RFRHSP40_RFRChecklist Rev 1.doc

RFR Submission Checklist HSP40 Medical Commodities Rev 1 Bidders must download, complete and submit this RFR Checklist with their COMMBUYS online response, including filling in all Bidder contact information and checking off (by double clicking each box below and in the pop-up selecting “checked”), thereby certifying completion and submission of each of the forms required by this RFR.

RFR Number: HSP40, Entitled: Medical Commodities Bidder Contact Information (To be completed by Bidder):

· Bidder’s name (individual or company):

· Bidders Federal Tax ID (TIN)

· Contract Manager Name & Title:

· Contract Manager Emergency Phone Number (24 Hours)

· Bidder’s Address (Street, City/Town, state, zip):

· Telephone number: Facsimile number:

· Email address:

· Website (Please note that it is the Bidder’s responsibility to inform the Contract Manager of any changes in their Bidder Contact Information by resubmitting this form with any changes during the RFR process or during the contract term, if awarded a contract.)

Required Forms – To check a box, double click the box and in the pop up select “checked”. By checking the box for each of the forms listed below, the Bidder is certifying that each of these forms has been completed, executed and submitted with their bid/response:

FORMCHECKBOX

– Prompt Payment Discount (PPD)

FORMCHECKBOX

– a minimum of three (3) and a maximum of five (5) letters of reference from your most recent year largest dollars billed customers on the references’ letterhead signed by a principal of the reference organization, using the template with instructions provided on COMMBUYS.

FORMCHECKBOX

– This RFR Bidders Check List

– Supplier Diversity Program (SDP) Plan Form 1 - note that % commitments are a % of all sales under the contract

– Environmentally Preferable Products/Practices Form No Submission Form, please submit documents:

– Statement of # items to be offered, do not submit a catalog with Bid, will be requested if a contract is awarded

FORMCHECKBOX

– Statement of insurance (typically your insurance agent’s ACCORD form) Vendor Fair Participation - Bidders please check one of the boxes below, exhibiting is not a requirement to bid:

– I will exhibit at the MASSbuys event

– I do not plan to exhibit