Att. G Responsibility Inquiry .pdf
PDF 71 KB Posted
- Solicitation number
- S-63400-00011896
- Issued by
- Benton County, Oregon
About this file
This is a Responsibility Inquiry form (Attachment G) used by the Oregon Department of Administrative Services (DAS) Procurement Services for evaluating proposer qualifications in response to RFP S-60300-00011897 for the Oregon Aquatic Weeds Assessment project. The form requires proposers to demonstrate financial capability, material resources, equipment, facilities, personnel expertise, and the ability to obtain necessary resources to meet all contractual responsibilities. Proposers must document their contract performance history over the past five years, specifically the number of similar contracts completed on time and within budget without claims, as well as any contracts that failed to meet these standards. Additionally, proposers must disclose any criminal or civil charges, indictments, or convictions within the past three years involving public contract performance, antitrust violations, embezzlement, theft, forgery, bribery, falsification of records, false statements, tax evasion, or receipt of stolen property.
The form further requires disclosure of contract terminations for default, lawsuits involving creditors or contract disputes, outstanding judgments, and financial distress within the past three years. Proposers must certify sufficient cash flow to fund day-to-day operations throughout the contract period and disclose any bankruptcy filings, reorganizations, assignments of assets, or insolvency actions. Proposers must confirm possession of all required licenses, insurance, registrations, and legal authorization to conduct business in Oregon. For proposers employing fifty or more full-time workers with contracts exceeding $500,000, a current Pay Equity Certificate from the Department of Administrative Services is required, unless previously submitted with the original bid or proposal. An authorized representative must sign and date the completed form, certifying that all responses are complete, accurate, and not misleading.
View the file
Other files
Show all 24
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
RFP S-60300-00011897 – Oregon Aquatic Weeds Assessment Att G
DAS Procurement Services, Version 1.0 – December 9, 2016 Page 1 of 3
ATTACHMENT G - RESPONSIBILITY INQUIRY
| Agency | will | determine | responsibility | of | a | Proposer | prior | to | award | and | execution | of | a | Contract. | In |
| addition | to | this | form, | Agency | may | notify | Proposer | of | other | documentation | required, | which | may | ||
| include | but | is | not | limited | to | recent | profit-and-loss | history, | current | balance | statements | and | cash | flow | |
| information, | assets-to-liabilities | ratio, | including | number | and | amount | of | secured | versus | unsecured | |||||
| creditor | claims, | availability | of | short | and | long-term | financing, | bonding | capacity, | insurability, | credit | ||||
| information, | materials | and | equipment, | facility | capabilities, | personnel | information, | record | of | ||||||
| performance | under | previous | contracts, | etc. | Failure | to | promptly | provide | requested | information | or | ||||
| clearly | demonstrate | responsibility | may | result | in | an | Agency | finding | of | non-responsibility | and |
rejection.
| 1. Does | Proposer | have | available | the | appropriate | financial, | material, | equipment, | facility | and | personnel | ||||
| resources | and | expertise, | or | ability | to | obtain | the | resources | and | expertise, | necessary | to | demonstrate | ||
| the | capability | of | Proposer | to | meet | all | contractual | responsibilities? | YES | / | NO | . |
| 2. Within | the | last | five | years, | how | many | contracts | of | a | similar | nature | has | Proposer | completed | that, | to | the |
| extent | that | the | costs | associated | with | and | time | available | to | perform | the | contract | remained | within | |||
| Proposer′s | control, | Proposer | stayed | within | the | time | and | budget | allotted, | and | there | were | no | contract | |||
| claims | by | any | party? | Number: | ____ |
How many contracts did not meet those standards? Number: ____ If any, please explain.
