ESBD_377739_1727372924394_303-2-01738 Attachment G - Contractor's Qualification Form.docx
DOCX document 35 KB Posted
- Attached to
- RFP for Refrigeration Repairs and Services
- Solicitation number
- 303-2-01738
- Issued by
- Travis County, Texas
About this file
This document is an Attachment G - Contractor's Qualification Form for RFP 303-2-01738 Refrigeration Repairs and Services, issued by the state agency. The RFP seeks contractors to provide refrigeration repairs and maintenance services. Respondents must complete this form to provide information about their company, financial history, relevant experience and qualifications, and the office that will service the contract. This includes details on required certifications and licenses, the proposed methodology for fulfilling the contract requirements, safety training and equipment, and three references for similar past work. The contract term and any renewal options are not specified.
The form requires respondents to disclose information about any bankruptcy filings, defaults, or contract terminations in the past five years, as well as any pending sale or acquisition of the company. Contractors must also provide their Workers' Compensation Modification rate. Pricing terms, funding sources, and other financial details are not included in this document.
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Text version
RFP 303-2-01738
Refrigeration Repairs and Services
ATTACHMENT G - CONTRACTOR’S QUALIFICATIONS FORM
RFP 303-2-01738
Refrigeration Repairs and Services Respondent Instructions: Complete the form below and submit with response as per Attachment K – RFP Submission Instructions and Guidelines. This form or a reasonable likeness must be returned with response. Failure to do so will result in disqualification. Failure to complete the form may result in disqualification of response. Failure to submit Attachment G – Contractor’s Qualifications Form through the Bonfire online system will result in disqualification of submitted response.
COMPANY INFORMATION:
Company Name:
Federal EIN Number:
(Attach W9 to this form)
Company Description
Number of Years in Business:
Primary Contact Name:
Primary Contact Phone:
Primary Contact Email:
FINANCIAL HISTORY
Indicate if your company or any of its subsidiaries filed or met criteria for bankruptcy within the past five years. If yes, provide explanation.
Indicate if your firm is currently in default on any loan agreement or financial agreement institution, or other entity. If so, specify date(s), details, circumstances, and prospect resolution.
Identify if your company is currently for sale or involved in any transaction to expand or become acquired by another business entity. If so, explain the impact both in organization and company direction.
Indicate if your company has had a contract terminated for default or convenience within the past five years. If yes, provide explanation
MAIN/HOME OFFICE LOCATION INFORMATION:
Main Office Address:
# of Permanent, FT Employees:
# of Permanent, PT Employees:
RELEVANT EXPERIENCE AND QUALIFICATIONS
OFFICE THAT WILL SERVICE THIS CONTRACT INFORMATION:
Servicing Office Address:
# of Permanent, FT Employees:
# of Permanent, PT Employees:
# of Service Technicians:
| Geographic Service Area: |
| |_| Austin/San Antonio |
|_| Houston |_| Waco |_| Fort Worth |_| El Paso
(Checked service area should have an Attachment E – Compensation and Fees filled in)
1. What certifications, licenses, or permits are required to perform refrigeration repairs and maintenance as requested in this RFP?
2. Explain how you meet the requirements stated in question 1 above.
Provide the names and certifications/licenses held by staff that will perform services, if awarded this contract.
| Name |
| Certification/License (Include number if applicable) |
List any specialized Safety Materials Training Provided to Staff Relevant to Statement of Work
| Name |
| Training |
PROPOSED METHODOLOGY
Describe how you propose to fulfill the requirements outlined in Attachment A – Service Contract Draft, Section 1.01, Statement of Work. Answer should include, when called out please explain your process on: how equipment will be tested and repaired; how services are scheduled and requested as-needed; available service times; explain the turnaround of parts (i.e. do you keep any parts in stock); explain your warranty process when replacing or repairing equipment; explain your emergency response protocol; and any additional information we would need to know going into the contract.
SAFETY:
Describe safety training program provided to employees relevant to Statement of Work.
Describe the safety equipment issued and provided to employees performing services relevant to Statement of Work.
Provide on insurance letterhead, the Workers’ Compensation Modification rate for the past five years. Attach as a separate document. Below, provide explanation for any rating above a value of one (1).
REFERENCES: Contractor shall submit three (3) references for which the contractor has provided services of similar size, scope and complexity within the last three (3) years. Additional information may be submitted or attached at Respondent’s discretion to provide a detailed summary of Qualifications & Experience of similar/relevant scope.
| A. |
| Client: |
Point of Contact:
Telephone:
Email:
Facility Name:
Facility Address:
Start Date of Contract:
End Date of Contract:
Description of Scope of Work:
| A. |
| Client: |
Point of Contact:
Telephone:
Email:
Facility Name:
Facility Address:
Start Date of Contract:
End Date of Contract:
Description of Scope of Work:
| A. |
| Client: |
Point of Contact:
Telephone:
Email:
Facility Name:
Facility Address:
Start Date of Contract:
End Date of Contract:
Description of Scope of Work:
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