Technical Proposal Short Form - KY Spinal Cord and Head Injury Research Board.pdf

COMMONWEALTH OF KENTUCKY

REQUEST FOR PROPOSAL-SHORT FORM APPLICATION

RFP 728 2600000364 – Kentucky Spinal Cord and Head Injury Research Board

Instructions: Please fill out all spaces below with your information. Check all requirements that you meet.

The links above (blue) will take you to the General Conditions and Instructions for Solicitations and Contracts.

PROPOSAL MUST BE SIGNED.

ALL QUALIFIED VENDORS WILL BE REQUIRED TO PROVIDE A NOTARIZED AFFIDAVIT, AND

OTHER SUPPORTING DOCUMENTATION AS REQUIRED

FAP 110-10-00 GENERAL CONDITIONS AND INSTRUCTIONS FOR SOLICITATIONS AND CONTRACTS

Overview

The Department for Public Health seeks a Contractor to meet the technical needs of the Kentucky Spinal Cord and Head Injury Research Board. The awardee will empanel and moderate a grant proposal review team composed of leading researchers in spinal cord and head injuries. The review team will research, study and score the grant proposals from the two research centers in Kentucky. The awardee will present the findings of the review panel to the Board who will determine which project(s) will receive funding.

It is the intent to award one (1) contract from this solicitation.

Contractor Qualifications

The Contractor must be able to provide the services listed in Section 2.00 of the Request for Proposal 728 2600000364.

1. Contractor must have a minimum of five (5) years of experience in National Institute of Health (NIH) Research Protocols as a funded investigator.

2. Contractor must have a minimum of five (5) years experience as a NIH Study Section member.

3. Contractor shall be regularly and continuously engaged in the business of providing grant review and administrative organization of grant proposal services for at least one (1) year.

Proposal Submission

This technical proposal short form must be included in your proposal submission. Failure to do so will result in the proposal being deemed non-responsive and will not be evaluated.

RFP 728 2600000364 – Kentucky Spinal Cord and Head Injury Research Board

Vendor Information Vendor Name:

Kentucky Vendor Customer Number:

Phone Number:

Email Address:

Technical Proposal

1. The Contractor must have a minimum of 5 years of experience in National Institute of Health (NIH) Research Protocols as a funded investigator.

State the number of years the Contractor has been providing these services. Click or tap here to enter text.

Provide a brief overview of the Contractor’s experience:

Click or tap here to enter text.

2. The Contractor must have a minimum of five years experience as a NIH Study Section member.

State the number of years of experience the Contractor has as a NIH Study Section member. Click or tap here to enter text.

3. The Contractor shall be regularly and continuously engaged in the business of providing grant review and administrative organization of grant proposal applications services for at least one (1) year.

State the number of years the Contractor been providing these services. Click or tap here to enter text.

Provide a brief overview of the Contractor's experience:

Click or tap here to enter text.

RFP 728 2600000364 – Kentucky Spinal Cord and Head Injury Research Board

4. Contractor must be independent of and have no current employment, contractual, financial, or other professional affiliation with UK or UofL, to avoid conflicts of interest in proposal review and to preserve grant review integrity.

The Contractor confirms there is no current relationship with either the University of Kentucky or the University of Louisville.

Yes No

If no, please provide a brief overview of the relationship:

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5. Confirmation that the Contractor can provide all the required services as outlined in the Request for Proposal Scope of Work?

Yes No

This form is for the purpose of determining eligibility to perform contractor services. This does not constitute a guarantee of a contract award.

SIGNATURE: Click or tap here to enter text.

Name: Click or tap here to enter text.

DATE: Click or tap here to enter text.

Per KRS 369.105(2) & 369.102(8), by typing your name in the signature block of the short-form application, the bidder:

(a) acknowledges all terms and requirements of the originating RFP, (b) confirms they are an authorized representative of the company, and (c) agrees to the use of electronic signature as legally binding.