RFR 233132 Specialized Laboratory Testing Services Application form 5 3 22.docx

The Commonwealth of Massachusetts Department of Public Health Bureau of Infectious Disease and Laboratory Sciences 305 South Street Boston MA 02130

APPLICATION RESPONSE FORM AND INSTRUCTIONS

RFR Title: Specialized Laboratory Testing Services

RFR #: 233132

General Instructions:

1. All responses are to be submitted using the online submission tools available to Vendors registered in COMMBUYS. There is no charge to register in COMMBUYS. To Register go to www.COMMBUYS.com and click on the “Register” link on the front page.

Bidders are solely responsible to monitor COMMBUYS for Bid amendments, if any. Bidders may monitor the record by frequently checking the Amendment Section on the Summary screen for the BID in COMMBUYS.

2. Deadline for Quotes/Bid Responses (“Bid Opening Date” in COMMBUYS) This is a rolling enrollment bid for Specialized Laboratory Testing Services only. Awards will be made as quotes are received and evaluated if successful. DO NOT wait for the Bid Opening Date to submit a quote (bid response).

3. Notification of Apparent Successful Bidder(s):

Apparent Successful Bidders will be notified as their quotes are received and evaluated.

4. Estimated Contract Start Date The Start Date for awarded vendors’ contracts will be upon DPH execution of the individual contract.

APPLICATION RESPONSE COVER PAGE

RFR #: 233132

Organization Organization Name: [ ]

Address:

City: [ ] State: [ ] Zip: [ ]

Vendor Code: [ ]

CEO (Chief Executive Officer) First Name: [ ] Last Name: [ ]

FEIN: [ ]

Contact Person for the Application First Name: [ ] Last Name: [ ]

Title: [ ]

Telephone: ( ) - FAX: ( ) -

E-Mail: [ ]

Contact Person Address (if different):

City: [ ] State: [ ] Zip: [ ]

Location(s) of Proposed Service(s)

Address 1:

City: [ ] State: [ ] Zip: [ ]

Address 2:

City: [ ] State: [ ] Zip: [ ]

Address 3:

City: [ ] State: [ ] Zip: [ ]

APPLICATION RESPONSE SUBMISSION PAGE

RFR #: 233132

1. LABORATORY TESTING SERVICE AREA(S):

Check the area(s) of laboratory testing service for which you are applying

1.1 Priority laboratory testing areas (check all that apply, provide details) |_| SARS-CoV-2 testing services |_| Wastewater surveillance testing services |_| In-home collection testing services |_| Genomic sequencing and analysis |_| Other (specify)

1.2 Other laboratory testing service areas to address public health priorities during disease identification, surveillance, and/or response (check all that apply, provide details)

|_| Diagnostic testing |_| Reference testing |_| Laboratory-based surveillance |_| Consultation for laboratory test interpretation and related subject matter expertise |_| Environmental testing |_| Emergency response testing for emerging infectious diseases and foodborne illness |_| Genomic sequencing and analysis for the purposes of public health surveillance |_| Laboratory result reporting and integration |_| Other (specify)

2. BIDDER QUALIFICATIONS AND AFFIRMATION

2.1 Describe your ability to provide service(s) in the testing areas selected; include your organization experience, staff, and capacity for the proposed activities, include years in service

2.2 List all appropriate licenses, approvals, certificates, or waivers required to perform proposed testing services

2.3 Describe sample collection protocols and/or attach specimen transportation protocols

2.4 The Bidder is expected to provide, at no additional cost, all necessary supplies and items that will be used to obtain specimen and report results of processed tests to the ordering sites(s) unless the Bidder provides the exemption justification to the no-charge provision

2.5 The Bidder must be able to transmit the lab results electronically; describe the proposed format of reporting test results and turnaround time of reporting

All applicants (Bidders) should initial next to the following statements to affirm that you will:

Initials

· The Bidder agrees to report lab data (results) in a format that is acceptable to DPH / BIDLS and within the time frame established in SOW

· The Bidder agrees to provide a qualified representative for telephone and/or in-person consultation

· The Bidder agrees to prioritize BIDLS referred laboratory testing to ensure agreed upon turnaround times are met

· The Bidder agrees, when applicable and/or as requested, to provide documentation related to appropriate quality control and quality assurance measures or infection control policies and procedures as applicable to the proposed activities

· The Bidder reviewed the Standard Confidentiality Agreement and Business Associate Agreement. A signed Agreement will be required for each SOW / Engagement.

APPLICATION PACKAGE CHECKLIST:

|_| The Application Response Form |_| Business Reference Form |_| Copy of operational manual |_| Resume(s) |_| Rate Sheet |_| CLIA License (if applicable) |_| Specimen collection and/or transportation protocols |_| Supplier Diversity Plan (SDP) |_| Certificate of liability insurance

I affirm that I will comply with the requirements of this Request for Response and with the terms of this proposal.

Signature (blue ink preferred): _______________________________________________

Date: _____________________________________________________________________ image1.png