RFR201230 Vendor Response Form 12 9 19.doc
DOC document 33 KB Posted
- Attached to
- RFR201230 Cardiac Holter Monitoring Services
- Solicitation number
- BD-20-1031-LSH00-LSH01-46429
- Issued by
- Massachusetts
About this file
This document is a Vendor Response Form for RFR201230 Cardiac Holter Monitoring Services, a request for response from the Massachusetts Department of Public Health. The form requires the vendor to provide contact information, including the company name, federal employee identification number, address, phone, fax, and email of the contact person. Vendors are instructed to upload the completed form, their proposal, and a business reference form to the Massachusetts procurement website COMMBUYS. The contract forms that must be signed and submitted include a Massachusetts W-9, EFT authorization, Contractor Authorized Signatory List Form, and Prompt Payment Discount Form. A standard contract form will be emailed to the vendor upon acceptance of the proposal, which must be returned with a wet signature.
The contract opportunity is for cardiac holter monitoring services in the state of Massachusetts. Vendors are required to submit their proposals through the COMMBUYS system by the specified due date. No other details about the project scope, quantities, or term of the contract are provided in the vendor response form.
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Other files
| File | Type | Posted |
|---|---|---|
| COMPREQ W9 Form~93.doc | DOC document | |
| READ Standard Required Information revised 10-31-19.docx | DOCX document | |
| REQ Prompt Pay Discount Form~90.doc | DOC document | |
| REQ Business Reference Form~40.doc | DOC document | |
| REQ SDP Form - Standard RFRs -Supplier Diversity Program updated 11-1-19.docx | DOCX document | |
| INFO Business_Associate_Agreement_Revised_7_15~12.doc | DOC document | |
| INFO StandardContractForm updated 2019.docx | DOCX document | |
| COMPREQ Electronic Funds Transfer~92.doc | DOC document | |
| READ _Vendors_Create-Quote-In-COMMBUYS_2016-09-22~61.pdf | ||
| INFO Contractor Authorized Signatory Listing~23.doc | DOC document | |
| READ Supplier Diversity Program Form FAQs updated 10-31-19.docx | DOCX document | |
| RFR201230 new cardiac monitoring~3.doc | DOC document |
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Text version
Vendor Response Form DPH - Request for Response #201230 Cardiac Holter Monitoring Services Bidder Contact Information:
Vendor Company Name: ________________________________________________________ Federal Employee Identification Number (FEIN): #___________________________________ Vendor Address: _______________________________________________________________ City/Town____________________________________ ZIP Code: ___________________ Phone: ( ) __________________ ext.________ Fax: ( ) _____________________ Name of contact person for this bid ____________________________________________________
Contact Person phone ________________________________________________________________ Contact person E-mail address: _________________________________________________________ Website Address if applicable: _____________________________________________________
Please upload this form and your proposal to the Massachusetts Procurement Website COMMBUYS. Instructions for registering and uploading in COMMBUYS are on paragraphs 7.2 and 9.0 of the RFR document.
The uploaded proposal must include this vendor response form, your cost proposal and the business reference form. Please contact Barry.Bergen@state.ma.us or 617-971-3513 if you have any questions about your submission.
Contract Forms that must be signed and sent to the address below ( Massachusetts W-9 (if not on file) ( EFT authorization (if not on file) ( Contractor Authorized Signatory List Form ( Prompt Payment Discount Form ( Standard Contract Form*
*A standard contract form will be emailed to you upon acceptance of your proposal.
Send one original of each contract form signed with a “wet” signature, preferably in blue ink to:
Lemuel Shattuck Hospital
Contracts Department
170 Morton Street
Jamaica Plain, MA 02130-3735
File details come from the government source that posted it. Updated .