6610 - Transportation Consulting Services, 0.Main Solicitation (2)
/
Materials Management Department
901-B Texas Street
Denton, Texas 76209
REQUEST FOR QUALIFICATIONS
RFQ 6610 Transportation Consulting Services
PROFESSIONAL CONSULTING SERVICES FOR TRANSPORTATION FOR THE CITY OF DENTON
NIGP CLASS and ITEM
918
16
Issue Date: November 21, 2017
Response due Date and Time (Central Time):
Thursday, December 21, 2017 11:00 A.M.
Table of Contents
1. INTRODUCTION 3
2. SERVICE DESCRIPTION 3
3. MINIMUM QUALIFICATIONS 3
4. SCHEDULE OF EVENTS 4
5. PRE-SUBMITTAL CONFERENCE 4
6. CONTRACT TERM 4
7. PRICING 5
8. ADDENDA 5
9. BUSINESS OVERVIEW 5
10. STATEMENT OF QUALIFICATIONS 5
11. EXCEPTIONS 6
12. SCHEDULE AND BUDGET COMPLIANCE SCHEDULE 6
13. REFERENCES 6
14. DISCLOSURES 6
15. ACKNOWLEDGEMENT 6
16. SUBMITTAL INSTRUCTIONS 6
17. HARD COPY SUBMISSION FORMAT 7
18. ELECTRONIC SUBMISSIONS 7
19. EVALUATION PROCEDURES 8
20. CONTACT BETWEEN RESPONDENT AND THE CITY 9
SOLICITATION CHECKLIST 11
ATTACHMENT A-BUSINESS OVERVIEW QUESTIONNAIRE AND FORMS 12
ATTACHMENT B-SUBMISSION EXCEPTIONS 14
ATTACHMENT C- SCHEDULE & BUDGET COMPLIANCE FORM 15
ATTACHMENT D-REFERENCES 19
ATTACHMENT E-CONFLICT OF INTEREST QUESTIONNAIRE 20
ATTACHMENT F-ACKNOWLEDGEMENT 22
Exhibit 1 NOT APPLICABLE
Exhibit 2 General Provisions, Standard Terms and Conditions and Appendices
Exhibit 3 Scope of Work
INTRODUCTION
In accordance with the provisions of Texas Government Code, Chapter 2254, the City of Denton (the City) is requesting submissions to contract with an individual or business with considerable
experience in providing the services of this solicitation. The responses shall be submitted to the City of Denton in a sealed submission.
The awarded individual or business shall possess a proven track record of using innovative approaches to providing services that represent the best value to their clients. The awarded
individual or business shall have the ability to accomplish all aspects of the requested services. The selected individual or firm should be able to provide innovative methods to deal
with municipal challenges, and cost effective solutions.
SERVICE DESCRIPTION
The City is seeking a professional services contract for consulting services for transportation for the City of Denton.
The products and services shall be accomplished per all exhibits identified in the table of contents.
MINIMUM QUALIFICATIONS
The following minimum requirements must be demonstrated in order for the submission to be considered responsive to the City of Denton. Any submission received, which is determined to
not meet these mandatory requirements shall be immediately disqualified and rejected as non-responsive.
A demonstrated competence in providing transportation consulting.
Three (3) references from governmental entities for the services requested. The City prefers references from municipalities of similar size.
The responding individual or business must be registered in the State of Texas, or the County of Denton, to provide the products or services required in the solicitation, and the individual
or business must have all licensure required by the State to provide any services required under this contact.
To learn how to obtain information about filing with the State of Texas, or obtaining copies or certificates from the Secretary of State visit Webpage: http://www.sos.state.tx.us/corp/copies.shtml;
Phone 512-463-5578; or email corpcert@sos.state.tx.us.
Submittal documents including a cover sheet, Solicitation Checklist, Statement of Qualifications, Attachments A -F and any additional requirements, per the method described in SUBMITTAL
INSTRUCTIONS.
