Vendor Responsibility Questionnaire.pdf

Vendor Responsibility Questionnaire (VRQ)

Objective To proactively mitigate procurement risk, ensure vendor integrity, and demonstrate compliance with applicable Georgia procurement laws, the Vendor Responsibility Questionnaire (VRQ) shall be required for all formal solicitations exceeding $100,000 and/or involving public health, infrastructure, or operational service delivery.

Legal Basis for Disclosure Requirements O.C.G.A. § 50-5-50: Requires governmental entities to evaluate bidder responsibility, including their performance history, reliability, and record of legal compliance.

O.C.G.A. § 50-5-82: Prohibits contracts with vendors identified as "prohibited sources" due to unpaid taxes or regulatory violations.

O.C.G.A. §§ 50-5-84, 84.1, 84.2: Prohibits state entities from contracting with companies engaged in certain prohibited activities or operations connected to Sudan unless a legal exception or DOAS approval is granted, and prohibits the purchase of concerned goods from foreign countries of concern as defined by the United States Secretary of Commerce or from foreign companies of concern as defined by statute.

O.C.G.A. § 13-10-91: Requires contractors and subcontractors to utilize E-Verify for public works projects and affirm their compliance through affidavit.

Instructions to Bidders / Vendors for Completing the VRQ

1. Complete all sections of the form truthfully and thoroughly. All fields are mandatory unless otherwise indicated.

2. If a question does not apply to your business, write “N/A.” Do not leave fields blank.

3. For every question in Section B (Legal & Regulatory Compliance) answered “Yes,” you must:

- Provide a detailed written explanation in the space provided.

- Attach supporting documents as necessary (e.g., OSHA citation letters, resolution letters, consent orders).

4. The final page must be notarized, and a valid commission expiration date must be included.

5. If the vendor is a subsidiary or affiliate, include parent company disclosures as well.

Section A: General Vendor Identification

Legal Business Name:

DBA (if applicable): _____________________________________________________

Physical Address (no P.O. Boxes): _________________________________________

City / State / Zip: ______________________________________________________

Mailing Address (if different): ____________________________________________

Primary Contact Name: _________________________________________________

Contact Email: ________________________________________________________

Contact Phone Number: ________________________________________________

Federal Employer Identification Number (FEIN): _____________________________

State of Incorporation: _________________________________________________

Organizational Type (Sole Proprietor, LLC, Corporation, Partnership, Other):

Georgia Professional License (Type and No.- write N/A if not appliacable):__________________________________________________________

Section B: Legal & Regulatory Compliance For each item, mark "Yes" or "No". For any "Yes" response, you must provide full details in the narrative space provided.

6. Has your company, any principal, or affiliate been debarred, suspended, or declared ineligible to contract with any public entity in the past 5 years?

☐ Yes ☐ No

Explanation (if Yes): ________________________________________________

7. Has your firm or affiliates received civil or criminal penalties for violations of federal, state, or local environmental laws within the past 5 years?

☐ Yes ☐ No

Explanation (if Yes): ________________________________________________

8. Has your firm received citations or violations from OSHA (federal or state-level) in the past 5 years?

☐ Yes ☐ No

Explanation (if Yes): ________________________________________________

9. Has your firm been convicted of procurement fraud, bid rigging, or collusive practices?

☐ Yes ☐ No

Explanation (if Yes): ________________________________________________

10. Is your company or any affiliate identified as a “scrutinized company” and/or “foreign company of concern” under Georgia law (O.C.G.A. §§ 50-5-84, 84.1, or 84.2)?

☐ Yes ☐ No

Explanation (if Yes): ________________________________________________

11. Has your company ever failed to complete a government contract for any reason?

☐ Yes ☐ No

Explanation (if Yes): ________________________________________________

12. Are there any ongoing investigations or unresolved legal matters that could materially impact your firm’s performance or eligibility?

☐ Yes ☐ No

Explanation (if Yes): ________________________________________________

Section C: Financial and Operational Stability Please check each applicable statement:

☐ Our firm has sufficient cash flow or financial capacity to perform the contract if awarded.

☐ We maintain all required insurance as specified in the solicitation documents.

☐ We are able to obtain required payment and performance bonds.

If “No” to any, explain: ________________________________________________

Section D: Tax Compliance Are you currently in good standing with the Georgia Department of Revenue? ☐ Yes ☐ No

Have you been notified by any government entity of outstanding tax liabilities or non-filing in the past 3 years? ☐ Yes ☐ No

If “Yes,” describe current status and resolution plan:

Section E: Certification I certify under oath that:

- The information provided in this VRQ is accurate and complete.

- I am authorized to bind the firm contractually.

- I understand that failure to disclose any relevant information or falsification may result in immediate disqualification or termination.

Authorized Signatory: ________________________________

Printed Name: _________________________________________

Title: _________________________________________________

Date: _____________________

Notary Public Signature: ________________________________

My Commission Expires: ________________________________