2017 PURCHASE OF SERVICE PROPOSAL CONTENTS SHEET This proposal contents sheet must be attached immediately after the proposal summary sheet (item #1) Technical Requirements Proposal Check each Item Page # of Item Description Item # Included Proposal INTRODUCTION 1 Cover Letter 2 Proposal Summary Sheet Part 1 AGENCY PROPOSAL/FORMS – 3 Authorization To File 4 Agency Description and Assurances 5 Board Of Directors, Owners, Stockholders Demographic Summary 6 Agency Owners/Stockholders/Officers 7 Agency Organizational Chart 9 Related Organization/Related Party Disclosure 10 Employee Hours-Related Organization Disclosure 11 Conflict Of Interest & Prohibited Practices Certification 12 Equal Employment Opportunity Certificate 13 Equal Opportunity Policy 14 Audit Fraud Hotline 15 Certification Statement Regarding Debarment And Suspension 16 Additional Disclosures ** Disadvantaged Business Development Goals DCPI Designation of Confidential and Proprietary Information SDE Statement of Deviations and Exceptions Note: DCPI and SDE forms are mandatory In addition to the above forms, a Program Proposal must also be submitted. See the separately published Program Requirements/Descriptions document for the Division you are applying to for procedures and forms needed to write your Program Proposal. Agency attests that all items and documents checked above are complete and included in the proposal packet. Authorized Signature: ____________________________ Date: _________________ Printed Name: ____________________________________ Title: __________________________ Agency: _________________________________________________________
2017 PURCHASE OF SERVICE PROPOSAL CONTENTS SHEET This proposal contents sheet must be attached immediately after the proposal summary sheet (item #1) Technical Requirements Item Description Proposal Item # Check each Item Included Page # of Proposal INTRODUCTION 1 Cover Letter 2 Proposal Summary Sheet Part 1 – AGENCY PROPOSAL/FORMS 3 Authorization To File 4 Agency Description and Assurances 5 Board Of Directors, Owners, Stockholders Demographic Summary 6 Agency Owners/Stockholders/Officers 7 Agency Organizational Chart 9 Related Organization/Related Party Disclosure 10 Employee Hours-Related Organization Disclosure 11 Conflict Of Interest & Prohibited Practices Certification 12 Equal Employment Opportunity Certificate 13 Equal Opportunity Policy 14 Audit Fraud Hotline 15 Certification Statement Regarding Debarment And Suspension 16 Additional Disclosures ** Disadvantaged Business Development Goals DCPI Designation of Confidential and Proprietary Information SDE Statement of Deviations and Exceptions Note: DCPI and SDE forms are mandatory In addition to the above forms, a Program Proposal must also be submitted. See the separately published Program Requirements/Descriptions document for the Division you are applying to for procedures and forms needed to write your Program Proposal. Agency attests that all items and documents checked above are complete and included in the proposal packet. Authorized Signature: ____________________________ Date: _________________ Printed Name: ____________________________________ Title: __________________________ Agency: _________________________________________________________
HDPBVRFP2016Final.docx