7-RFP-04-Authorized Signature and Questionnaire.docx
DOCX document 46 KB Posted
- Attached to
- RFP Online Backflow Testing Management Solution
- Solicitation number
- 26-0221
- Issued by
- Tarrant County, Texas
About this file
This is an Authorized Signature and Questionnaire form for RFP 26-0221 issued by the City of Fort Worth Purchasing Division for an Online Backflow Testing Management Solution for the Water Department. The RFP seeks a cloud-based compliance management platform combined with long-term program administration services to manage municipal backflow testing programs on an as-needed basis. The form requires proposers to provide authorized representative information, legal business details, and Federal Tax Identification numbers, along with contact information for up to three project representatives. Bidders must demonstrate experience and expertise across multiple technical and regulatory areas, including municipal backflow management programs, hosted compliance management systems, large-scale database management, TCEQ requirements, cross-connection control, grease abatement, GIS integration, and utility bill integration capabilities.
Proposers are required to answer questionnaire items addressing business history, litigation status, criminal investigations, cooperative purchasing eligibility, and prompt payment discount terms. The form mandates submission of documentation for all available API and integration tools, relevant certifications or licenses, and sample program documents including annual notifications, overdue notices, utility failure notices, compliance reminders, tester notifications, and customer correspondence templates. Bidders must also explain how their platform provides scalability, cloud-based architecture, and program administration services that improve operational efficiency, reduce manual processing, strengthen regulatory compliance, improve customer communications, and establish a sustainable framework. Any information claimed as proprietary must be clearly identified. The submission requires detailed responses to demonstrate responsiveness to the solicitation requirements.
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Other files
| File | Type | Posted |
|---|---|---|
| 6-RFP-02-Scope of Services.pdf | ||
| 1-RFP-05-Forms.pdf | ||
| 3-RFP-01-Instruction to Proposers.docx | DOCX document | |
| 5-RFP-03-Draft VSA.pdf | ||
| 2-RFP-06-Small Business Utilization Form V1.docx | DOCX document | |
| 4-RFP-07-Deviations.xlsx | XLSX spreadsheet |
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION AUTHORIZED SIGNATURE AND QUESTIONNAIRE
| RFP Ref. #: 26-0221 |
| Doc. Ref#: RFP-04 |
| Page 1 of 2 |
RFP Title: Online Backflow Testing Management Solution
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 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 on 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 | Can your demonstrate experience and expertise with the following requirement? |
| Municipal backflow management programs | Yes___ No____ |
Operating hosted compliance management systems Yes___ No____
| Large -Scale Database Management | Yes___ No____ | |
| TCEQ Requirements | Yes___ No____ |
| Cross-connection Control | Yes___ No____ | ||
| Grease Abatement | Yes___ No____ | ||
| GIS Integration | Yes___ No____ | ||
| Utility Bill Integration | Yes___ No____ | ||
| 8.0 | Can your company provide documentation for all available API and Integration tools and indicated in section 3.1.1 of RFP-02- Scope of Services? | ||
| Yes _______ | No________ |
(If included in the proposal, please specify the corresponding page number and section where it can be found) Page _______ Section_______
9.0 Please attach any copy of any certifications or license as stated in section 4.6 of RFP-02- Scope of Services.
10.0 Please attach sample of program documents including annual notifications, overdue notices, utility failure notices, compliance reminders, tester notifications, and customer correspondence templates as stated in section 3.3 of RFP-02- Scope of Services.
| 11.0 | Please explain how your company provide scalable, cloud-based compliance management platform combined with long-term program administration services that improve operational efficiency, reduce manual processing, strengthen regulatory compliance, improve customer communications, and provide a sustainable framework. (If included in the proposal, please specify the corresponding page number and section where it can be found) | |
| Page _______ | Section_______ |
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