RFR 252234 Hospital & Clinic Client Services Response Cover Sheet Attachment A~1.doc
DOC document 41 KB Posted
- Attached to
- RFR 252234 Hospital & Clinic Client Services
- Solicitation number
- BD-24-1031-LSH00-LSH01-99356
- Issued by
- Suffolk County, Massachusetts
About this file
This document is an Attachment A Bidder Contact Information for RFR 252234 Hospital & Clinic Client Services (Outside Client Services) issued by the Massachusetts Department of Public Health. The RFR is seeking bidders to provide client services for the Lemuel Shattuck Hospital in Massachusetts. The document requires the submission of various completed forms, including the Bidder Contact Information, Business Associate Agreement, Business Reference Form, Current Price List, Prompt Payment Discount Form, and Supplier Diversity Plan, before a contract can be executed.
The related state and local contract opportunity is identified as RFR 252234 Hospital & Clinic Client Services, issued by the state of Massachusetts. No additional details are provided about the project scope, quantities, response dates, or contract term.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| INFO Business_Associate_Agreement_Revised_7_15~44.doc | DOC document | |
| INFO Commonwealth-terms-and-conditions~5.pdf | ||
| REQ Prompt Pay Discount Form new~54.doc | DOC document | |
| RFR 252234 Hospital and Clinic Client Services.docx | DOCX document | |
| INFO CASL form for Organizations - Updated 2023~13.pdf | ||
| REQ Business Reference Form~85.doc | DOC document | |
| READ_SDP_RFR_Requirements updated 10-2023~1.docx | DOCX document | |
| REQ SDP_Plan_Form 2023~2.xlsx | XLSX spreadsheet | |
| INFO StandardContractForm- Updated 2023~8.docx | DOCX document | |
| READ Standard Required Information revised 10-2023~7.docx | DOCX document |
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Text version
Attachment: A
Lemuel Shattuck Hospital
Massachusetts Department of Public Health
RFR 252234 Hospital & Clinic Client Services (Outside Client Services) Response Cover Sheet
Bidder Contact Information:
Vendor Name: _____________________________________________________________
Federal Employee Identification Number (FEIN):__________________________________
Vendor Address: ___________________________________________________________
City/Town/State____________________________________________________________
Zip Code: _______________________________
Phone: ( ) __________________ ext.________
Fax: ( ) _____________________________
Email address: ____________________________________________________________
The Following Completed Documents Are Required Before Executing a Contract (please submit with your response):
FORMCHECKBOX
Bidder Contact Information (This Form: attachment A)
FORMCHECKBOX
Business Associate Agreement
FORMCHECKBOX
Business Reference Form (please provide three (3) references)
FORMCHECKBOX
Current Price List (submit on company letterhead, see specifications for required information)
FORMCHECKBOX
Prompt Payment Discount Form (required for payment)
FORMCHECKBOX
Supplier Diversity Plan
Signature: _______________________________________________________________
Print Name: ______________________________________________________________
Date: ____________________________________________________________________
File details come from the government source that posted it. Updated .