6-Vendor Questionnaire - Quotes and Bids.docx

VENDOR QUESTIONNAIRE

QUOTATION AND INVITATION TO BID

The completed Vendor Questionnaire should be submitted with the solicitation response. If not submitted with solicitation response, it must be submitted within three business days after County’s written request. Failure to timely submit this form may result in the Vendor being deemed nonresponsive.

If a response requires additional information, the Vendor should upload a written detailed response with submittal; each response should be labeled to match the question number.

1. Legal business name: Click or tap here to enter text.

2. Doing Business As/Fictitious Name (if applicable): Click or tap here to enter text.

3. Federal Employer I.D. No. (FEIN): Click or tap here to enter text.

4. Dun and Bradstreet No.: Click or tap here to enter text.

5. Website address (if applicable): Click or tap here to enter text.

6. Principal place of business address: Click or tap here to enter text.

7. Office location responsible for this project: Click or tap here to enter text.

8. Telephone No.: Click or tap here to enter text. Fax No.: Click or tap here to enter text.

9. Generic e-mail for purchase orders: Click or tap here to enter text.

(Broward County auto distributes purchase orders; to ensure Vendor receives purchase orders, a company accessible e-mail address is suggested.)

10. Type of business (check appropriate box):

☐ Corporation (specify the state of incorporation): Click or tap here to enter text.

☐ Sole Proprietor ☐ Limited Liability Company (LLC) ☐ Limited Partnership ☐ General Partnership ☐ Other – Specify: Click or tap here to enter text.

11. Specify the type of services or commodities Vendor offers: Click or tap here to enter text.

12. Years Vendor has been in business providing the services and/or products offered? Click or tap here to enter text.

13. Authorized Contact(s):

14. List name and title of each principal, owner, officer, and majority shareholder:

15. Is Vendor or any of its principals or officers currently a principal or officer of another organization? If yes, specify details in an attached written response. ☐ Yes ☐ No

16. Affiliated Entities of the Principal(s): List the names and addresses of “affiliated entities” of the Vendor’s principal(s) over the last five years (from the solicitation opening deadline) that have acted as a prime vendor with the County. Affiliated entities of the principal(s) are those entities related to the Vendor by the sharing of stock or other means of control, including but not limited to a subsidiary, parent, or sibling entity.

17. Has Vendor, or any of its principals, officers, or predecessor organization(s), been debarred or suspended by any government entity within the last three years? If yes, specify details in an attached written response. ☐ Yes ☐ No

18. Has Vendor ever failed to complete any services and/or delivery of products during the last three years? If yes, specify details in an attached written response. ☐ Yes ☐ No

19. Has a voluntary or involuntary bankruptcy petition been filed by or against Vendor, its parent, or any of its subsidiaries or predecessor organizations, during the last three years? If yes, specify details in an attached written response. ☐ Yes ☐ No

20. Has Vendor’s surety intervened to assist in the completion of a contract or have Performance and/or Payment Bond claims been made to Vendor’s or its predecessor’s sureties during the last three years? If yes, specify details in an attached written response, including contact information for owner and surety company.

☐ Yes ☐ No

21. Affirm Vendor is currently authorized by the manufacturer as a dealer/seller of the product(s) offered, and the warranty offered is the manufacturer’s warranty with Broward County recorded as the original purchaser? ☐ Yes ☐ No ☐ N/A (if service)

22. Will Vendor extend the same price, terms, and conditions to other governmental entities during the period covered by this contract? ☐ Yes ☐ No

23. Does Vendor accept a Visa credit card as payment from Broward County, with no additional fees or change to bid price? Procurement Contract must be approved and designated for procurement card (p-card) by Director of Purchasing for use prior to ordering. ☐ Yes ☐ No

24. Non-Collusion Certification: The Vendor must disclose, to their best knowledge, any Broward County officer or employee, or any relative of any such officer or employee as defined in Section 112.3135(1)(d), Florida Statutes, who is an officer or director of, or has a material interest in, the Vendor’s business, who is in a position to influence this procurement. Any Broward County officer or employee who has any input into the writing of specifications or requirements, solicitation of offers, decision to award, evaluation of offers, or any other activity pertinent to this procurement is presumed, for purposes hereof, to be in a position to influence this procurement. Failure of a Vendor to disclose any relationship described herein shall be reason for debarment in accordance with the provisions of the Broward County Procurement Code.

