Vermont Suicide Prevention Symposium

1 Department of Mental Health 280 State Drive, NOB 2 North | Waterbuty, VT 05671-2010 802-241-0090 phone |802-241-0100 fax | 800-253-0191 tty https://mentalhealth.vermont.gov/ SEALED BID REQUEST FOR PROPOSAL RFP108 Vermont Suicide Prevention Symposium ISSUE DATE February 12, 2024 QUESTIONS DUE February 23, 2024, at 4:30 PM EST RFP RESPONSES DUE BY February 29, 2024 – 4:30 PM EST PLEASE BE ADVISED THAT ALL NOTIFICATIONS, RELEASES, AND ADDENDUMS ASSOCIATED WITH THIS RFP WILL BE POSTED AT: http://www.bgs.state.vt.us/pca/bids/bids.php THE STATE WILL MAKE NO ATTEMPT TO CONTACT INTERESTED PARTIES WITH UPDATED INFORMATION. IT IS THE RESPONSIBILITY OF EACH BIDDER TO PERIODICALLY CHECK THE ABOVE WEBPAGEFOR ANY AND ALL NOTIFICATIONS, RELEASES AND ADDENDUMS ASSOCIATED WITH THIS RFP. STATE CONTACT: Jennifer Rowell TELEPHONE:

(802) 241-0090 E-MAIL: AHS.DMHSubmissions@vermont.gov https://mentalhealth.vermont.gov/ http://www.bgs.state.vt.us/pca/bids/bids.php mailto:AHS.DMHSubmissions@vermont.gov?subject=RFP%20Submission Revised: October 4, 2023 Page 2 of 15 1. OVERVIEW: 1.1. SCOPE AND BACKGROUND: Through this Request for Proposal (RFP) the Department of Mental Health (DMH, hereinafter the “State”) is seeking to establish an agreement with a non-profit organization that can coordinate the Vermont Suicide Prevention Symposium. 1.1.1. RFP OBJECTIVE: The purpose of the RFP is to solicit proposals from non-profit organizations for the delivery of an annual, in person Vermont Suicide Prevention Symposium. The organization will organize, develop, deliver, complete, and provide an evaluation. The intent of the symposium is for mental health providers, community members, suicide preventions leaders, and field advocates to learn, engage, and increase knowledge via workshops and plenaries on best practices, innovative strategies, and current research. Components of the symposium should include, various learning tracks, relevant discussion topics, a minimum of one keynote address, and time for networking with colleagues. The space should comply with accessibility requirements. 1.1.2. DESCRIPTION OF ORGANIZATION: The Vermont Agency of Human Services (AHS) strives to improve the health and well-being of Vermonters today and tomorrow and to protect those among us who are unable to protect themselves. The scope of AHS is profound. Through its six departments, twelve district offices, and a network of community partners and providers, it is responsible for the implementation and delivery of all human service programs within the state. Each department has a distinct area of focus and responsibility and contributes to the creation and sustenance of an entire system of human service supports. The Department of Mental Health (DMH) resides under AHS and has the same critical mission in mind: to improve the conditions and well-being of Vermonters and protect those who cannot protect themselves. DMH continues to focus on its vision for self-determination, empowerment, recovery, and resiliency. This means being responsive to the needs of Vermonters and their families, as well as continuing to challenge ourselves to try to change society’s culture, philosophy, and values, while working to fully embrace the concepts of recovery and resiliency. By improving our effectiveness and coordination of programs and services around the State, we will help Vermonters meet their needs. 1.2. CONTRACT PERIOD: Agreements arising from this RFP will be no longer than a year. The State anticipates the start date for such agreement will be April 15, 2024. 1.3. SINGLE POINT OF CONTACT: All communications concerning this RFP are to be addressed in writing to the State Contact listed on the front page of this RFP. Actual or attempted contact with any other individual from the State concerning this RFP is strictly prohibited and may result in disqualification. 1.4. QUESTION AND ANSWER PERIOD: Any bidder requiring clarification of any section of this RFP or wishing to comment on any requirement of the RFP must submit specific questions in writing no later than the deadline for question submission indicated on the first page of this RFP. Questions may be e-mailed to the point of contact on the front page of this RFP. Questions or comments not raised in writing on or before the last day of the question period are thereafter waived. At the close of the question period a copy of all questions or comments and the State's responses will be posted on the State’s Revised: October 4, 2023 Page 3 of 15 web site http://www.bgs.state.vt.us/pca/bids/bids.php. Every effort will be made to post this information as soon as possible after the question period ends, contingent on the number and complexity of the questions. 