Vendor Questionnaire Worksheet.docx
DOCX document 46 KB Posted
- Attached to
- FISH / WILDLIFE POND PUMP REPLACEMENT
- Solicitation number
- RFP 751 190000003004 1
- Issued by
- Michigan
About this file
This is a Vendor Questionnaire Worksheet and Confidential Treatment Form issued by the State of Michigan for use in responding to a Request for Proposals (RFP). The document serves as a standardized template requiring bidders to provide comprehensive company information and certifications necessary for proposal evaluation and contract award consideration. Bidders must complete either Section 1 (confirming no confidential treatment is requested) or Section 2 (identifying specific confidential materials with detailed justifications) and submit the signed form with their proposal. Failure to submit a completed Confidential Treatment Form results in rejection of the proposal as non-responsive.
The Vendor Questions Worksheet requires bidders to provide detailed responses across seven main categories: contact information for the primary RFP representative and contract signatory; company background including legal structure, formation state, years in business, employee count, parent company information, organizational changes, litigation history, contract defaults within the past five years, and gross annual sales for the preceding five years; qualified disabled veteran or service-disabled veteran-owned business status with supporting documentation; disclosure of any participation in RFP development or evaluation; State of Michigan experience and prior contracts held within the last ten years; affirmation of agreement with standard contract terms; and multiple statutory certifications regarding labor practices, Michigan business tax compliance, Iran-linked business status, environmental compliance, convict labor usage, State of Michigan tax and debt payment status, and authorization for information verification. All responses must be signed by the individual authorized to sign the bidder's proposal.
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Text version
STATE OF MICHIGAN
CONFIDENTIAL TREATMENT FORM (CT FORM)
INSTRUCTIONS. Complete either Section 1 or Section 2 of this CT Form and sign where indicated. This CT Form must be signed by the individual who signed the bidder’s proposal. A completed CT Form must be submitted with your proposal, regardless of whether your proposal contains confidential information. Failure to submit a completed CT Form with your bid is grounds for rejecting the proposal as non-responsive. See Section 16 of the Proposal Instructions for additional information.
Section 1. Confidential Treatment Is Not Requested
This section must be completed, signed, and submitted with the proposal if bidder does not request confidential treatment of any material contained in the proposal.
By signing below, the bidder affirms that confidential treatment of material contained in the proposal is not requested.
| ____________________________________ | ____________________________ | |
| RFP Number | RFP Title |
| ____________________________________ | _____________________ | |
| Signature | Date |
[Printed Name] [Title] [Company]
Section 2. Confidential Treatment Is Requested
The section must be completed, signed, and submitted with the proposal if bidder requests confidential treatment of any material contained in the proposal. Submission of a completed CT Form is required to request confidential treatment.
Provide the information in the table below. Bidder may add rows or additional pages using the same format shown in the table. Bidder must specifically identify the information to be protected as confidential and state the reasons why protection is necessary. The CT Form will not be considered fully complete unless, for each confidentiality request, the bidder: (1) identifies whether the material is a trade secret (TS), financial information (FI), or proprietary information (PI); (2) explains the specific legal grounds that support treatment of the material as TS, FI, or PI; and (3) provides the contact information for the person at bidder’s organization authorized to respond to inquiries by the State concerning the material. Bidders must not simply cite to an applicable act or case name; rather, bidders must provide a complete justification as to how the material falls within the scope of an applicable act or relevant case law.
CONFIDENTIAL TREATMENT FORM (CT FORM)
| RFP page #, paragraph #, and section # |
| State whether the material is a trade secret (TS), financial information (FI), or proprietary information (PI) |
| Explain the specific grounds in State or other applicable law which supports treatment of the material as TS, FI, or PI. Do not simply cite to the applicable act. Provide a complete justification as to how the material falls within the scope of the applicable act or relevant case law. |
| Provide the bidder contact information |
By signing below, the bidder affirms that confidential treatment of material contained in its proposal is requested and has attached to this form a redacted “Public Copy” of the bidder’s proposal.
| ____________________________________ | ____________________________ | |
| RFP Number | RFP Title |
| ____________________________________ | _____________________ | |
| Signature | Date |
[Printed Name] [Title] [Company]
VENDOR QUESTIONS WORKSHEET
Provide a detailed response to each question. “You” and “company” refers to the bidder.
| Information Sought |
| Bidder Response |
1. Contact Information
Bidder’s sole contact person during the RFP process. Include name, title, address, email, and phone number.
Person authorized to receive and sign a resulting contract. Include name, title, address, email, phone number and vendor customer code in SIGMA VSS.
2. Company Background Information
Legal business name and address. Include business entity designation, e.g., sole proprietor, Inc., LLC, or LLP.
What state was the company formed in?
Phone number
Website address
Number of years in business and number of employees
Legal business name and address of parent company, if any
Has there been a recent change in organizational structure (e.g., management team) or control (e.g., merger or acquisition) of your company? If the answer is yes: (a) explain why the change occurred and (b) how this change has affected your company.
Discuss your company’s history. Has growth been organic, through mergers and acquisitions, or both?
