RFP 2025HCA15 Exhibit A Bidder Forms and Certifications

Description

REQUEST FOR PROPOSALS (RFP) RFP NO. 2025HCA15 EXHIBIT A: BIDDER FORMS AND CERTIFICATIONS A. BIDDER PROFILE & SUBMITTAL FORM HCA reserves the right to request additional information or proof of documentation as referenced in this document. 1. MINIMUM QUALIFICATIONS Bidder confirms they meet all requirements specified in the Minimum Qualifications section of the RFP as a prerequisite to submitting a proposal in response to this solicitation. ☐YES If a Bidder selects “yes” and it is verified later that the Bidder does not meet the Minimum Qualifications, the Bidder’s Proposal will be considered non-responsive. 2. ORGANIZATION INFORMATION Legal Name* DBA (if any) Street Address (a) Mailing Address: City, State, ZIP *HCA requires the legal name of Bidder’s organization as it is registered in the state of Washington or the state in which Bidder organization is registered. Telephone Number (b) (c) Area Code: Number: Extension: Email Address Signatory Information (person with signature authority for the organization) (d) Name & Title: HCA RFP No. 2025HCA15 Exhibit A, Bidder Forms and Certifications (A) Page 2 of 12 Email Address: Telephone Number: Area Code: Number: Extension: Primary Contact Information (for questions/contract negotiations) Name & Title: (e) Email Address: Telephone Number: Area Code: Number: Extension: WA State Unified Business Identification (UBI) Number: (f) If organization does not have a UBI Number to provide above, select the appropriate option below to show compliance with the licensing requirement: Our organization will obtain a business license within 30 calendar days of being notified of its selection as an Apparent Successful Bidder. OR Our organization has been exempted from state licensing by the State of Washington. (Proof of such exemption may be required) (g) If applicable, Unique Entity Identifier issued by SAM.gov: A Unique Entity Identifier is required if the solicitation uses federal funds. (h) If applicable, Washington State Office of Minority and Women’s Business Enterprises (OMWBE) Certification Number. For more information: http://www.omwbe.wa.gov. 3. ADDITIONAL INFORMATION IMPORTANT: If Bidder answers YES to any question in this Section 3, Bidder is required to submit the additional response materials as described below the question. A Bidder’s failure to provide this information may cause HCA to consider their Proposal non-responsive and reject it. HCA RFP No.