ESBD_563015_1790361798881_Form 3 - Financial Questionnaire.pdf
PDF 73 KB Posted
- Solicitation number
- 3202600207
- Issued by
- Texas
About this file
This is a Financial Questionnaire form for the Request for Qualifications (RFQ) No. 3202600207 issued by the Texas Workforce Commission (TWC) for Vocational Rehabilitation Impartial Hearing Officers. Respondents are required to complete this form to provide financial and organizational information unless they are governmental entities. The questionnaire applies to individuals, sole proprietors, and companies, with respondents directed to attach additional pages if needed for explanations.
The Financial Questionnaire requires respondents to disclose bankruptcy filings or criteria met within the past five years; current defaults on loan agreements or financial agreements with any institution; any pending sale or acquisition transactions anticipated within twelve months following the response submission deadline; ownership structure including corporations, partnerships, LLCs, sole proprietorships, subsidiaries, affiliated companies, or joint ventures with specific ownership percentages; year of company founding and incorporation details including state of incorporation; headquarters location and any field offices providing services; employee count both locally and nationally and assignment locations; and prior contract history with any Texas state agency including contract terms, duties performed, and the contracting agency. For joint ventures or affiliates, respondents must identify ownership percentages and confirm that the entity performing the majority of work will be the primary bidder. The proposed operating structure and identification of entities performing services must be clearly delineated.
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Text version
RFQ No. 3202600207 Page 1 of 3 Form 3: Financial Questionnaire v. Dec 2025
Request for Qualifications (RFQ) Form 3
– Financial Questionnaire
3202600207 Vocational Rehabilitation Impartial
Hearing Officers
Respondent name: ________________________
The Respondent must provide the following information unless it is a governmental entity. If the Respondent is an individual or sole proprietor, please answer on behalf of yourself/your independent practice. If more space is needed for an explanation, please attach additional page(s) as necessary:
a. Indicate if you, your company, or any of its subsidiaries filed or met criteria for bankruptcy within the past five (5) years. If so, provide an explanation.
b. Indicate if you or your firm is currently in default on any loan agreement or financial agreement with any financial institution, or other entity. If so, specify date(s), details, circumstances, and prospect resolution.
RFQ No. 3202600207 Page 2 of 3
c. Identify if your practice/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 Response
Submission Deadline. If so, explain the impact both in organization and company director, if applicable.
d. Ownership structure (e.g., corporation, partnership, LLC, or sole proprietorship), including any wholly-owned subsidiaries, affiliated companies, or joint ventures.
1. If Respondent is an affiliate of, or has a joint venture or strategic alliance with, another company, Respondent 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, Respondent must provide its proposed operating structure for the services requested under this Solicitation and which entities
RFQ No. 3202600207 Page 3 of 3
(i.e., parent company, affiliate, joint venture) 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; and
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.
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