Select One:

☐ The Vendor certifies that this offer is made independently and free from collusion; or

☐ The Vendor is disclosing names of officers or employees who have a material interest in this procurement and is in a position to influence this procurement. The Vendor must include a list of name(s) and each relationship with its submittal.

25. Drug-Free Workplace Certification: In accordance with Section 287.087, Florida Statutes, whenever two or more submittals are tied, a submittal received from a Vendor that certifies it has implemented a drug-free workplace program shall be given preference in the award process.

The Vendor hereby certifies that: (only if Vendor is certifying that it currently complies, check box)

☐ The Vendor hereby certifies that it has established a drug-free workplace program in accordance with the requirements of Section 287.087, Florida Statutes, (“Preference to businesses with drug-free workplace programs”).

26. Participation in Solicitation Development: By submission of this solicitation response, the Vendor certifies as follows (select one):

☐ I have not participated in the preparation or drafting of any language, scope, or specification that would provide Vendor or any affiliate an unfair advantage of securing this solicitation.

☐ I have provided information regarding the specifications and/or products listed in this solicitation. If this box is checked, provide the following:

Name /Division information was provided to: Click or tap here to enter text.

Title: Click or tap here to enter text.

Date information provided: Click or tap here to enter text.

For what purpose was the information provided? Click or tap here to enter text.

Questions 27 through 30 are only applicable to service contracts or construction contracts (repair, maintain, or furnish and install) solicitations:

27. List similar ongoing contracts Vendor currently working on. If additional space is required, provide on separate sheet.

Click or tap here to enter text.

28. Has Vendor completely inspected the project site(s) prior to submitting its solicitation response?

☐ Yes ☐ No

29. Does Vendor need to rent or purchase any equipment for this contract? If yes, please specify details in an attached written response. ☐ Yes ☐ No

30. List equipment Vendor owns that is available for this contract.

Click or tap here to enter text.

31. Provide at least three individuals, corporations, agencies, or institutions for which Vendor has provided similar type of services or commodities in the past three years. Only provide references for non-Broward County contracts. For Broward County contracts, the County will review performance evaluations in its database for vendors with previous or current contracts with the County. The County considers references and performance evaluations in the evaluation of the Vendor’s past performance.

Reference 1:

Services/Commodity Provided: Click or tap here to enter text.

Contract/Project Title: Click or tap here to enter text.

Agency: Click or tap here to enter text.

Contact Name/Title: Click or tap here to enter text.

Contact Telephone: Click or tap here to enter text.

Email: Click or tap here to enter text.

Contract/Project Dates (Month and Year): Click or tap here to enter text.

Contract Amount: Click or tap here to enter text.

Reference 2:

Services/Commodity Provided: Click or tap here to enter text.

Contract/Project Title: Click or tap here to enter text.

Agency: Click or tap here to enter text.

Contact Name/Title: Click or tap here to enter text.

Contact Telephone: Click or tap here to enter text.

Email: Click or tap here to enter text.

Contract/Project Dates (Month and Year): Click or tap here to enter text.

Contract Amount: Click or tap here to enter text.

Reference 3:

Services/Commodity Provided: Click or tap here to enter text.

Contract/Project Title: Click or tap here to enter text.

Agency: Click or tap here to enter text.

Contact Name/Title: Click or tap here to enter text.

Contact Telephone: Click or tap here to enter text.

Email: Click or tap here to enter text.

Contract/Project Dates (Month and Year): Click or tap here to enter text.

Contract Amount: Click or tap here to enter text.

I hereby certify the information provided in this Vendor Questionnaire is true and correct*:

Vendor Name: Click or tap here to enter text.

Signature: ______________________________ Printed Name: Click or tap here to enter text.

Title: Click or tap here to enter text.

Date: Click or tap to enter a date.

* I certify that I am authorized to sign this solicitation response on behalf of the Vendor as indicated in Certificate as to Corporate Principal, designation letter by Director/Corporate Officer, or other business authorization to bind on behalf of the Vendor. As the Vendor's authorized representative, I attest that any and all statements, oral, written or otherwise, made in support of the Vendor's response are accurate, true, and correct. I also acknowledge that inaccurate, untruthful, or incorrect statements made in support of the Vendor's response may be used by the County as a basis for rejection, rescission of the award, or termination of the contract, and may also serve as the basis for debarment of the Vendor pursuant to Part XI of the Broward County Procurement Code. I certify that the Vendor's response is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same items/services, and is in all respects fair and without collusion or fraud. I also certify that the Vendor agrees to abide by all terms and conditions of this solicitation.

Form Date 7/1/25