SCHEDULE OF EVENTS
The City of Denton reserves the right to change the dates indicated below:
Solicitation Schedule:
Issue Solicitation: 11/22/2017
Pre-submittal conference: 12/12/2017 at 1:30 PM CST
Deadline for Submission of Questions: 12/15/2017 at 11:00 AM CST
Deadline for Submission of Responses: 12/21/2017 at 11:00 AM CST
The City of Denton is using the solicitation ‘Issue Date’ as noted in the Schedule of Events above as the official 30 day notification requirement for an interview with a firm.
PRE-SUBMITTAL CONFERENCE
There will be no pre-submittal conference for this solicitation.
CONTRACT TERM
It is the intention of the City of Denton to award a contract for the initial term of two (2) years from date of executed contract or issued Purchase Order. At the expiration of the
initial contract period, the contract may be renewed annually by written agreement between both parties for up to three (3) one-year renewals at the same terms and conditions as agreed
upon in the initial contract.
The Contract shall commence upon the issuance of a Notice of Award by the City of Denton and shall automatically renew each year, from the date of award by City Council, unless either
party notifies the other prior to the scheduled renewal date in accordance with the provision of the section titled “price adjustments”, or the section(s) titled “termination” in Exhibit
2. At the sole option of the City of Denton, the Contract may be further extended as needed, not to exceed a total of six (6) months.
PRICING
This contract is for professional services as defined in the Texas Government Code 2254 and price shall not be solicited. The City will select a firm on the basis of demonstrated competence
and qualifications to perform the services described in this RFQ. Once the most qualified firm is selected, a fair and reasonable price will be set. The professional fees under this
contract may not exceed any maximum provided by law.
Compensation will be negotiated with the most highly qualified and experienced firm. Professional services will include the Professional’s schedule of document preparation costs, as
well as hourly rates. Upon completion of the work, the Professional will provide electronic files, plots, maps, exhibits, field notes, and/or other materials as requested by the City.
ADDENDA
Respondents are required to acknowledge addenda with their submission. Respondents will be responsible for monitoring the City of Denton Purchasing website at www.dentonpurchasing.com
to ensure they have downloaded and signed all addenda required for submission with their submission. Respondents should acknowledge each individual addendum on Attachment F.
BUSINESS OVERVIEW
Respondent shall complete the Business Overview Questionnaire as applicable per Attachment A.
STATEMENT OF QUALIFICATIONS
Statement of Qualification should be no longer than 25 pages. All pages with the exception of the front cover, the back cover and qualified divider sheets will be counted in the 25 pages.
In order to be considered a qualified divider sheet, the page may have a description (i.e. Project Team, Experience, etc) or a numeral on the divider tab only. Resumes and/or brochures
will be included in the page count. Cover letters (if bound into the SOQ) will be included in the page count. Please include at a minimum the following:
A maximum three (3) page narrative as to the firm’s interest, particular abilities and qualifications related to this project.
The location of your office where the majority of the work on the project will be performed and the approximate number of employees in that office.
Resumes of key personnel to be assigned to this project with an organizational chart.
A list and general description of each project that the above-mentioned staff has performed that would indicate your firm’s ability to perform the work being considered. At least five
(5) project examples should be included. The list of specific projects shall indicate the professional services necessary to accomplish the project, along with your client’s name and
phone number.
EXCEPTIONS
The Request for Qualifications (RFQ) process allows for negotiation of the terms and conditions of this proposal. The respondent shall note any exceptions to the solicitation document,
on Attachment B. The exceptions will be reviewed to ensure they meet the minimum specifications and requirements and will be ranked in accordance with the evaluation criteria. The
City reserves the right to accept, reject or negotiate the exceptions provided.
Respondents shall itemize all exceptions on Attachment B. Additional pages may be added as necessary. Do not mark or change the text of the solicitation document, exceptions shall be
noted only on Attachment B.
If no exceptions are taken, the respondent shall sign and return Attachment B in the appropriate signature block.
