7-FORM 4 - REPRESENTATIONS and CERTIFICATIONS.pdf
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- Attached to
- Re-Bid Claim Field Investigative Services
- Solicitation number
- RFP-066-26-KM
- Issued by
- Leon County, Florida
About this file
This is a Representations and Certifications form (Form 4) for the Re-Bid Claim Field Investigative Services solicitation (RFP-111-25-KM) issued by the City of Florida. The form requires respondents to provide comprehensive company information including official company registration details, mailing address, and contact telephone and facsimile numbers. Additionally, respondents must designate a company contact for contract management purposes and provide a separate payment remittance address with associated contact information. The form also requires identification of a contact person for invoice inquiries and specification of where purchase orders should be directed if applicable. The underlying contract opportunity seeks field investigative and adjusting services with a five-year base period, requiring firms to have sufficient resources and qualified staff to investigate liability claims for the City, with most field work occurring during normal business hours Monday through Friday from 7:00 a.m. to 7:00 p.m.
Respondents are required to complete and submit a Federal Form W-9 with their bid to provide taxpayer identification information. The form serves as the standard documentation vehicle for establishing official company information as registered with the respective state and local authorities. This representations and certifications submission is a mandatory component of the proposal package and must be completed accurately and thoroughly to ensure compliance with solicitation requirements.
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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 .