5-RFP-04-Authorized Signature and Questionnaire.pdf

CITY OF FORT WORTH - PURCHASING DIVISION

AUTHORIZED SIGNATURE AND QUESTIONNAIRE

RFP Ref. #: 26-0207 Doc. Ref#: RFP-04 Page 1 of 4

RFP Title: Traffic Signal Poles and Arms

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:

RFP Ref. #: 26-0207 Doc. Ref#: RFP-04 Page 2 of 4

RFP Title: Traffic Signal Poles and Arms

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 in 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 are your standard business hours and days?

RFP Ref. #: 26-0207 Doc. Ref#: RFP-04 Page 3 of 4

RFP Title: Traffic Signal Poles and Arms

8.0 What is the physical address of your facility (or the location that will be servicing this agreement)?

9.0 How many years has your firm been in the business of providing traffic signal poles and arms?

10.0 What is your firm’s standard response time to client…

10.1 Emails?

10.2 Phone calls?

11.0 How long does it take your firm to deliver an order (on average)?

12.0 Are the products offered by your firm manufactured by one of the approved manufacturers as outlined in RFP-02 Sec. 3.4?

13.0 Is your firm able to provide sealed engineering shop drawings if needed?

13.1 If you answered “no” to the above, please elaborate on why not below.

Yes No

Yes No

RFP Ref. #: 26-0207 Doc. Ref#: RFP-04 Page 4 of 4

RFP Title: Traffic Signal Poles and Arms

14.0 Is your firm able to meet the delivery specifications outlined in RFP-02 Sec.

4.3?

15.0 Does your company have experience filling contracts of similar volume to the projections for this bid? If so, please share this experience below. If not, please share how you will meet the estimated volume set forth in the bid.

16.0 Please describe your firm’s communication and service standards as they relate to this bid. Proposer may use a separate sheet if needed, as long as each answer is labeled with the corresponding question number.

NoYes