T3035 Hospital Incentive Program Offer and Acceptance Page~2.pdf

OFFER AND ACCEPTANCE State of New Jersey Department of the Treasury

Division of Purchase and Property 33 West State Street, P.O. Box 230 Trenton, New Jersey 08625-0230Bid Solicitation {RFP} #:

Bid Solicitation {RFP} Title:

OFFER (To be completed by the Vendor {Bidder})

TO THE STATE OF NEW JERSEY:

The Undersigned hereby offers and agrees to furnish the goods, products, or services in compliance with all terms of this Master Blanket Purchase Order (Blanket P.O.) {Contract} as defined in Section 2.0 of the Bid Solicitation {Request for Proposal (RFP)}.

Vendor {Bidder}: Title:

Address: E-Mail Address:

City, State, ZIP: Phone Number:

Fax Number:

Printed Name: FEIN:

By signing and submitting this Offer, the Vendor {Bidder} certifies and confirms that:

1. Neither the Vendor {Bidder}, nor its representatives, agents or lobbyists have initiated any inappropriate contact with any Executive Branch employee during the procurement to attempt to affect the bidding process and shall not do so after submission of its Quote {Proposal};

2. The Vendor {Bidder} has read, understands, and agrees to all terms, conditions, and specifications set forth in the Bid Solicitation {RFP}, including but not limited to the acceptance of the State of New Jersey Standard Terms and Conditions, the provisions set forth in Section 4.4.1.1.1 (MacBride Principles Certification), Section 4.4.1.1.2 (No Subcontractor Certification), Section 4.4.1.1.3 (Non- Collusion), and Section 4.4.1.1.4 (New Jersey Business Ethics Guide Certification);

3. The Vendor's {Bidder's} failure to meet any terms and conditions of the Blanket P.O. {Contract} as defined in the Bid Solicitation {RFP} shall constitute a breach and may result in suspension or debarment from further State bidding;

4. A defaulting Vendor {Contractor} may also be liable, at the option of the State, for the difference between the Blanket P.O {Contract} price and the price bid by an alternate vendor of the goods or services in addition to other remedies available; and

5. By signing and submitting this Offer, the Vendor {Bidder} consents to receipt of any and all documents related to this Bid Solicitation {RFP} and the resulting Blanket P.O. {Contract} by electronic medium or facsimile.

Blanket P.O. {Contract} Term: Open to Cooperative Purchasing

ACCEPTANCE OF OFFER (For State Use Only) The Offer above is hereby accepted and now constitutes a Blanket P.O. {Contract} with the State of New Jersey. The Vendor {Contractor} is now bound to sell the goods, products, or services listed by the attached Blanket P.O. {Contract} as defined by Section 2.0 of the Bid Solicitation {RFP}. The Vendor {Contractor} shall not commence any work or provide any good, product, or service under this Blanket P.O. {Contract} until the Vendor {Contractor} complies with all requirements set forth in the Bid Solicitation {RFP} and receives written notice to proceed.

Blanket P.O. {Contract} Number:

Blanket P.O. {Contract} Effective Date:

State of New Jersey Authorized Signature:

Blanket P.O. {Contract} Award Date:

THIS FORM MUST BE SIGNED, COMPLETED AND INCLUDED WITH THE VENDOR'S {BIDDER'S} QUOTE {PROPOSAL}.

ADDITIONAL VENDOR {BIDDER} REQUIREMENTS (For State Use Only)

Performance Security

For set-aside contracts only, a Vendor {Bidder} must be registered with the N.J. Division of Revenue and Enterprise Services, Small Business Registration and M/WBE Certification Services Unit. Please refer to N.J.A.C. 17:13-3.1 & 17:13-3.2 for additional information.

Amount:

Bid Security Amount: Payment Security

Authorized Signature:

Amount:

Percentage: Retainage

9.0.0.2.20120627.2.874785

OFFER AND ACCEPTANCE

State of New Jersey Department of the Treasury Division of Purchase and Property 33 West State Street, P.O. Box 230 Trenton, New Jersey 08625-0230 OFFER (To be completed by the Vendor {Bidder})

TO THE STATE OF NEW JERSEY:

The Undersigned hereby offers and agrees to furnish the goods, products, or services in compliance with all terms of this Master Blanket Purchase Order (Blanket P.O.) {Contract} as defined in Section 2.0 of the Bid Solicitation {Request for Proposal (RFP)}.

By signing and submitting this Offer, the Vendor {Bidder} certifies and confirms that:

1. Neither the Vendor {Bidder}, nor its representatives, agents or lobbyists have initiated any inappropriate contact with any Executive Branch employee during the procurement to attempt to affect the bidding process and shall not do so after submission of its Quote {Proposal};

2. The Vendor {Bidder} has read, understands, and agrees to all terms, conditions, and specifications set forth in the Bid Solicitation {RFP}, including but not limited to the acceptance of the State of New Jersey Standard Terms and Conditions, the provisions set forth in Section 4.4.1.1.1 (MacBride Principles Certification), Section 4.4.1.1.2 (No Subcontractor Certification), Section 4.4.1.1.3 (Non-Collusion), and Section 4.4.1.1.4 (New Jersey Business Ethics Guide Certification);

3. The Vendor's {Bidder's} failure to meet any terms and conditions of the Blanket P.O. {Contract} as defined in the Bid Solicitation {RFP} shall constitute a breach and may result in suspension or debarment from further State bidding;

4. A defaulting Vendor {Contractor} may also be liable, at the option of the State, for the difference between the Blanket P.O {Contract} price and the price bid by an alternate vendor of the goods or services in addition to other remedies available; and

5. By signing and submitting this Offer, the Vendor {Bidder} consents to receipt of any and all documents related to this Bid Solicitation {RFP} and the resulting Blanket P.O. {Contract} by electronic medium or facsimile.

ACCEPTANCE OF OFFER (For State Use Only) The Offer above is hereby accepted and now constitutes a Blanket P.O. {Contract} with the State of New Jersey. The Vendor {Contractor} is now bound to sell the goods, products, or services listed by the attached Blanket P.O. {Contract} as defined by Section 2.0 of the Bid Solicitation {RFP}. The Vendor {Contractor} shall not commence any work or provide any good, product, or service under this Blanket P.O. {Contract} until the Vendor {Contractor} complies with all requirements set forth in the Bid Solicitation {RFP} and receives written notice to proceed.

THIS FORM MUST BE SIGNED, COMPLETED AND INCLUDED WITH THE VENDOR'S {BIDDER'S} QUOTE {PROPOSAL}.

ADDITIONAL VENDOR {BIDDER} REQUIREMENTS (For State Use Only) For set-aside contracts only, a Vendor {Bidder} must be registered with the N.J. Division of Revenue and Enterprise Services, Small Business Registration and M/WBE Certification Services Unit. Please refer to N.J.A.C. 17:13-3.1 & 17:13-3.2 for additional information.

See Section 5.2 of the Bid Solicitation {RFP}