sdp-rplan-form-2-declaration rev 03-07-2016.docx
DOCX document 49 KB Posted
- Attached to
- MED52 Flu Vaccine 2018-2019 season
- Solicitation number
- BD-18-1080-OSD03-SRC3-20396
- Issued by
- Suffolk County, Massachusetts
About this file
This document is a Supplier Diversity Program (SDP) Plan Declaration Form for a state and local contract opportunity in Massachusetts. The form requires the prime bidder to provide information on their SDP partners, including the partner company name, certification type, and the functions to be performed. The prime bidder must also commit to a specific final percentage of the contract value to be spent with all certified SDP partners on an annual basis for the life of the contract. If the prime bidder does not yet have any SDP partners, they can acknowledge this and commit to meeting the percentage requirement while working with the Supplier Diversity Office to identify and establish relationships with certified partners.
The related state and local contract opportunity is for the MED52 Flu Vaccine for the 2018-2019 season in the state of Massachusetts. The contract term and any renewal options are not specified in the provided information.
View the file
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| MED52 Bidders Submission Checklist.doc | DOC document | |
| Certificate of NonCollusion-1 MED52.docx | DOCX document | |
| c-tc.doc | DOC document | |
| RFR MED52 10-31-17.docx | DOCX document | |
| standard_contract_MED52.doc | DOC document | |
| sdp-plan-form-1-commitment rev 03-07-2016.docx | DOCX document | |
| EFT_FORM.pdf | ||
| w_9.doc | DOC document | |
| ppd.doc | DOC document | |
| consig contractor authorized signatory.doc | DOC document | |
| MED52 Bidders Price Sheet 10-27-17.doc | DOC document | |
| MED52 eppform.docm | DOCM document |
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Text version
Supplier Diversity Program (SDP) Plan - Declaration of SDP Partner(s) SDP Plan Form #2
Contract/RFR Document Number: Click here to enter text.
Instructions: Completing all parts of this form is mandatory. Please read all sections of the Bid related to the SDP. Complete one form and submit within a period of up to 30 days (or as stated in RFR) of Contract Execution. See SDP Resources information below to assist in partnering with certified businesses.
Important: Prime bidders that are certified as an M/WBE, M/WNPO, VBE and SDVOBE must also submit an SDP Plan Form and may not list themselves or their affiliates as SDP Partners.
Part I Contractor Information and Annual Financial Commitment (Required)
| Business Name: Click here to enter text. |
| Contact Name: Click here to enter text. |
| Phone #: Click here to enter phone number. |
| Email address: Click here to enter email address. |
Provide a specific final percentage of Bidder/Contractor sales derived from this contract to be spent with all certified SDP Partners on a Massachusetts fiscal year (July 1-June 30) basis.
Final Annual SDP Percentage Committed for Life of Contract:
Click here to enter percentage.%
Part II Contractor’s SDP Partners (Required) (Fill in Applicable Lines; Insert Additional Rows as Needed)
| Planned SDP Partner Company Name |
| Check Planned SDP Partner’s Certification(s) |
| Certifying Organization |
| Functions to be Performed by the Partner (optional unless otherwise stated in the RFR) |
| Click here to enter text. | Choose an item. | Choose an item. | Click here to enter text. | |
| Click here to enter text. | Choose an item. | Choose an item. | Click here to enter text. | |
| Click here to enter text. | Choose an item. | Choose an item. | Click here to enter text. | |
| Click here to enter text. | Choose an item. | Choose an item. | Click here to enter text. | |
| Alternative to Contractor Providing List of SDP Partners: | ||||
| ☐ | If specifically authorized in the Request for Response (RFR) to utilize this option, by checking this box, the Contractor acknowledges that they do not yet have any SDP Partners but will meet the percentage commitment in Part I (above) and all other contract requirements and will work with the SDO to identify and establish business relationships with SDO Partners. |
Part III Under the pains and penalties of perjury I certify that the information provided on this form is accurate. (Required)
| Name: Click here to enter text. |
| Title: Click here to enter text. |
| Signature: |
(May be left blank if submitted electronically) Date: Click here to enter a date.
Supplier Diversity Program (SDP) Resources:
· Lists of M/WBEs, M/WNPOs, VBEs and SDVOBEs certified or verified by the Supplier Diversity Office (SDO) are located at www.mass.gov/sdo.
· Resources to assist Prime Bidders in finding potential Certified Partners can be found at www.mass.gov/sdp.
· The Operational Services Division offers trainings on compliance with the SDP Plan requirements. Registration information for upcoming trainings can be found on the Supplier Diversity Program Trainings webpage.
Revised: March 8, 2016
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File details come from the government source that posted it. Updated .