RFR Vendor Response Checklist_April_2024~8.docx
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- Solicitation number
- BD-25-1071-AO-02021-105669
- Issued by
- Massachusetts
About this file
This document is a Response Checklist for a Request for Response (RFR) issued by the Massachusetts Rehabilitation Commission (MRC) for Clinical Services for Individuals with Disabilities. The RFR seeks to recruit qualified Masters and Doctoral level clinicians to provide a range of specified assessment, consultation, and treatment services to individuals with disabilities. The checklist outlines the required documents and forms that vendors must submit, including a Business Response, CORI Assurance Letter, Business Reference Form, copy of organization liability insurance, Prompt Payment Discount Form, W9, resumes of key personnel, and organizational chart. Optional forms and documents are also listed, such as CORI for individual clinicians, Equal Employment Opportunity Plan, and clinician applications.
The contract opportunity is open to clinicians and provider organizations in the state of Massachusetts. Pricing terms, set asides, incumbent providers, funding requirements, and other salient details are not provided in this document. The Response Checklist focuses on the administrative requirements for submitting a proposal in response to the RFR.
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THE COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF HEALTH & HUMAN SERVICES
MASSACHUSETTS REHABILITATION COMMISSION (MRC)
RFR Response Checklist
Vendor/Provider Name___________________
RFR NAME____________________________
COMMBUYS Bid Solicitation # __________________ Response Due Date/Bid Opening Date __________________
· RFR Cover Page and Cover Letter
· Business Response
· CORI Assurance Letter
· Business Reference Form
· Copy of corrective action plan during last five years, if any, along with status
· Copy of Organization Liability Insurance
· Prompt Payment Discount Form
· MA Department of Revenue Certificate of Good Standing
· Contractor Authorized Signatory Listing
· W9
· Electronic Funds Transfer (EFT)
· Resumes of Key Personnel
· Organizational Chart
· Financial Prequalification Requirements (only for Chapter 257-unit rate contracts)
· OPTIONAL FORMS DOCUMENTS
· CORI (Required for Individual Clinicians in the Submission)
· Equal Employment Opportunity Plan (Required with submission if organization has an EEOP)
· For Individual Clinicians Responding:
Completed Application for Individual Clinicians (Appendix B1 of this RFR)
b. Current Resume (for Individual Clinicians)
c. All forms listed in the “File Attachments” section of the bid on COMMBUYS (see list below)
d. Copy of professional license
· For Provider Organizations:
a. Completed Application for the Provider Organization (Appendix B2 of this RFR)
b. Completed applications for each clinician the organization seeks to qualify (Appendix B1 for each clinician).
c. Current Resume (for each clinician the organization seeks to qualify)
d. Copy of clinician professional licenses and the copy of organization’s/ clinic’s license
e. Brief description of how your program will ensure cultural and linguistic diversity; do not exceed one page. Include copies of your cultural competency policies.
f. All forms listed in the “File Attachments” section of the bid on COMMBUYS (see list below)
g. Provider Agency Organizational Chart image1.png
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