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

CITY OF FORT WORTH - PURCHASING DIVISION

AUTHORIZED SIGNATURE AND QUESTIONNAIRE

RFP Ref. #: 26-0068 Doc. Ref#: RFP-04 Page 1 of 4 RFP Title: Cast Iron Valve Boxes and Lids

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. #: 26-0068 Doc. Ref#: RFP-04 Page 2 of 4

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 Does your firm have at least two years of experience?

RFP Ref. #: 26-0068 Doc. Ref#: RFP-04 Page 3 of 4

8.0 Are you able to provide documentation confirming that all cast iron products meet ASTM A48, Class 35?

9.0 How does your firm handle backorders, discontinued items, substitutions, and warranty claims?

10.0 Are all items new, unused, and of recent production?

11.0 A proposal may be deemed to be non-responsive and may be disqualified, at the City’s discretion, if the Proposal fails to include all requested documents.

Are all required documents, response forms, and technical response documents attached to your submission? Yes__ No__

12.0 Can you successfully deliver the items to the locations listed in section 4.1 of RFP-02-Scope of Services? Yes__ No__ If not, please explain why.

RFP Ref. #: 26-0068 Doc. Ref#: RFP-04 Page 4 of 4

13.0 Did you make any changes to RFP-03-Drafts Vendor Service Agreements? If so, what?

14.0 Are you the manufacturer or distributor of the proposed products? If distributor, identify the manufacturer.

15.0 Are you able to provide same day delivery? If not, why?

16.0 Please list all cities, counties, or other municipalities your company has or currently holds a contract with as it relates to this solicitation’s scope of service.

17.0 What is your standard delivery time?