5-Form 3 Financial Questionnaire.pdf
PDF 98 KB Posted
- Solicitation number
- 3202600161
- Issued by
- Williamson County, Hughes Springs City, Texas
About this file
This is a Financial Questionnaire form required by the Texas Workforce Commission (TWC) Vocational Rehabilitation Division for bidders responding to a solicitation for assistive accessibility technology home modifications and equipment in Hutto, Texas. The form requires bidders to provide comprehensive financial and organizational information as part of their bid submission, including disclosure of any bankruptcy filings or criteria met within the past five years, current defaults on loan or financial agreements, pending sales or acquisition activities anticipated within twelve months of bid submission, and detailed ownership structure documentation showing corporate hierarchy, subsidiaries, affiliates, joint ventures, and strategic alliances with ownership percentages identified. Additionally, bidders must specify which entities will perform the majority of work under any resulting contract and describe the proposed operating structure for service delivery.
The questionnaire further requires bidders to disclose company founding and incorporation dates and states, headquarters and field office locations that may provide services under the contract, total employee counts both locally and nationally along with the locations from which project staff will be assigned, and any prior contract history with Texas state agencies including contract terms, duties performed, and specific agencies involved. These financial and organizational disclosures are designed to establish bidder qualifications, financial stability, and capacity to perform the single home modification and equipment project for the TWC VRD customer.
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Text version
FORM 3 – FINANCIAL QUESTIONNAIRE
Bidder name: ________________________
The Bidder must provide the following information. If more space is needed for the explanation, please attach additional page(s) as necessary:
a. Indicate if your company or any of its subsidiaries filed or met criteria for bankruptcy within the past five (5) years, if so, provide explanation.
b. Indicate if your firm is currently in default on any loan agreement or financial agreement institution, or other entity. If so, specify date(s), details, circumstances, and prospect resolution.
c. Identify if your company is currently for sale or involved in any transaction to expand or become acquired by another business entity during the next twelve (12) months following the Bid Submission Deadline. If so, explain the impact both in organization and company director.
d. Ownership structure (e.g., corporation, partnership, LLC, or sole proprietorship), including any wholly owned subsidiaries, affiliated companies, or joint ventures. (Please provide this information both in a narrative and as a graphical representation.)
1. If Bidder is an affiliate of, or has a joint venture or strategic alliance with, another company, Bidder must identify the percentage of ownership of each joint venture member or affiliate and the percentage of the parent company’s ownership. The entity performing the majority of the work under any Contract resulting from this Solicitation, throughout the duration of the Contract, must be the primary Bidder.
2. Finally, Bidder must provide its proposed operating structure for the services requested under this Solicitation and which entities (i.e., parent company, affiliate, joint venture, subcontractor) will be performing the services;
e. The year the company was founded and/or incorporated. If incorporated, please indicate the state where the company is incorporated and the date of incorporation;
f. The location of company headquarters and any field office(s) that may provide services for any resulting Contract under this Solicitation;
g. The number of employees in the company, both locally and nationally, and the location(s) from which employees will be assigned to TWC’s project.
h. Indicate whether the company has ever been in contract with any Texas state agency. If “Yes,” specify the contract term, for what duties, and with which agency.
FORM 3 – FINANCIAL QUESTIONNAIRE
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