RFP Form C Vendor Profile and Qualifications.pdf
PDF 94 KB Posted
- Attached to
- Zoning Code Rewrite
- Solicitation number
- 23-PLA28
- Issued by
- Dane County, Sun Prairie City, Wisconsin
About this file
This is a Vendor Profile and Qualifications form (Form C) for RFP #23-PLA28 issued by the City of Sun Prairie, Wisconsin's Planning Department for a zoning code rewrite and development regulation project. The form must be completed and submitted with all proposal responses and requests vendors to provide comprehensive company information including legal name, FEIN or SSN, primary contact details, and orders/billing contact information. Vendors must also indicate their local vendor status, as the City of Sun Prairie grants a scoring preference to suppliers located within city limits as of the bid due date. The form requires submission of corporate officer and director names for corporations, documentation of key personnel licenses and professional registrations with expiration dates, and detailed work experience including contracts for similar services completed within the last five years with project references.
The form mandates disclosure of potential conflicts of interest involving company employees or family members, prior work history with the City of Sun Prairie, key project personnel assignments with years of experience and relevant qualifications, and any pending or outstanding judgments, claims, or suits. Vendors must also disclose disputes regarding liens, any bankruptcy or receivership filings within the past five years, federal or state regulatory citations or fines within the past two years, and bonding capacity when applicable. The City reserves the right to audit information provided and update requirements within 30 days for significant changes including legal status, ownership, licensure loss, or suspension by government agencies. Failure to provide accurate information may result in suspension or debarment from doing business with the City of Sun Prairie and contract termination.
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Text version
This form must be returned with your response.
COMPANY 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
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
Address City State Zip
Form C: Vendor Profile/Qualifications
RFP#: 23-PLA28
LOCAL VENDOR STATUS
The City of Sun Prairie has included a local vendor preference granting a scoring preference to local suppliers. Only suppliers within the City of Sun Prairie limits as of the bid’s due date will receive preference.
CHECK ONLY ONE:
Yes, we are a local vendor.
No, we are not a local vendor.
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- Only if needed
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 Sun Prairie.
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 Sun Prairie and termination of contracts.
File details come from the government source that posted it. Updated .