Has bidder ever been debarred, suspended, or disqualified from bidding or contracting with any entity, including the State of Michigan? If yes, provide the date, the entity, and details about the situation.
Has your company been a party to litigation against the State of Michigan? If the answer is yes, then state the date of initial filing, case name and court number, and jurisdiction.
Within the last 5 years, has your company or any of its related business entities defaulted on a contract or had a contract terminated for cause? If yes, provide the date, contracting entity, type of contract, and details about the termination or default.
State your gross annual sales each of the last 5 years. If receiving a contract under this RFP will increase your gross revenue by more than 25% from last year’s sales, explain how the company will scale-up to manage this increase.
Describe partnerships and strategic relationships you think will bring significant value to the State.
State the physical address of the place of business that would have primary responsibility for this account if bidder is awarded a contract under this RFP.
3. Qualified Disabled Veteran/Service Disabled Veteran-Owned Business Program
| Under MCL 18.1261, a “qualified disabled veteran” means a business entity that is 51% or more owned by 1 or more veterans with a service-connected disability. A “service-connected disability” means a disability incurred or aggravated in the line of duty in the active military, naval, or air service as described in 38 USC 101(16). Are you a qualified disabled veteran? |
| Enter YES or NO. |
To demonstrate qualification as a qualified disabled veteran, you must provide:
(a) Proof of service and conditions of discharge (DD214 or equivalent);
(b) Proof of service-connected disability (DD214 if the disability was documented at discharge or Veterans Administration Rating Decision Letter or equivalent if the disability was documented after discharge); and
(c) Legal documents setting forth the ownership of the business entity.
In lieu of the documentation identified above, you may provide proof of certification by the National Veterans Business Development Council.
Enter the names of documents submitted with your proposal to demonstrate status as a qualified disabled veteran.
4. Participation in RFP Development or Evaluation
Did your company, an employee, agent, or representative of your company, or any affiliated entity participate in developing any component of this solicitation? For purposes of this question, business concerns, organizations, or individuals are affiliates of each other if, directly or indirectly: (1) either one controls or has power to control the other or (2) a third party controls or has the power to control both. Indicia of control include, but are not limited to, interlocking management or ownership, identity of interests among family members, shared facilities or equipment, and common use of employees.
If you entered “YES”, you are not eligible for contract award or to work as a subcontractor for the awarded vendor.
| If you are awarded a contract under this solicitation, in order to provide the goods or services required under a resulting contract, do you intend to partner or subcontract with a person or entity that assisted in the development of this solicitation? |
| If you entered “YES,” you are not eligible for contract award. An awarded vendor may not partner or subcontract with anyone to provide goods and services required under a resulting contract if that subcontractor or partner assisted in the development of this solicitation. |
| Will your company, or an employee, agent, or representative of your company, participate in the evaluation of the proposals received in response to this RFP? |
| If you entered “YES”, you are not eligible for contract award or to work as a subcontractor for the awarded vendor. |
5. State of Michigan Experience and Prior Experience
Does your company have experience working with the State of Michigan? If so, please provide a list (including the contract number) of the contracts you hold or have held with the State for the last 10 years.
6. Standard Contract Terms
Bidder must affirm agreement with the attached Contract Terms. If not in agreement, written exceptions in accordance with Section 8 Evaluation Process must be provided with Bidder’s proposal.
7. Other
| Abusive Labor Practices. The Contractor certifies that it will not furnish any Deliverable that was produced fully or partially by forced labor, forced or indentured child labor, or indentured servitude. |
| Enter YES or NO. |
| Certification of Michigan Business- Public Act 431 of 1984, Sec. 268. I certify that the company has, pursuant to the provisions of Sec 268 of Public Act 431 of 1984, filed a Michigan Business Tax Corporate Income Tax Return. I certify that the company has, pursuant to the provisions of Sec 268 of Public Act 431 of 1984, filed a Michigan Income Tax return showing income generated in, or attributed to the State of Michigan. I certify that the company has, pursuant to the provisions of Sec 268 of Public Act 431 of 1984, withheld Michigan Income Tax from compensation paid to the company’s owners and remitted the tax to the Michigan Department of Treasury. |
| Enter YES or NO. |
| Iran Linked Business- Public Act 517 of 2012. I certify that the Company is not an Iran-Linked business as defined by Public Act 517 of 2012. |
| Enter YES or NO. |
| Clean Corporate Citizen. I certify that the Company is a Clean Corporate Citizen as defined by the Environmental Protection Act, 1994 PA 451. |
| Enter YES or NO. |
| Convict Labor. The Contractor certifies that if using convict labor, it is complying with all applicable state and federal laws and policies. |
| Enter YES or NO. |
| SOM Debt/Tax Payment. All SOM tax/debts. I certify that all applicable State of Michigan taxes are paid, and that no outstanding debt is owed to the State of Michigan. |
| Enter YES or NO. |
| Authorization to Verify Information provided by Vendor. I authorize the State to verify that all information provided in this registration, in bidding and contracting documents, and any attachments or supplement documents and processes are accurate. |
| Enter YES or NO. |
Version 4 (5/2019) 38
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