19-Part G - Attachment A Fillable - Authorized Signatory Statement - RFP 2010.pdf
PDF 175 KB Posted
- Attached to
- Operation of Senior Congregate Programs
- Solicitation number
- 2010
- Issued by
- Alexandria City, Virginia
About this file
This is an Authorized Signatory Statement form for the City of Alexandria's Request for Proposals (RFP) No. 2010 for the Operation of Senior Congregate Programs in Virginia. The RFP seeks qualified proposers to coordinate and manage two senior centers that provide congregate meal programs. Proposers may submit proposals to operate either one or both senior centers and must identify which center(s) they intend to serve in their technical and cost proposals. For Senior Center II, proposers must additionally propose a viable site capable of serving an average of 60 participants daily. The solicitation requires an authorized signatory—an officer, partner, member, manager, or duly authorized agent of the responding organization—to execute this form, certifying the respondent's authority to submit the proposal and bind the organization to the solicitation requirements.
The signatory must certify that the response is a firm and valid submission prepared independently without collusion, that all information is true and complete, and that the respondent complies with applicable ethics in public contracting requirements and drug-free workplace provisions as required by Virginia law. The signatory statement serves as the official authorization document confirming the respondent's understanding of and agreement to comply with all solicitation documents, instructions, specifications, evaluation criteria, terms and conditions, and any issued addenda. False certifications may subject respondents to criminal and civil penalties, and material misrepresentations may result in response rejection, termination of negotiations, termination for default, or other remedies available to the City.
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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.:
| Date: |
| Printed Name: |
| Title: |
| Respondent Legal Name: |
| Address: |
| PhoneEmail: |
| Signature1_es_:signer:signature: |
| Solicitation Type: Request for Proposals |
| Solicitation Name_es_:sender: Operation of Senior Congregate Programs |
| Solicitation No_es_:sender: 2010 |
| Solicitation Abbreviation_es_:sender: RFP |
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