Attachment_2_-_Proposer_Questionnaire_and_References.pdf

Sourcing Event 0000012057 / Dept. Contract ID: SHF|2026-06 Medi-Cal Enrollment Services

P-690 (01-26): Attachment 2 Sourcing Event 0000012057 Proposer Questionnaire and References August 28, 2026

Attachment 2 Proposer Questionnaire and References

Part I Proposer Information

Name of Firm:

Headquarter Address:

Phone No.:

Toll Free Phone No.:

Contact Name & Title:

E-mail:

SF Supplier ID:

Federal Tax ID:

Payment Terms:

Person Preparing Bid:

Local Representative Name and Number:

P-690 (01-26): Attachment 2 Sourcing Event 0000012057 Proposer Questionnaire and References August 28, 2026

Part II Proposer Questionnaire

Question Yes No

1. Do you certify that you have complied and will continue to comply with Section XII (E) of this Solicitation entitled “Limitation on Communications during Solicitation”?

2. Have you registered as a Supplier, through the Supplier Portal (https://sfcitypartner.sfgov.org/)?

If yes, what is your Supplier ID? _________________

3. Has your company enrolled with Paymode-X to receive electronic payments from the City?

https://www.sf.gov/get-paid-your-vendor-services

4. Have you registered your business with the San Francisco Treasurer & Tax Collector as required prior to submission of any Proposal?

Enter your Business Tax Registration ID here: __________________________________

5. List each subcontractor directly performing services on this contract. If none, enter none. Add additional rows as needed.

Subcontractor’s Full Legal Business Name

% of work to be performed

If this subcontractor is an LBE, enter its LBE Certification Number.

Otherwise enter “N/A”.

6. Can you comply with the terms set forth in Attachment 1, City’s Proposed Agreement Terms?

If you reply NO, you must submit a redline copy of any proposed changes.

7. Have you completed and submitted Attachment 5 – Budget Proposal Template in accordance with the instructions in the Solicitation?

8. Have you submitted with your Proposal all the Minimum Qualification Documentation outlined in the accompanying solicitation document?

If you reply NO to any document, please explain.

9. Have you submitted with your Proposal all the Required Supporting Documentation outlined in the accompanying solicitation document? If you reply NO to any document, please explain.

10. Have you submitted with your Proposal a Written Proposal that complies with the requirements of the accompanying solicitation document?

If you reply NO to any document, please explain.

https://sfcitypartner.sfgov.org/?

https://www.sf.gov/get-paid-your-vendor-services

P-690 (01-26): Attachment 2 Sourcing Event 0000012057 Proposer Questionnaire and References August 28, 2026

Part III Proposer References

All proposers, including current Contractor, must provide references from at least one (1) organization but no more than three (3) organizations, of the approximate size and volume comparable to commodities and/or services described in this Solicitation. Upon request, successful proposer(s) may also be required to submit a letter of reference from each reference listed within five (5) days of notification. Failure to do so may result in rejection of proposal.

1. Name of Company

Address (street, city, state, zip)

Contact Name

Phone No.

Email

Number of Years Providing Service

2. Name of Company

3. Name of Company

P-690 (01-26): Attachment 2 Sourcing Event 0000012057 Proposer Questionnaire and References August 28, 2026

Part IV

Proposer Release of Liability for References

The undersigned hereby fully and forever release, exonerate, discharge and covenant not to sue the City, its commissions and boards, officers and employees, and all individuals, entities and firms providing information, comments, or conclusions ("Reference Information") in response to inquiries that the City may make regarding the qualifications or experience of a Prime proposer, proposed joint venture partner, proposed subconsultant or proposed key/lead team member in connection with the selection process for Sourcing Event 0000011465 / Dept. Contract ID: SHF|2026-01 – Pretrial Services from and for any and all claims, causes of action, demands, damages, and any and all liabilities of any kind or description, in law, equity, or otherwise arising out of the provision of said Reference Information. This Release and Waiver is freely given and will be applicable whether or not the responses by said individuals, entities or firms are accurate or not, or made willfully or negligently.

Company Name

Signature of Authorized Representative of Company Date

Print Name and Title

P-690 (01-26): Attachment 2 Sourcing Event 0000012057 Proposer Questionnaire and References August 28, 2026

Part V.

Proposer Certification of Truth, Accuracy, and Completeness

I certify that based on information and belief formed after reasonable inquiry, the statements and information contained in this document are true, accurate, and complete. Additionally, by submitting this bid/proposal, I attest that I have reviewed and accepted all terms found in this solicitation, any and all addenda issued to this solicitation, and City’s contract terms.

Company Name

Signature of Authorized Representative of Company Date

Print Name and Title