RFP 25-03_Attachment B.pdf
PDF 167 KB Posted
- Attached to
- Low-Code Application Development Services
- Solicitation number
- RFP-15318
- Issued by
- Polk County, Florida
About this file
This is a Vendor Responsibility Disclosure form (Attachment B) for RFP 25-03 Low-Code Application Development Services issued by the Florida Department of Citrus (FDOC). The RFP seeks a qualified vendor to design and develop a replacement for FDOC's current revenue system. The disclosure form requires the authorized representative of responding vendors to attest to their responsibility status by answering seven yes-or-no questions regarding their business history within the past five years. These questions address civil litigation or settlements, criminal judgments or administrative actions, suspension or debarment from competitive processes, suspension or revocation of licenses or certifications, contract terminations for cause, bankruptcy proceedings, and major organizational changes including ownership or name changes.
For each affirmative response to the disclosure questions, vendors must provide a detailed written explanation not to exceed one page and attach supporting documentation of unlimited length. The Department reserves the right to request additional information as necessary to make a final determination of vendor responsibility pursuant to Florida Statute section 287.012(25). Respondents must complete the form under sworn attestation, with the authorized representative providing their name, title, and the vendor's legal name before signing and dating the document.
View the file
Other files
Show all 39
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
RFP 25-03
Low-Code Application Development Services
Attachment B: Vendor Responsibility Disclosure 1 of 1
Attachment B: Vendor Responsibility Disclosure
Respondents shall complete and submit answers to the questions set forth below. For each affirmative answer, Respondents shall provide a detailed, written explanation (1 page) relevant to the issue and attach copies of documents relevant to the written explanation(s) provided (unlimited pages). The Department reserves the right to request additional information, as needed, to determine a Respondent’s Responsibility pursuant to section 287.012(25), F.S.
I, _____________________________________ am the ________________________________ of
(Authorized Representative’s Name) (Title)
_______________________________________, (the “Vendor”), and am authorized to represent and
(Vendor’s Legal Name) contractually bind Vendor. Having been duly sworn, I do hereby attest, to the best of my knowledge and belief, the following:
Within the past 5 years, has the vendor:
1. Been the subject of civil litigation or settlements? ☐No ☐Yes
2. Been subject to criminal judgments or administrative actions? ☐No ☐Yes
3. Been suspended or barred from participation in any competitive process or contract award?
☐No ☐Yes
4. Had any licenses or certifications suspended, revoked, or canceled? ☐No ☐Yes
5. Had any contracts or agreements terminated for cause? ☐No ☐Yes
6. Been the subject of bankruptcy proceedings? ☐No ☐Yes
7. Undergone a major change of organizational structure, ownership, or name? ☐No ☐Yes
Signature
Date
File details come from the government source that posted it. Updated .