8-RFP-04-Authorized Signature and Questionnaire.pdf

CITY OF FORT WORTH - PURCHASING DIVISION

AUTHORIZED SIGNATURE AND QUESTIONNAIRE

RFP Ref. #: 26-0243 Doc. Ref#: RFP-04 Page 1 of 6 RFP Title: Janitorial Services at Fort Worth City Hall

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. #: 26-0243 Doc. Ref#: RFP-04 Page 2 of 6

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 List any former names your organization has operated under and the timeframe(s).

RFP Ref. #: 26-0243 Doc. Ref#: RFP-04 Page 3 of 6

8.0 How long has your company been in active janitorial services?

9.0 What are your business hours and days?

10.0 Does your firm provide services in case of an emergency?

☐ Yes ☐ No If Yes, list days and hours emergency services are offered.

11.0 List the address(es) of your firm’s location

12.0 What is your firm’s response time to acknowledge a service request submitted by phone or email?

13.0 Once a service request is received, what is your firm’s timeframe to complete the services?

14.0 Once your firm receives an Emergency Order, what is the estimated time to complete the services?

15.0 How many full-time employees does your company have? Please state the number of full-time employees: ___________________________________

RFP Ref. #: 26-0243 Doc. Ref#: RFP-04 Page 4 of 6

16.0 How many part-time/temporary employees does your company have? Please state the number of part-time/temporary employees:____________________________________________________

17.0 What are the average years of work of your company’s full-time employees?

Check one:

☐ < One Year ☐ Two to Three Years ☐ Four to Five Years

☐ Five to Eight Years ☐ Nine to Ten Years ☐ More than 10 years

18.0 How many supervisors does your company have that will service this account? Please state the number of supervisors that will be dedicated to this account:

19.0 Is your company organizational chart submitted with your bid response?

☐ Yes ☐ No

20.0 Provide the name of the proposed Job Manager for this account as specified in section 13.1.1 of RFP-02-Scope of Services:

21.0 How many years’ experience in the janitorial services industry does the proposed Job Manager have? _____________________________________

22.0 Are the resumes of all management staff submitted with your bid response?

☐ Yes ☐ No

23.0 Will your company be using subcontractors to fulfill any portion of this contract?

☐ Yes ☐ No

24.0 What is the name of the remote electronic timekeeping system your company uses?

25.0 Please confirm if your firm has the minimum equipment required, add the quantity of equipment in inventory or accessible through a rental option, and whether equipment is owned or rented.

RFP Ref. #: 26-0243 Doc. Ref#: RFP-04 Page 5 of 6

Equipment Description Quantity Yes Owned Rented Hand (Portable) Vacuum ☐ ☐ ☐

Extractor Shampoo Machine

High Speed Floor Machine

Buffer ☐ ☐ ☐ Wet/Dry Vacuum ☐ ☐ ☐

Upright Vacuum with Beater Bars

Shelf-Type Janitorial Cart ☐ ☐ ☐ Small Pump-Up Sprayer ☐ ☐ ☐

Wall Cavity Machine ☐ ☐ ☐ Johnny Mop ☐ ☐ ☐ Toy Broom ☐ ☐ ☐ Push Broom ☐ ☐ ☐

Dust Mop Broom (Floor) ☐ ☐ ☐ Floor Machine Pads ☐ ☐

Hand Scrub Brush ☐ ☐ ☐

Swivel Pad Holder & Abrasive Pad (Doodle

Bug)

Window Brush ☐ ☐ ☐ Window Squeegee ☐ ☐ ☐

Mop Bucket & Ringer ☐ ☐ ☐ Dustpan ☐ ☐ ☐

One (1) Gallon Bucket ☐ ☐ ☐ Putty Knife ☐ ☐ ☐ Wall Duster ☐ ☐ ☐ Hand Duster ☐ ☐ ☐

Wet Floor Caution Signs ☐ ☐ ☐ Rubber Gloves ☐ ☐ ☐

RFP Ref. #: 26-0243 Doc. Ref#: RFP-04 Page 6 of 6

26.0 Provide a proposed Daily Report Form as specified in Section 7.3.17 of

RFP-02-Scope of Work.

27.0 Is your company’s proposed uniforms submitted with your bid response?

☐ Yes ☐ No

28.0 List the name, square footage, and amount of the contract of three facilities of similar size and scope to the City that your company has services 1.____________________________________________ $______________ 2.____________________________________________ $______________ 3.____________________________________________ $______________