AHP Request Form for Approval of BHWD Grantee CONSULTANT or SUBCONTRACTOR Agreement

AHP Request Form for Approval of BHWD Grantee CONSULTANT or SUBCONTRACTOR Agreement

This form is required for BHWD subcontractors and consultants receiving more than $5,000.00 from a BHWD grantee in one year.

If the value of the subcontract is more than $50,000 and the vendor was specified in the grantee’s original grant application, then the grantee does not need to submit anything else to AHP as the vendor was already approved when the grant was awarded.

Please complete this form prior to finalizing your subcontractor or consultant agreement. One form is required for each agreement per year.

Date*

Program*

Select or enter value

Grantee Agency Name*

Grantee Agency Contact Email*

Grantee Coach*

Select

Unique Site ID*

Vendor Name*

Vendor Point of Contact Name*

Vendor Email*

Vendor Address*

Was your vendor specified in your original grant application?*

Yes

Period of Performance*

(i.e.: M/D/YYYY-M/D/YYYY)

Subcontract/Consultant Value:*

Deliverable Description*

(Bullet points/100 words or less)

BHWD Grantee is responsible to ensure that this form has been sent and received by your Grantee Coach in a timely manner before proceeding with your Subcontractor or Consultant Agreement. Please keep a copy for your files.

If the value of your vendor subcontract is more than $50,000.00, you must complete the following section. If the value is $50,000.00 or less, then you may stop here and submit the form.

Instructions for Grantees with Vendor Subcontracts Valued at More than $50,000

If the value of subcontract is more than $50,000 and the vendor was specified in the grantee’s original grant application, then the grantee does not need to submit anything else to AHP as the vendor was already approved when grant was awarded.

If the value of subcontract is more than $50,000 and vendor was NOT specified in the grantee’s original grant application, then:

A) The grantee must show that they got at least 3 bids and submit the form for the selected vendor.

B) The grantee may request permission to not solicit bids, however a justification as to why the “sole sourced” vendor was chosen must be submitted, explaining the unique capabilities of the vendor that prompted the grantee to choose this vendor.

Vendor Names

Please list the names of the 2 vendors from which you got bids but did NOT select.

Justification*

Please provide your justification for selecting a vendor as a sole-source contract instead of getting 3 bids. Please explain why this particular vendor was chosen.

(No more than 150 words, bullet points acceptable).

Send me a copy of my responses

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