6862-0 Prog Mgmt + SVC Main RFQ
/
Materials Management Department
901-B Texas Street
Denton, Texas 76209
REQUEST FOR QUALIFICATIONS
RFQ #6862
PROFESSIONAL ENGINEERING SERVICES
FOR ELECTRIC TRANSMISSION AND SUBSTATION CAPITAL
PROGRAM MANAGEMENT SERVICES
NIGP CLASS and ITEM
925
95
925
78
Issue Date: October 30, 2018
Response due Date and Time (Central Time):
Thursday, November 29, 2018, 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 5
6. CONTRACT TERM 5
7. PRICING 5
8. ADDENDA 6
9. BUSINESS OVERVIEW 6
10. STATEMENT OF QUALIFICATIONS 6
11. EXCEPTIONS 7
12. REFERENCES 7
13. DISCLOSURES 7
14. ACKNOWLEDGEMENT 7
15. SUBMITTAL INSTRUCTIONS 7
16. Submission Format 8
17. Electronic Submission Requirements 8
18. EVALUATION PROCEDURES 9
19. CONTACT BETWEEN RESPONDENT AND THE CITY 11
SOLICITATION CHECKLIST 12
ATTACHMENT A-BUSINESS OVERVIEW QUESTIONNAIRE AND FORMS 13
ATTACHMENT B-SUBMISSION EXCEPTIONS 15
ATTACHMENT D-REFERENCES 17
ATTACHMENT E-CONFLICT OF INTEREST QUESTIONNAIRE 18
ATTACHMENT F-ACKNOWLEDGEMENT 19
Exhibit 2 General Provisions, Standard Terms and Conditions and Appendices
Exhibit 3 Statement 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 services as described in Exhibit 3 – Statement of Work to support the Denton Municipal Electric (DME) Capital Improvement Plan
(CIP) for transmission line and substation projects. Respondents’ proposals must be structured to provide all of the categories of work outlined in the Statement of Work. The Easement/Property
Acquisition Services (real estate support services) may be awarded as a separate contract or be awarded as a part of the contract for the all other categories of work outlined in the
Statement of Work, whichever is more advantageous for the City of Denton. Consequently, the City will accept SOQ’s directly from real estate service entities that are capable of demonstrating
the ability to provide all the required services.
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 will be disqualified and rejected as non-responsive.
General: Proposals must demonstrate competence in providing each the services described in the Statement of Work – Exhibit 3. Respondents must have a minimum of three years’ experience
in providing services of the types listed in Exhibit 3. At the city’s option, preference may be given to respondents who have managed at least two major programs with a total value
of at least $20,000,000 each or at least ten (10) projects valued at an average of at least $2,000,000 each. Sufficient descriptions of work completed must be provided as a part of
the SOQ to illustrate the work undertaken and the results obtained. Higher points may be awarded to respondents who have had specific experience in working on electric utility programs
or projects.
Real Estate (in addition to the General qualifications required above, if applicable):
Must be registered with the Texas Real Estate Commission as agents
Must be a TxDOT approved vendor or must be capable of being approved
Must have experience in Senate Bill 18 real estate transactions over the past five years
Provide a list and descriptions of Senate Bill 18 eligible projects worked on during at least three (3) of the past five (5) years
Construction Inspection for Substation Projects (in addition to the General qualifications required above):
Must have at least three years of construction inspection experience directly applicable to the types of construction DME will undertake. To allow evaluation of the qualifications,
provide a list and description of project inspection work completed during, at least three (3) of the past five (5) years with project owner contact information to allow verification.
It should be noted that much of the inspection work in substation projects will relate to site preparation, foundation installation (both pad and drilled pier), concrete drive construction,
electrical conduit installation, and precast concrete fence installation.
Lead engineer and any other firm employee that will be signing/sealing official documents must be licensed by the Texas Board of Profession Engineers. Attached a copy of licenses or
certifications. Supervisory engineer shall be a Registered Professional Engineer licensed to practice in the State of Texas.
Three (3) references from governmental or utility agencies.
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: 10/30/2018
Pre-submittal conference 11/15/2018 at 10:00 AM CST
Deadline for Submission of Questions: 11/20/2018 at 11:00 AM CST
Deadline for Submission of Responses: 11/29/2018 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
A non-mandatory, pre-solicitation conference will be available to interested contractors. Attendance at the pre-solicitation conference is strongly encouraged prior to submission of
a response. The conference will be held on Thursday, November 15, 2018 at 10:00 AM in the Purchasing Conference Room, 901B Texas Street, Denton, Texas 76209.
Internet link to meeting location:
http://maps.google.com/maps?f=q&source=s_q&hl=en&geocode=&q=901b+Texas+Street,+Denton,+TX&aq=&sll=37.0625,-95.677068&sspn=45.332616,107.929687&ie=UTF8&hq=&hnear=901+Texas+St,+Denton,+Texas+76209&z=16
CONTRACT TERM
It is the intention of the City of Denton to award a contract for a three (3) year period. The City and the Awarded Contractor shall have the option to renew this contract for an additional
two (2) one-year periods. Services undertaken pursuant to this solicitation will be required to commence within fourteen (14) days of delivery of a Notice to Proceed.
