8-RFP-03-Authorized Signature and Questionnaire.pdf

PDF 314 KB Posted Apr 13, 2026

Attached to: RFP Filter Media
Solicitation number: 26-0173
Issued by: Tarrant County, Texas

About this file

Written by GovTribe AI · Apr 14, 2026

This is an Authorized Signature and Questionnaire form for RFP 26-0173 issued by the City of Fort Worth Purchasing Division for Filter Media procurement. The RFP seeks proposals for filter media to be supplied on an "as needed" basis for the City's water and wastewater treatment facilities. The document requires proposers to provide company information, including legal name, federal identification number, and authorized representative details, along with contact information for up to three designated representatives. Bidders must complete a comprehensive questionnaire addressing operational and technical qualifications, including years of experience supplying filter media to municipal water and wastewater treatment facilities, at least three project references of similar scope, anticipated lead times from approval to delivery, quality control procedures, and operational response times for both routine and emergency requests.

The questionnaire requires vendors to address pricing terms through prompt payment discount offerings and to confirm willingness to extend contract terms to other governmental entities under cooperative purchasing arrangements. Additional evaluation criteria include confirmation that all media supplied will be from a single source and lot per facility, availability of Safety Data Sheets for all materials, provision of certification documentation, delivery ticket specifications including material type and lot number, packaging removal protocols, and confirmation that materials are specifically manufactured for water and wastewater treatment filtration. Vendors must also declare whether they have made any modifications to the draft Vendor Service Agreements, provide sample invoices, and detail their hours of operation and contamination protection measures during transport. The form includes yes/no questions regarding any current litigation adverse to the City or criminal investigations involving the business or its principals.

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2-RFP-06-Small Business Utilization Form V1.docx	DOCX document	Apr 13, 2026
7-RFP-01-Instruction to Proposers.pdf	PDF	Apr 13, 2026
4-RFP-09-Deviations.xlsx	XLSX spreadsheet	Apr 13, 2026
6-RFP-07-Reference Sheet.pdf	PDF	Apr 13, 2026
3-RFP-04-Draft Vendor Service Agreement.pdf	PDF	Apr 13, 2026
5-RFP-08-Discount Calculator.xlsx	XLSX spreadsheet	Apr 13, 2026
1-RFP-05-Forms.pdf	PDF	Apr 13, 2026

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CITY OF FORT WORTH - PURCHASING DIVISION

AUTHORIZED SIGNATURE AND QUESTIONNAIRE

RFP Ref. #: 26-0173 Doc. Ref#: RFP-03 Page 1 of 5 RFP Title: Filter Media

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:

RFP Ref. #: 26-0173 Doc. Ref#: RFP-03 Page 2 of 5 RFP Title: Filter Media

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 How many years has your company been supplying filter media for municipal water and wastewater treatment facilities??

RFP Ref. #: 26-0173 Doc. Ref#: RFP-03 Page 3 of 5 RFP Title: Filter Media

8.0 Provide at least three recent project references of similar size and scope to City of Fort Worth.

9.0 Will all media for each facility be supplied from a single source and lot?

10.0 What is your anticipated lead time from approval to delivery?

12.0 Did you make any changes to RFP-03-Drafts Vendor Service Agreements?

13.0 Can you provide current certification documentation with submittals?

RFP Ref. #: 26-0173 Doc. Ref#: RFP-03 Page 4 of 5 RFP Title: Filter Media

14.0 Are Safety Data Sheets (SDS) available for all materials?

15.0 What quality control procedures are in place to ensure consistency between tested and delivered materials?

16.0 How will materials be protected from contamination during transport?

17.0 Provide sample invoice.

18.0 Will delivery tickets include material type, lot number, and quantity?

19.0 Will all packaging materials be removed from the site after delivery?

RFP Ref. #: 26-0173 Doc. Ref#: RFP-03 Page 5 of 5 RFP Title: Filter Media

20.0 Is the material provided made specifically for water/wastewater treatment filtration?

21.0 What is your average response time?

22.0 What is your response time to an emergency request?

23.0 What are your hours of operation?

City of Fort Worth BidderSupplier ID:

Legal Name of Proposer:

DBA Name of Proposer:

Federal Id Number TIN:

Address:

Name of the Authorized Representative:

Title:

Email:

Phone:

Name of Contact Person 1:

Title of Contact Person 1:

Email_2:

Phone_2:

Name of Contact Person 2:

Title of Contact Person 2:

Email_3:

Phone_3:

Name of Contact Person 3:

Title of Contact Person 3:

Email_4:

Phone_4:

RFP Ref 260173_2:

Page 2 of 5:

RFP Title Filter Media_2:

Length of time in business:

adverse to the City Yes:

No:

Yes:

No_2:

Yes_2:

No_3:

Prompt Payment Discount Terms:

Percent:

water and wastewater treatment facilities:

of Fort Worth 1:

of Fort Worth 2:

of Fort Worth 3:

of Fort Worth 4:

of Fort Worth 5:

90 Will all media for each facility be supplied from a single source and lot 1:

90 Will all media for each facility be supplied from a single source and lot 2:

90 Will all media for each facility be supplied from a single source and lot 3:

90 Will all media for each facility be supplied from a single source and lot 4:

90 Will all media for each facility be supplied from a single source and lot 5:

100 What is your anticipated lead time from approval to delivery 1:

100 What is your anticipated lead time from approval to delivery 2:

100 What is your anticipated lead time from approval to delivery 3:

120 Did you make any changes to RFP03Drafts Vendor Service Agreements 1:

120 Did you make any changes to RFP03Drafts Vendor Service Agreements 2:

120 Did you make any changes to RFP03Drafts Vendor Service Agreements 3:

120 Did you make any changes to RFP03Drafts Vendor Service Agreements 4:

120 Did you make any changes to RFP03Drafts Vendor Service Agreements 5:

130 Can you provide current certification documentation with submittals 1:

130 Can you provide current certification documentation with submittals 2:

130 Can you provide current certification documentation with submittals 3:

130 Can you provide current certification documentation with submittals 4:

130 Can you provide current certification documentation with submittals 5:

140 Are Safety Data Sheets SDS available for all materials 1:

140 Are Safety Data Sheets SDS available for all materials 2:

140 Are Safety Data Sheets SDS available for all materials 3:

tested and delivered materials 1:

tested and delivered materials 2:

tested and delivered materials 3:

160 How will materials be protected from contamination during transport 1:

160 How will materials be protected from contamination during transport 2:

160 How will materials be protected from contamination during transport 3:

170 Provide sample invoice 1:

170 Provide sample invoice 2:

180 Will delivery tickets include material type lot number and quantity 1:

180 Will delivery tickets include material type lot number and quantity 2:

180 Will delivery tickets include material type lot number and quantity 3:

190 Will all packaging materials be removed from the site after delivery 1:

190 Will all packaging materials be removed from the site after delivery 2:

190 Will all packaging materials be removed from the site after delivery 3:

190 Will all packaging materials be removed from the site after delivery 4:

200 Is the material provided made specifically for waterwastewater treatment:

filtration 1:

filtration 2:

filtration 3:

210 What is your average response time 1:

210 What is your average response time 2:

210 What is your average response time 3:

220 What is your response time to an emergency request 1:

220 What is your response time to an emergency request 2:

220 What is your response time to an emergency request 3:

230 What are your hours of operation 1:

230 What are your hours of operation 2:

230 What are your hours of operation 3:

File details come from the government source that posted it. Updated Apr 14, 2026.