RFP Proposal Form.docx
DOCX document 31 KB Posted
- Solicitation number
- 60389
- Issued by
- Fairfax County, Falls Church City, Virginia
About this file
This document is a Proposal Submission Form for a state and local contract opportunity in Virginia. The opportunity is to develop a strategic plan focused on affordable housing and addressing homelessness in Fairfax County and Falls Church City. The form requires the business to provide identification details, qualifications, and references. It also asks the offeror to disclose any potential conflicts of interest or collusion, and to acknowledge understanding of the solicitation terms and conditions. The offeror must indicate whether their proposal contains any trade secrets or proprietary information. The contract opportunity is subject to the Virginia State and Local Government Conflict of Interests Act.
The proposal form does not provide details on pricing, set-asides, incumbents, funding requirements, or other salient financial information. It focuses on the administrative and compliance requirements for submitting a proposal for this strategic planning contract opportunity across the two Virginia jurisdictions of Fairfax County and Falls Church City.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP 60389 Affordable Housing and Homelessness Strategic Plan.pdf | ||
| RFP 60389 Addendum #1.pdf |
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Text version
PROPOSAL SUBMISSION FORM
Business Identification
BUSINESS NAME:
ADDRESS:
CONTACT PERSON:
TITLE:
TELEPHONE NO.:
EMAIL ADDRESS:
REMITTANCE ADDRESS:
| PROMPT PAYMENT DISCOUNT: |
| ___% FOR PAYMENT WITHIN____ DAYS; NET___DAYS |
BUSINESS ORGANIZED UNDER THE STATE LAWS OF:
PRINCIPAL BUSINESS LOCATION:
STATE CORPORATION COMMISSION IDENTIFICATION NO.:
DUNS NUMBER:
Business Classifications Corporation
Partnership
Sole Proprietor
Minority Owned
Small Business
Non Profit
Woman Owned
Ownership Disclosure Names and address of all persons having an ownership interest of 5% or more in the business:
1.
2.
3.
Qualifications and References Type of work performed by this business:
Number of years this business has been in operation:
| Number of employees: |
| Full time: |
| Part Time: |
| Business License: |
| Type: |
| Issued: |
| Has the business ever defaulted or failed to complete any public body contract: |
| No: |
Yes- Explain:
| Is the entity or any of its principals currently debarred, disqualified or suspended from submitting responses to the City, or any other state, local or federal entities? |
| No: |
Yes:
| Exceptions (Legally Required Contract Terms are required by law: Non-Discrimination, Authorization to Conduct Business in the Commonwealth, No Indemnification by the City, Disputes, Drug Free Workplace, Immigration Reform and Control Act, Availability of Funds) |
| No (Offeror accepts all RFP terms and conditions) |
Yes (Offeror takes exception to non-legally required RFP terms and conditions)
TRADE SECRETS OR PROPRIETARY INFORMATION:
Trade secrets or proprietary information submitted by the Offeror in connection with a procurement transaction shall not be subject to public disclosure under the Virginia Freedom of Information Act. However, the Offeror must identify the data and materials that need such protection prior to the submission of such data and material, and state the reasons why protection is necessary. Please mark one:
[ ] Yes, the Proposal I have submitted does contain trade secrets and/or proprietary information.
[ ] No, the Proposal I have submitted does not contain any trade secrets and/or proprietary information.
If Yes, Offeror must clearly identify below the exact data or other materials to be protected and list all applicable page numbers of the Proposal containing such data or materials:STATE THE SPECIFIC REASON(S) WHY PROTECTION IS NECESSARY:
Use additional attachments if necessary
NOTE: If the Offeror fails to identify the data or other materials to be protected and fails to state the reasons why such protection is necessary in the space provided above, then the Offeror has not invoked protection accordingly, effectively making the Proposal open for public inspection consistent with applicable law.
Conflict of Interests
| This solicitation is subject to the provisions of Section 2.2-3100 et. Seq., Virginia Code Annotated, the State and Local Government Conflict of Interests Act. The business is aware of information bearing on the existence of any potential organizational conflict of interest. |
| YES |
NO
Collusion:
| I certify that this bid is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a bid for the same goods and services and is in all respects fair and without collusion or fraud. I understand collusive bidding is a violation of the State and Federal law and may result in fines, prison sentences, and civil damage awards. |
| YES |
NO
Authorized Signature By signing this proposal, offeror certifies, acknowledges, understands, and agrees to be bound by the conditions set forth in this Solicitation.
| Authorized Signature: |
| Date: |
| Name (Printed): |
| Title: |
| Email Address: |
| Telephone Number: |
See RFP paragraph 6 for proposal instructions.
State Corporation Commission Form
Virginia State Corporation Commission (SCC) registration information. The offeror:
· is a corporation or other business entity with the following SCC identification number: ____________ -OR-
· is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust -OR-
· is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the offeror in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from offeror’s out-of-state location) -OR-
· is an out-of-state business entity that is including with this proposal an opinion of legal counsel which accurately and completely discloses the undersigned offeror’s current contacts with Virginia and describes why those contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles 13.1 or 50 of the Code of Virginia.
**NOTE** >> Check the following box if you have not completed any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for proposals (the City reserves the right to determine in its sole discretion whether to allow such waiver):
RFP 60389 Page 3
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