15-3202600039 FORM 4-Financial Questionnaire.docx
DOCX document 27 KB Posted
- Attached to
- RFP 3202600039 CCRC Backup Generator
- Solicitation number
- 3202600039
- Issued by
- Travis County, Austin City, Texas
About this file
This is a Financial Questionnaire form for RFP 3202600039, issued by the Texas Workforce Commission (TWC) for the installation of a backup building generator at the TWC Criss Cole Rehabilitation Center (CCRC) located at 4800 North Lamar Boulevard in Austin, Texas. The form requires respondents to provide comprehensive financial and organizational information as part of the proposal submission process. Respondents must disclose any bankruptcy filings or criteria met within the past five years, current defaults on loan or financial agreements, pending sales or business transactions planned within twelve months following the submission deadline, and detailed ownership structures including subsidiaries, affiliated companies, and joint ventures with percentage ownership breakdowns.
Additionally, respondents must provide their company's founding year and state of incorporation, headquarters and field office locations, employee counts both locally and nationally, and assignment locations for project personnel. The form requires disclosure of any prior contracts with Texas state agencies, including contract terms, duties performed, and the specific agency involved. For joint ventures or affiliates, respondents must identify the entity performing the majority of work under the resulting contract and provide both narrative and graphical representations of their proposed operating structure for the generator installation project.
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Text version
FORM 4 – FINANCIAL QUESTIONNAIRE
3202600039 CCRC Backup Generator Respondent name: ________________________
The Respondent must provide the following information. If more space is needed for the explanation, please attach additional page(s) as necessary:
a. Indicate if your company or any of its subsidiaries filed or met criteria for bankruptcy within the past five (5) years, if so, provide explanation.
b. Indicate if your firm is currently in default on any loan agreement or financial agreement institution, or other entity. If so, specify date(s), details, circumstances, and prospect resolution.
c. Identify if your company is currently for sale or involved in any transaction to expand or become acquired by another business entity during the next twelve (12) months following the submission deadline. If so, explain the impact both in organization and company director.
d. Ownership structure (e.g., corporation, partnership, LLC, or sole proprietorship), including any wholly owned subsidiaries, affiliated companies, or joint ventures. (Please provide this information both in a narrative and as a graphical representation.)
1. If Respondent is an affiliate of, or has a joint venture or strategic alliance with, another company, Respondent must identify the percentage of ownership of each joint venture member or affiliate and the percentage of the parent company’s ownership. The entity performing the majority of the work under any Contract resulting from this Solicitation, throughout the duration of the Contract, must be the primary bidder.
2. Finally, Respondent must provide its proposed operating structure for the services requested under this Solicitation and which entities (i.e., parent company, affiliate, joint venture, subcontractor) will be performing the services;
a. The year the company was founded and/or incorporated. If incorporated, please indicate the state where the company is incorporated and the date of incorporation;
b. The location of company headquarters and any field office(s) that may provide services for any resulting Contract under this Solicitation;
c. The number of employees in the company, both locally and nationally, and the location(s) from which employees will be assigned to TWC’s project; and
d. Indicate whether the company has ever been in contract with any Texas state agency. If “Yes,” specify the contract term, for what duties, and with which agency.
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