6-RFP-04-CFW Required Forms.docx
DOCX document 48 KB Posted
- Attached to
- RFP Large Vehicle Subrogation
- Solicitation number
- 26-0297
- Issued by
- Tarrant County, Texas
About this file
This is a Required Forms and Questionnaire document for an RFP issued by the City of Fort Worth, Texas, seeking proposals for large vehicle subrogation and claims recovery services. The RFP (Reference #26-0297) requests vendors to provide comprehensive claims recovery and subrogation services for the Financial Management Services Department on an "as needed" basis. Prospective bidders must submit completed forms including company identification, authorized representative signatures, and documentation acknowledging receipt and acceptance of all RFP terms and conditions. The submission requires at least three references for similar services performed within the past five years, with governmental or public-sector references preferred, though the City of Fort Worth itself cannot be used as a reference.
The questionnaire requires vendors to disclose any current litigation or criminal investigations involving their business or principals, confirm willingness to extend contract terms and pricing to other governmental entities under cooperative purchasing arrangements, and provide prompt payment discount terms. Vendors must demonstrate relevant experience and capabilities, including years of operation providing claims recovery and subrogation services, specific experience with large vehicles, commercial fleets, heavy equipment, and specialty vehicles, ability to review and pursue recovery from historical or previously closed claims, and current contingency-based service capabilities. The document requests identification of any proprietary information included in submissions and establishes a structured evaluation framework for assessing bidder qualifications and responsiveness to the City's requirements.
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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 | |
| 8-RFP-02-Scope of Services.docx | DOCX document | |
| 4-RFP-03-Draft Vendor Services Agreement (1).pdf | ||
| 1-RFP-05-Forms.pdf | ||
| 7-RFP 26-0279 Bid Table.xlsx | XLSX spreadsheet | |
| 5-RFP-07-Deviations.xlsx | XLSX spreadsheet |
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Text version
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 provide at least three (3) references for services of similar size and scope involving large vehicle claims recovery, subrogation, and related services performed within the last five (5) years. Governmental or public-sector references are preferred, where available. The City of Fort Worth may not be used as a reference.
1. Company’s Name:
| Name of Contact: | |
| Title of Contact: | |
| Address: | |
| Phone No. | Email: |
| Length of Contract: | |
| Type of Services Provided: |
2. Company’s Name:
| Name of Contact: | |
| Title of Contact: | |
| Address: | |
| Phone No. | Email: |
| Length of Contract: | |
| Type of Services Provided: |
3. Company’s Name:
| Name of Contact: | |
| Title of Contact: | |
| Address: | |
| Phone No. | Email: |
| Length of Contract: | |
| Type of Services Provided: |
Please answer each question below thoroughly. Responses to the questions will be used to assess the submission’s responsiveness. Proposers may use a separate sheet if needed, as long as each answer is labeled with the corresponding question number.
| 1. | Is your business or any of its principals currently involved in litigation adverse to the City? | |
| Yes | No | |
| 2. | Is your business or any of its principals under criminal investigation? | |
| Yes | No |
If 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.
| 3. | 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 |
| 4. | Prompt Payment Discount Terms: ____ Percent _______ Days (e.g. 3 Percent Net 15 Days) |
| 5. | Proprietary Information - If a Proposer believes certain information in their submission 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-Instructions to Proposers, Section 15.4. |
| Pages with information believed to be Proprietary | |
| Please indicate if only specific sections on the page are believed to be Proprietary |
CITY OF FORT WORTH - PURCHASING DIVISION REQUIRED FORMS AND QUESTIONNAIRE
| RFP Ref. #: 26-0297 |
| Doc. Ref#: RFP-04 |
| Page 1 of 2 |
RFP Title: Large Vehicle Subrogation
6.
7. How many years has your firm provided claims recovery and/or subrogation services?
8. Does your firm have experience providing claims recovery or subrogation services involving large vehicles, commercial fleets, heavy equipment, or specialty vehicles?
Yes No
9. Does your firm have the capability to review and pursue recovery opportunities from historical or previously closed claims?
Yes No
10. Does your firm currently perform claims recovery or subrogation services on a contingency basis?
Yes No image1.jpeg
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