1.5. CHANGES TO THIS RFP: Any modifications to this RFP will be made in writing by the State through the issuance of an Addendum to this RFP and posted online at http://www.bgs.state.vt.us/pca/bids/bids.php. Modifications from any other source are not to be considered. 1.6. SOURCE OF FUNDS: The Department anticipates using Mental Health Block Grant funds for the resulting agreement. The Department may choose to modify the source of funding contingent upon the availability of funds at the time of award. Any selected Vendor will be subject to the requirements in the Catalog of Federal Domestic Assistance (CFDA) # 93.778, U.S. Department of Health and Human Services, Centers for Medicare and Medicaid. OPTION 1: Socioeconomic affirmative steps under 2 C.F.R. § 200.321: If using applicable federal funds Socioeconomic affirmative steps under 2 C.F.R. § 200.321 affirmative steps must include at least the following six steps: 1. Placing qualified small, historically marginalized group, and women’s business enterprises on solicitation lists; 2. Assuring that small, historically marginalized group, and women’s business enterprises are solicited whenever they are potential sources; 3. Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum participation by small, historically marginalized group, and women’s business enterprises; 4. Establishing delivery schedules, where the requirement permits, which encourage participation by small, historically marginalized group, and women’s business enterprises; 5. Using the services and assistance, as appropriate, of such organizations as the Small Business Administration and the Minority Business Development Agency of the Department of Commerce; and 6. Requiring the prime/general contractor, if subcontracts are to be let, to take the same affirmative steps as listed in numbers 1 through 5. If a bidder requires assistance in preparing their proposal, registering with SAM.gov, or needs guidance on socioeconomic certifications, the bidder may contact the Agency of Commerce and Community Development (ACCD), Department of Economic Development (DED), APEX Accelerator (formerly the Procurement Technical Assistance Center [PTAC]). The Vermont APEX Accelerator specializes in helping small businesses navigate the documentation associated with State and Federal procurement. There is no cost to the Contractor for assistance provided by APEX Accelerator. Their website is: https://accd.vermont.gov/economic-development/programs/ptac. http://www.bgs.state.vt.us/pca/bids/bids.php http://www.bgs.state.vt.us/pca/bids/bids.php https://www.ecfr.gov/current/title-2/subtitle-A/chapter-II/part-200/subpart-D/subject-group-ECFR45ddd4419ad436d/section-200.321 https://accd.vermont.gov/economic-development/programs/ptac Revised: October 4, 2023 Page 4 of 15 2. GENERAL REQUIREMENTS: 2.1. Certificate of Approval (COA) Process: DMH requires projects that meet the following criteria to undergo the COA process. The COA applications procedures and instructions can be found on the DMH website. Please refer to these instructions to ensure that you provide the details needed in your proposal to meet all COA application requirements. 2.1.1. Criteria for projects that require COA (any of the following): 2.1.1.1. Capital expenditure exceeding $1,500,000 for construction, development, purchase or long-term lease of property or an existing structure. 2.1.1.2. Purchase of technology, technology upgrade, other equipment or a renovation with a cost exceeding $1,000,000. 2.1.1.3. The offering of a health care service having a projected annual operating expense that exceeds $500,000 for either of the next two budgeted fiscal years if the service was not offered or employed by the health care facility within the previous three fiscal years. 2.2. PRICING: Bidders must price the terms of this solicitation at their best pricing. Any and all costs that Bidder wishes the State to consider must be submitted for consideration. If applicable, all equipment pricing is to include Free On Board (FOB) delivery to the ordering facility. No request for extra delivery cost will be honored. All equipment shall be delivered assembled, serviced, and ready for immediate use, unless otherwise requested by the State. 