S000000282 Reentry Facility Response Packet.docx
DOCX document 51 KB Posted
- Attached to
- Reentry Facility
- Solicitation number
- S000000282
- Issued by
- Baxter County, Arkansas
About this file
This document is a Response Packet for the S000000282 Reentry Facility contract opportunity issued by the state of Arkansas, involving Pulaski County and the City of Little Rock. The contract seeks providers for reentry facilities to service the specified counties in Arkansas. The Response Packet includes forms for the prospective contractor to provide company information, contact details, confirmation of redacted documentation, certifications regarding illegal immigrants and boycotting Israel, and a list of proposed subcontractors, facility information, and counties serviced. The contract does not specify a response deadline, award date, term length, or renewal options.
The Response Packet does not contain information about pricing terms, set-asides, incumbents, funding requirements or sources, or other financial details. It focuses on the administrative and operational requirements for prospective contractors to submit their qualifications and facility information to be considered for the reentry facility services contract.
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Text version
RESPONSE PACKET
S000000282 Reentry Facility
RESPONSE 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 bid 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 Bid Solicitation for additional information.
ILLEGAL IMMIGRANT CONFIRMATION
By signing and submitting a response to this Bid Solicitation, a Prospective Contractor agrees and certifies that they do not employ or contract with illegal immigrants. If selected, the Prospective Contractor certifies that they will not employ or contract with illegal immigrants during the aggregate term of a contract.
ISRAEL BOYCOTT RESTRICTION CONFIRMATION
By checking the box below, a Prospective Contractor agrees and certifies that they do not boycott Israel, and if selected, will not boycott Israel during the aggregate term of the contract.
☐ Prospective Contractor does not and will 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 Bid Solicitation will cause the Prospective Contractor’s response to be rejected.
| Authorized Signature: | Title: |
| Use Ink Only. | |
| Printed/Typed Name: | Date: |
RESPONSE PACKET CHECK LIST
Original signed Response Signature Page
Completed Proposed Subcontractors Form
Completed and signed EO 98-04 Contract and Grant Disclosure Form (posted as an additional document to this RFQ)
Copy of Prospective Contractor’s Equal Opportunity Policy
Completed Facility Information Form
Completed Original List of Counties Serviced Form
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.
FACILITY INFORMATION FORM
· Multiple facilities may be listed on this form. Form may be copied as needed.
· Attach a copy of the ACC Reentry Facility license for each facility listed.
Company Name:
| Facility Information |
| Facility Name: |
License Level:
Highest Planned Level:
Address:
City:
Zip Code:
Contact Name:
Phone:
Alternate Phone:
Email:
| Facility Information |
| Facility Name: |
License Level:
Highest Planned Level:
Address:
City:
Zip Code:
Contact Name:
Phone:
Alternate Phone:
Email:
| Facility Information |
| Facility Name: |
License Level:
Highest Planned Level:
Address:
City:
Zip Code:
Contact Name:
Phone:
Alternate Phone:
Email:
List of Counties Serviced Form Indicate the counties that your Facility would service
| Northwest |
| Northeast |
| Southwest |
| Southeast |
| Central |
| ☐Baxter |
| ☐ Clay |
| ☐ Calhoun |
| ☐ Arkansas |
| ☐ Faulkner |
| ☐Benton |
| ☐ Cleburne |
| ☐ Clark |
| ☐ Ashley |
| ☐ Garland |
| ☐ Boone |
| ☐ Craighead |
| ☐ Columbia |
| ☐ Bradley |
| ☐ Grant |
| ☐ Carroll |
| ☐ Crittenden |
| ☐ Dallas |
| ☐ Chicot |
| ☐ Lonoke |
| ☐ Conway |
| ☐ Cross |
| ☐ Hempstead |
| ☐ Cleveland |
| ☐ Perry |
| ☐ Crawford |
| ☐ Fulton |
| ☐ Hot Springs |
| ☐ Desha |
| ☐ Pulaski |
| ☐ Franklin |
| ☐ Green |
| ☐ Howard |
| ☐ Drew |
| ☐ Saline |
| ☐ Johnson |
| ☐ Independence |
| ☐ Lafayette |
| ☐ Jefferson |
| ☐ Logan |
| ☐ Izard |
| ☐ Little River |
| ☐ Lee |
| ☐ Madison |
| ☐ Jackson |
| ☐ Montgomery |
| ☐ Lincoln |
| ☐ Marion |
| ☐ Lawrence |
| ☐ Miller |
| ☐ Monroe |
| ☐ Newton |
| ☐ Mississippi |
| ☐ Nevada |
| ☐ Phillips |
| ☐ Pope |
| ☐ Poinsett |
| ☐ Ouachita |
| ☐ Prairie |
| ☐ Searcy |
| ☐ Randolf |
| ☐ Pike |
| ☐ St Francis |
| ☐ Sebastian |
| ☐ Sharp |
| ☐ Polk |
| ☐ Scott |
| ☐ Stone |
| ☐ Sevieer |
| ☐ Van Buren |
| ☐ White |
| ☐ Union |
| ☐ Washington |
| ☐ Woodruff |
☐ Yell
(Check ALL that apply)
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