11-Part G - Attachment A - Authorized Signatory Statement.pdf
PDF 147 KB Posted
- Attached to
- Transportation Stipend Card Management Services
- Solicitation number
- 2017
- Issued by
- Alexandria City, Virginia
About this file
This is an Authorized Signatory Statement form from the City of Alexandria, Virginia, related to a Request for Proposals (RFP 2017) for Transportation Stipend Card Management Services. The document serves as a certification and binding submission by an authorized representative of the responding firm, confirming that the signatory has full authority to submit the response on behalf of the respondent and to bind the organization to all representations and requirements outlined in the solicitation documents. The respondent acknowledges reading, understanding, and agreeing to comply with all solicitation requirements, including instructions, specifications, scope, evaluation criteria, applicable terms and conditions, and all addenda issued by the City.
The form requires the signatory to certify several critical compliance matters, including that the response was prepared and submitted independently without collusion with other respondents, that no gratuities or kickbacks have been offered to City employees or officials, that the respondent maintains a drug-free workplace as required by Virginia law, and that all information submitted is true, complete, and accurate. The signatory must provide their name, title, the respondent's legal name, address, phone number, and email address. The purpose of the underlying solicitation is to establish a contract with a qualified firm to provide a comprehensive, secure, and scalable debit or prepaid card management solution for the City of Alexandria.
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City of Alexandria
Attachment A Authorized Signatory Statement
By signing below, the undersigned certifies and represents that:
1. Authority / Binding Offer: The undersigned is an officer, partner, member, manager, or duly authorized agent of the Respondent with full authority to submit this Response on behalf of the Respondent and to bind the Respondent to the representations made herein and to the requirements of this Solicitation.
2. Validity of Response: This Response constitutes a firm and valid submission for evaluation purposes and shall remain effective for the period stated in the Solicitation Documents, or, if no period is stated, for a reasonable period as determined by the City.
3. Acknowledgment of Solicitation Requirements: The Respondent acknowledges that it has read, understands, and agrees to comply with all requirements of the Solicitation Documents, including all instructions, specifications or scope, evaluation criteria, applicable terms and conditions, and all addenda issued by the City (as acknowledged by the Respondent).
4. No Collusion / Independent Submission: The Respondent certifies that this Response has been prepared and submitted independently and without collusion, consultation, communication, or agreement with any other respondent, bidder, or offeror regarding prices, qualifications, intent to submit, or response terms, except as expressly permitted by law. The Respondent understands that false certification may subject it to criminal and civil penalties.
5. Ethics in Public Contracting: The Respondent certifies that it has not offered, given, or agreed to give any City employee or official any gratuity, kickback, or thing of value in connection with this Solicitation and will comply with all applicable ethics in public contracting requirements
6. Drug-Free Workplace (when applicable): Where required by Virginia law and/or the Solicitation Documents, the Respondent certifies that it will provide and maintain a drug-free workplace during performance of any resulting contract and will include the required provisions in subcontracts.
7. Accuracy / Non-Misrepresentation: The Respondent certifies that all information submitted in its Response is true, complete, and accurate, and to the best of its knowledge and acknowledges that any material misrepresentation may result in rejection of the Response, termination of negotiations, termination for default, and/or other remedies available to the City.
Authorized Signature: Date:
Printed Name: Title:
Respondent Legal Name:
Address:
Phone/Email: _________________________________________________________________
No.:
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| Untitled |
| Date: |
| Printed Name: |
| Title: |
| Respondent Legal Name: |
| Address: |
| PhoneEmail: |
| Signature1_es_:signer:signature: |
| Solicitation Type: Request for Proposals |
| Solicitation Name_es_:sender: Transportation Stipend Card Management Services |
| Solicitation No_es_:sender: 2017 |
| Solicitation Abbreviation_es_:sender: RFP |
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