ATTACHMENT_II-PROPOSER_QUALIFICATIONS-GENERAL_QUESTIONNAIRE_REC.pdf

ATTACHMENT II

PROPOSER QUALIFICATIONS – GENERAL QUESTIONNAIRE

Name/Name of Agency/Company:

(full, correct legal name)

Address: _______________________________________________________________________________

Telephone/Fax: _________________________________________________________________________

Website address: _______________________________________________________________________

Year established: _______________________________________________________________________

Provide the number of years in business under present name: ___________________________________

Social Security Number or Federal Employer Identification Number: _______________________________

Texas Comptroller’s Taxpayer Number, if applicable:

(NOTE: This 11-digit number is sometimes referred to as the Comptroller’s TIN or TID.)

DUNS NUMBER:

Business Structure: Check the box that indicates the business structure of the Respondent.

____Individual or Sole Proprietorship if checked, list Assumed Name, if any

_____Partnership ____Corporation If checked, check one: _____For-Profit Nonprofit.

Also, check one: ____Domestic ____Foreign ____Other If checked, list business

Structure:

Printed Name of Contract Signatory:

Job Title:

Provide any other names under which Respondent has operated within the last 10 years and length of time under for each:

Provide address of office from which this project would be managed:

City: State: Zip code:

Telephone No. Fax No:

Annual Revenue: $

Total Number of Employees:

Total Number of Current Clients/Customers:

Briefly describe other lines of business that the company is directly or indirectly affiliated with:

List Related Companies:

2. Contact Information: List the one person who the City may contact concerning your proposal or setting dates for meetings.

Name: Title:

Address:

City: State: Zip Code:

Telephone No. Fax No:

Email:

3. Does Respondent anticipate any mergers, transfer of organization ownership, management reorganization, or departure of key personnel within the next twelve (12) months?

Yes No

4. Is Respondent authorized and/or licensed to do business in Texas?

Yes No If “Yes”, list authorizations licenses.

5. Where is the Respondent’s corporate headquarters located?

6. Local/County Operation: Does the Respondent have an office located in Edinburg, Texas?

Yes No If “Yes”, respond to a and b below:

a. How long has the Respondent conducted business from its Edinburg office?

Years Months_________

b. State the number of full‐time employees at the San Antonio office.

If “No”, indicate if Respondent has an office located within Hidalgo County, Texas: Yes No

If “Yes”, respond to C and D below:

c. How long has the Respondent conducted business from its Bexar County office?

Years _______ Months______

d. State the number of full‐time employees at the Hidalgo County office.

7. Debarment/Suspension Information: Has the Respondent or any of its principals been debarred or suspended from contracting with any public entity?

Yes No If “Yes”, identify the public entity and the name and current phone number of a representative of the public entity familiar with the debarment or suspension, and state the reason for or circumstances surrounding the debarment or suspension, including but not limited to the period of time for such debarment or suspension.

8. Surety Information: Has the Respondent ever had a bond or surety canceled or forfeited?

Yes No If “Yes”, state the name of the bonding company, date, amount of bond and reason for such cancellation or forfeiture.

9. Bankruptcy Information: Has the Respondent ever been declared bankrupt or filed for protection from creditors under state or federal proceedings?

Yes No If “Yes”, state the date, court, jurisdiction, cause number, amount of liabilities and amount of assets.

10. Disciplinary Action: Has the Respondent ever received any disciplinary action, or any pending disciplinary action, from any regulatory bodies or professional organizations? If “Yes”, state the name of the regulatory body or professional organization, date and reason for disciplinary or impending disciplinary action.

11. Previous Contracts: a. Has the Respondent ever failed to complete any contract awarded?

Yes No If “Yes”, state the name of the organization contracted with, services contracted, date, contract amount and reason for failing to complete the contract.

b. Has any officer or partner proposed for this assignment ever been an officer or partner of some other organization that failed to complete a contract? Yes No If “Yes”, state the name of the individual, organization contracted with, services contracted, date, contract amount and reason for failing to complete the contract.

c. Has any officer or partner proposed for this assignment ever failed to complete a contract handled in his or her own name? Yes No If “Yes”, state the name of the individual, organization contracted with, services contracted, date, contract amount and reason for failing to complete the contract.

12. References: Provide three (3) references that Respondent has provided services to within the past three (3) years.

The contact person named should be familiar with the day-to-day management of the Respondent and be willing to respond to questions regarding the type, level, and quality of service provided.

Reference No. 1:

Firm/Company Name

Contact Person: Title:

Address:

City: State: Zip Code:

Email:

Phone:

Date and Type of Service(s) Provided:

Reference No. 2:

Reference No. 3