Form C Vendor Profile and Qualifications - FINAL.pdf

270 KB Posted

Attached to
City of Onalaska Assessing Services
Solicitation number
19-Finance 01
Issued by
La Crosse County, Wisconsin

About this file

Written by GovTribe AI ·

Form C is a vendor profile and qualifications questionnaire required by the City of Onalaska Finance Department for its request for proposals (RFP #19-Finance01) for property tax assessment services. The RFP seeks qualified vendors to provide real estate, personal property, and mobile home tax assessment services for the City of Onalaska, Wisconsin, covering five years from 2020 through 2024. Onalaska, located in LaCrosse County with a population of 18,788, currently manages 6,271 parcels with a 2019 taxable value of approximately $2.0 billion. The form must be completed and returned with all proposal responses.

Form C requires vendors to provide comprehensive company information including legal company name, federal employer identification number (FEIN), contact details, and corporate officer and director names. Vendors must disclose key personnel licenses and professional registrations, potential conflicts of interest, prior work history with the City of Onalaska, and relevant work experience on similar contracts completed within the past five years. The form also mandates disclosure of any pending judgments, claims, liens disputes, bankruptcy filings within the past five years, legal infractions related to federal or state regulations within the past two years, and bonding capacity verified by a Wisconsin-licensed surety company. Vendors must acknowledge that provision of information does not guarantee qualification and that the City of Onalaska may audit all submitted information, requiring vendors to update significant changes in writing within 30 days and understand that failure to provide accurate information may result in suspension or debarment from City contracts.

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Other files

File Type Posted
Form A Signature Affidavit - FINAL.pdf PDF
Form F Fee Proposal - FINAL.pdf PDF
Form B Receipt of Forms and Submittal Checklist - FINAL.pdf PDF
2019 Assessor FINAL.pdf PDF
Form D References - FINAL.pdf PDF
Addenda 1.pdf PDF
Form E Professional Services Insurance and Indemnification Requirements - FINAL.pdf PDF

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07/16/2019 10:53 AM

This form must be returned with your response.

PROPOSER INFORMATION

Company Name (Make sure to use your complete, legal company name.)

FEIN (If FEIN is not applicable, SSN collected upon award.)

Contact Name (Able to answer questions about proposal.) Title

Telephone Number Fax Number

Email

Address City State Zip

ORDERS/BILLING CONTACT

Address where City purchase orders/contracts are to be mailed and person the department contacts concerning orders and billing.

Contact Title

Telephone Number Fax Number

Email

Address City State Zip

Form C: Vendor Profile/Qualifications

RFP #: 19-Finance01

CORPORATION INFORMATION

If applicant is a corporation, please complete both columns:

Names of Corporate Officers Names of Corporate Directors

LICENSES AND PROFESSIONAL REGISTRATION

List names of each key person of the firm. If a requested service requires a licensed/registered practitioner, you will be required to provide a copy of such license/registration before work can begin.

Name

Capacity

(Owner, Partner, Etc.)

Current Licenses/Registrations (Include Certificate # if applicable)

License/Registration

Expiration Date

CONFLICT OF INTEREST

A conflict of interest may exist where an employee or close relative/family member has a connection to your business, and a third party may consider that this relationship may compromise the competitive process. Does any employee of your company have a possible conflict of interest with this process? Yes No If yes, please specify the following:

Employee Name: __________________________ Employee Phone Number: _______________

Employee’s Relationship: _________________________

PRIOR WORK

Has your organization ever performed work for the City of Sun Prairie? Yes No If yes, please specify scope of work:

WORK EXPERIENCE

List contracts for similar services or materials that have been completed within the last five years.

Project Location Type of Service Total Amount of Contract

Completion Date

Name/Phone of Owner or Other

References

KEY PROJECT PERSONNEL INFORMATION

Provide the requested information for key personnel who would be assigned to work on contracts awarded or who would, at a minimum, supervise such work.

Name and Title Primary Responsibilities

Years of Experience

Education (Degrees, Certificates)

Other Relevant Experience and/or

Qualifications

JUDGEMENTS AND CLAIMS

Are there any judgements, claims or suits pending our outstanding against you or your organization?

Yes No

If yes, please explain:

DISPUTES REGARDING LIENS

Has any owner or higher-tier contractor with whom you r business has had a contract ever disputed a claim of lien filed by you or your organization? Yes No

RECEIVERSHIP

Have you or your organization filed for bankruptcy, receivership, or reorganization within the last five years?

Yes No

LEGAL INFRACTIONS

Have you or your organization been cited and/or fined for failure to comply with federal or state regulations and/or statues in the past two years? Yes No

BONDING

Attach a letter from your surety company or its agent licensed to do business in Wisconsin verifying your organization’s capacity to provide adequate performance and payment bonds.

Have any funds been expanded by a surety company on your behalf? Yes No

List all of the surety companies that have provided bonds for your company for the past five years:

Information provided in this application may be audited by the City of Onalaska.

Provision of information on Form C does not relieve your company from providing the same or additional information as requested in a response to a request for proposal.

Submittal of Form C does not guarantee qualification. Qualification will be given only if your company meets all statutory, regulatory or City requirements, including those not listed on this application. Qualification does not guarantee your company any business.

Your company must update significant information changes in writing within 30 days.

