sdp-rplan-form-3-reporting.xlsx
XLSX spreadsheet 16 KB Posted
- Attached to
- 19-DOC-9004-Health Care Consultants
- Solicitation number
- BD-18-1025-DOCFS-FISCM-25532
- Issued by
- Massachusetts
About this file
The document is a Supplier Diversity Program (SDP) Spending Report Form that must be completed and submitted quarterly by a contractor to the Commonwealth Contract Manager. The report requires the contractor to provide information on their annual supplier diversity spending commitment percentage, quarterly contract sales, and spending with certified SDP partner companies. The form also includes a compliance check and the ability to explain any non-compliance with the annual spending commitment.
The related state and local contract opportunity is a request from the Massachusetts Department of Correction, Health Services Division, to establish a qualified list of contractors with clinical and/or correctional health care expertise for consultation, peer review and quality review of medical, mental health, forensic mental health and dental services to the state inmate population.
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Text version
SDP Spending Report
| Supplier Diversity Program (SDP) Spending Report |
| SDP Plan Form #3 |
| Document Number/Name: |
| Instructions: This form must include information on your company's spending with your Supplier Diversity Program (SDP) Partner(s) and must be completed and submitted |
| within 45 days of the end of each quarter to Commonwealth Contract Manager. |
Part I Contractor Information (Required)
| Contractor Company | Contact Name | Annual Supplier Diversity | Quarterly Contract Sales | Fiscal Year | |||
| Name | Spending Commitment %* | Quarter 1 (7/1-9/30) | Quarter 2 (10/1-12/31) | Quarter 3 (1/1-3/31) | Quarter 4 (4/1-6/30) | Total (calculates automatically) | |
| $ - 0 |
Part II SDP Partner Information (Required) (Insert additional lines as needed)
| SDP Partner(s) Company | Email Address** | Certification Type*** | Quarterly Spending with Supplier Diversity Partner(s) | Fiscal Year | |||
| Name (as it appears on a list at www.mass.gov/sdo) | (Choose One) | Quarter 1 (7/1-9/30) | Quarter 2 (10/1-12/31) | Quarter 3 (1/1-3/31) | Quarter 4 (4/1-6/30) | Total (calculates automatically) | |
| $ - 0 | |||||||
| $ - 0 | |||||||
| $ - 0 | |||||||
| $ - 0 | |||||||
| $ - 0 | |||||||
| $ - 0 | |||||||
| Year-To-Date Compliance Check (Do not change this line) | $ - 0 |
If not in compliance, please explain why and what actions will be taken to bring your company to compliance with the annual spending commitment:
Part III Under the pains and penalties of perjury I certify that the information provided in this report is accurate.
| Name | Supplier Diversity Certification Acronyms: | |
| Title | MBE - Minority Business Enterprise | |
| Phone | WBE - Woman Business Enterprise | |
| M/WBE - Minority and Woman Business Enterprise | ||
| Authorized Signature | SDVOBE - Service-Disabled Veteran-Owned Business Enterprise | |
| (May be left blank if submitted electronically) | VBE - Veteran-Owned Business Enterprise | |
| Date | M/NPO - Minority Non-Profit Organization | |
| W/NPO - Women Non-Profit Organization | ||
| *This is your company's SDP Plan commitment percentage submitted in your Bid Response | M/W/NPO - Minority and Women Non-Profit Organization | |
| or established through negotiation. | DOBE - Disability-Owned Business Enterprise | |
| **The Supplier Diversity Office and contracting department reserves the right to contact | LGBTBE - Lesbian, Gay, Bisexual or Transgender Business Enterprise | |
| SDP Partners at any time to request that they attest to the amounts reported to have been | ||
| paid to them by the Contractor. | ||
| ***Certification Type for SDP Partner(s) can be checked at www.mass.gov/sdo | Revised: March 8, 2016 |
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File details come from the government source that posted it. Updated .