S372 Bid Response Packet Final.docx
DOCX document 45 KB Posted
- Solicitation number
- S000000372
- Issued by
- Arkansas
About this file
This document is a bid response packet template provided by an unnamed government agency in Arkansas for solicitation S000000372 related to pediatric therapy services. The packet includes required forms and templates that prospective contractors must complete, including a bid signature page, proposed subcontractors form, and statement of qualifications focused on experience providing direct pediatric therapy services. The template requires contractors to demonstrate a minimum of three years of experience in providing pediatric therapy services and developing treatment plans and assessments in Arkansas.
The packet includes several certification requirements, including confirmation that the contractor is not a Scrutinized Company, does not boycott Israel or energy/fossil fuel/firearms industries, and does not employ illegal immigrants. Required submissions include an Equal Opportunity Policy, current certifications and licenses per therapy group, certificate of insurance, National Provider Identifier (NPI), Medicaid Provider Number, and an official bid price sheet. Optional pre-award submissions include an EO 98-04 Contract and Grant Disclosure Form and a Voluntary Product Accessibility Template (VPAT).
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Contract and Grant Disclosure~86.pdf | ||
| AMENDED S372 Bid Response Packet 030625.docx | DOCX document | |
| Services Contract SRV-1 Sample~10.pdf | ||
| S000000372 Questions and Answers.pdf | ||
| S372 IFB Occupational Physical Speech and Therapy Services Final.pdf | ||
| S372 Official Bid Price Sheet Final.xlsx | XLSX spreadsheet |
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Text version
BID RESPONSE PACKET
S000000372
BID SIGNATURE PAGE
PROSPECTIVE CONTRACTOR’S INFORMATION
Company:
Address:
City:
State:
Zip Code:
Minority or Women-Owned Designation See the Minority and Women-Owned Business section of the Solicitation.
| ☐ Not Applicable |
| AR Certification #: ________________ |
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.
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, except for financial data (other than pricing), will be released in response to any request made under the Arkansas Freedom of Information Act (FOIA). See the Proprietary Information section of the Solicitation.
REQUIRED CERTIFICATIONS
By signing and submitting a response to this Solicitation, Prospective Contractor represents, warrants, and certifies that they are not a Scrutinized Company and they do not currently and shall not for the aggregate term of a resultant contract:
· Boycott Israel.
· Knowingly employ or contract with illegal immigrants.
· Boycott Energy, Fossil Fuel, Firearms, or Ammunition Industries.
· Employ a Scrutinized Company as a contractor.
Prospective Contractor further represents, warrants, and certifies that it shall not become a Scrutinized Company during the aggregate term of a contract resulting from this Solicitation.
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 bid 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:
· Bid Signature Page
· Proposed Subcontractors Form
· Statement of Qualifications
· Experience (4 pages or less)
· Copy of Prospective Contractor’s Equal Opportunity Policy
· Copies of Current Certifications and Licenses, Per Therapy Group, as indicated in the IFB
· Copy of Current Certificate of Insurance (COI)
· National Provider Identifier (NPI)
· Medicaid Provider Number
· Official Bid 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:
· EO 98-04: Contract and Grant Disclosure Form
· Voluntary Product Accessibility Template (VPAT), if applicable (itic.org, use the VPAT 2.4 Rev 508 version)
PROPOSED SUBCONTRACTORS FORM
Prospective Contractors shall complete the form for all subcontractors the Prospective Contractor proposes to use under a resulting contract (Services Contract (SRV-1) Fillable Form, section 14). If the Prospective Contractor does not intend to use subcontractor(s), Prospective Contractor should indicate so by checking the appropriate box.
Prospective Contractors should 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) under a resulting contract:
| SUBCONTRACTOR’S COMPANY NAME |
| STREET ADDRESS |
| CITY, STATE, ZIP |
☐ Prospective Contractor does not propose to use subcontractors under a resulting contract.
statement of qualifications – EXPERIENCE Using this template, Prospective Contractors shall list previous experience in direct pediatric therapy services and developing treatment plans and assessments in the State of Arkansas that demonstrate the three (3) years minimum qualifications as specified in IFB Section 2.1. Prospective Contractors shall not exceed the four (4) page limit for this subsection.
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02/2024
File details come from the government source that posted it. Updated .