2.2.1. Prices and rates shall remain firm for the initial term of the contract. The pricing policy submitted by Bidder must (i) be clearly structured, accountable, and auditable and (ii) cover the full spectrum of materials and services required. 2.2.2. Cooperative Agreements. Bidders that have been awarded similar contracts through a competitive bidding process with another state or cooperative are welcome to submit the pricing in response to this solicitation. 2.2.3. Retainage. At the discretion of the State, a contract resulting from this RFP may provide that the State withhold a percentage of the total amount payable for some or all deliverables, such retainage to be payable upon satisfactory completion and State acceptance in accordance with the terms and conditions of the contract. 2.3. STATEMENT OF RIGHTS: The State shall have the authority to evaluate Responses and select the Bidder(s) as may be determined to be in the best interest of the State and consistent with the goals and performance requirements outlined in this RFP. The State of Vermont reserves the right to obtain clarification or additional information necessary to properly evaluate a proposal. Failure of bidder to respond to a request for additional information or clarification could result in rejection of that bidder's proposal. To secure a project that is deemed to be in the best interest of the State, the State reserves the right to accept or reject any and all bids, in whole or in part, with or without cause, and to waive technicalities in submissions. The State also reserves the right to make purchases outside of the awarded contracts where it is deemed in the best interest of the State. 2.3.1. Best and Final Offer (BAFO). At any time after submission of Responses and prior to the final selection of Bidder(s) for Contract negotiation or execution, the State may invite Bidder(s) to provide a BAFO. The state reserves the right to request BAFOs from only those Bidders that meet the minimum qualification https://mentalhealth.vermont.gov/sites/mentalhealth/files/doc_library/Certificate_of_Approval%28COA%29.pdf Revised: October 4, 2023 Page 5 of 15 requirements and/or have not been eliminated from consideration during the evaluation process. 2.3.2. Presentation. An in-person or webinar presentation by the Bidder may be required by the State if it will help the State’s evaluation process. The State will factor information presented during presentations into the evaluation. Bidders will be responsible for all costs associated with providing the presentation. 2.4. WORKER CLASSIFICATION COMPLIANCE REQUIREMENTS: In accordance with Section 32 of The Vermont Recovery and Reinvestment Act of 2009 (Act No. 54), Bidders must comply with the following provisions and requirements. 2.4.1. Self-Reporting: For bid amounts exceeding $250,000.00, Bidder shall complete the appropriate section in the attached Certificate of Compliance for purposes of self-reporting information relating to past violations, convictions, suspensions, and any other information related to past performance relative to coding and classification of workers. The State is requiring information on any violations that occurred in the previous 12 months. 2.4.2. Subcontractor Reporting: For bid amounts exceeding $250,000.00, Bidders are hereby notified that upon award of contract, and prior to contract execution, the State shall be provided with a list of all proposed subcontractors and subcontractors’ subcontractors, together with the identity of those subcontractors’ workers compensation insurance providers, and additional required or requested information, as applicable, in accordance with Section 32 of The Vermont Recovery and Reinvestment Act of 2009 (Act No. 54). This requirement does not apply to subcontractors providing supplies only and no labor to the overall contract or project. This list MUST be updated and provided to the State as additional subcontractors are hired. A sample form is available online at http://bgs.vermont.gov/purchasing-contracting/forms. The subcontractor reporting form is not required to be submitted with the bid response. 