Certification of contract

Attachment 2
Reference Summaries

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Provide a minimum of five references; large governmental and/or commercial accounts are preferred. No actual form is provided.

Information shall include:

• 
  Customer name, customer contact name, address, phone number, fax number and email address.
  
• 
  Description of services provided.
  
• 
  Specific dates of service.
  
• 
  Average cost per job/task, or total cost of project.
  

Attachment 3
Experience Certification Form

Attention: Department of Management Services

From: (insert Respondent’s name)
RE: RFP 10-475-000-J Medical and Dental Supplies
This form will serve to confirm that _____________________________ (insert Company Name) has a minimum of five (5) years experience in manufacturing and/or distributing quality medical and dental supplies.

Signed: ________________________________________

Title: ________________________________________
Company: ______________________________________
Sworn to a subscribed before me this _____ day of _____________, 20___
Notary Public: ___________________________________
My Commission Expires: ___________________________

The balance of this sheet is blank, intentionally

Attachment 4
Respondents Capability Form
Please use this form as a guideline for your narrative response.

1. 
   Can your company provide quality medical and dental supplies statewide?
   
2. 
   Does your company offer free or low cost local deliveries? Please explain.
   
3. 
   Does your company offer free inside delivery?
   
4. 
   Please detail and identify the purchasing district(s) or individual counties your company is capable of servicing. (See district map on the next page)
   
5. 
   Provide your company’s State of Florida license number.
   
6. 
   Does your company have the capability to respond quickly to a disaster/emergency? Please explain.
   
7. 
   Explain your company’s VMI (Vendor Managed Inventory) capabilities.
   
8. 
   Provide a copy of your company’s liability policy – declaration page only - if your company does not have the necessary insurance coverage at the time of response submittal, please note this in the response and refer to section 5.2.
   

The balance of this sheet is blank, intentionally

Attachment 5

Ordering Instructions Form