RFR 2026 DOI 006 SUBMISSION CHECKLIST.docx

SUBMISSIONS CHECKLIST

Name of Bidder: ______________________________________________

Indicate which Service Categories you are responding to:

_____ Third Referee Services for Review of Fire and Casualty Insurance Agent Contract Cancellation, Modification, or Expiration in Accordance with M.G.L. c. 175, § 163

_____ Third Referee Services for Review of Disputes as to Amount of Loss in Fire Insurance Claims in Accordance with M.G.L. c. 175, §§ 99 through 100H

The following checklist represents the content and sequential order of the RFR Response:

BUSINESS RESPONSE

I. ____ Submissions Checklist

II. ____ Introduction to Business Response. A Cover Letter of introduction to the Bidder’s organization.

III. ____ A description of the Bidder’s qualifications to provide the specific services in the description of procurement section in this RFR.

IV. Evidence of Professional Background

V. Other General Forms

a. ____ Contractor Authorized Signature Verification Form

b. ____ Environmental Practices Form

VI. Contract Forms

a. ____Commonwealth Terms and Conditions

b. ____ Verification of Taxation Reporting Information W-9 (If one is not already on file with the Commonwealth).

c. ____ Standard Contract Form

VII. Forms to be submitted during selection as a Qualified Vendor for a specific project:

a. Memorandum of Understanding (M.G.L. c. 175, § 163 Reference Proceeding) (Appendix B)

b. Memorandum of Understanding (M.G.L. c. 175, §§ 100 through 100H Reference Proceeding) (Appendix C)

c. Prompt Pay Discount Form

d. Authorization for Electronic Funds Payment (EFT) (upon award)

COST PROPOSAL

a. ____ Cover letter which states that the Cost Proposal is in effect for ninety (90) days from response due date.

b. ____ Cost Proposal Form

This Submissions Checklist must be completed and submitted as the first item in the Business Response.