2.5. EXECUTIVE ORDER 05-16: CLIMATE CHANGE CONSIDERATIONS IN STATE PROCUREMENTS: For bid amounts exceeding $25,000.00 Bidders are requested to complete the Climate Change Considerations in State Procurements Certification, which is included in the Certificate of Compliance for this RFP. After consideration of all relevant factors, a bidder that demonstrates business practices that promote clean energy and address climate change as identified in the Certification, shall be given favorable consideration in the competitive bidding process. Such favorable consideration shall be consistent with and not supersede any preference given to resident bidders of the State or products raised or manufactured in the State, as explained in the Method of Award section. However, such favorable consideration shall not be employed if prohibited by law or other relevant authority or agreement. 2.6. METHOD OF AWARD: Awards will be made in the best interest of the State. The State may award one or more contracts and reserves the right to make additional awards to other compliant bidders at any time if such award is deemed to be in the best interest of the State. All other considerations being equal, preference will be given first to resident bidders of the state and to products raised or manufactured in the state, and then to http://bgs.vermont.gov/purchasing-contracting/forms Revised: October 4, 2023 Page 6 of 15 bidders who have practices that promote clean energy and address climate change, as identified in the applicable Certificate of Compliance. 2.6.1. Evaluation Criteria: Consideration shall be given to the Bidder’s project approach and methodology, qualifications and experience, ability to provide the services within the defined timeline, cost, and success in completing similar projects, as applicable, and to the extent specified below. The State will use a scoring scale of 100 total points, with a maximum of 80 points awarded based on the Technical Proposal and a maximum of 20 points awarded based on the Cost Proposal. Points are divided into categories set forth below. Technical Proposal Met formatting requirements 5 Quality of organizational capacity and experience 35 Responsiveness to specifications 40 Cost Proposal Budgets 20 Total Points 100 2.7. CONTRACT NEGOTIATION: Upon completion of the evaluation process, the State may select one or more bidders with which to negotiate a contract, based on the evaluation findings and other criteria deemed relevant for ensuring that the decision made is in the best interest of the State. In the event State is not successful in negotiating a contract with a selected bidder, the State reserves the option of negotiating with another bidder, or to end the proposal process entirely. 2.8. COST OF PREPARATION: Bidder shall be solely responsible for all expenses incurred in the preparation of a response to this RFP and shall be responsible for all expenses associated with any presentations or demonstrations associated with this request and/or any proposals made. 2.9. CONTRACT TERMS: The selected bidder(s) will be expected to sign a contract with the State, including the Standard Contract Form and other standard attachments provided with this RFP for reference. 2.9.1. Business Registration. To be awarded a contract by the State of Vermont a bidder (except an individual doing business in his/her own name) must be registered with the Vermont Secretary of State’s office https://sos.vermont.gov/corporations/registration/ and must obtain a Contractor’s Business Account Number issued by the Vermont Department of Taxes http://tax.vermont.gov/ . 2.9.2. The contract will obligate the bidder to provide the services and products identified in its bid, at the prices listed. 2.9.3. Payment Terms. Percentage discounts may be offered for prompt payments of invoices; however, such discounts must be in effect for a period of 30 days or more in order to be considered in making awards. https://sos.vermont.gov/corporations/registration/ http://tax.vermont.gov/ Revised: October 4, 2023 Page 7 of 15 2.9.4. Quality. If applicable, all products provided under a contract with the State will be new and unused, unless otherwise stated. Factory seconds or remanufactured products will not be accepted unless specifically requested by the purchasing agency. All products provided by the contractor must meet all federal, state, and local standards for quality and safety requirements. Products not meeting these standards will be deemed unacceptable and returned to the contractor for credit at no charge to the State. 