SCHEDULE AND BUDGET COMPLIANCE SCHEDULE
Respondents shall provide schedule for two projects of similar scope to this RFQ. Please complete the forms in detail (Attachment C).
REFERENCES
Respondents shall provide a list of three references as noted in Attachment D.
DISCLOSURES
The individual or business must disclose any business relationship that would have an effect, of a conflict of interest. A conflict of interest statement must be signed as part of the
contract negotiated with the awardee(s). (Attachment E)
ACKNOWLEDGEMENT
Submit a signed acknowledgement by authorized agent of the responding firm (Attachment F).
SUBMITTAL INSTRUCTIONS
The City of Denton will accept electronic or hard copy submittals until the date and time on the cover sheet of this solicitation. Any submission received after the date and/or hour
set for solicitation opening will be returned unopened.
Electronic submittals may be emailed to ebids@cityofdenton.com with the solicitation number and name in the subject line. Please consolidate attachments as much as possible, and do not
exceed 35MB total for attachments. Emails received by the City will remain unopened until after the due date and time. Only authorized Materials Management Staff will have access to
the e-bid email inbox. Please do not email the buyer directly to ensure security of the proposal. Electronic proposals must be received by the City before the due date and time. The
date and time used by the City shall be the official time. It is highly recommended that respondents do not wait until minutes before the due date and time to email their submission.
It can take significant time for the email to reach the City.
Hard copy submissions may be hand delivered (by firm or express courier) to the address listed below:
City of Denton
Materials Management
SOLICITATION NUMBER AND NAME
901B Texas Street
Denton, TX 76209
The City of Denton reserves the right to accept or reject in part or in whole any submission, and to waive technicalities of the submission, in the best interest of obtaining best value
for the City.
Each respondent is responsible for taking the necessary steps to ensure their submission is received by the date and time noted herein. The City is not responsible for missing, lost
or late mail or any mail or email delays, internal or external, that may result in the submission arriving after the set time.
Submission Format
Respondents shall provide detailed information to allow the City to properly evaluate the submission. The City requests the following format be used:
Hard copy submissions shall be bound only utilizing a staple or binder clip. Do not submit responses in a binder or file folder.
Submission shall be no more than 200 pages in length
Utilize tabs to identify exhibits and attachments
The submission shall be in the following order:
Coversheet – including Solicitation number and name, firm name, address, contact name, phone, fax, website and email address.
Completed Solicitation Checklist
Statement of Qualifications
Attachment A- Business Questionnaire
Attachment B- Exception Form
Attachment C -Safety Record (if applicable form will be attached)
Attachment D -References
Attachment E -Conflict of Interest Questionnaire Form
Attachment F -Signed Acknowledgement form
Appendices may be used for additional documentation or clarification at the respondent’s option.
Hard Copy submittals shall include one (1) original signed by an officer authorized to bind the firm, and three (3) copies of the completed response.
Submit response, before the published due date. Hard copy submittals must be in a sealed envelope with the solicitation number and name.
Electronic Submission Requirements
If a respondent is only submitting a hard copy, they shall provide a flash drive, containing a complete copy of the response to this solicitation, or submit electronically to ebids@cityofdenton.com.
Emails to the City should include the RFP number and name in the subject line, consolidate attachments as much as possible, and not exceed 35MB total. Please do not email the buyer
directly to ensure security of the proposal
EVALUATION PROCEDURES
Selection of a firm(s) to provide the aforementioned materials and services shall be in accordance with the City of Denton Purchasing Policies and procedures and the State of Texas Government
Code 2254. The City of Denton shall open all submissions and evaluate each respondent in accordance to the below criteria:
Step 1: The City of Denton will evaluate the submission in accordance with the selection criteria and will rank the firms on the basis of the submittals. The City of Denton, reserves
the right to consider information obtained in addition to the data submitted in the response. The selection criterion is listed below:
Identification and understanding of the City's requirements for this project (FACTOR: 10%)
The respondent's understanding of the objectives and scope of the requested services of the primary areas, in a clear and concise, written expression. The respondent will provide all
the appropriately requested criteria consideration to be a critical component of the evaluation.
