2-2A - BUSINESS INFORMATION FORM - OPS 2128.pdf

OFFICE OF PROCUREMENT SERVICES

BUSINESS INFORMATION FORM

OPS-FRM-2128 3/23/2022

Rev. 12.14.2021 Page 1 of 1

LEGAL NAME AND ADDRESS OF BUSINESS

Please Do Not Use All Caps

Business Name:

Parent Company:

Street Address, City, State, Zip:

County:

Contact Name: Contact Telephone No.:

Contact E-mail Address:

FORM OF BUSINESS ENTITY (please check one) ☐ Texas Corporation ☐ Texas Professional Corporation ☐ Texas Non-profit Corporation

☐ Texas General Partnership ☐ Texas Limited Partnership ☐ Texas Limited Liability Company

☐ Out-of-State Corporation State of Incorporation: ☐ Profit ☐ Non-profit ☐ Out-of-State Partnership State of Legally Registered Partnership:

☐ Individual Doing Business As:

☐ Other:

Tax Identification No.: Texas Tax ID No.: DUNS No.:

Length of time in business:

1) Is your business or any of its principals currently involved in litigation adverse to the City? ☐ YES ☐ NO

2) Is your business or any of its principals under criminal investigation? ☐ YES ☐ NO Have you answered YES to either Question 1 or Question 2 above? Please provide the details outlining the situation on a separate document with the submission of this form.

OWNER(S) / OFFICER(S) OF THE COMPANY

Name: Title:

Name and title of person(s) legally authorized to sign contracts:

COOPERATIVE PURCHASING (please check one) Should other governmental entities decide to participate in this contract, would you, the vendor, agree that all terms, conditions, specifications, and pricing would apply? ☐ YES ☐ NO If you checked “YES,” the following will apply:

• Governmental entities utilizing Inter-Governmental Contracts with the City of Dallas will be eligible, but not obligated, to purchase material/services under a contract(s) awarded as a result of this solicitation.

• All purchases by governmental entities, other than the City of Dallas, will be billed directly to that governmental entity, and paid by that governmental entity.

• Each governmental entity will order its own material/services, as needed. The City of Dallas will not be responsible for another governmental entity’s debts.

ENVIRONMENTAL POLICY (please check) ☐ YES, I acknowledge and agree to comply with the City’s Environmental Policy found at the following link:

https://dallascityhall.com/departments/OEQ/Pages/contractors.aspx https://dallascityhall.com/departments/OEQ/Pages/contractors.aspx