Attachment D Responsibility Inquiry~1.pdf
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- Attached to
- ITB 23-0016 Capital Center PA Replacement
- Solicitation number
- S-P34048-00009210
- Issued by
- Washington County, Barlow City, Oregon
About this file
Responsibility Inquiry Form Summary
This is a Responsibility Inquiry form (Attachment D) issued by the Department of Administrative Services (DAS) Procurement Services for the Oregon Department of Human Services (ODHS) ITB S-10000-00009212 (5725) regarding On Site Generator Service and Maintenance. The form establishes the framework through which the agency will evaluate a bidder's responsibility prior to contract award and execution. Bidders must demonstrate they possess adequate financial, material, equipment, facility, and personnel resources to meet all contractual responsibilities. The agency reserves the right to request additional documentation beyond the form responses, including profit-and-loss history, balance statements, cash flow information, assets-to-liabilities ratios, bonding capacity, insurability information, credit data, materials and equipment availability, facility capabilities, personnel qualifications, and records of performance on previous contracts. Failure to promptly provide requested information or failure to clearly demonstrate responsibility may result in a non-responsibility finding and bid rejection.
The responsibility inquiry requires bidders to provide detailed responses across eight primary areas: availability of necessary resources and expertise; performance history on similar contracts within the last five years, including any instances where time and budget were exceeded or claims were filed; any criminal or civil charges, indictments, or convictions within the last three years by the bidder, partners, shareholders owning ten percent or more of the firm, or major subcontractors related to public contracts, antitrust violations, or crimes including embezzlement, theft, forgery, bribery, falsification of records, or tax evasion; any contract terminations for default or lawsuits involving creditors or contract disputes within the last three years; outstanding or pending judgments and evidence of financial distress or cash flow difficulties; any bankruptcy filings or insolvency actions within the last three years; possession of all required licenses, insurance, and registrations to legally conduct business in Oregon; and submission of a current Pay Equity Certificate if the bidder employs fifty or more full-time workers and the contract price exceeds $500,000. All responses must be certified as complete, accurate, and not misleading by an authorized representative of the bidding entity.
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Text version
ITB ODHS S-10000-00009212 (5725) ON SITE GENERATOR SERVICE AND MAINTENANCE
Att D
DAS Procurement Services, Version 1.0 – December 9, 2016 Page 1 of 3
ATTACHMENT D - RESPONSIBILITY INQUIRY
Agency will determine responsibility of a Bidder prior to award and execution of a Price Agreement.
In addition to this form, Agency may notify Bidder 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 Bidder 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 Bidder to meet all contractual responsibilities? YES / NO .
2. Within the last five years, how many contracts of a similar nature has Bidder completed that, to the extent that the costs associated with and time available to perform the contract remained within Bidder′s control, Bidder 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 Bidder (incl. a partner or shareholder owning 10% or more of Bidder’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 Bids, 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:
4. Within the last three years, has Bidder 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.)
DAS Procurement Services, Version 1.0 – December 9, 2016 Page 2 of 3
Response:
5. Does Bidder have any outstanding or pending judgments against it? YES / NO .
Is Bidder experiencing financial distress or having difficulty securing financing? YES / NO .
Does Bidder 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 Bidder 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 Bidder have all required licenses, insurance and/or registrations, if any, and is Bidder legally authorized to do business in the State of Oregon? YES /NO .
If "NO," please explain.
Response:
8. Pay Equity Certificate. This certificate is required if Bidder 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 Bidder 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 Bid submitted for a solicitation related to the prospective contract, then it is not necessary to resubmit it. Just indicate “see Bid” or “see Bid” 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 Bidder certifies to the best of his or her knowledge and belief that the responses provided on this form are complete, accurate, and not misleading.
DAS Procurement Services, Version 1.0 – December 9, 2016 Page 3 of 3
Bidder Name: ITB: ODHS S-10000-00009212 (5725)
Project Name: ON SITE GENERATOR
SERVICE AND MAINTENANCE
Authorized Signature Date
Print Name Title
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