also receive credit in the evaluation process if a brief explanation is included with the form. It is preferable if such training materials and other information are included with the Response.

4) Certifications – Bidders should familiarize themselves with the various certifications for products and processes that are available within the industry in which they operate, with particular attention to those concerning environmental issues. Providing information with the EPP form on such certifications and/or attaching a copy of the actual certificate is important to receive credit in the evaluation process.

5) Other Environmental Criteria – If Bidders are already doing something indicated in the RFR as a “desirable” criteria and they include a statement with their RFR that they have implemented such measures, this will be considered in the evaluation phase as well. In addition, any initiative untaken by the Bidder that may be considered an environmental benefit, should be mentioned as part of this section in the RFR.

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