ATTACHMENT G – RESPONSIBILITY INQUIRY

OREGON BUYS SOLICITATION # S-33000-00017127; AGENCY RFQ #26-099 SEED

ATTACHMENT G - RESPONSIBILITY INQUIRY

Agency will determine responsibility of the Energy Analyst Firm prior to award and execution of a Prequalified List Agreement. In addition to this form, Agency may notify the Energy Analyst Firm 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.

Does the Energy Analyst Firm 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 the Energy Analyst Firm to meet all contractual responsibilities?

YES |_| / NO |_|.

Within the last five years, how many contracts of a similar nature has the Energy Analyst Firm completed that, to the extent that the costs associated with and time available to perform the contract remained within the Energy Analyst Firm’s control, the Energy Analyst Firm 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:

Within the last three years has the Energy Analyst Firm (incl. a partner or shareholder owning 10% or more of the Energy Analyst’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 Offers, 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:

Within the last three years, has the Energy Analyst Firm 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:

Does the Energy Analyst Firm have any outstanding or pending judgments against it? YES |_| / NO |_| Is the Energy Analyst Firm experiencing financial distress or having difficulty securing financing? YES |_| / NO |_|.

Does the Energy Analyst Firm have sufficient cash flow to fund day-to-day operations throughout the proposed Prequalified List Agreement period? YES |_| / NO |_| If "YES” on the first question or second question, or “NO” on the third question, please provide additional details.

Response:

Within the last three years, has the Energy Analyst Firm 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:

Does the Energy Analyst Firm have all required licenses, insurance and/or registrations, if any, and is the Energy Analyst Firm legally authorized to do business in the State of Oregon? YES |_| /NO |_|.

If "NO," please explain.

Response:

Pay Equity Certificate. This certificate is required if the Energy Analyst Firm 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 the Energy Analyst Firm 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 Offer submitted for a solicitation related to the prospective contract, then it is not necessary to resubmit it. Just indicate “see Bid” or “see Offer” 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 the Energy Analyst Firm certifies to the best of his or her knowledge and belief that the responses provided on this form are complete, accurate, and not misleading.

RFQ:

Project Name:

Energy Analyst Firm’s Authorized Representative Signature Date Energy Analyst Firm’s Authorized Representative Printed Name and Title

ATTACHMENT G – RESPONSIBILITY INQUIRY

OREGON BUYS SOLICITATION #S-33000-00017127; AGENCY RFQ #26-099 SEED Page 1 of 3