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

CITY OF FORT WORTH - PURCHASING DIVISION

AUTHORIZED SIGNATURE AND QUESTIONNAIRE

RFP Ref. #: 26-0245 Doc. Ref#: RFP-04 Page 1 of 5

RFP Title: Wastewater Siphon Cleaning

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. #: 26-0245 Doc. Ref#: RFP-04 Page 2 of 5

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 in 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 firm been in the business of wastewater siphon cleaning services?

RFP Ref. #: 26-0245 Doc. Ref#: RFP-04 Page 3 of 5

8.0 What is the physical address of your facility (or the location that will be servicing this agreement)?

9.0 What are your standard business hours and days?

10.0 What is your firm’s standard response time to client…

10.1 Emails?

10.2 Phone calls?

10.3 Emergency service requests?

11.0 What is the distance from service scheduling and the date of service (on average)?

12.0 Please provide the name, contact, and any relevant information for the account representative that will be assigned to this agreement.

13.0 Are your firm’s transporters registered with the Texas Commission on

Environmental Quality (TCEQ)?

Yes No

14.0 Is your firm able to services for a range of standard sizes classes as noted in

RFP-02 Sec. 2.1?

Yes No

RFP Ref. #: 26-0245 Doc. Ref#: RFP-04 Page 4 of 5

15.0 Does your company have experience filling contracts of similar volume to the projections for this bid? If so, please share this experience below. If not, please share how you will meet the estimated volume set forth in the bid.

Response may be used to help score RFP-02 Sec. 5.2.

16.0 Please describe your firm’s cleaning records, inspection practices, and documentation performed for each work order. Response may be used to help score RFP-02 Sec. 5.3.

17.0 Please describe the quality control, specifications, or other relevant information about your firm’s services. Proposer may use a separate sheet if needed, as long as each answer is labeled with the corresponding question number. Response may be used to help score RFP-02 Sec. 5.3.

RFP Ref. #: 26-0245 Doc. Ref#: RFP-04 Page 5 of 5

18.0 Please describe your firm’s communication and service standards as they relate to this bid. Proposer may use a separate sheet if needed, as long as each answer is labeled with the corresponding question number. Response may be used to help score RFP-02 Sec. 5.3.