Attachment B_Vendor Responsibility Disclosure.pdf
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- Attached to
- Managed Information Technology Services
- Solicitation number
- RFP-12281
- Issued by
- Polk County, Florida
About this file
The document is a Vendor Responsibility Disclosure form for RFP# 24-04 for Managed Information Technology Services issued by Florida Citrus, designed to be completed by potential vendors. The form requires vendors to disclose critical information about their business history, including any civil litigation, criminal judgments, contract terminations, license suspensions, competitive process restrictions, or organizational changes within the past 5 years.
The disclosure is a standard due diligence document that allows the procuring agency to assess a vendor's reliability and past performance before awarding a contract. Vendors must provide detailed written explanations for any affirmative responses, with the department reserving the right to request additional information to determine the vendor's responsibility under Florida Statute 287.012(25). The form serves as a transparent mechanism for evaluating potential risks associated with vendor selection for the managed information technology services contract.
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Text version
RFP# 24-04
Managed Information Technology Services
Attachment B: Vendor Responsibility Disclosure 1 of 1
Attachment B: Vendor Responsibility Disclosure
Respondents shall complete and submit answers to the questions set forth below. For each affirmative answer, Respondents shall provide a detailed, written explanation (1 page) relevant to the issue and attach copies of documents relevant to the written explanation(s) provided (unlimited pages). The Department reserves the right to request additional information, as needed, to determine a Respondent’s Responsibility pursuant to section 287.012(25), F.S.
I, _____________________________________ am the ________________________________ of
(Authorized Representative’s Name) (Title)
_______________________________________, (the “Vendor”), and am authorized to represent and
(Vendor’s Legal Name) contractually bind Vendor. Having been duly sworn, I do hereby attest, to the best of my knowledge and belief, the following:
Within the past 5 years, has the vendor:
1. Been the subject of civil litigation or settlements? ☐No ☐Yes
2. Been subject to criminal judgments or administrative actions? ☐No ☐Yes
3. Been suspended or barred from participation in any competitive process or contract award?
☐No ☐Yes
4. Had any licenses or certifications suspended, revoked, or canceled? ☐No ☐Yes
5. Had any contracts or agreements terminated for cause? ☐No ☐Yes
6. Been the subject of bankruptcy proceedings? ☐No ☐Yes
7. Undergone a major change of organizational structure, ownership, or name? ☐No ☐Yes
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