Past Performance and experience on projects of this magnitude and complexity (FACTOR: 30%).
The respondent's successful experience in projects within the primary areas similar to the scope of work requested in this RFQ will be a major consideration. Based on the past performance
of both the individual project personnel and the respondent, The City of Denton will determine if the respondent has the track record to provide the required services in successfully
administering similar projects.
Experience with specific issues related to this project (FACTOR: 20%).
The respondent’s successful resolution experience in projects with similar scope of work requested in this RFQ will be a major consideration. Based on the respondents ability and capability
to identify issues and produce satisfactory resolutions to issues.
Experience and qualifications of the Respondent and key personnel available for this project (FACTOR: 20%).
The qualifications of the respondent in terms of experience, service capability and resources will be reviewed in order to assess the ability of the respondent to successfully complete
the project assignment. The firm’s ability to provide the necessary professional and technical expertise and supervision will be a major consideration.
The qualifications and experience of the individuals who will be directly assigned to the primary areas is a major evaluation factor to be considered. The personnel cited shall be designated
as to whether they are an employee, consultant or contract employee of the RFQ respondent. Their educational and professional credentials as well as direct experience on similar projects
will be considered in evaluating the respondent. Experience with other municipally funded projects and familiarity with municipal requirements and procedures will also be considered
in the evaluation process.
Creativity and thoroughness of proposed approach and/or methodology to providing services (FACTOR: 10%)
Respondent will be reviewed in ability to demonstrate enhancements to The City of Denton Transportation System. Responses should clearly provide detailed current like situations where
changes were recommended.
Availability and dedication to City of Denton projects (FACTOR: 10%)
Respondent to include list with contact information detailing current like contracts and how you would prioritize the needs of the City of Denton in relation to other clients with conflicting
projects. The respondent will describe in detail the turnaround times for communication and responses to needs by the City of Denton and successfully demonstrate the ability to support
Denton with regards to the size and scope of work.
The total possible score of the submissions shall be scored and weighted as indicated above, Step 1 items a-e. Based on the outcome of the computations performed, each submission will
be assigned a raw score. The assigned weight will then be applied to these scores to calculate an overall score for each submission for completion of the final scoring process.
Step 2: City of Denton will proceed to negotiate a contract with the highest ranked firm. The City may elect to conduct oral discussions, request clarifications, and presentations concerning
the project approach and ability to furnish the requirements, as part of the negotiation process.
Provided the City of Denton cannot successfully contract with the highest ranked firm, the City of Denton shall formally, and in writing, end all negotiations with that firm and the
City of Denton may elect to proceed to negotiate with the next firm in the order of the selection ranking until a contract is reached or negotiations with all ranked firms end, in accordance
with Texas Government Code 2254.
Step 3: A written recommendation will be presented to the appropriate approving authority for the City of Denton (the City Manager, Public Utility Board, City Council) requesting authorization
to proceed with contract execution for the proposed services.
In accordance with Local Government Code 252.049, trade secrets and confidential information in competitive sealed proposals are not open for public inspection. All submissions shall
be opened in a manner that avoids disclosure of the contents to competing respondents and keeps the responses secret during negotiations. A public opening will not be conducted with
this process.
After the contract has been awarded all submissions will be open for public inspection, and the unsuccessful respondent(s) may request a debriefing regarding their submittal. Please
contact the City of Denton Materials Management staff to document the request for a debriefing. A meeting with the City of Denton Materials Management Staff and the using Division will
be scheduled within a reasonable time.
