6-Part G - Attachment C - Required Information Form.pdf

236 KB Posted

Attached to
Transportation Services for the DOT Paratransit Program and City Programs
Solicitation number
2037
Issued by
Alexandria City, Virginia

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This is a Required Information Form (Attachment C) issued by the City of Alexandria, Virginia, as part of Request for Proposal No. 2037 for Transportation Services for the DOT Paratransit Program and City Programs. The form establishes mandatory submission requirements for all respondents participating in the solicitation. Respondents must complete organizational classification information, including designations as minority business firms, small business firms, partnerships, corporations, or sole proprietorships. The form requests comprehensive company information including business address, state of incorporation for corporate entities, and incorporation dates and charter numbers for Virginia Certificate of Authority holders.

All corporations are required to identify key officers including the President, Vice President(s), Secretary, Treasurer, and Registered Agent(s). Sole proprietorships and partnerships must provide owner names and addresses for all partners. The completed form requires certification through the signature of an authorized signatory with corresponding name and title. Foreign corporations intending to conduct business in Virginia must register with the State Corporation Commission in accordance with Section 13.1-757 of the Code of Virginia. The form serves as a baseline qualification and organizational documentation requirement that must be submitted with all proposals to establish bidder eligibility and corporate legitimacy for this transportation services contract opportunity.

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City of Alexandria

Attachment C

Required Information Form

Each Respondent must provide the following information:

1. Minority Business Firm Yes [ ] No [ ] Partnership Yes [ ] No [ ] Small Business Firm Yes [ ] No [ ] Corporation Yes [ ] No [ ] Sole Proprietorship Yes [ ] No [ ]

2. Partnerships* and Sole Proprietorships must provide the following information:

Name: __________________________________________________________ Address: __________________________________________________________ City and State: __________________________________________________________

* Partnerships must complete this information for all partners

3. Corporations must provide the following information:

State of Incorporation: ________________ Date of Incorporation: _________________ Charter Number of the Virginia Certificate of Authority: ___________________________ Foreign corporations desiring to transact business in the State of Virginia shall register with the State Corporation Commission in accordance with Section 13.1-757 of the Code of Virginia, as amended.

Corporations must provide the names of the following officers:

President: ____________________________________________________ Vice President: ____________________________________________________ Secretary: ____________________________________________________ Treasurer: ____________________________________________________ Registers Agent(s): ____________________________________________________

Bidder/Offeror Name: __________________________Date: ____________________________ Signature of Authorized Signatory: _________________________________________________ Name & Title of Authorized Signatory: ______________________________________________

Name:
Address:
City and State:
State of Incorporation:
Date of Incorporation:
Charter Number of the Virginia Certificate of Authority:
Corporations must provide the names of the following officers:
Vice President 1:
Vice President 2:
Vice President 3:
Registers Agents:
BidderOfferor Name:
Date:
Signature1_es_:signer:signature:
Signature2_es_:signer:signature:
Check Box3:
0:
0: Off
1: Off
1:
0: Off
1: Off
2:
0: Off
1: Off
3:
0: Off
1_es_:signature: Off
4:
1_es_:signature: Off
5:
1_es_:signature: Off
Enter Solicitation Type Abbreviation_es_:sender:
Enter Solicitiation Type_es_:sender: Request for Proposal
Enter Title_es_:sender: RFP No. 2037
Enter No_es_:sender:

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