Vendor Form

Congratulations! Let's get started. Please fill out this form and you'll be on your way. Vendor Information:
Company Contact:(This will appear on the TQHUB. )
Company Name:
Company Address:
Street:
City:
State:
Zip:
Company Phone:
	555-555-1234 x 1000
Company Website:
	www.domain.com
Current Member of TechQuest PA:	Yes No
Primary Contact(This will appear on the TQHUB. )
Phone:
Fax:
E-mail: (This will become your primary username)
Password: (Please create a password)
Confirm Password: (Please confirm your password)
Best method:	Phone E-mail
Secondary Contact (This will appear on the TQHUB. Content MUST be different from Primary Contact)
Phone:
Fax:
E-mail: (This will become your secondary username)
Password: (Please create a password)
Confirm Password: (Please confirm your password)
Best method:	Phone E-mail
Provider History:(This will appear on the TQHUB. )
Years in Business:
Employees: (W2 Employess)
Contractors: (W9 Employees)
Yearly Revenue:
Organization Type:
Please indicate the services you offer: (This will appear on the TQHUB. )
Communication services and devices Recent Project Description Optional Broadband service provider* Recent Project Description Optional Broadband consultant* Recent Project Description Optional Computer software Recent Project Description Optional Computer back Up Recent Project Description Optional Data migration services Recent Project Description Optional Call center services Recent Project Description Optional IT Break/Fix services for maintenance & repair Recent Project Description Optional IT interface specialist service providers Recent Project Description Optional IT project management specialist and service providers Recent Project Description Optional IT implementation providers and services Recent Project Description Optional Green IT consulting services Recent Project Description Optional GIS tracking and service providers (Geospatial Information Systems) Recent Project Description Optional Enterprise Architecture Design Services & Information Technology Systems Recent Project Description Optional Disaster recovery service providers Recent Project Description Optional Business continuity service providers Recent Project Description Optional Strategic IT consultation services Recent Project Description Optional Cyber-security and business assurance providers and services Recent Project Description Optional Cyber-security consultant Recent Project Description Optional Organizational change management Recent Project Description Optional Workforce training Recent Project Description Optional Workflow analysis Recent Project Description Optional Physician office management systems and services Recent Project Description Optional Staffing, Jobs, and Placements* Recent Project Description Optional Internships* Recent Project Description Optional Internships and connections with academia (TechQuest Internships)* Recent Project Description Optional Temporary CIO providers and services Recent Project Description Optional Health Information Exchange vendors Recent Project Description Optional Health Information Exchange software selection consultants Recent Project Description Optional Electronic Medical Records software selection consultants Recent Project Description Optional Software integrator Recent Project Description Optional Lawyers, Accountants and Service Providers Recent Project Description Optional Banks, financial firms and financing resources Recent Project Description Optional End Of Life - computer and technology recycling centers Recent Project Description Optional Agriculture IT software and Agriculture IT consulting Recent Project Description Optional Infrastructure software and infrastructure IT consulting Recent Project Description *Optional
References 1:
Name:
Phone:
E-mail:
References 2:
Name:
Phone:
E-mail:
References 3:
Name:
Phone:
E-mail:
Do you have at least 3 customer references from the main categories you selected above, that would provide endorsement of your company if requested during a sales inquiry?
Yes No
About Us:
Briefly describe your technology product or what you trying to sell as a company (300 words max)

You have words left.

