FAC98 Bidder Response Form_Amended 3.23.2018.docx

FAC98 Bidder Response Form The following information is mandatory for this RFR. Failure to provide the requested information may be cause for the bid to be deemed as non-responsive and may result in disqualification. Please note all boxes will expand to accommodate answers. Once completed, save the Word file (do not convert to PDF must be submitted as a Word file) with the following name “FAC98_CompanyName_Bidder Response Form" for submission.

1. Bidder General Information Company Name:

Company Address:

Company Phone Number:

Company Fax Number:

Company Internet Address:

2. Office Locations Provide the address of the office from which this contract will be managed. In addition, list any New England locations, including facility type, complete address and phone number. A separate document with this information may be provided.

Primary Location:

Other MA/New England Locations:

3. Years in Business Provide the number of years in business prior to the close date of the solicitation.

Bidder Response

Number of years in business

4. Industry Experience Provide a brief summary of your company’s experience in the industry and experience servicing MA government/commercial/industrial accounts.

5. Designated Contract Manager Provide a brief description of the designated contract manager’s experience that will be responsible for the overall management, reporting and ensuring adherence to the performance measures of this contract during normal business hours. This must include the name, address, phone number, fax number and E-mail address.

Contract Manager Name:

Business Phone:

Business Fax:

E-mail Address:

Brief Description of Contract Manager Experience:

6. Designated Reporting Contact Provide a primary contact for all reporting requirements under the statewide contract. See RFR section 17 for reporting requirements & due dates.

Reporting Contact Name:

Business Phone:

E-mail Address:

7. Categories Specify the Categories that your company is bidding on:

1. Carpet

2. Hard Surface

3. Installation, Maintenance and Repair

8. Service Area Specify the County/ Counties that your company wishes to service. Link to county breakdown for reference.

Barnstable

Berkshire

Bristol

Dukes

Essex

Franklin

Hampden

Hampshire

Middlesex

Nantucket

Norfolk

Plymouth

Suffolk

Worcester

9. Companies Bidding on Categories 1 and/or 2 Only

Please answer Y/N in the columns below:

Is your company the Manufacturer?

Is your company an Authorized Dealer/Distributor?

If company bidding is the Manufacturer please list the names and locations of any authorized dealers/distributors in MA that would be allowed to sell products through your company under the contract. If needed this can be provided as a separate attachment. If your company will only be selling products direct please put N/A in the box below.

If company bidding is an Authorized Dealer/Distributor please list the Manufacturer Name(s) for products that your company is authorized to sell under the contract.

10. State of Emergency Contact Provide the name and phone number of the designated individual who can be contacted by the Commonwealth (365 days, 24 hours) during a declared state of emergency.

State of Emergency Contact:

State of Emergency Phone Number:

11. Emergency Preparedness: COOP Plan Indicate whether there is a written Continuity of Operations Plan (COOP) that describes how the company will continue to do business in case of an emergency (see RFR Section 4.6). This information will not be considered in the evaluation of the response.

Yes

No

12. Financial Information In addition to submitting a Certificate of Good Standing from the Department of Revenue (DOR), state you total annual gross revenue for each of the last three (3) calendar years: 2014, 2015, and 2016.

2016:

2015:

2014:

Is your company compliant with both state and federal taxes: |_| yes |_|no

13. Litigation, Penalties, Pending Actions, Enforcement Actions, or Bankruptcy Bidder shall submit a description of any and all investigations, indictments or pending litigation by any federal, state or local jurisdiction relating to the bidder, any officer, director, partner or member thereof, any affiliate or any related company. A list of all criminal convictions within the last five years relating to the bidder, any officer, director, partner or member thereof, any affiliate or any related entity. A list of all civil penalties, judgments, consent decrees and other sanctions within the last five years, as a result of any violation of any law, rule, regulation or ordinance in connection with its business activities relating to the bidder, any officer, director, partner or member thereof, any affiliate or any related entity. A list of all actions occurring within the last five years which have resulted in revocation or suspension of any permit or authority to do business in any jurisdiction relating to the submitting entity, any officer, director, partner or member thereof, any affiliate or any related entity. A list of all actions occurring within the last five years that have resulted in the barring from public bidding relating to the bidder, an officer, director, partner or member thereof, any affiliate or any related entity. A list of all pending actions and enforcement actions, including OSHA violations. A list of all bankruptcy and other similar proceedings within the past five years relating to the bidder, any officer, director, partner or member thereof, any affiliate or any related entity.