3. CONTENT AND FORMAT OF RESPONSES: The content and format requirements listed below are the minimum requirements for State evaluation. These requirements are not intended to limit the content of a Bidder’s proposal. Bidders may include additional information or offer alternative solutions for the State’s consideration. However, the State discourages overly lengthy and costly proposals, and Bidders are advised to include only such information in their response as may be relevant to the requirements of this RFP. 3.1. The bid should include a Cover Letter, a Technical Response, and Price Schedule. 3.2. COVER LETTER: 3.2.1. Confidentiality: To the extent your bid contains information you consider to be proprietary and confidential, you must comply with the following requirements concerning the contents of your cover letter and the submission of a redacted copy of your bid (or affected portions thereof). 3.2.2. All responses to this RFP will become part of the contract file and will become a matter of public record under the State’s Public Records Act, 1 V.S.A. § 315 et seq. (the “Public Records Act”). If your response must include material that you consider to be proprietary and confidential under the Public Records Act, your cover letter must clearly identify each page or section of your response that you consider proprietary and confidential. Your cover letter must also include a written explanation for each marked section explaining why such material should be considered exempt from public disclosure in the event of a public records request, pursuant to 1 V.S.A. § 317(c), including the prospective harm to the competitive position of the bidder if the identified material were to be released. Additionally, you must include a redacted copy of your response for portions that are considered proprietary and confidential. Redactions must be limited so that the reviewer may understand the nature of the information being withheld. It is typically inappropriate to redact entire pages, or to redact the titles/captions of tables and figures. Under no circumstances may your entire response be marked confidential, and the State reserves the right to disqualify responses so marked. 3.2.3. Exceptions to Contract Terms and Conditions: If a Bidder wishes to propose an exception to any terms and conditions set forth in the Standard Contract Form and its attachments, such exceptions must be included in the cover letter to the RFP response. Failure to note exceptions when responding to the RFP will be deemed to be acceptance of the State contract terms and conditions. If exceptions are not noted in the response to this RFP but raised during contract negotiations, the State reserves the right to cancel the negotiation if deemed to be in the best interests of the State. Note that exceptions to contract terms may cause rejection of the proposal. 3.3. TECHNICAL RESPONSE. In response to this RFP, a Bidder shall: Revised: October 4, 2023 Page 8 of 15 3.3.1. Provide details concerning your form of business organization, company size and resources. 3.3.2. Describe your capabilities and particular experience relevant to the RFP requirements, particularly any current or past State projects. 3.3.3. Identify the names of all subcontractors you intend to use, the portions of the work the subcontractors will perform, and address the background and experience of the subcontractor(s), as per RFP section 4.3.2 above. 3.4. REFERENCES. Provide the names, addresses, and phone numbers of at least three companies with whom you have transacted similar business in the last 12 months. You must include contact names who can talk knowledgeably about performance. 3.5. REPORTING REQUIREMENTS: Provide a sample of any reporting documentation that may be applicable to the Detailed Requirements of this RFP. 3.6. PRICE SCHEDULE: Bidders shall submit their pricing information in the Price Schedule attached to the RFP. 3.7. CERTIFICATE OF COMPLIANCE: This form must be completed and submitted as part of the response for the proposal to be considered valid. 4. SUBMISSION INSTRUCTIONS: 4.1. CLOSING DATE: Bids must be received by the State by the due date specified on the front page of this RFP. Late bids will not be considered. 