Significant changes include, but are not limited to: change of legal status, TIN, ownership, name, address, as well as loss of licensure or registration, filing of bankruptcy, or suspension by any federal, state, or local government agency.

Failure to provide accurate and reliable information required by this form may, in accordance with any and all applicable laws, result in penalties including, but not limited to, suspension or debarment from doing business with the City of Onalaska and termination of contracts.

Company Name Make sure to use your complete legal company name:
FEIN If FEIN is not applicable SSN collected upon award:
Contact Name Able to answer questions about proposal:
Title:
Telephone Number:
Fax Number:
Email:
Address:
City:
State:
Zip:
Contact:
Title_2:
Telephone Number_2:
Fax Number_2:
Email_2:
Address_2:
City_2:
State_2:
Zip_2:
Names of Corporate OfficersRow1:
Names of Corporate DirectorsRow1:
Names of Corporate OfficersRow2:
Names of Corporate DirectorsRow2:
Names of Corporate OfficersRow3:
Names of Corporate DirectorsRow3:
Names of Corporate OfficersRow4:
Names of Corporate DirectorsRow4:
Names of Corporate OfficersRow5:
Names of Corporate DirectorsRow5:
NameRow1:
Capacity Owner Partner EtcRow1:
Current LicensesRegistrations Include Certificate if applicableRow1:
LicenseRegistration Expiration DateRow1:
NameRow2:
Capacity Owner Partner EtcRow2:
Current LicensesRegistrations Include Certificate if applicableRow2:
LicenseRegistration Expiration DateRow2:
NameRow3:
Capacity Owner Partner EtcRow3:
Current LicensesRegistrations Include Certificate if applicableRow3:
LicenseRegistration Expiration DateRow3:
NameRow4:
Capacity Owner Partner EtcRow4:
Current LicensesRegistrations Include Certificate if applicableRow4:
LicenseRegistration Expiration DateRow4:
NameRow5:
Capacity Owner Partner EtcRow5:
Current LicensesRegistrations Include Certificate if applicableRow5:
LicenseRegistration Expiration DateRow5:
NameRow6:
Capacity Owner Partner EtcRow6:
Current LicensesRegistrations Include Certificate if applicableRow6:
LicenseRegistration Expiration DateRow6:
NameRow7:
Capacity Owner Partner EtcRow7:
Current LicensesRegistrations Include Certificate if applicableRow7:
LicenseRegistration Expiration DateRow7:
Employee Name:
Employee Phone Number:
Employees Relationship:
If yes please specify scope of work:
ProjectRow1:
LocationRow1:
Type of ServiceRow1:
Total Amount of ContractRow1:
Completion DateRow1:
NamePhone of Owner or Other ReferencesRow1:
ProjectRow2:
LocationRow2:
Type of ServiceRow2:
Total Amount of ContractRow2:
Completion DateRow2:
NamePhone of Owner or Other ReferencesRow2:
ProjectRow3:
LocationRow3:
Type of ServiceRow3:
Total Amount of ContractRow3:
Completion DateRow3:
NamePhone of Owner or Other ReferencesRow3:
ProjectRow4:
LocationRow4:
Type of ServiceRow4:
Total Amount of ContractRow4:
Completion DateRow4:
NamePhone of Owner or Other ReferencesRow4:
ProjectRow5:
LocationRow5:
Type of ServiceRow5:
Total Amount of ContractRow5:
Completion DateRow5:
NamePhone of Owner or Other ReferencesRow5:
ProjectRow6:
LocationRow6:
Type of ServiceRow6:
Total Amount of ContractRow6:
Completion DateRow6:
NamePhone of Owner or Other ReferencesRow6:
ProjectRow7:
LocationRow7:
Type of ServiceRow7:
Total Amount of ContractRow7:
Completion DateRow7:
NamePhone of Owner or Other ReferencesRow7:
ProjectRow8:
LocationRow8:
Type of ServiceRow8:
Total Amount of ContractRow8:
Completion DateRow8:
NamePhone of Owner or Other ReferencesRow8:
Name and TitleRow1:
Primary ResponsibilitiesRow1:
Years of ExperienceRow1:
Education Degrees CertificatesRow1:
Other Relevant Experience andor QualificationsRow1:
Name and TitleRow2:
Primary ResponsibilitiesRow2:
Years of ExperienceRow2:
Education Degrees CertificatesRow2:
Other Relevant Experience andor QualificationsRow2:
Name and TitleRow3:
Primary ResponsibilitiesRow3:
Years of ExperienceRow3:
Education Degrees CertificatesRow3:
Other Relevant Experience andor QualificationsRow3:
Name and TitleRow4:
Primary ResponsibilitiesRow4:
Years of ExperienceRow4:
Education Degrees CertificatesRow4:
Other Relevant Experience andor QualificationsRow4:
Name and TitleRow5:
Primary ResponsibilitiesRow5:
Years of ExperienceRow5:
Education Degrees CertificatesRow5:
Other Relevant Experience andor QualificationsRow5:
Name and TitleRow6:
Primary ResponsibilitiesRow6:
Years of ExperienceRow6:
Education Degrees CertificatesRow6:
Other Relevant Experience andor QualificationsRow6:
If yes please explain:
If yes please explain_2:
If yes please explain_3:
If yes please explain_4:
If yes please explain_5:
years:

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