12-VENDOR DISCLOSURE FORM.pdf

Vendor Disclosure/Litigation History

Harris County will consider a vendor’s litigation history information in its review and determination of responsibility. Vendors are required to disclose all cases noticed on, filed, pending, settled or otherwise resolved against vendor or any subsidiary in any jurisdiction within the last five (5) years whether such case(s) was brought by or against the vendor, any parent or subsidiary of the vendor or any predecessor organization. If vendor is a joint venture, the information provided should encompass the joint venture (if it is not newly-formed for purposes of responding to the solicitation) and each of the entities forming the joint venture.

For purpose of Attachment j – Vendor Disclosure requirement, a “case” shall include lawsuits or settlements

(whether by mediation, arbitration, or court ordered) and include any governmental investigation to which the vendor or its directors, officers, or employees have been officially or unofficially been notified. A case should be included if it relates, in whole or in part, to the vendor in any manner whether civil, criminal, mediation/arbitration or bankruptcy, including but not limited to:

a. Any allegation of negligence, misconduct, erroneous invoicing practices, errors or omissions against the vendor or any of its principals or agents;

b. Any breach of contract;

c. Any vendor default, termination, suspension, failure to perform or improper performance, and applicable assessment of damages (state type, amount and resolution);

d. Any allegations or investigation brought by another governmental entity [federal, state, or local] in which the vendor or its principles, officers, or employees are named;

e. Any bankruptcy petition (voluntary or involuntary) or receivership or

f. Any criminal proceeding or hearing in which the vendor or its principals (including officers or employees) were/are defendants.

Although the review of a vendor's litigation history is an issue of responsibility, the failure to provide litigation history as required in the Evaluation Criteria may result in a disqualification of your response to this solicitation. For each case, vendor is required to provide all information herein identified, on

Attachment j – Vendor Disclosure.

If you have any questions concerning a disclosure, do not hesitate to contact the Office of the Harris County

Purchasing Agent.

Vendor Disclosure

Vendor Disclosure

Job No.____________

INVESTIGATION/CASE

SYNOPSIS

Vendor: __________________________________________

Vendor’s Parent Company: __________________________

Vendor’s Subsidiary Company: _______________________

Vendor’s Predecessor Organization: ___________________

Party (note in claim or counter) Plaintiff Defendant

Case Name

Case Number

Date Filed

Name of Court, Tribunal or

Investigative Agency

Type of Case

Civil Criminal Investigation

Mediation/Arbitration Bankruptcy

Claim or Cause of Action and

Brief description of each Count

Brief description of the Subject

Matter and Project Involved

Disposition of Case

Judgement

Pending Settled Dismissed

Vendor’s Favor Against Vendor

If Judgement Against, is

Judgment Satisfied?

Yes No

Damages Assessed? Yes No

Damages Type, Amount and

Brief description of cause and resolution

Brief summary to ensure how same issues do not occur with resulting contract