Technical Response PMT-59.pdf
PDF 173 KB Posted
- Solicitation number
- ITB-13206
- Issued by
- Glades County, Florida
About this file
The document is a Technical Response (PMT-59) form for the Florida Department of Children and Families (DCF) Invitation to Bid (ITB 2526 010) for milk procurement for state mental health treatment facilities. The form is designed for potential vendors to provide detailed information about their qualifications, organizational capabilities, and compliance with bid requirements. Respondents must complete sections on related parties, conflicts of interest, terminated contracts, organizational experience, subcontractor details, and professional qualifications to demonstrate their ability to supply milk to Florida State Hospital, Northeast Florida State Hospital, and North Florida Evaluation and Treatment Center.
The technical response form requires vendors to disclose organizational details, including years in business, experience providing similar services, and references from comparable clients. Vendors must list any proposed subcontractors, provide their Federal Employer Identification Number (FEIN), and demonstrate their capability to meet the specific requirements outlined in the Purchase Order Scope of Work. The solicitation encourages diversity by offering potential tiebreaking advantages to Minority Business Enterprises, Veteran Business Enterprises, or Florida Businesses, and emphasizes compliance with state regulations, E-Verify requirements, and background check procedures. While specific financial details are not explicitly stated in this form, vendors should be prepared to pay a 0.7% transaction fee for MyFloridaMarketPlace registration and potentially face penalties for non-compliance.
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Text version
TECHNICAL RESPONSE
DCF ITB 2526 010
MILK FOR STATE MENTAL HEALTH TREATMENT FACILITIES
PMT-59 1 Effective June 14, 2024
1. DISCLOSURES
1.1. RELATED PARTIES
Complete the following table for all affiliates (§287.133(1)(a), Florida Statutes (F.S.)), related parties (§409.987(7)(a)3., F.S.), entities, partnerships, or associations.
☐ Select the checkbox if related parties, as described above, do not exist.
RELATED PARTY
Name Click or tap here to enter text.
Relation to Respondent
☐ Affiliate ☐ Related Party ☐ Entity ☐ Partnership ☐ Association
Address Click or tap here to enter text.
City, State, Zip Click or tap here to enter text.
Phone Number Click or tap here to enter text.
Duplicate table as necessary for additional related parties.
1.2. CONFLICT OF INTEREST
Complete the following table to disclose the name of any officer, director, employee or other agent who is also an employee of the State. Respondents shall also disclose the name of any State employee who owns, directly or indirectly, an interest of five percent or more in the Respondent or its affiliates, related companies, partnerships, or associations.
☐ Select the checkbox if conflicts of interest, as described above, do not exist.
EMPLOYEE OF BOTH RESPONDENT AND STATE OF FLORIDA
Name Click or tap here to enter text.
Title with Responding Organization
☐ Officer ☐ Director ☐ Employee ☐ Other Agent
State Agency Click or tap here to enter text.
Does this employee have an interest of five percent or more in Respondent or its affiliates, related companies, partnerships, or associations?
☐ Yes ☐ No
Duplicate table as necessary for additional conflicts of interest.
1.3. LIST OF TERMINATED CONTRACTS
Complete the following table for any State or Federal government Contract terminated for cause or terminated by the Respondent prior to Contract end within the last five years; provide the terminated Contracts in chronological order. The Department may use information provided on this list or other information about terminated contracts in its assessment of a Respondent’s responsibility.
☐ Select the checkbox if terminated contracts do not exist.
TERMINATED CONTRACT
Respondent Name: Click or tap here to enter text.
PMT-59 2 Effective June 14, 2024
Client’s Name: Click or tap here to enter text.
Term of Terminated Contract:
Click or tap here to enter text.
Description of Services: Click or tap here to enter text.
Termination Party and Brief Summary of Termination Reason(s):
Click or tap here to enter text.
Duplicate table as necessary for additional terminated contracts.
2. QUALIFICATIONS
2.1. CAPABILITY TO PERFORM THE WORK
2.1.1. Provide a description of the Respondent’s organization, including number of years in business, subsidiaries, and details concerning the number of available locations, if applicable.
Click or tap here to enter text.
2.1.2. Provide the number of years of experience providing similar services.
Click or tap here to enter text.
2.1.3. Provide information for three entities that the Respondent has provided services of a similar size and nature of those requested in this Solicitation.
1 Click or tap here to enter text.
2 Click or tap here to enter text.
3 Click or tap here to enter text.
2.1.4. Provide a statement on the Respondent’s and subcontractor(s)' ability to successfully complete the work described in this Solicitation and its appendices, attachments, exhibits and referenced supporting documentation. The Respondent’s and any proposed subcontractor(s)’ information shall be shown separately.
Respondent:
Click or tap here to enter text.
2.2. PROPOSED SUBCONTRACTOR LIST
Complete the following table for any proposed subcontractors to perform work under the Contract(s) resulting from this Solicitation.
☐ Select the checkbox if subcontractors will not be utilized.
PROPOSED SUBCONTRACTOR
Subcontractor Name
Click or tap here to enter text.
Subcontracted Services
Click or tap here to enter text.
Address Click or tap here to enter text.
PMT-59 3 Effective June 14, 2024
City, State, Zip Click or tap here to enter text.
Phone Number Click or tap here to enter text.
FEIN Click or tap here to enter text.
Duplicate table as necessary for additional subcontractors.
2.3. Professional Qualifications
Respondents must provide details regarding meeting the requirements of the Purchase Order Scope of Work, Section 5, Elements of Service.
File details come from the government source that posted it. Updated .