Source: http://www.rasteredge.com/gallery/c14/1744/
Timestamp: 2020-02-21 06:04:17
Document Index: 29514804

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Pdf picture to powerpoint SDK control service wpf azure web page dnn HSS_15004LabService_RFP7-part1746
BIDDERS SIGNATURE FORM
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TYPE IN NAME OF AUTHORIZED PERSON:
TITLE OF AUTHORIZED PERSON:
BIDDER’S FEDERAL EMPLOYERS IDENTIFICATION NUMBER:
THE FOLLOWING MUST BE COMPLETED BY THE VENDOR:
AS CONSIDERATION FOR THE AWARD AND EXECUTION BY THE DEPARTMENT OF HEALTH AND
SOCIAL SERVICES OF THIS CONTRACT, THE (COMPANY NAME)
HEREBY GRANTS, CONVEYS, SELLS, ASSIGNS, AND TRANSFERS TO THE STATE OF DELAWARE ALL OF
ITS RIGHTS, TITLE AND INTEREST IN AND TO ALL KNOWN OR UNKNOWN CAUSES OF ACTION IT
PRESENTLY HAS OR MAY NOW HEREAFTER ACQUIRE UNDER THE ANTITRUST LAWS OF THE UNITED
STATES AND THE STATE OF DELAWARE, RELATING THE PARTICULAR GOODS OR SERVICES
PURCHASED OR ACQUIRED BY THE DELAWARE HEALTH AND SOCIAL SERVICES DEPARTMENT,
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As the official representative for the proposer, I certify on behalf of the agency
a. They are a regular dealer in the services being procured.
b. They have the ability to fulfill all requirements specified for development
within this RFP.
c. They have independently determined their prices.
d. They are accurately representing their type of business and affiliations.
They will secure a Delaware Business License.
They have acknowledged that no contingency fees have been paid
to obtain award of this contract.
The Prices in this offer have been arrived at independently, without
consultation, communication, or agreement, for the purpose of restricting
competition, as to any matter relating to such prices with any other
contractor or with any competitor;
Unless otherwise required by Law, the prices which have been quoted in this
offer have not been knowingly disclosed by the contractor and prior to the
award in the case of a negotiated procurement, directly or indirectly to any
other contractor or to any competitor; and
No attempt has been made or will be made by the contractor in part to
other persons or firm to submit or not to submit an offer for the purpose of
They have not employed or retained any company or person (other than a
full-time bona fide employee working solely for the contractor) to solicit or
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secure this contract, and they have not paid or agreed to pay any company
or person (other than a full-time bona fide employee working solely for the
contractor) any fee, commission percentage or brokerage fee contingent
upon or resulting from the award of this contract.
They (check one) operate ___an individual; _____a Partnership ____a non-
profit (501 C-3) organization; _____a not-for-profit organization; or _____for
profit corporation, incorporated under the laws of the State of
The referenced offerer has neither directly or indirectly entered into any
agreement, participated in any collusion or otherwise taken any action in
restraint of free competitive bidding in connection with this bid submitted this
date to Delaware Health and Social Services.
The referenced bidder agrees that the signed delivery of this bid represents
the bidder’s acceptance of the terms and conditions of this invitation to bid
including all Specifications and special provisions.
They (check one): _______are; ______are not owned or controlled by a
parent company. If owned or controlled by a parent company, enter name
and address of parent company:
Each contract entered into by an agency for professional services shall contain
a prohibition against contingency fees as follows:
The firm offering professional services swears that it has not employed or
retained any company or person working primarily for the firm offering
professional services, to solicit or secure this agreement by improperly
influencing the agency or any of its employees in the professional service
The firm offering the professional services has not paid or agreed to pay any
person, company, corporation, individual or firm other than a bona fide
employee working primarily for the firm offering professional services, any
fee, commission, percentage, gift, or any other consideration contingent
upon or resulting from the award or making of this agreement; and
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For the violation of this provision, the agency shall have the right to terminate
the agreement without liability and at its discretion, to deduct from the
contract price, or otherwise recover the full amount of such fee, commission,
percentage, gift or consideration.
The following conditions are understood and agreed to:
a. No charges, other than those specified in the cost proposal, are to be levied
upon the State as a result of a contract.
b. The State will have exclusive ownership of all products of this contract unless
mutually agreed to in writing at the time a binding contract is executed.
Signature & Title of Official Representative
Type Name of Official Representative
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STATEMENTS OF COMPLIANCE FORM
As the official representative for the contractor, I certify on behalf of the agency
(Company Name) will comply with all Federal
and Delaware laws and regulations pertaining to equal employment
opportunity and affirmative action. In addition, compliance will be assured in
regard to Federal and Delaware laws and regulations relating to confidentiality
and individual and family privacy in the collection and reporting of data.
DPH CONTRACT # _______
THE DIVISION OF PUBLIC HEALTH,
DELAWARE DEPARTMENT OF HEALTH & SOCIAL SERVICES,
[TYPE OF SERVICE]
This contract is entered into between the Delaware Department of Health and Social
Services (the Department), Division of Public Health, Division of Aging and Adults With
Physical Disabilities and _______________________ (the Contractor).
The Contract shall commence on __________________ and terminate on _____________
unless specifically extended by an amendment, signed by all parties to the Contract. Time is
of the essence. (Effective contract start date is subject to the provisions of Paragraph C. 1. of
Contractor recognizes that it is operating as an independent Contractor and that it is liable
for any and all losses, penalties, damages, expenses, attorney's fees, judgments, and/or
settlements incurred by reason of injury to or death of any and all persons, or injury to any
and all property, of any nature, arising out of the Contractor's negligent performance under
this Contract, and particularly without limiting the foregoing, caused by, resulting from, or
arising out of any act of omission on the part of the Contractor in their negligent
performance under this Contract.
The Contractor shall maintain such insurance as will protect against claims under Worker’s
Compensation Act and from any other claims for damages for personal injury, including
death, which may arise from operations under this Contract. The Contractor is an
independent contractor and is not an employee of the State.
During the term of this Contract, the Contractor shall, at its own expense, carry insurance
with minimum coverage limits as follows:
a) Comprehensive General Liability
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