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

CITY OF FORT WORTH - PURCHASING DIVISION

AUTHORIZED SIGNATURE AND QUESTIONNAIRE

RFP Ref. #: 26-0104 Doc. Ref#: RFP-04 Page 1 of 6

RFP Title: Grease Trap Cleaning and Waste Removal Services

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. #: 26-0104 Doc. Ref#: RFP-04 Page 2 of 6

RFP Title: Grease Trap Cleaning and Waste Removal Services

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 Does your firm have a minimum of five (5) years providing grease trap and waste tank cleaning services as a business?

Yes No

RFP Ref. #: 26-0104 Doc. Ref#: RFP-04 Page 3 of 6

RFP Title: Grease Trap Cleaning and Waste Removal Services

7.1 How many years has your firm provided these services as a business?

8.0 Does your firm maintain a hazardous waste treatment, storage, or disposal facility, trucks, solid waste landfills and/or industrial service center that meets Texas Commission on Environmental Quality (TCEQ) Type V certification?

Yes No

8.1 If above answer is no, please provide the name and address of the waste disposal site being utilized.

9.0 Is your firm’s place of business within a fifty (50) mile radius of the City?

10.0 Is your firm able to respond to routine service requests within twenty-four

(24) hours of notification?

Yes No

11.0 Is your firm able to respond to emergency service requests within four (4) hours of notification?

Yes No

12.0 Does your firm have an extended tank hose of seventy (70) feet or more in length?

Yes No

13.0 Is your firm able to provide services seven (7) days a week?

14.0 How long has your firm operated under its present name?

15.0 Please list any former names your organization has operated with, along with what years the name was used.

RFP Ref. #: 26-0104 Doc. Ref#: RFP-04 Page 4 of 6

RFP Title: Grease Trap Cleaning and Waste Removal Services

16.0 What is the physical address of your facility?

17.0 What are your standard business hours and days?

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

18.1 Emails?

18.2 Phone calls?

18.3 Emergency service requests?

18.3.1 How long does it take your firm to have someone on-site for an emergency service request?

19.0 Please summarize the equipment that your firm will use to service this contract:

Equipment Owner or Leased?

Committed to Another Project?

Available / Release Date

RFP Ref. #: 26-0104 Doc. Ref#: RFP-04 Page 5 of 6

RFP Title: Grease Trap Cleaning and Waste Removal Services

20.0 Please describe your firm’s standard process for cleaning and waste removal for grease traps.

21.0 Please describe your firm’s process for cleaning and waste removal for septic/waste tanks.

22.0 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.

RFP Ref. #: 26-0104 Doc. Ref#: RFP-04 Page 6 of 6

RFP Title: Grease Trap Cleaning and Waste Removal Services

23.0 Please list any key personnel for performing services as well as their qualifications (e.g. job title, licenses, certifications, qualifications). Proposer may use a separate sheet if needed, as long as each answer is labeled with the corresponding question number. Response may be used to help score

RFP-02 Sec. 7.2.3.

24.0 Please describe your firm’s capabilities and experience as it relates to this bid. Proposer may use a separate sheet if needed, as long as each answer is labeled with the corresponding question number. Response may be used to help score RFP-02 Sec. 7.2.2 or 7.2.4.