Sourcing Event 0000011689 Attachment 2 Proposer Questionnaire and References Part I Proposer Information Name of Firm:

Headquarter Address:

Firm Phone No.:

Contact Name & Title:

Contact E-mail:

Contact Phone:

SF Supplier ID:

Federal Tax ID:

Person Preparing Bid:

Contact Information for Support:

Telephone:

Email:

Website:

Urgent Issue Contact:

Part II Proposer Questionnaire

1. Do you certify that you have complied and will continue to comply with Section 13.5 of this Solicitation entitled “Limitation on Communications during Solicitation”?

2. Have you registered as a Bidder or Supplier, through the Supplier Portal (https://sfcitypartner.sfgov.org/)?

If yes, what is your Bidder ID or Supplier ID? _________________

3. Have you registered your business with the San Francisco Treasurer & Tax Collector as required prior to submission of any Proposal?

Enter your Business Tax Registration ID here: __________________________________

Are you claiming LBE preference on this solicitation per Chapter 14B?

To claim LBE preference for this solicitation, you must be certified in one or more of the following LBE certification category/categories by the Proposal Due Date:

· San Francisco - LBE and Non-Profit LBEs

List each subcontractor directly performing services on this contract. If none, enter none. Add additional rows as needed.

Subcontractor’s Full Legal Business Name

4. Can you comply with the terms set forth in Attachment 1, City’s Proposed Agreement Terms?

If you reply NO, you must submit a revised copy of City’s Contract Terms with your Proposal and no later than the Proposal Due Date. The revised copy of City’s Contract Terms must clearly:

(1) Mark those sections to which it requests changes;

(2) Set forth Proposer’s alternative terms with respect to each such section showing proposed changes (double underline added language; strikethrough deleted language); and

(3) Explain the basis for each proposed change.

5. Have you submitted with your Proposal all the Minimum Qualification Documentation outlined in the accompanying solicitation document?

If you reply NO to any document, please explain.

6. Have you submitted with your Proposal a Price Proposal that complies with the requirements of the accompanying solicitation document including pricing must not be dependent on a fixed minimum timeframe since per Article 8 Termination; Disposition of Content; Survival of the City’s Contract Terms, there may be cause for termination of the Contract prior to the end of the initial term.

7. Have you submitted with your Proposal a Written Proposal (Attachment 4) that complies with the requirements of the accompanying solicitation document?

Part III Proposer References All proposers, including current Contractor, must provide references for at least two (2) organizations of the approximate size and volume comparable to commodities and/or services described in this Solicitation. Upon request, successful proposer(s) may also be required to submit a letter of reference from each reference listed within five (5) days of notification. Failure to do so may result in rejection of proposal.

Address (street, city, state, zip)

Contact Name

Phone No.

Email

Number of Years Providing Service

Address (street, city, state, zip)

Contact Name

Phone No.

Email

Number of Years Providing Service

Part IV Proposer Release of Liability for References The undersigned hereby fully and forever release, exonerate, discharge and covenant not to sue the City, its commissions and boards, officers and employees, and all individuals, entities and firms providing information, comments, or conclusions ("Reference Information") in response to inquiries that the City may make regarding the qualifications or experience of a Prime proposer, proposed joint venture partner, proposed subconsultant or proposed key/lead team member in connection with the selection process for Solicitation 0000011689, “An online secure, consent-based income verification system” from and for any and all claims, causes of action, demands, damages, and any and all liabilities of any kind or description, in law, equity, or otherwise arising out of the provision of said Reference Information. This Release and Waiver is freely given and will be applicable whether or not the responses by said individuals, entities or firms are accurate or not, or made willfully or negligently.

Company Name

Signature of Authorized Representative of Company Date

Print Name and Title

Part V.

Proposer Certification of Truth, Accuracy, and Completeness

I certify that based on information and belief formed after reasonable inquiry, the statements and information contained in this document are true, accurate, and complete. Additionally, by submitting this bid/proposal, I attest that I have reviewed and accepted all terms found in this solicitation, any and all addenda issued to this solicitation, and City’s contract terms.

Company Name

Signature of Authorized Representative of Company Date

Print Name and Title