Response:
| 3. Within | the | last | three | years | has | Proposer | (incl. | a | partner | or | shareholder | owning | 10% | or | more | of |
| Proposer’s | firm) | or | a | major | subcontractor | (receiving | 10% | or | more | of | a | total | contract | amount) | been | |
| criminally | or | civilly | charged, | indicted | or | convicted | in | connection | with: |
| • obtaining, | attempting | to | obtain, | or | performing | a | public | (Federal, | state, | or | local) | contract | |||
| or | subcontract, | ||||||||||||||
| • violation | of | federal | or | state | antitrust | statutes | relating | to | the | submission | of | bids | or | ||
| Proposals, | or | ||||||||||||||
| • embezzlement, | theft, | forgery, | bribery, | falsification | or | destruction | of | records, | making | false | |||||
| statements, | tax | evasion, | or | receiving | stolen | property? | YES | / | NO | . |
| If | "YES," | indicate | the | jurisdiction, | date | of | indictment, | charge | or | judgment, | and | names | and | summary | of |
| charges | in | the | response | field | below. |
Response:
RFP S-60300-00011897 – Oregon Aquatic Weeds Assessment Att G
DAS Procurement Services, Version 1.0 – December 9, 2016 Page 2 of 3
4. Within the last three years, has Proposer had:
| • any | contracts | terminated | for | default | by | any | government | agency, | or | |||||
| • any | lawsuits | filed | against | it | by | creditors | or | involving | contract | disputes? | YES | / | NO | . |
If "YES," please explain. (With regard to judgments, include jurisdiction and date of final judgment or dismissal.)
Response:
5. Does Proposer have any outstanding or pending judgments against it? YES / NO .
Is Proposer experiencing financial distress or having difficulty securing financing? YES / NO .
| Does | Proposer | have | sufficient | cash | flow | to | fund | day-to-day | operations | throughout | the | proposed |
| contract | period? | YES | / | NO |
| If | "YES” | on | the | first | question | or | second | question, | or | “NO” | on | the | third | question, | please | provide |
| additional | details. |
Response:
| 6. Within | the | last | three | years, | has | Proposer | filed | a | bankruptcy | action, | filed | for | reorganization, | made | a |
| general | assignment | of | assets | for | the | benefit | of | creditors, | or | had | an | action | for | insolvency | instituted |
| against | it? | YES | / | NO | . |
| If | "YES," | indicate | the | filing | dates, | jurisdictions, | type | of | action, | ultimate | resolution, | and | dates | of |
| judgment | or | dismissal, | if | applicable. |
Response:
| 7. Does | Proposer | have | all | required | licenses, | insurance | and/or | registrations, | if | any, | and | is | Proposer | |
| legally | authorized | to | do | business | in | the | State | of | Oregon? | YES | /NO | . |
If "NO," please explain.
Response:
RFP S-60300-00011897 – Oregon Aquatic Weeds Assessment Att G
DAS Procurement Services, Version 1.0 – December 9, 2016 Page 3 of 3
| 8. Pay | Equity | Certificate. | This | certificate | is | required | if | Proposer | employs | 50 | or | more | full-time | workers | ||||||||
| and | the | prospective | contract | price | is | estimated | to | exceed | $500,000. | [This | requirement | does | not | apply | ||||||||
| to | architectural, | engineering, | photogrammetric | mapping, | transportation | planning | or | land | surveying | |||||||||||||
| and | related | services | contracts.] | Does | a | current | authorized | representative | of | Proposer | possess | an | ||||||||||
| unexpired | Pay | Equity | Certificate | issued | by | the | Department | of | Administrative | Services? | YES | / | NO | |||||||||
| / | N/A | . | [If | the | certificate | was | provided | with | the | Bid | or | Proposal | submitted | for | a | solicitation |
| related | to | the | prospective | contract, | then | it | is | not | necessary | to | resubmit | it. | Just | indicate | “see | Bid” | or |
| “see | Proposal” | in | the | response | field. | Otherwise, | if | applicable, | submit | a | copy | of | the | certificate | with | ||
| this | form.] |
Response:
AUTHORIZED SIGNATURE
| By | signature | below, | the | undersigned | Authorized | Representative | on | behalf | of | Proposer | certifies | to | the | |||
| best | of | his | or | her | knowledge | and | belief | that | the | responses | provided | on | this | form | are | complete, |
| accurate, | and | not | misleading. |
Proposer Name: RFP:
Project Name:
Authorized Signature Date
Print Name Title
File details come from the government source that posted it. Updated .