5-02 Required Form-Proposer Information Form.pdf
PDF 176 KB Posted
- Attached to
- Onsite Fuel Services
- Solicitation number
- RFP #13-01-27
- Issued by
- Bastrop County, Texas
About this file
This is a Proposer Information Form for RFP #13-01-27 Onsite Fuel Services issued by the City of Temple, Texas. The Request for Proposals seeks to establish an annual services agreement for the purchase and delivery of onsite fuel, including gasoline and diesel, on an as-needed basis. The form requires proposers to submit company information, acknowledge receipt of any addenda issued through the Euna e-procurement portal, and authorize the City to conduct credit checks to determine financial responsibility before contract award. Proposers must identify authorized personnel authorized to represent their firm regarding the proposal and any resulting contract, confirm their ability to execute the attached Services Agreement and comply with specified insurance requirements, and disclose any exceptions taken to RFP terms.
The form establishes compliance requirements for various federal regulations and statutes, including the Davis-Bacon Act for construction contracts exceeding $2,000, the Contract Work Hours and Safety Standards Act for contracts exceeding $100,000 involving mechanics or laborers, the Clean Air Act and Federal Water Pollution Control Act for contracts exceeding $150,000, and the Byrd Anti-Lobbying Amendment for awards exceeding $100,000. Proposers must certify compliance with all federal, state, and local laws, rules, regulations, and ordinances. The form requires an authorized signature, printed name, title, and date from the proposer's representative to validate the submission and acknowledge all terms and conditions outlined in the solicitation.
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Text version
RFP #13-01-27 Onsite Fuel Services 19
FORM 5.1. – PROPOSER INFORMATION FORM
1. Company Information
Company Name: ________________________________________________________
Business Address: ______________________________________________________
Remit-to Address, if different: ______________________________________________
Tax Identification Number: _________________________________________________
Contact Person: ________________________________________________________
Phone: _______________________________________________________________
Email: ________________________________________________________________
2. Addenda
Our company has reviewed and formally acknowledges receipt of all addenda, if any, provided in the Euna e-procurement portal. Please record the number of addenda acknowledged here:
____________ (number of addenda acknowledged)
3. Credit Check Authorization
The City is required to determine whether a Proposer who may be awarded a contract is financially responsible. The City may run a credit check on the potential vendor before award of the contract. By signing this Proposer Information Form, I hereby authorize the City of Temple, credit bureau, or other investigative agency employed by the City of Temple to investigate my credit history and financial responsibility.
4. Authorized Personnel
State your firm’s personnel authorized to give representations regarding your proposal or resulting contract, if any:
Name Phone Number Email Address
RFP #13-01-27 Onsite Fuel Services 20
5. Agreement
The successful Proposer shall be able to execute the attached Services Agreement and be able to comply with the insurance requirements as stated within the agreement.
Please confirm your ability to execute this agreement.
____________ (initial to confirm)
6. Exceptions Taken by Proposer State exceptions taken to any of the terms of this RFP, if any.
7. Authorization
Authorized Signature: ____________________________________________________
Print Name: ____________________________________________________________
Title: ___________________________________ Date: _______________________
| b. Termination for Cause or Convenience for Contracts Exceeding $10,000 |
| c. Equal Employment Opportunity |
| Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of “federally assisted construction contract” in 41 CFR Part 60-1.3 shall be deemed to include the equal opportunity clause provided under 41 CFR 60-1.4(b), in a... |
| d. Davis-Bacon Act as amended (40 U.S.C. 3141-3148) |
| When required by Federal program legislation, all prime construction contracts in excess of $2,000, Vendor shall comply with the Davis-Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, “L... |
| The City must place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation. Vendor agrees that for any purchase to which this requirement applies, the award is conditioned upon Vendor’s acceptance of... |
| Vendor further agrees that it shall comply with the Copeland “Anti-Kickback” Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, “Contractors and Subcontractors on Public Building or Public Work Financed in Whole o... |
| e. Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708) |
| Where applicable, all contracts awarded by the City in excess of $100,000 that involve the employment of mechanics or laborers, Vendor agrees to comply with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). U... |
| f. Rights to Inventions Made Under a Contract or Agreement |
| If the Federal award meets the definition of “funding agreement” under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assi... |
| g. Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended. |
| Where applicable, all contracts awarded by the City in excess of $150,000, Vendor agrees to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control... |
| h. Debarment and Suspension (Executive Orders 12549 and 12689) |
| A contract award (see 2 CFR 180.220) must not be made to parties listed on the government-wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 19... |
| i. Byrd Anti-Lobbying Amendment (31 U.S.C. 1352) |
| Vendors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or att... |
| Vendor agrees to comply with all federal, state, and local laws, rules, regulations and ordinances, as applicable. It is further acknowledged that vendor certifies compliance with all provisions, laws, acts, regulations, etc. as specifically noted above. |
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