14-DC Statement of Disclosure.pdf

Statement of Disclosure

Respondent’s disclosures must fully answer all questions posed by Board. Such disclosure must be submitted at the time of the Qualifications Statement submission and included as a part of the Qualifications Statement.

For the purposes of this disclosure form:

1. “Respondent” means, and disclosure is required for, each Respondent and its constituent Persons (e.g.

members, firms, partners, joint ventures, or similar Persons), and all Subconsultants/Subcontractors (at any tier), and such Subconsultants’/Subcontractors’ constituent Persons (e.g. members, firms, partners, joint ventures, or similar Persons).

2. "Affiliate" means:

a. any Person that, directly or indirectly through one of more intermediate Persons, controls, is controlled by or is under common control with Respondent or its constituent Persons (e.g.

members, firms, partners, joint ventures, or similar Persons); or

b. any Person that, directly or indirectly through one of more intermediate Persons, controls, is controlled by or is under common control with Subconsultant/Subcontractor or its constituent Persons (e.g. members, firms, partners, joint ventures, or similar Persons).

3. “Person” includes but is not limited to, any individual, sole proprietorship, partnership, company, corporation, limited liability company, limited liability partnership, association, joint venture, or other entity of any nature whatsoever, including any successor (by merger or otherwise).

4. “Control” means that the controlling Person: (i) possesses, directly or indirectly, the power to direct or cause the direction of the management and policies of the controlled Person, whether through the ownership of voting securities or by contract or otherwise; or (ii) has direct or indirect ownership in the aggregate of fifty one (51%) or more of any class of voting or equity interests in the controlled Person.

The following information must be provided:

1. Please provide the names and business addresses of Respondent and each of Respondent’s officers, directors, managers, general partners, affiliates and other employees, agents or representatives for this project at Dallas/Fort Worth International Airport. Describe accurately, fully and completely their respective relationships with Respondent, including their ownership interests and their anticipated role in the management and operations of Respondent.

2. Please describe the general development of Respondent's business during the past ten (10) years, or such shorter period of time that Respondent has been in business.

3. List any legal claims, threatened litigation, demands, lawsuits, and administrative actions to which Respondent, including Respondent’s management, team members, key personnel, and supervisory personnel, is currently a party or has been a party (either as a plaintiff or defendant) during the past ten (10) years based upon fraud, theft, breach of contract, professional negligence, misrepresentation, safety, wrongful death or other similar conduct. For each of the foregoing, list all parties and indicate the role such party played and the transaction out of which it arose (e.g.

bonding company, insurance company, an owner, etc.). State the project giving rise to the matter, explain the basis for all claims, etc., and state whether a settlement was reached or a judgment was entered, specifying the terms of the settlement, judgment, fine, and/or penalty and identifying each party against whom a judgment was entered and/or fine or penalty was levied.

4. Provide details if Respondent has been charged with a criminal offense within the last ten (10) years.

5. Describe any investigations, administrative actions, warnings, citations or notices of violation which Respondent, including Respondent’s management, team members, key personnel, and supervisory level personnel, received from any government agency in connection with any of its/their work or professional license during the past ten (10) years (including the determination of liability and amount of any judgment, settlement, or fine/penalty). Include OSHA violations, except for de minimis dollar amounts.

6. Please state whether any of the following events have occurred in the last ten (10) years with respect to Respondent. If any answer is yes, explain fully the circumstances surrounding the subject matter of the affirmative answer:

(a) Whether Respondent, or affiliate currently or previously associated with Respondent, has ever filed a petition in bankruptcy, taken any actions with respect to insolvency, reorganization, receivership, moratorium or assignment for the benefit of creditors, or otherwise sought relief from creditors.

(b) Whether Respondent, or affiliate currently or previously associated with Respondent, was subject of any order, judgment or decree not subsequently reversed, suspended or vacated by any court permanently enjoining Respondent from engaging in any type of business practice.

(c) Whether Respondent, or affiliate currently or previously associated with Respondent, was the subject of any civil or criminal proceeding in which there was a final adjudication adverse to Respondent which directly arose from activities conducted by Respondent which submitted a bid, proposal or qualifications statement for the subject project.

(d) Whether Respondent, or affiliate currently or previously associated with Respondent, has been debarred or suspended from the participation in any procurement conducted by any governmental entity or other legal entity engaged in competitive public procurements.

(e) Past termination(s) of Respondent’s management, team members, key personnel, and supervisory personnel.

7. State whether any employee, agent or representative of Respondent who is or will be directly involved in the Services, in the last ten (10) years: (i) has or had, directly or indirectly, a business relationship with Board; (ii) directly or indirectly has received revenues from Board or

(iii) directly or indirectly has received revenues from conducting business on Board property or pursuant to any contract with Board.

8. State whether any employee, agent or representative of Respondent who is or will be directly involved in the project has or had within the last ten (10) years a direct or indirect business relationship with any elected or appointed Board official or with any Board employee.

9. List:

(a) any current contract under which Respondent or an Affiliate (as a prime contractor or Subcontractor/Subconsultant) provides work or services to Board or any Person doing business at the Airport; and

(b) pending contract (e.g. not finalized and executed) under which Respondent or an Affiliate (as a prime contractor or Subcontractor/Subconsultant) will provide work or services to Board or any Person doing business at the Airport.

10. List any other Board solicitations (including those being done or that will be done on Board’s behalf;

e.g. Construction Manager at Risk procurements under Chapter 2269 of the Texas Government Code) that Respondent or an Affiliate (as a prime contractor or Subcontractor/Subconsultant) is currently participating in or intends to participate in during the next 6 months.

NOTE: Respondent may complete this Disclosure and Questionnaire Form by answering the questions on a separate submittal that is organized according to the numbered inquiries in this form. In addition to providing detailed narrative answers to the questions posed in this Disclosure and Questionnaire Form, Respondent may attach any other documents that may provide information responsive to the subjects addressed in this form.

Under penalty of perjury, I declare that I have examined this Disclosure and Questionnaire Form and all attachments to it, if applicable, and, to the best of my knowledge and belief, and all statements contained in it and all attachments, if applicable, are true, correct and complete.

Corporate Respondent:

Signature:

Name:

Title:

Non-Corporate Respondent:

Signature:

Name:

Title: