4-ITB-04-Authorized Signature and Questionnaire-1.pdf
PDF 132 KB Posted
- Attached to
- ITB - Bulk Chemicals
- Solicitation number
- 26-0231
- Issued by
- Tarrant County, Texas
About this file
This is an Authorized Signature and Questionnaire form for the City of Fort Worth, Texas Purchasing Division for ITB Reference #26-0231 regarding Bulk Chemicals procurement for the Water Department on an "as needed" basis. The form serves as the binding proposal document through which bidders authorize a representative to commit their company to fulfilling the contract terms and specifications outlined in the solicitation packet. Bidders must provide comprehensive company information including legal name, federal identification number, address, and authorized representative details along with three designated contact persons and their respective contact information.
The questionnaire component requires bidders to disclose operational and compliance information including length of time in business, involvement in litigation or criminal investigations with the City, willingness to participate in cooperative purchasing arrangements with other governmental entities, prompt payment discount terms offered, and proprietary information designations. Additional mandatory disclosures include company email response time, years of experience providing the specified goods, business hours of operation, and submission of a recently certified chemical analysis with the bid. Bidders must also confirm their ability to meet delivery timeframes specified in the bid specifications or provide detailed explanations for any inability to do so. All responses must be thorough and complete for the proposal to be considered responsive to the solicitation requirements.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 6-ITB-02-Standard Purchasing Terms and Conditions.pdf | ||
| 2-ITB-05-CFW Required Forms.pdf | ||
| 5-ITB-03-Specifications.pdf | ||
| 3-ITB-06-Reference Sheet.pdf | ||
| 1-ITB-01 Instruction to Bidders.pdf | ||
| 7-ITB-07-Consideration of Location of Bidder.pdf | ||
| 8-ITB-08-Discount Calculator.xlsx | XLSX spreadsheet |
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION
AUTHORIZED SIGNATURE AND QUESTIONNAIRE
ITB Ref. #: 26-0231 Doc. Ref#: ITB-04 Page 1 of 3 ITB Title: Bulk Chemicals
City of Fort Worth Bidder/Supplier ID:____________________________________ Legal Name of Proposer:
D/B/A Name of Proposer:
Federal Id Number (TIN):______________________________________________ Address:
Name of the Authorized Representative: __________________________________ Title: _____________________________________________________________ The undersigned, by his/her signature, represents that he/she is submitting a binding Proposal and is authorized to bind the respondent to fully comply with the solicitation document contained herein. The Respondent, by submitting and signing below, acknowledges that he/she has received and read the entire document packet for this RFP and agrees to be bound by the terms therein.
The undersigned agrees if the Proposal is accepted, to furnish any and all items and/or services upon which prices are offered, at the price(s) and upon the terms, conditions, and scope/specifications contained in this RFP.
Signature of the Authorized Representative: _____________________________ Email: Phone:
Name of Contact Person - 1:
Title of Contact Person - 1:
Email: Phone:
Name of Contact Person - 2:
Title of Contact Person - 2:
Email: Phone:
Name of Contact Person - 3:
Title of Contact Person - 3:
Email: Phone:
ITB Ref. #: 26-0231 Doc. Ref#: ITB-04 Page 2 of 3
Please answer each question below thoroughly. Responses to the questions will be used to assess the Proposal’s responsiveness. Bidders may use a separate sheet if needed, as long as each answer is labeled with the corresponding question number.
1.0 Length of time in business: _______________________________________
2.0 Is your business or any of its principals currently involved in litigation adverse to the City? Yes_______ No________
3.0 Is your business or any of its principals under criminal investigation?
Yes_______ No________ Have you answered Yes to either Question 1 or 2 above? Please provide the details outlining the situation on a separate document with the submission of this form.
4.0 Cooperative Purchasing - 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________
5.0 Prompt Payment Discount Terms: ____ Percent _______ Days (i.e. 3% Net 15, etc.)
6.0 Proprietary Information - If a Bidder believes certain information in their proposal is proprietary and wishes to prevent its disclosure, they must clearly identify those pages and information in the chart below, for more information see RFP-01, Section 15.4.
Pages with information believed to be Proprietary
Please indicate if only specific sections on the page are believed to be Proprietary
7.0 What is your company’s response time to e-mails?________________
8.0 How many years of experience do you have providing these
goods?______________________________
9.0 What are your business hours and days? ______________________
10.0 Please provide a recently certified chemical analysis of your product with the bid.
ITB Ref. #: 26-0231 Doc. Ref#: ITB-04 Page 3 of 3
11.0 Can you successfully deliver orders within the timeframe specified in the bid specifications? If not, please explain why not.
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