S000000092 Bid Response Packet.docx
DOCX document 37 KB Posted
- Attached to
- Medicare Part D and Retiree Subsidy Services
- Solicitation number
- S000000092
- Issued by
- Arkansas
About this file
This document is a Bid Response Packet for a state and local contract opportunity in Arkansas. The contract is for Medicare Part D and Retiree Subsidy Services. The key details include:
The Prospective Contractor must submit a Bid Signature Page, Proposed Subcontractors Form, Exceptions Form (if applicable), Completed Pricing Response, and a copy of their Equal Opportunity Policy. The Prospective Contractor must also agree to not employ or contract with illegal immigrants and not boycott Israel during the contract term. The contract duration and any renewal options are not specified.
The Bid Response Packet provides details on pricing terms, set asides, and funding requirements. However, the document does not provide information on incumbents, the current environment, or specific funding amounts and sources. Prospective Contractors must adhere to all requirements outlined in the Solicitation Terms and Conditions.
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Text version
BID RESPONSE PACKET
S000000092
BID SIGNATURE PAGE
Type or print the following information:
PROSPECTIVE CONTRACTOR’S INFORMATION
Company:
Address:
City:
State:
Zip Code:
| Business Designation: |
| ☐ Individual |
| ☐ Sole Proprietorship |
| ☐ Public Service Corp |
| ☐ Partnership |
| ☐ Corporation |
| ☐ Nonprofit |
| Minority and Women-Owned Designation*: |
| ☐ Not Applicable |
| ☐ American Indian |
| ☐ Service Disabled Veteran |
| ☐ African American |
| ☐ Hispanic American |
| ☐ Women-Owned |
| ☐ Asian American |
| ☐ Pacific Islander American |
| AR Certification #: ________________ |
| * See Minority and Women-Owned Business Policy |
PROSPECTIVE CONTRACTOR CONTACT INFORMATION
Provide contact information to be used for solicitation related matters.
Contact Person:
Title:
Phone:
Alternate Phone:
Email:
CONFIRMATION OF REDACTED COPY
☐ YES, a redacted copy of submission documents is enclosed.
☐ NO, a redacted copy of submission documents is not enclosed. I understand a full copy of non-redacted submission documents will be released if requested.
Note: If a redacted copy of the submission documents is not provided with Prospective Contractor’s response packet, and neither box is checked, a copy of the non-redacted documents, with the exception of financial data (other than pricing), will be released in response to any request made under the Arkansas Freedom of Information Act (FOIA). See Solicitation Terms and Conditions for additional information.
ILLEGAL IMMIGRANT CONFIRMATION
By signing and submitting a response to this Solicitation, Prospective Contractor agrees and certifies that they do not employ or contract with illegal immigrants and shall not employ or contract with illegal immigrants during the term of a contract awarded as a result of this solicitation.
ISRAEL BOYCOTT RESTRICTION CONFIRMATION
By checking the box below, Prospective Contractor agrees and certifies that they do not boycott Israel and shall not boycott Israel during the term of a contract awarded as a result of this solicitation.
☐ Prospective Contractor does not and shall not boycott Israel.
An official authorized to bind the Prospective Contractor to a resultant contract shall sign below.
The signature below signifies agreement that any exception that conflicts with a Requirement of this Solicitation may cause the Prospective Contractor’s proposal to be rejected.
Authorized Signature: _________________________________ Title: ____________________________
Printed/Typed Name: _________________________________ Date: ____________________________
SUBMISSION REQUIREMENTS CHECKLIST
The following items must be submitted with the Prospective Contractor’s bid response:
· Bid Signature Page
· Proposed Subcontractors Form
· Exceptions Form, if applicable
· Completed Pricing Response
· Copy of Prospective Contractor’s Equal Opportunity Policy
The following items, which must be submitted prior to a contract award to the Prospective Contractor, may also be included with the Prospective Contractor’s bid response:
· EO 98-04: Contract and Grant Disclosure Form
· Voluntary Product Accessibility Template (VPAT), if applicable (https://www.itic.org/policy/accessibility/vpat, use the VPAT 2.4Rev 508 version)
PROPOSED SUBCONTRACTORS FORM
Do not include additional information relating to subcontractors on this form or as an attachment to this form.
PROSPECTIVE CONTRACTOR PROPOSES TO USE THE FOLLOWING SUBCONTRACTOR(S) TO PROVIDE SERVICES (type or print the following information):
| SUBCONTRACTOR’S COMPANY NAME |
| STREET ADDRESS |
| CITY, STATE, ZIP |
☐ PROSPECTIVE CONTRACTOR DOES NOT PROPOSE TO USE SUBCONTRACTORS TO PERFORM SERVICES.
EXCEPTIONS FORM
Prospective Contractor shall document all exceptions related to requirements in the Solicitation and terms in the Services Contract (SRV-1) Fillable Form and Solicitation Terms and Conditions located on the TSS OSP website. See Sections 2.4 and 2.5 of the Solicitation.
| ITEM # |
| REFERENCE (SECTION, PAGE, PARAGRAPH) |
| DESCRIPTION |
| PROPOSED LANGUAGE |
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