4.1.1. The State may, for cause, issue an addendum to change the date and time when bids are due. If a change is made, the State will inform all bidders by posting at the webpage indicated on the front page of this RFP. 4.1.2. There will not be a public bid opening. However, the State will record the name, city and state for any and all bids received by the due date. This information will be posted as promptly as possible following the due date online at: https://mentalhealth.vermont.gov/RFP. Bidders are hereby notified to review the information posted after the bid opening deadline to confirm receipt of bid by the State. Any bidder that submitted a bid, and is not listed on the bid tabulation sheet, shall promptly notify the State Contact listed on the front page of this RFP. Should a bidder fail to notify the State Contact listed on the front page of this RFP within two weeks of posting the bid tabulation sheet, the State shall not be required to consider the bid. 4.2. STATE SECURITY PROCEDURES: Please be advised extra time will be needed when visiting or delivering information to State of Vermont offices. All individuals visiting State offices must present a valid government issued photo ID when entering the facility. 4.2.1. State office buildings may be locked or otherwise closed to the public. If this RFP permits hand delivery of bids, delivery instructions will be posted at the entrance to the State facility. Any delay caused by State Security Procedures will be at the bidder’s own risk. https://mentalhealth.vermont.gov/RFP Revised: October 4, 2023 Page 9 of 15 4.3. BID DELIVERY INSTRUCTIONS: 4.3.1. ELECTRONIC: Electronic bids will be accepted. 4.3.1.1. E-MAIL BIDS. Emailed bids will be accepted. Bids will be accepted via email submission to AHS.DMHSubmissions@vermont.gov. Bids must consist of a single email with a single, digitally searchable PDF attachment containing all components of the bid. Multiple emails and/or multiple attachments will not be accepted. There is an attachment size limit of 40 MB. It is the Bidder’s responsibility to compress the PDF file containing its bid, if necessary, in order to meet this size limitation. 4.3.1.2. FAX BIDS: Faxed bids will not be accepted. 4.4. U.S. MAIL OR EXPRESS DELIVERY OR HAND DELIVERY: 4.4.1. All paper format bids must be addressed to the State of Vermont, Department of Mental Health, 166 Horseshoe Drive, Waterbury, VT 05671-2010. BID ENVELOPES MUST BE CLEARLY MARKED ‘SEALED BID’ AND SHOW THE REQUISITION NUMBER AND/OR PROPOSAL TITLE, OPENING DATE AND NAME OF BIDDER. 4.4.2. NUMBER OF COPIES: 4.4.3. For bids submitted via mail, express, or in-hand, submit one digital copy in PDF. If large file transfer needed, bidder must request secure file transfer link. 4.4.4. Paper Format Delivery Methods: 4.4.4.1. U.S. MAIL: Bidders are cautioned that it is their responsibility to originate the mailing of bids in sufficient time to ensure bids are received and time stamped by the Department of Mental Health prior to the time of the bid opening. 4.4.4.2. EXPRESS DELIVERY: If bids are being sent via an express delivery service, be certain that the RFP designation is clearly shown on the outside of the delivery envelope or box. Express delivery packages will not be considered received by the State until the express delivery package has been received and time stamped by the Department of Mental Health. 4.4.4.3. HAND DELIVERY: Hand carried bids shall be delivered to a representative of the Department of Mental Health at the Waterbury State Office Complex prior to the bid opening. A Security Officer is at 280 State Drive until 4:30PM which is the normal hours. A bid submitted by Hand Delivery will not be accepted after 4:30 PM. 5. BID SUBMISSION CHECKLIST: ✓ Required Number of Copies ✓ Cover Letter mailto:AHS.DMHSubmissions@vermont.gov?subject=RFP%20Submission Revised: October 4, 2023 Page 10 of 15 ✓ Technical Response ✓ Redacted Technical Response, if applicable ✓ References ✓ Price Schedule ✓ Signed W-9 Tax Identification Form (signed non-electronically within the past 12 months) ✓ Signed Certificate of Compliance 6. ATTACHMENTS & LINKS: 6.1. Certificate of Compliance 6.2. Worker Classification Compliance Requirement; Subcontractor Reporting Form 6.3. COA applications procedures and instructions 6.4. Standard State Contract with its associated attachments, including but not limited to: 6.4.1. Attachment C: Standard State Provisions for Contracts and Grants (12/7/2023) 6.4.2. Attachment E – Business Associate Agreement (BAA) (5/22/2020) 