S000000165 X-Ray Imaging System Response Packet.docx
DOCX document 33 KB Posted
- Attached to
- Digital Radiographic X-Ray Imaging System
- Solicitation number
- S000000165
- Issued by
- Pulaski County, Arkansas
About this file
This document is a bid response packet for a state and local contract opportunity in Arkansas to provide a digital radiographic X-ray imaging system. The prospective contractor must submit the bid signature page, proposed subcontractors form, exceptions form (if applicable), and the official solicitation price sheet. Prior to contract award, the contractor may also submit the EO 98-04 contract and grant disclosure form, equal opportunity policy, and voluntary product accessibility template (VPAT). Addenda, if applicable, must also be included in the bid response. The contract term is not specified. The document outlines the required information and certifications the prospective contractor must provide, including confirmation of illegal immigrant employment, Israel boycott restrictions, and use of subcontractors. Pricing terms, set-asides, incumbents, funding requirements, and other salient information are not detailed in this document.
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Other files
| File | Type | Posted |
|---|---|---|
| S000000165 Official Price Sheet.xlsx | XLSX spreadsheet | |
| Contract and Grant Disclosure Form~93.pdf | ||
| S000000165 Digital X-Ray Imaging System.pdf |
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Text version
BID RESPONSE PACKET
S000000165
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 in Solicitation Terms and Conditions |
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
· Official Solicitation Price Sheet
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
· Copy of Prospective Contractor’s Equal Opportunity Policy
· Voluntary Product Accessibility Template (VPAT), if applicable (https://www.itic.org/policy/accessibility/vpat (Use the VPAT 2.3Rev 508 version)
The following should be included in the Prospective Contractor’s bid response:
· Signed addenda, if applicable
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 “Standard Services Contract (SRV-1) Fillable Form” and “Solicitation Terms and Conditions” located on the TSS OSP website.
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| REFERENCE (SECTION, PAGE, PARAGRAPH) |
| DESCRIPTION |
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