Terms of Use: View Terms and Conditions
I. INTRODUCTION A. TechQuest PA (TQ PA) is the catalyst for sustained growth in technology business development in Pennsylvania. We lead strategies that build strong industry partnerships, robust technology infrastructures, and strengthen our technology workforce in order to discover, demonstrate and deploy advanced technology and innovations across regions and the state. TQ PA's programs include TechQuest Internship, TechQuest-Workforce Training, the Pennsylvania Infrastructure Group, The Harrisburg Health Information Exchange (HHIE), and the Military Information eXchange MiX. B. In May 2009, TQ PA and the Harrisburg Health Information Exchange Advisory Board established the EMR/HIE Adoption and Usage Subcommittee. Its mission is to aid doctors and health care providers in implementing all aspects of electronic health systems. C. TQ-HUB shall: 1. Streamline the acquisition and implementation process of technology and technology-related services as a one-stop-shop 2. Provide access to vendors based on distinguishable service offering 3. Add value to health care providers by providing education and tools to institutionalize best practices 4. Showcase industry best practices for IT procurement II. REQUEST FOR INFORMATION A. This is a Request for Information (RFI) for the TechQuest Shared Services HUB (TQ-HUB). B. This RFI provides an opportunity for respondents to submit their ideas, capabilities and/or processes related to this request. C. This RFI is intended to speed the adoption and use of technology in PA. D. This RFI is intended to specifically speed the adoption and meaningful use of Electronic Medical Records (EMR) and Health Information Technologies (HIE) products and services into Pennsylvania. E. This RFI provides a cursory vetting process to better enable respondents and purchasers to seek, review and secure contracts for products and services. No certification or endorsement is created by this program. F. This RFI is issued solely for information and planning purposes. The RFI does not constitute a Request for Proposal (RFP) or a commitment to issue an RFP. TechQuest Pennsylvania (TQ-PA) does not intend to award a contract on the basis of this solicitation or to pay for any information, or otherwise reimburse responders for any costs associated with their respective submissions in response to this RFI. Any response will be treated as information only. It shall not be used as a proposal. G. This RFI shall be specifically utilized by TQ-PA's Electronic Medical Record (EMR)/Health Information Exchange (HIE) efforts to speed adoption and meaningful use and support for Pennsylvania physician offices and health care providers. Support consists, but is not limited to, commercial off the shelf software (COTS) providers, implementation of COTS software using traditional and Service Oriented Architectures (SOA) within the practices. Additionally, complete infrastructure support which includes but is not limited to, equipment upgrade, equipment purchase and installation, equipment maintenance, communication consulting required to maintain a secure IT network. H. Do not supply confidential information in the RFI submission. I. Hub Fees and Pricing: Vendors must be paid members of TQ-PA. They shall also pay a $500 annual fee to cover their participation in the HUB. The fee is payable upon application to the HUB and renewable annually on the anniversary date or sooner. Failure to maintain TQ membership, pay fee/or renewable fee, shall result in deletion of vendor name from the TQ-HUB. III. INDEMNIFICATION/HOLD HARMLESS A. The Contractor shall hold the Technology Council of Central Pennsylvania, also known as, TechQuest PA harmless from, and indemnify them against, any and all claims, demands, and actions based upon or arising out of any activities the Contractor and employees and agents may perform under any contracts arising from and through this program, website, or otherwise. At the request of TQ-PA, the Contractor shall defend any and all actions brought against TQ-PA based upon any such claims or demands. The Contractor shall hold TQ-PA harmless from any liability whatsoever arising out of the specifics of a Purchaser-issued PO under any contracts arising from and through this program, website, or otherwise. IV. REQUEST FOR INFORMATION A. You may submit an RFI response HUB categories listed at http://tqhub.higherinfogroup.com. B. Please provide an Executive Summary of your service areas of expertise. Additional electronic marketing material may be included as an appendix to your submission. (300 words or less) C. Three References, one page each, must be included with you submission. Submitted references may be contacted by members of TQ-PA and inquiring buyers. D. All information must be submitted to online at http://tqhub.higherinfogroup.com including the following response elements: 1. Responder organization's name and address; 2. Contact person name and secondary contact name, 3. Telephone and fax numbers, 4. E-mail 5. Web addresses 6. Executive summary 7. Vendor requested HUB categories 8. Three reference letters E. Submissions will be reviewed and accepted as they are received. F. Questions can be directed to Leigh Twiford at the following email address: (ltwiford@tccp.org)
I Accept (All the following information will be seen on the TQHUB.)