ESBD_472567_1764018568069_04_Form 3 Financial Questionnaire.pdf
PDF 97 KB Posted
- Attached to
- Home Modifications
- Solicitation number
- 3202600132
- Issued by
- Bell County, Texas
About this file
This is a Financial Questionnaire form (Form 3) required as part of a bidding process for a Home Modifications contract opportunity with the State of Texas, specifically the Texas Workforce Commission (TWC). The form serves as a financial and organizational assessment tool for prospective bidders and does not contain specific project details, quantities, timelines, or award information. Instead, it functions as a due diligence document to evaluate bidder qualifications and financial stability prior to contract award.
The questionnaire requires bidders to disclose comprehensive financial and organizational information, including any bankruptcy filings or criteria met within the past five years, current loan defaults or financial agreement violations, pending sales or acquisition activities, detailed ownership structure with percentage breakdowns for affiliates and joint ventures, company founding or incorporation date and state, headquarters and field office locations, employee counts both locally and nationally, and prior contracting history with Texas state agencies. Bidders must also specify which entities within their organizational structure will perform the majority of work under any resulting contract and provide both narrative and graphical representations of their operating structure. This form establishes baseline requirements for financial responsibility and organizational transparency but does not address pricing, contract terms, specific project scope, or funding amounts.
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Text version
FORM 3 – FINANCIAL QUESTIONNAIRE
Bidder name: ________________________
The Bidder must provide the following information. If more space is needed for the explanation, please attach additional page(s) as necessary:
a. Indicate if your company or any of its subsidiaries filed or met criteria for bankruptcy within the past five (5) years, if so, provide explanation.
b. 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.
c. Identify if your company is currently for sale or involved in any transaction to expand or become acquired by another business entity during the next twelve (12) months following the Bid Submission Deadline. If so, explain the impact both in organization and company director.
d. Ownership structure (e.g., corporation, partnership, LLC, or sole proprietorship), including any wholly owned subsidiaries, affiliated companies, or joint ventures. (Please provide this information both in a narrative and as a graphical representation.)
1. If Bidder is an affiliate of, or has a joint venture or strategic alliance with, another company, Bidder must identify the percentage of ownership of each joint venture member or affiliate and the percentage of the parent company’s ownership. The entity performing the majority of the work under any Contract resulting from this Solicitation, throughout the duration of the Contract, must be the primary Bidder.
2. Finally, Bidder must provide its proposed operating structure for the services requested under this Solicitation and which entities (i.e., parent company, affiliate, joint venture, subcontractor) will be performing the services;
e. The year the company was founded and/or incorporated. If incorporated, please indicate the state where the company is incorporated and the date of incorporation;
f. The location of company headquarters and any field office(s) that may provide services for any resulting Contract under this Solicitation;
g. The number of employees in the company, both locally and nationally, and the location(s) from which employees will be assigned to TWC’s project.
h. Indicate whether the company has ever been in contract with any Texas state agency. If “Yes,” specify the contract term, for what duties, and with which agency.
FORM 3 – FINANCIAL QUESTIONNAIRE
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