CONTACT BETWEEN RESPONDENT AND THE CITY
Respondents shall direct all inquiries and communications concerning this solicitation to the Point of Contact(s) listed below:
Jamie Cogdell, CTPM, Senior Buyer
901-B Texas Street
Denton, TX 76209
P: (940) 349-7100 / F: (940) 293-1837 / jamie.cogdell@cityofdenton.com
SOLICITATION CHECKLIST
Submit response, with tabs marking each section, in the following order:
Order for Submission
Document
1
Cover Sheet
2
Solicitation Checklist
3
Attachment A- Business Overview Questionnaire
4
Statement of Qualifications
5
Attachment B – Exception Form
6
Attachment C- Schedule and Budget Compliance Form
7
Attachment D – Reference Form
8
Attachment E – Conflict of Questionnaire Form
9
Attachment F - Acknowledgment
Check when Completed
Task to be Completed by Respondent
Review Exhibit 2 – General Provisions and Terms and Conditions
Review Exhibit 3 – Scope of Work/Technical Specifications
Review Exhibit 4 – Technical Drawings and Plans (if applicable)
Submission of Exhibit 5 – FTP Site Form (if applicable)
Review Exhibit 6 – Federal Grant Requirements (if applicable)
Cover sheet
Solicitation number
Solicitation name
Firm name
Firm address
Contact name
Contact phone
Contact fax
Website address
Contact email address
Solicitation Checklist
Attachment A- Business Overview Questionnaire
Document how firm meets minimum qualifications (Section 3)
Detail to support evaluation criteria
Statement of Qualifications
Attachment B – Exception Form
Attachment C – Schedule and Budget Compliance Form
Attachment D – Reference Form
Attachment E – Conflict of Interest Questionnaire Form – with signature
Attachment F - Acknowledgment
Acknowledgment of Addenda
Submission signed by authorized officer, in the order specified below
Hard Copy Submission: If submitting a hard copy, the City requires one (1) original and three (3) copies.
Electronic Submission: If submitting an electronic proposal only, email to Ebids@cityofdenton.com with the Solicitation # and name in the subject line.
ATTACHMENT A-BUSINESS OVERVIEW QUESTIONNAIRE AND FORMS
Contract Information (for formal contracting purposes):
The following information will be used to write a contract, should your firm be selected for award.
Firm’s Legal Name:
Address:
Agent Authorized to sign contract (Name):
Agent’s email address:
Subsidiary of:
Organization Class (circle):
Partnership Corporation Individual Association
Tax Payer ID#:
Date Established:
Historically Underutilized Business: Yes or No
Does your company have an established physical presence in the State of Texas, or the City of Denton? Yes or No, in which?
Please provide a detailed listing of all products and/or services that your company provides.
Has your company filed or been named in any litigation involving your company and the Owner on a contract within the last five years under your current company name or any other company
name? If so provide details of the issues and resolution if available. Include lawsuits where Owner was involved. (Notice: Failure to disclose this information during proposal submission,
and later discovered, may result in contract termination at the Owner’s option.)
Have you ever defaulted on or failed to complete a contract under your current company name or any other company name? If so, where and why? Give name and telephone number of Owner.
Have you ever had a contract terminated by the Owner? If so, where and why? Give name and telephone number (s) of Owner (s).
Has your company implemented an Employee Health and Safety Program compliant with 29 CFR 1910 “General Industry Standards” and/or 29 CFR 1926 “General Construction Standards” as they
apply to your Company’s customary activities?
http://www.osha.gov/pls/oshaweb/owasrch.search_form?p_doc_type=STANDARDS&p_toc_level=1&p_keyvalue=1926
Provide details to support the evaluation criteria, including experience and delivery.
Provide details on how firm meets the minimum qualifications stated in this Main document Section 3.
The details must be completed on this form, and shall not point to another document in the respondent’s proposal.
Sign below and return form with final submission.
I certify that our firm meets the minimum qualifications as stated in this Main document, section 3.
_______________________ _____________________ _____________________
Signature Company Date
ATTACHMENT B-SUBMISSION EXCEPTIONS
Any exceptions taken to this solicitation (including terms and conditions in Exhibit 2, the General Provisions and Terms and Conditions) must be itemized on the lines below. Additional
pages may be added as needed. If there are no exceptions, please sign where indicated at the bottom of the page
Item # Description
The above exceptions (and any additional pages identified) are the ONLY exceptions to the specifications, General Provisions and Terms and Conditions in Exhibit 2, and sample contract
to this solicitation. I understand that the City may not accept additional exceptions produced after final submission of this proposal.
