3.0-Responsibility Responsiveness and Susceptibility Form.pdf

Rev. 12-18-2018

Responsibility, Responsiveness and Susceptibility Form

Solicitation: BPM003500

Description: Water Quality Sampling and Monitoring

Procurement Officer: Trish Lorenzen Signature: ________________

Offeror # (Used

During

Evaluation)

Offeror Name Exceptions (Y/N) [If Exceptions, note the

Exceptions here and note any status updates to

Offeror in response]Attachment 5B, Supplement

#1

Confidential (Y/N) [If Offeror Marked, then note what was marked Confidential and note any status updates to Offeror in response]

Offer $Amount #References

Provided

Subcontractor

Name(s)

Offer contained all

Attachment Forms

(Y/N) [identify any missing/not completed

Attachments]

Solicitation

Amendments

Acknowledged by

Supplier (Y/N)

Completion

Schedule Date

Proposed

Ranking after

Evaluation

Score after

Evaluation

Offeror has not had a contract within the last five

(5) years that was terminated for cause due to breach or similar failure to comply with the terms of the contract.

Offeror’s record of performance does not include factual evidence of failure to satisfy the terms of the Offeror’s agreements with any party to a contract. Factual evidence may consist of documented Contractor performance reports, customer complaints and/or negative references.

Offeror is legally qualified to contract with the State and the Offeror’s financial, business, personnel, or other resources, including subcontractors.

Offeror is legally qualified as neither the Contractor nor Key Personnel have been debarred, suspended or otherwise lawfully prohibited from participating in any public procurement activity, including but not limited to, being disapproved as a subcontractor of any public procurement unit or other governmental body.

Offeror promptly supplied all requested information concerning its responsibility.

Offer was sufficient to permit evaluation by the

State, in accordance with evaluation criteria identified in solicitation or other necessary offer components. Necessary offer components include:

attachments, documents/forms to be submitted with the offer, indication of the Offeror's intent to be bound, reasonable or acceptable

Offer was in conformance with the requirements contained in the Scope of

Work, Terms and

Conditions, and

Instructions for the

Solicitation including its

Amendments and all documents incorporated by reference.

Offer does not limit the rights of the State.

Offer does not include nor is is Offer subject to unreasonable conditions, to include conditions upon the State necessary for successful Contract performance. The State shall be the sole determiner as to the reasonableness of a condition.

Offer does not materially change the contents set forth in the Solicitation, which includes the Scope of

Work, Terms and

Conditions, or Instructions.

Offeror did not provide misleading or inaccurate information.

Harris Environmental N N Y Y Y Y Y N/A 3 527 Y Y Y Y Y Y Y Y Y Y Y

Blaine Tech Services N N Y Y Y Y Y N/A 4 450 Y Y Y Y Y Y Y Y Y Y Y

Tetra Tech N N Y Y Y Y Y N/A 1 643 Y Y Y Y Y Y Y Y Y Y Y

GLEC N N Y Y Y Y Y N/A 2 541 Y y y y y y y y y y Y

NOTES:

Enter "N/A" if does not apply

Need All of these to be "YES" (for Offer to be Responsible, Responsive, and Susceptible for award):