Defaults Bidder shall provide a description, in detail, of any situation in which the bidder’s firm (either alone or as part of a joint venture), or a subsidiary of the bidder’s firm, defaulted or was deemed to be in noncompliance of any contractual obligations, explaining the situation, its outcome and all other relevant facts associated with the event described. Please also provide the name, title and telephone number of the principal manager of the contract user who asserted the event of default or noncompliance.

Other Adverse Situations Bidder shall provide a description of any present facts known to the bidder that might reasonably be expected to affect adversely either its ability to perform any aspect of the agreement or the viability of any affiliated entity that might reasonably be expected to supply financial support.

Describe any Litigation, Penalties or Bankruptcy within the last 5 years:

Describe any Defaults within the last 5 years:

Describe any other Adverse Conditions:

Describe any actions, pending actions, enforcement actions, or violations:

Category 3 Installation Maintenance and Repair Only - OSHA Violations – Bidder must disclose any safety violations received within the last five (5) years. Bidder must provide explanation of circumstances and status:

14. Insurance Requirements Bidders must carry Liability [General and Auto], Property, Personal Injury, and Worker’s Compensation. Bidders must indicate below their insurance limitations in the table below. Bidder’s insurance limits must meet requirements as stated in Section 4.5 the RFR. Insurance copies must be provided with response.

General Liability

Auto

Property

Personal Injury

Worker’s Compensation

15. Commodity Specifications:

All commodity specifications can be found in the Request for Response (RFR). Please acknowledge that you have read the commodity specifications listed. Failure to comply with any specification or requirement of this RFR after contract award may result in termination of an awarded contract.

Signed electronically:

Authorized officer name:

Title:

Date:

16. Price Benchmarking Please describe any price agreements you may have with the U.S. Federal Government (e.g. General Services Administration), national public purchasing cooperatives (e.g. US Communities, NJPA, etc.), local purchasing cooperatives (e.g. chemical buying consortiums), or other states or large public organizations within the Commonwealth of Massachusetts. How does the pricing proposed by your company under this contract compare to pricing offered under agreements with above-mentioned organizations.

Use this column for the answer

If Yes, name the organization(s) supplied under that contract:

If Yes, please compare the pricing offered under that contract with the pricing proposed to the Commonwealth in response to that solicitation:

If Yes, please compare the pricing offered under that contract with the pricing proposed to the Commonwealth in response to that solicitation:

If Yes, please compare the pricing offered under that contract with the pricing proposed to the Commonwealth in response to that solicitation:

If Yes, please compare the pricing offered under that contract with the pricing proposed to the Commonwealth in response to that solicitation:

17. Catalog:

If the SSST determines that it would like to elect the option to a Line Item Catalog, Bidders must commit to Line Item Catalog. Definitions of these can be found in the Glossary of the RFR.

Bidder’s Response with an X confirming the above.

Line Item Catalog

18. Training and Product Support:

Describe your company’s ability to provide training and product support to Purchasing Entities.

23. Returns:

Describe your company’s ability to handle all returns, refunds and/or cancellations to Purchasing Entities.

Certification

I , ___________________________________, agree to all terms, conditions and requirements stated in this RFR. I realize failure to comply with any requirement of this RFR after contract award may result in termination of an awarded contract.

Signed electronically Authorized officer name:

Title:

Date:

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