6.4.3. Attachment F – AHS Customary Contract/Grant Provisions (5/16/2018) 6.4.4. State of Vermont – Federal Terms Supplement (7/19/2023) 6.4.5. State of Vermont – IRS Pub. 1075 Terms Supplement (7/14/2022) https://mentalhealth.vermont.gov/sites/mentalhealth/files/doc_library/Certificate_of_Approval%28COA%29.pdf https://bgs.vermont.gov/sites/bgs/files/files/purchasing-contracting/Forms/Form%20Standard-Contract-Services-SSCERT-07-28-22.doc https://bgs.vermont.gov/sites/bgs/files/files/purchasing-contracting/Forms/ATTACHMENT%20C%20-%20rev%202023%20FINAL%20PROOF%20CLEAN%2012-07-23.pdf https://bgs.vermont.gov/sites/bgs/files/files/purchasing-contracting/Forms/Attachment_E_BAA_REV_2020%20-%20june%2010.doc https://bgs.vermont.gov/sites/bgs/files/files/purchasing-contracting/ATTACHMENT%20F%20%20Combined%2005162018.docx https://bgs.vermont.gov/sites/bgs/files/files/purchasing-contracting/Forms/Revised-State_of_VT_Federal_TC_2021-%20Non-construction%20-%2007-19-23.docx https://bgs.vermont.gov/sites/bgs/files/files/purchasing-contracting/Forms/STATE%20OF%20VERMONT%20IRS%20Pub%201075%20TERMS%20rev07.14.22%20FINAL.docx Revised: October 4, 2023 Page 11 of 15 RFP/PROJECT: Vermont Suicide Prevention Symposium DATE: of when it gets posted Page 1 of 3 CERTIFICATE OF COMPLIANCE For a bid to be considered valid, this form must be completed in its entirety, executed by a duly authorized representative of the bidder, and submitted as part of the response to the proposal. A. NON-COLLUSION: Bidder hereby certifies that the prices quoted have been arrived at without collusion and that no prior information concerning these prices has been received from or given to a competitive company. If there is sufficient evidence to warrant investigation of the bid/contract process by the Office of the Attorney General, bidder understands that this paragraph might be used as a basis for litigation. B. CONTRACT TERMS: Bidder hereby acknowledges that is has read, understands and agrees to the terms of this RFP, including Attachment C: Standard State Contract Provisions, and any other contract attachments included with this RFP. C. WORKER CLASSIFICATION COMPLIANCE REQUIREMENT: In accordance with Section 32 of The Vermont Recovery and Reinvestment Act of 2009 (Act No. 54), the following provisions and requirements apply to Bidder when the amount of its bid exceeds $250,000.00. Self-Reporting. Bidder hereby self-reports the following information relating to past violations, convictions, suspensions, and any other information related to past performance relative to coding and classification of workers, that occurred in the previous 12 months. Summary of Detailed Information Date of Notification Outcome Subcontractor Reporting. Bidder hereby acknowledges and agrees that if it is a successful bidder, prior to execution of any contract resulting from this RFP, Bidder will provide to the State a list of all proposed subcontractors and subcontractors’ subcontractors, together with the identity of those subcontractors’ workers compensation insurance providers, and additional required or requested information, as applicable, in accordance with Section 32 of The Vermont Recovery and Reinvestment Act of 2009 (Act No. 54), and Bidder will provide any update of such list to the State as additional subcontractors are hired. Bidder further acknowledges and agrees that the failure to submit subcontractor reporting in accordance with Section 32 of The Vermont Recovery and Reinvestment Act of 2009 (Act No. 54) will constitute non-compliance and may result in cancellation of contract and/or restriction from bidding on future state contracts. Revised: October 4, 2023 Page 12 of 15 RFP/PROJECT: Vermont Suicide Prevention Symposium DATE: Page 2 of 3 D. Executive Order 05 – 16: Climate Change Considerations in State Procurements Certification Bidder certifies to the following (Bidder may attach any desired explanation or substantiation. Please also note that Bidder may be asked to provide documentation for any applicable claims): 1. Bidder owns, leases or utilizes, for business purposes, space that has received: ❑ Energy Star® Certification ❑ LEED®, Green Globes®, or Living Buildings ChallengeSM Certification ❑ Other internationally recognized building certification: ____________________________________________________________________________ 2. Bidder has received incentives or rebates from an Energy Efficiency