Submittals_-_Offer_Page_rev_2-2025.pdf
PDF 229 KB Posted
- Solicitation number
- RFP PS-27-0005
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is an offer submission form issued by the City of Phoenix, Arizona for worker's compensation third-party administration (TPA) claims management services. The solicitation invites sealed offers for a five-year agreement commencing on July 1, 2027, or upon final signature and recording by the City Clerk's department, whichever is later. The contract term is for five years with no options to extend and will terminate upon reaching the end of the term or through other termination provisions outlined in the agreement. Offerors must submit completed and signed offer pages through the City's Procurement Portal, and technical support is available through the portal's support feature or via procurement-support@opengov.com.
The offer form requires offerors to provide complete company information, including federal taxpayer identification number or social security number, Arizona Sales Tax number, Use Tax License number, and Arizona Corporation Commission file number. Offerors must certify that they have read and understood all solicitation terms, conditions, specifications, and addenda, and that pricing was independently developed without consultation with other potential offerors. The form includes fields for authorized signature, company legal name, street address, telephone number, email address, City Registration System ID number, and vendor identification information. Offerors must include their Arizona Sales Tax number, Use Tax number, ACC number, and City of Phoenix Vendor number with their submission.
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Text version
OFFER
(please complete, sign, and return with the submittal)
TO THE CITY OF PHOENIX - The Undersigned hereby offers and agrees to furnish the material and or service(s) in compliance with all terms, conditions, specifications, and addenda issued as a result of a solicitation.
Arizona Sales Tax No.
Use Tax License No. for Out-of-State Arizona Corporation Commission File No.
Taxpayer’s Federal Identification No.: If recommended for contract award, Offeror agrees to provide its federal taxpayer identification number or as applicable its social security number to the City of Phoenix for the purposes of reporting to appropriate taxing authorities, monies paid by the City of Phoenix under the awarded contract. If the Offeror provides its social security number, the City will only share this number with appropriate state and federal officials. This submission is mandatory under 26 U.S.C. § 6041A.
Enter City’s Registration System ID Number Located at City’s eProcurement website (see SECTION 2
– INSTRUCTIONS - CITY’S REGISTRATION)
Offeror has read, understands, and will fully and faithfully comply with this solicitation, its attachments and any referenced documents. Offeror certifies that the prices offered were independently developed without consultation with any other Offeror or potential Offerors.
Authorized Signature
Print Name and Title (President, Manager, Member)
Date
Offeror Legal Name
Street Address:
City, State, Zip Code:
Telephone Number:
Email Address: __________________________________________________
| Offer AZ Sales Tax No: |
| Offer Use Tax No: |
| Offer ACC No: |
| Offer COP Vendor No: |
| Offer Authorized Signature 1: |
| Offer Date: |
| Offer Name and Title 1: |
| Offer Co Legal Name: |
| Offer Company Name: |
| Offer Company Address: |
| Offer Authorized Signature 2: |
| Offer Name and Title 2: |
File details come from the government source that posted it. Updated .