7-FORM 4 - REPRESENTATIONS and CERTIFICATIONS.pdf
PDF 836 KB Posted
- Attached to
- Claim Field Investigative Services
- Solicitation number
- RFP-029-26-KM
- Issued by
- Leon County, Florida
About this file
This is a Representations and Certifications form for a Request for Proposals (RFP-111-25-KM) issued by the State of Florida for Claim Field Investigative Services. The solicitation seeks proposals from qualified firms to provide field investigative and adjusting services, including reporting and processing capabilities, to be delivered from a local office or through resident adjusters. The contract will establish a 5-year base period, and respondents must demonstrate sufficient resources and qualified staff to investigate liability claims on behalf of the City. Firms are required to submit detailed information regarding their official company registration, including company name, mailing address, telephone and fax numbers, and website URL, as well as designated points of contact for contract management, payment remittance, invoice inquiries, and purchase order delivery.
Respondents must complete and submit a Federal Form W-9 for taxpayer identification purposes along with their bid submission. The form requires firms to provide comprehensive organizational details across multiple contact categories to facilitate contract administration and financial processing. No specific pricing terms, response dates, due dates, bidders' meetings, site visits, award dates, or funding amounts are referenced in this representations and certifications document, as it serves primarily as an administrative requirement for establishing vendor information and tax compliance prior to proposal evaluation.
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Text version
REPRESENTATIONS/CERTIFICATIONS
TAXPAYER IDENTIFICATION
Respondent must complete Federal Form W-9 and submit it with their bid.
OFFICIAL COMPANY INFORMATION AS REGISTERED (Type/Print)
COMPANY NAME:
MAILING ADDRESS:
(City) (State) (Zip Code + 4)
TELEPHONE NO.:
(Toll-Free Preferred) VOICE: EXTENSION:
OTHER: FAX:
WEBSITE URL:
COMPANY CONTACT FOR CONTRACT MANAGEMENT (Type/Print)
NAME:
TELEPHONE NO.:
(Toll-Free Preferred) VOICE: EXTENSION:
OTHER: FAX:
EMAIL ADDRESS:
PAYMENT REMITTANCE ADDRESS (Type/Print)
NAME:
MAILING ADDRESS:
(City) (State) (Zip Code + 4)
TELEPHONE NO.:
(Toll-Free Preferred) VOICE: EXTENSION:
OTHER: FAX:
EMAIL ADDRESS:
CONTACT FOR INVOICE INQUIRIES
NAME:
TELEPHONE NO.:
(Toll-Free Preferred) VOICE: EXTENSION:
OTHER: FAX:
EMAIL ADDRESS:
WHERE TO SEND PURCHASE ORDER (IF APPLICABLE)
COMPANY NAME:
MAILING ADDRESS:
(City) (State) (Zip Code + 4)
EMAIL ADDRESS:
RFP-111-25-KM
REPRESENTATIONS/CERTIFICATIONS
File details come from the government source that posted it. Updated .