Response Form A~63.docx
DOCX document 42 KB Posted
- Attached to
- SP26-OAT-Breath Alcohol Database-L01
- Solicitation number
- BD-26-1084-POLCL-FIMAY-125244
- Issued by
- Middlesex County, Massachusetts
About this file
This is a Response Form A for a solicitation issued by the Commonwealth of Massachusetts for a Breath Alcohol Database contract (RFR # SP26-OAT-Breath Alcohol Database-L01, COMMBUYS # BD-26-1084-POLCL-FIMAY-125244). The form serves as the mandatory response template that all bidders must complete and submit to be considered responsive to the solicitation. Bidders are required to provide comprehensive company information including business background, years in operation, service offerings, corporate headquarters location, business hours, and industry experience. The form requests detailed documentation of all company locations and offices with employee counts and contact information.
The form mandates submission of multiple supporting documents including a Standard Contract Form, Contractor Authorized Signatory form, Business Reference Form, Prompt Pay Discount Form, Environmental Preferable Products/Practices form, Massachusetts Substitute W-9 Form, Supplier Diversity Plan Form, Proposal and Price Sheet with Price Narrative, and Certificate of Liability Insurance. Bidders must disclose comprehensive insurance coverage details across general liability, auto, workers' compensation, and professional liability categories. The form requires full disclosure of any litigation, penalties, bankruptcy proceedings, contract defaults, enforcement actions, OSHA violations, permit suspensions or revocations, and other adverse conditions occurring within the past five years. Bidders must also provide detailed information regarding any subcontractors, their qualifications, and services they will provide under the contract, with each subcontractor subject to individual approval. All bidders must certify agreement to all terms and conditions, understanding that failure to comply with RFR requirements following contract award may result in contract termination.
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RESPONSE FORM A
RFR # SP26-OAT-Breath Alcohol Database-L01 Breath Alcohol Database
COMMBUYS # BD-26-1084-POLCL-FIMAY-125244
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.
| Section 1- | Contact Information |
| Company Information | |
| Use this column for the answer |
Company name
Street address, city, state, zip
Main phone number
Toll-free phone number
Fax number
Website
| Contract Manager |
| Use this column for the answer |
Name, Title
Phone number
Fax
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.
| Required Document |
| Instructions |
| Mark with “X” if done |
| Response Form A (this document) |
| Complete electronically and submit with response. |
File name: Response Form A_[your company name] Response description: Response Form A
| Terms and Conditions for IT Contracts |
| This document is incorporated by reference in the Standard Contract Form. |
Response description: Bidders must check the box to the right to signify agreement and understanding.
| Commonwealth Standard Contract Form |
| Complete electronically and submit with response. |
File name: SCF_[your company name] Response description: Standard Contract Form
Contractor Authorized Signatory
Complete electronically and submit with response.
File Name: Auth_Sig_[your company name] Response description: Contractor Authorized Signatory
| Business Reference Form |
| Complete electronically and submit with response. |
File Name: Bidder _Ref _[your company name] Response description: Business Reference Form
| Prompt Pay Discount Form |
| Complete electronically and submit with response. |
File Name: PPD_[your company name] Response description: Prompt Pay Discount Form
| Additional Environmentally Preferable Products/Practices |
| Complete electronically and submit with response. |
File Name: EPP_[your company name] Response description: EPP Form
| Massachusetts Substitute W-9 Form |
| Complete electronically and submit with response. |
File Name: W9_[your company name] Response description: W9
| Supplier Diversity Plan (SDP) Form |
| Complete electronically and submit with response. |
File Name: SDP_[your company name] Response description: SDP Form
| Proposal & Price Sheet & Price Narrative |
| Complete electronically and submit with response. |
File Name: Proposal / Bid Response Sheet [your company name] Response description: Proposal / Bid Response Sheet
| Certificate of Liability Insurance |
| Complete electronically and submit with response. |
File Name: Cert Ins_ [your company name] Response description: Certificate of Insurance
Authorization of Electronic Funds Transfer *If notified of contract award
Will be processed with selected bidder(s) if notified of contract award
N/A
Company Information:
| Business Background. Bidders must provide a brief description of your business and business background. Limit: 1 page. |
| Use the box below for the answer |
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 service that that your company is submitting a response.
Corporate Headquarters location.
Business hours/days
| Industry Experience. Bidders must provide a brief description of your company’s experience in the industry business. Limit: 1 page. |
| Use the box below for the answer |
| Locations. List your firm’s locations/offices, number of employees and the phone number. |
| # |
| Location Address |
| # of Employees |
| Phone Number |
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.
| Total Limit |
| Per Incident Limit |
General liability
Auto
Worker’s Compensation
Professional Liability
Personal injury
(Other)
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
Subcontractor Disclosure. Please copy and paste additional copies of the table below for more subcontractors. Each subcontractor is subject to individual SST approval.
| Company Information |
| Use this column for the answer |
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)
Value Added Services (for all categories). Please describe any value-added services provided by your company that are relevant to the scope of your response to this RFR. Limit: 1 page.
Use the box below for the answer
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:
File details come from the government source that posted it. Updated .