RFP 25-010-10A Proposal Response Cover Sheet

Agency:	Shelby County
State:	Tennessee
Type of Government:	State & Local
Posted Date:	Mar 2, 2026
Due Date:	Mar 4, 2026
Original Source:	Please Login to View Page
Contact information:	Please Login to View Page
Bid Documents:	Please Login to View Page

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Proposal Response Sheet

Shelby County Government – RFP # 25-010-10A

Employee Assistance Program

(Human Resources Department)

Name of firm: ________________________________________________________

Firm’s Website: _________________________________

Mailing Address:

________________________________________

Phone: ______________________________

Fax: ________________________________

Remit Address:

_______________________________________

Phone: _______________________________

Fax: _________________________________

Payment Terms: _______________

Authorized Representative: ___________________________ Print: _____________________________________

Signature (Person authorized to negotiate with the County on behalf of the organization/firm.)

Email address: ____________________________________

Authorized Representative: ___________________________ Print: _____________________________________

Signature (Person authorized to negotiate with the County on behalf of the organization/firm.)

Email address: ____________________________________

The signature (s) above indicates that certifies that:

(i) the Proposer’s signatory is an agent authorized to submit proposals on behalf of the organization/firm;

(ii) all declarations in the proposal and attachments are true to the best of reasonable knowledge;

(iii) all aspects of the proposal, including cost, have been determined independently, without consultation

with any other prospective Proposer or competitor for the purpose of restricting competition;

(iv) the offer made in the proposal is firm and binding for 90 days after receipt of the proposal by the

County; and

(v) all aspects of this RFP and the proposal submitted are binding for the duration if this proposal is

selected and a contract awarded.

Vendor #___________________ (Required) EOC #: _______________________________ (Required)

If EOC certification was obtained through a Teaming agreement and the EOC number starts with a “T”, please

complete the next page. If this does not apply, disregard the next page.

______ Check here if you qualify as a MBE___, HBE___ or WBE___ (Minority, Hispanics or Woman owned

Business Enterprise) If so, please indicate the classification below:

⁭African American ⁭Hispanic American ⁭Asian American ⁭Native American ⁭Other ___________________________

______ Check here if you are a qualified M/WBE (Minority/Women Business Enterprise) vendor. Certification for

this status is received through the EOC Administration. This is not a self-certifying classification.

Page 2

Proposal Response Sheet

Shelby County Government – RFP # 25-010-10A

Employee Assistance Program

(Human Resources Department)

Are you currently in an EOC Teaming Agreement? If so, please complete the following:

Please name the firm you agreed to team with in order to be qualified to do business with Shelby

County Government: _____________________________________________________________________

You are aware that part of being approved with a “Teaming Agreement” you agreed to team with the certified

M/WBE identified on your agreement on “ALL” County projects? __________

Will this company participate in the completion of services for this proposal? ________________

If not, why? _____________________________________________________________________________

______________________________________________________________________________________

If you answered no to the above question, is your Teaming M/WBE vendor aware that you are bidding on this project

for the County? __________

Have you included another firm to participate in the completion of the services? __________

If so, who? ______________________________________________________________________________

_______________________________________________________________________________________

(Include the complete business name, address, phone and contact person)

Are they a certified M/WBE with Shelby County? _______ Include M/WBE#_____________________________

**Please note that all of the information contained on this page will be used during the evaluation of the responses**

The first page of this document MUST be printed on your company letterhead or stationery.

Definitions for the information listed on the first page

Minority and Women Business Enterprise

As defined in Shelby County Government Ordinances No. 472, 544, 555, and related Amendments.

Response Checklist:

Please make sure that basic information listed below is provided in your RFP before you submit

your response.

⁭Cover Sheet/Proposal Response Sheet (Required)

⁭Comprehensive Response to Minimum Requirements & Required Services

⁭Cost & Fees

⁭Experience of Respondent

⁭References

⁭Additional Information (optional)

(This checklist does not absolve the Respondent of any other required documentation indicated in

the document not list above. Please use the information highlighted above as a reference only)

This page summarizes the opportunity, including an overview and a preview of the attached documents.

RFP 25-010-10A Proposal Response Cover Sheet

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