5-Part G - Attachment A Fillable - Authorized Signatory Statement - DRAFT 3-2-26.pdf
PDF 175 KB Posted
- Attached to
- Temporary Staffing Services
- Solicitation number
- 2022
- Issued by
- Alexandria City, Virginia
About this file
This is an Authorized Signatory Statement form issued by the City of Alexandria, Virginia, in connection with a Request for Proposals (RFP) for Temporary Staffing Services (Solicitation No. 2022). The form serves as a certification document that must be completed and signed by an authorized representative of each responding organization. The statement requires the signatory to confirm authority to submit the proposal on behalf of the respondent, validate that the response constitutes a firm and binding submission, and acknowledge full understanding of and compliance with all solicitation requirements, instructions, specifications, evaluation criteria, terms and conditions, and any addenda issued by the City. No specific response dates, due dates, site visits, bidder meetings, award dates, or contract terms are detailed in this document.
The form includes mandatory certifications regarding independence of submission without collusion with other respondents, compliance with ethics in public contracting requirements, non-provision of gratuities or kickbacks to City employees, maintenance of a drug-free workplace where applicable under Virginia law, and accuracy and truthfulness of all submitted information. Respondents acknowledge that material misrepresentation may result in rejection, termination of negotiations, termination for default, or other available remedies to the City. The form requires completion of fields for authorized signature, date, printed name, title, respondent legal name, address, and contact information for one or more authorized signatories.
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City of Alexandria
Attachment A Authorized Signatory Statement
By signing below, the undersigned certifies and represents that:
1. Authority / Binding Offer: The undersigned is an officer, partner, member, manager, or duly authorized agent of the Respondent with full authority to submit this Response on behalf of the Respondent and to bind the Respondent to the representations made herein and to the requirements of this Solicitation.
2. Validity of Response: This Response constitutes a firm and valid submission for evaluation purposes and shall remain effective for the period stated in the Solicitation Documents, or, if no period is stated, for a reasonable period as determined by the City.
3. Acknowledgment of Solicitation Requirements: The Respondent acknowledges that it has read, understands, and agrees to comply with all requirements of the Solicitation Documents, including all instructions, specifications or scope, evaluation criteria, applicable terms and conditions, and all addenda issued by the City (as acknowledged by the Respondent).
4. No Collusion / Independent Submission: The Respondent certifies that this Response has been prepared and submitted independently and without collusion, consultation, communication, or agreement with any other respondent, bidder, or offeror regarding prices, qualifications, intent to submit, or response terms, except as expressly permitted by law. The Respondent understands that false certification may subject it to criminal and civil penalties.
5. Ethics in Public Contracting: The Respondent certifies that it has not offered, given, or agreed to give any City employee or official any gratuity, kickback, or thing of value in connection with this Solicitation and will comply with all applicable ethics in public contracting requirements
6. Drug-Free Workplace (when applicable): Where required by Virginia law and/or the Solicitation Documents, the Respondent certifies that it will provide and maintain a drug-free workplace during performance of any resulting contract and will include the required provisions in subcontracts.
7. Accuracy / Non-Misrepresentation: The Respondent certifies that all information submitted in its Response is true, complete, and accurate, and to the best of its knowledge and acknowledges that any material misrepresentation may result in rejection of the Response, termination of negotiations, termination for default, and/or other remedies available to the City.
Authorized Signature: Date:
Printed Name: Title:
Respondent Legal Name:
Address:
Phone/Email: _________________________________________________________________
No.:
| Date: |
| Printed Name: |
| Title: |
| Respondent Legal Name: |
| Address: |
| PhoneEmail: |
| Signature1_es_:signer:signature: |
| Solicitation Type: Request for Proposals |
| Solicitation Name_es_:sender: Temporary Staffing Services |
| Solicitation No_es_:sender: 2022 |
| Solicitation Abbreviation_es_:sender: RFP |
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