5-RFP-04-Authorized Signature and Questionnaire (1).docx
DOCX document 44 KB Posted
- Attached to
- RFP Lab Supplies
- Solicitation number
- 26-0031
- Issued by
- Tarrant County, Texas
About this file
This is an Authorized Signature and Questionnaire form for RFP 26-0031 issued by the City of Fort Worth Purchasing Division for laboratory supplies to support the Water Department on an as-needed basis. The form requires the authorized representative of the bidding organization to certify that they are authorized to bind the respondent to the terms and conditions outlined in the solicitation document. Bidders must provide company information including legal name, Federal ID number, address, and contact details for up to three designated representatives. The form does not specify quantities, response dates, due dates, site visits, bidders' conferences, award dates, or contract term information.
The questionnaire portion requires bidders to disclose their length of time in business, any ongoing litigation or criminal investigations involving the business or its principals, willingness to extend contract terms to other governmental entities under cooperative purchasing arrangements, and prompt payment discount terms. Bidders must also identify any pages or specific information within their proposals that they consider proprietary and wish to protect from disclosure. The form provides space for bidders to submit additional questions related to their bid. No specific pricing guidance, set-asides, incumbent information, funding amounts, or contract renewal options are detailed within this document.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-RFP-01-Instruction to Proposers.pdf | ||
| 2-RFP-06-Small Business Utilization Form V1.docx | DOCX document | |
| 6-RFP-08-Deviations.xlsx | XLSX spreadsheet | |
| 4-RFP-03-Draft Vendor Services Agreement.docx | DOCX document | |
| 9-RFP-09-Discount Calculator.xlsx | XLSX spreadsheet | |
| 8-RFP-02-Scope of Services26-0031.pdf | ||
| 1-RFP-05-Forms.pdf | ||
| 7-RFP-07-Reference Sheet.docx | DOCX document |
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION AUTHORIZED SIGNATURE AND QUESTIONNAIRE
| RFP Ref. #: 26-0031 |
| Doc. Ref#: RFP-04 |
| Page 1 of 2 |
RFP Title: Laboratory Supplies
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:
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 Add any questions pertaining to your bid starting here.
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