Utility or Energy Efficiency Program in the last five years for energy efficient improvements made at bidder’s place of business. Please explain: _____________________________________________________________________________ 3. Please Check all that apply: ❑ Bidder can claim on-site renewable power or anaerobic-digester power (“cow-power”). Or bidder consumes renewable electricity through voluntary purchase or offset, provided no such claimed power can be double-claimed by another party. ❑ Bidder uses renewable biomass or bio-fuel for the purposes of thermal (heat) energy at its place of business. ❑ Bidder’s heating system has modern, high-efficiency units (boilers, furnaces, stoves, etc.), having reduced emissions of particulate matter and other air pollutants. ❑ Bidder tracks its energy consumption and harmful greenhouse gas emissions. What tool is used to do this? _____________________ ❑ Bidder promotes the use of plug-in electric vehicles by providing electric vehicle charging, electric fleet vehicles, preferred parking, designated parking, purchase or lease incentives, etc.. ❑ Bidder offers employees an option for a fossil fuel divestment retirement account. ❑ Bidder offers products or services that reduce waste, conserve water, or promote energy efficiency and conservation. Please explain: ____________________________________________________________________________ ____________________________________________________________________________ 4. Please list any additional practices that promote clean energy and take action to address climate change: _____________________________________________________________________________ ____________________________________________________________________________ _____________________________________________________________________________ Revised: October 4, 2023 Page 13 of 15 RFP/PROJECT: Vermont Suicide Prevention Symposium DATE: Page 3 of 3 E. Executive Order 02 – 22: Solidarity with the Ukrainian People ❑ By checking this box, Bidder certifies that none of the goods, products, or materials offered in response to this solicitation are Russian-sourced goods or produced by Russian entities. If Bidder is unable to check the box, it shall indicate in the table below which of the applicable offerings are Russian-sourced goods and/or which are produced by Russian entities. An additional column is provided for any note or comment that you may have. Provided Equipment or Product Note or Comment Bidder Name: Contact Name: Address: Fax Number: Telephone: E-Mail: By: Name: Signature of Bidder (or Representative) (Type or Print) END OF CERTIFICATE OF COMPLIANCE Revised: October 4, 2023 Page 14 of 15 PRICE SCHEDULE A. Fixed Price Deliverables: Deliverable Description Fixed Price Deliverable A: Staff $ Deliverable B: Symposium meeting space $ Deliverable C: Speaker fees $ Deliverable D: Operating (advertising, materials, supplies, travel etc.) $ Total Project Cost $ Name of Bidder: Signature of Bidder: Date: Revised: October 4, 2023 Page 15 of 15 RFP/PROJECT: Vermont Suicide Prevention Symposium DATE: SUBCONTRACTOR REPORTING FORM This form must be completed in its entirety and submitted prior to contract execution and updated as necessary and provided to the State as additional subcontractors are hired. The Department of Buildings and General Services in accordance with Act 54, Section 32 of the Acts of 2009 and for total project costs exceeding $250,000.00 requires bidders to comply with the following provisions and requirements. Contractor is required to provide a list of subcontractors on the job along with lists of subcontractor’s subcontractors and by whom those subcontractors are insured for workers’ compensation purposes. Include additional pages if necessary. This is not a requirement for subcontractor’s providing supplies only and no labor to the overall contract or project. Subcontractor Insured By Subcontractor’s Sub Insured By Date: Name of Company: Contact Name: Address: Title: Phone Number: E-mail: Fax Number: By: Name: Failure to adhere to Act 54, Section 32 of the Acts of 2009 and submit Subcontractor Reporting: Worker Classification Compliance Requirement will constitute non-compliance and may result in cancellation of contract and/or forfeiture of future bidding privileges until resolved. Send Completed Form to: Office of Purchasing & Contracting 133 State Street, 5th Floor Montpelier, VT 05633-8000