_______________________ _____________________ _____________________
Signature Company Date
No Exceptions are taken to this solicitation or the General Provisions and Terms and Conditions in Exhibit 2.
_______________________ _____________________ _____________________
Signature Company Date
ATTACHMENT C- SCHEDULE & BUDGET COMPLIANCE FORM
SCHEDULE COMPLIANCE FORM
Please detail two of the most recent projects your firm has completed:
Project #1
Name of Project:
Contract Award Date:
Actual Contract Completion Date:
Original Contract Required Completion Date:
Design Phase: Date of Completion # of Days diff in
Required schedule
Study/Analysis ________________ ______________
Preliminary Design ________________ ______________
Design ________________ ______________
Working Drawings ________________ ______________
Procurement Phase:
Issue Documents for Construction ________________ ______________
Receive Contractor submissions ________________ ______________
Contractor notice to proceed ________________ ______________
Construction Phase
Initial Site Work ________________ ______________
Installation of Equip ________________ ______________
Substantial Completion ________________ ______________
Final Completion of Construction ________________ ______________
Project Walk-through
and Inspection ________________ ______________
SCHEDULE COMPLIANCE FORM
Please detail two of the most recent projects your firm has completed:
Project #2
Name of Project:
Contract Award Date:
Actual Contract Completion Date:
Original Contract Required Completion Date:
Design Phase: Date of Completion # of Days diff in
Required schedule
Study/Analysis ________________ ______________
Preliminary Design ________________ ______________
Design ________________ ______________
Working Drawings ________________ ______________
Procurement Phase:
Issue Documents for Construction ________________ ______________
Receive Contractor submissions ________________ ______________
Contractor notice to proceed ________________ ______________
Construction Phase
Initial Site Work ________________ ______________
Installation of Equip ________________ ______________
Substantial Completion ________________ ______________
Final Completion of Construction ________________ ______________
Project Walk-through
and Inspection ________________ ______________
BUDGETING COMPLIANCE FORM
Please detail two of the most recent projects your firm has completed:
Project #1
Name of Project:
Owner’s Original Budget amount:
Design-Build Original Cost Estimate:
Original Contract Total Amount:
Final Construction Cost:
Design Phase: Original Cost Est. Final Cost
Study/Analysis ________________ ______________
Preliminary Design ________________ ______________
Design ________________ ______________
Working Drawings ________________ ______________
Procurement Phase:
Issue Documents for Construction ________________ ______________
Receive Contractor submissions ________________ ______________
Contractor notice to proceed ________________ ______________
Construction Phase
Initial Site Work ________________ ______________
Installation of Equip ________________ ______________
Substantial Completion ________________ ______________
Final Completion of Construction ________________ ______________
Project Walk-through
and Inspection ________________ ______________
BUDGETING COMPLIANCE FORM
Please detail two of the most recent projects your firm has completed:
Project #2
Name of Project:
Owner’s Original Budget amount:
Design-Build Original Cost Estimate:
Original Contract Total Amount:
Final Construction Cost:
Design Phase: Original Cost Est. Final Cost
Study/Analysis ________________ ______________
Preliminary Design ________________ ______________
Design ________________ ______________
Working Drawings ________________ ______________
Procurement Phase:
Issue Documents for Construction ________________ ______________
Receive Contractor submissions ________________ ______________
Contractor notice to proceed ________________ ______________
Construction Phase
Initial Site Work ________________ ______________
Installation of Equip ________________ ______________
Substantial Completion ________________ ______________
Final Completion of Construction ________________ ______________
Project Walk-through
and Inspection ________________ ______________
ATTACHMENT D-REFERENCES
Please list three (3) Government references, other than the City of Denton, who can verify the quality of service your company provides. The City prefers customers of similar size and
scope of work to this solicitation.
