RFP Form C Vendor Profile and Qualifications.pdf
PDF 99 KB Posted
- Attached to
- Pickleball Court Lighting & Design
- Solicitation number
- 22-PRF36
- Issued by
- Wisconsin
About this file
This is a Vendor Profile and Qualifications form (Form C) required by the City of Sun Prairie, Wisconsin for RFP #22-PRF36 related to pickleball court lighting and design services. The form serves as a standardized application document that vendors must complete and submit with their proposal responses. The RFP solicits qualified vendors to provide design and engineering services for tournament-quality lighting at the Wyndham Hills Pickleball complex, along with construction administration services. No specific response deadlines, site visit requirements, or bidder conferences are outlined in this form document.
The form requires vendors to provide comprehensive company information including legal entity name, FEIN, contact details, and corporate officer and director names. Vendors must disclose local vendor status to potentially qualify for the City's local vendor preference scoring advantage, available only to suppliers located within Sun Prairie city limits as of the bid due date. The form mandates disclosure of licenses and professional registrations for key personnel, conflict of interest statements, prior work history with the City, relevant work experience from the past five years, and key project personnel qualifications. Vendors must also certify the absence of pending judgments, bankruptcy filings, lien disputes, and regulatory infractions within specified timeframes. The City reserves the right to audit submitted information and requires vendors to report significant changes such as ownership changes, loss of licensure, or debarment within 30 days. Failure to provide accurate information may result in suspension or debarment from City contracts.
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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#: 22-PRF36
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
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 .