Att. G Responsibility Inquiry .pdf

PDF 71 KB Posted

Attached to
12279 Fort Stevens Campground Improvements Project
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

File Type Posted
Attachment C Plans and Drawings Part B, 01-13-2025-Addendum 1.pdf PDF
Attachment C Plans and Drawings Part B.pdf PDF
Question and Answer ITB 12279 FINAL_.docx DOCX document
Attachment C Plans and Drawings Part B Revised 2-6-2025 - Addendum 3.pdf PDF
Attachment B Technical Specifications Part B.pdf PDF
Attachment B Technical Specifications Part A, 01-10-2025-Addendum 1.pdf PDF
Attachment A Form A-2 Pricing Form 2-6-2025 - Addendum 3~1.xlsx XLSX spreadsheet
ITB 12279 Fort Stevens SP Bid Tabulation Preliminary.pdf PDF
Intent to Award_OreognBuys~1.docx DOCX document
Bid Tabulation and Responsive PW PI.xlsx XLSX spreadsheet
Attachment C Plans and Drawings Part C OPRD Prototype Electrical Kiosk Drawings.pdf PDF
Attachment B Technical Specifications Part A.pdf PDF
Attachment C Plans and Drawings Part A 2-6-2025 - Addendum 3.pdf PDF
Attachment B Technial Specifications Part B, 01-9-2025-Addendum 1.pdf PDF
Addendum 2 ITB 12279.pdf PDF
Addendum 3 to ITB 12279.pdf PDF
ITB 12279~1.docx DOCX document
Addendum 1 to ITB 12279.pdf PDF
Attachment C Plans and Drawings Part A.pdf PDF
Addendum 4 ITB 12279 FINAL .docx DOCX document
12279 JAN21-25 Pre-Bid Conference Agenda_Roster.pdf PDF
Attachment A Form A-2 Pricing Form Final.xlsx XLSX spreadsheet
Attachment A Form A-2 Pricing Form Revised Format - Addendum 1.xlsx XLSX spreadsheet
Attachment B Technial Specifications Part A 020625 Addendum.pdf PDF
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

AgencywilldetermineresponsibilityofaProposerpriortoawardandexecutionofaContract.In
additiontothisform,AgencymaynotifyProposerofotherdocumentationrequired,whichmay
includebutisnotlimitedtorecentprofit-and-losshistory,currentbalancestatementsandcashflow
information,assets-to-liabilitiesratio,includingnumberandamountofsecuredversusunsecured
creditorclaims,availabilityofshortandlong-termfinancing,bondingcapacity,insurability,credit
information,materialsandequipment,facilitycapabilities,personnelinformation,recordof
performanceunderpreviouscontracts,etc.Failuretopromptlyproviderequestedinformationor
clearlydemonstrateresponsibilitymayresultinanAgencyfindingofnon-responsibilityand

rejection.

1. DoesProposerhaveavailabletheappropriatefinancial,material,equipment,facilityandpersonnel
resourcesandexpertise,orabilitytoobtaintheresourcesandexpertise,necessarytodemonstrate
thecapabilityofProposertomeetallcontractualresponsibilities?YES/NO.
2. Withinthelastfiveyears,howmanycontractsofasimilarnaturehasProposercompletedthat,tothe
extentthatthecostsassociatedwithandtimeavailabletoperformthecontractremainedwithin
Proposer′scontrol,Proposerstayedwithinthetimeandbudgetallotted,andtherewerenocontract
claimsbyanyparty?Number:____

How many contracts did not meet those standards? Number: ____ If any, please explain.

Response:

3. WithinthelastthreeyearshasProposer(incl.apartnerorshareholderowning10%ormoreof
Proposer’sfirm)oramajorsubcontractor(receiving10%ormoreofatotalcontractamount)been
criminallyorcivillycharged,indictedorconvictedinconnectionwith:
• obtaining,attemptingtoobtain,orperformingapublic(Federal,state,orlocal)contract
orsubcontract,
• violationoffederalorstateantitruststatutesrelatingtothesubmissionofbidsor
Proposals,or
• embezzlement,theft,forgery,bribery,falsificationordestructionofrecords,makingfalse
statements,taxevasion,orreceivingstolenproperty?YES/NO.
If"YES,"indicatethejurisdiction,dateofindictment,chargeorjudgment,andnamesandsummaryof
chargesintheresponsefieldbelow.

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:

• anycontractsterminatedfordefaultbyanygovernmentagency,or
• anylawsuitsfiledagainstitbycreditorsorinvolvingcontractdisputes?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 .

DoesProposerhavesufficientcashflowtofundday-to-dayoperationsthroughouttheproposed
contractperiod?YES/NO
If"YES”onthefirstquestionorsecondquestion,or“NO”onthethirdquestion,pleaseprovide
additionaldetails.

Response:

6. Withinthelastthreeyears,hasProposerfiledabankruptcyaction,filedforreorganization,madea
generalassignmentofassetsforthebenefitofcreditors,orhadanactionforinsolvencyinstituted
againstit?YES/NO.
If"YES,"indicatethefilingdates,jurisdictions,typeofaction,ultimateresolution,anddatesof
judgmentordismissal,ifapplicable.

Response:

7. DoesProposerhaveallrequiredlicenses,insuranceand/orregistrations,ifany,andisProposer
legallyauthorizedtodobusinessintheStateofOregon?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. PayEquityCertificate.ThiscertificateisrequiredifProposeremploys50ormorefull-timeworkers
andtheprospectivecontractpriceisestimatedtoexceed$500,000.[Thisrequirementdoesnotapply
toarchitectural,engineering,photogrammetricmapping,transportationplanningorlandsurveying
andrelatedservicescontracts.]DoesacurrentauthorizedrepresentativeofProposerpossessan
unexpiredPayEquityCertificateissuedbytheDepartmentofAdministrativeServices?YES/NO
/N/A.[IfthecertificatewasprovidedwiththeBidorProposalsubmittedforasolicitation
relatedtotheprospectivecontract,thenitisnotnecessarytoresubmitit.Justindicate“seeBid”or
“seeProposal”intheresponsefield.Otherwise,ifapplicable,submitacopyofthecertificatewith
thisform.]

Response:

AUTHORIZED SIGNATURE

Bysignaturebelow,theundersignedAuthorizedRepresentativeonbehalfofProposercertifiestothe
bestofhisorherknowledgeandbeliefthattheresponsesprovidedonthisformarecomplete,
accurate,andnotmisleading.

Proposer Name: RFP:

Project Name:

Authorized Signature Date

Print Name Title

File details come from the government source that posted it. Updated .