REFERENCE ONE
GOVERNMENT/COMPANY NAME:
LOCATION:
CONTACT PERSON AND TITLE:
TELEPHONE NUMBER:
SCOPE OF WORK:
CONTRACT PERIOD:
REFERENCE TWO
GOVERNMENT/COMPANY NAME:
LOCATION:
CONTACT PERSON AND TITLE:
TELEPHONE NUMBER:
SCOPE OF WORK:
CONTRACT PERIOD:
REFERENCE THREE
GOVERNMENT/COMPANY NAME:
LOCATION:
CONTACT PERSON AND TITLE:
TELEPHONE NUMBER:
SCOPE OF WORK:
CONTRACT PERIOD:
ATTACHMENT E-CONFLICT OF INTEREST QUESTIONNAIRE
CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local
governmental entity and the vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after the date the vendor becomes aware of facts
that require the statement to be filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor.
1
Name of vendor who has a business relationship with local governmental entity.
2
Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware
that the originally filed questionnaire was incomplete or inaccurate.)
3
Name of local government officer about whom the information in this section is being disclosed.
Name of Officer
This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the vendor has an employment or other business relationship as defined by Section
176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?
Yes No
Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable
income is not received from the local governmental entity?
Yes No
Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an
ownership of one percent or more?
Yes No
D. Describe each employment or business and family relationship with the local government officer named in this section.
4
I have no Conflict of Interest to disclose.
5
Signature of vendor doing business with the governmental entity
Date
ATTACHMENT F-ACKNOWLEDGEMENT
The undersigned agrees this submission becomes the property of the City of Denton after the official opening.
The undersigned affirms he has familiarized himself with the specification, drawings, exhibits and other documents; the local conditions under which the work is to be performed; satisfied
himself of the conditions of delivery, handling and storage of materials and equipment; and all other matters that will be required for the work before submitting a response.
The undersigned agrees, if this submission is accepted, to furnish any and all items/services upon which prices are offered, at the price(s) and upon the terms and conditions contained
in the specification. The period for acceptance of this submission will be 120 calendar days unless a different period is noted.
The undersigned affirms that they are duly authorized to execute this contract, that this submission has not been prepared in collusion with any other respondent, nor any employee of
the City of Denton, and that the contents of this submission have not been communicated to any other respondent or to any employee of the City of Denton prior to the acceptance of this
submission.
Respondent hereby assigns to the City any and all claims for overcharges associated with this contract which arise under the antitrust laws of the United States, 15 USCA Section 1 et seq.,
and which arise under the antitrust laws of the State of Texas, Tex. Bus. & Com. Code, Section 15.01, et seq.
The undersigned affirms that they have read and do understand the specifications, all exhibits and attachments contained in this solicitation package.
The undersigned agrees that the solicitation package posted on the website are the official specifications and shall not alter the electronic copy of the specifications and/or pricing
sheet (Exhibit 1), without clearly identifying changes.
The undersigned understands they will be responsible for monitoring the City of Denton Purchasing Website at: http://www.cityofdenton.com/index.aspx?page=397 to ensure they have downloaded
and signed all addendum(s) required for submission with their response.
I certify that I have made no willful misrepresentations in this submission, nor have I withheld information in my statements and answers to questions. I am aware that the information
given by me in this submission will be investigated, with my full permission, and that any misrepresentations or omissions may cause my submission to be rejected.
Acknowledge receipt of following addenda to the solicitation:
Addendum No 1 Dated _______________________ Received _________________
Addendum No 2 Dated _______________________ Received _________________
Addendum No 3 Dated _______________________ Received _________________
NAME AND ADDRESS OF COMPANY: AUTHORIZED REPRESENTATIVE:
___________________________________ Signature
___________________________________ Date
___________________________________ Name
___________________________________ Title
Tel. No. ____________________________ Fax No.
Email.