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 twelve (12) 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(s) are 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. The compensation for engineering, program management, and construction inspection services will
be based on hourly rates with some allowances for other fee based expenses. Compensation for the real estate acquisition services will be fee based for specific services completed
with provision for some expenses. There may also be an opportunity to structure some services related to real estate acquisitions as hourly. Contract compensation and billing structure
will be negotiated with selected firm (or firms) in accordance with information contained in the RFQ invitation. The contract will have a total not-to-exceed amount for the entire
term of the contract.
The submission for this RFQ shall include the proposed structure for charges for services without any pricing. This should take the form of a listing of the types of hourly and expense
charges that the firm proposes to use for a billing structure for engineering, program management, construction inspection services, and the types of fees that will be used for real
estate services.
Accepted negotiated prices must remain firm for the entire contract period, including any periods of extension or renewal. At the time of any renewal or extension of the contract, the
city or firm may request a price adjustment based upon the economy. All requests for a price adjustment must include detailed documentation and rationale to support the requested adjustment.
The party to whom a request for price adjustment is made may, in its sole discretion, accept or reject the request. Any price adjustment must be mutually agreed upon in writing by
the parties, and shall be effective for the applicable renewal term.
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. A separate Statement of Qualification shall be provided for each subcontractor. 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 as 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 RFQ.
The location of the office where work not performed on site will be accomplished and the approximate number of employees in that office. Denton Municipal Electric will provide office
space for program management professional services at no charge.
Resumes of key personnel to be assigned to this project with an organizational chart.
A list and description of each project that the above-mentioned staff has performed that would indicate your firm’s ability to perform the work being considered and that demonstrate
the requirements in the Minimum Qualifications earlier in this document. Examples of at least five (5) of the most recent projects must be included. The list of specific projects
shall indicate the services necessary to accomplish the project, along with your client’s name and phone number. Include samples of program management documents generated (MS Project
samples, dash boards, real estate tracking, and/or other reporting).
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.
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 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 contract (FACTOR: 25%)
The respondent's understanding of the objectives and scope of the requested services of the primary areas, in a clear and concise, written expression. Compliance with the specifications
coupled with services that meet or exceed Owner’s expectations. The respondent will provide all the appropriately requested criteria consideration to be a critical component of the
evaluation.
Experience and qualifications of the Respondent (FACTOR: 40%).
The respondent's successful experience on projects within the primary areas similar to the scope of work requested in this RFQ will be a major consideration. 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 projects to be assigned
under this RFQ. The firm’s ability to provide the necessary professional and technical expertise and supervision will be a major consideration. Failure to provide sufficient information
to allow evaluation may result in loss of points in the evaluation or disqualification for lack of adequate response.
In the program management area, the following are examples of information that would be helpful in completing the evaluation:
What work has been completed?
In what way was the work successful, and how did the client assess the results?
Did the work have direct applicability to the types of work described in the Statement of Work?
What program management methods and measures were used?
What software was used to support the work?
What methods and software were used for document management?
What staff capabilities will be made available?
What is the general approach that the firm has used in providing program management in the past?
In the construction inspection area, the following are examples of information that would be helpful in completing the evaluation:
How long have construction inspection services been provided?
What projects have construction inspection services been provided for?
Would the same individuals be providing services for this contract?
How was the construction inspector supervised?
What professional engineering resources are available to support the construction inspector?
In the real estate services area, the following are examples of information that would be helpful in completing the evaluation:
What is the background of the staff that will be providing real estate services?
What firms will provide appraisals?
What firms will provide title and closing services?
What are the certifications and qualifications of the real estate staff?
What governmental experience does the real estate staff have (such as superintending SB18 requirements)?
How will relocation support services be provided?
What are the background, experience, and capabilities of the firm that will provide relocation services?
What have been the results obtained with relocation services?
In the engineering services area, the following are examples of information that would be helpful in completing the evaluation:
What are the disciplines that the firm is capable of supporting?
Where are the offices located that will support the contract?
What examples of work can be provided to allow evaluation of capability from the city’s perspective?
Key personnel and Project Team available for work categories submitted upon (FACTOR: 15%).
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.
Indicators of Probable Performance (FACTOR: 20%)
Indicators of probable performance include: past performance with the City of Denton and other entities, financial resources and ability to perform, demonstrated capability and responsibility,
references, and the respondent’s ability to provide reliable support.
The total possible score of the submissions shall be scored and weighted as indicated above, Step 1 items a-d. 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:
Cindy Alonzo, CTL, A.P.P., CPPB
Senior Buyer
901-B Texas Street
Denton, TX 76209
(940) 349-7100
Fax: (940) 293-1837
Cynthia.Alonzo@cityofdenton.com
SOLICITATION CHECKLIST
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
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.
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
Submit response, with tabs marking each section, in the following order:
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. Include the information requested under Evaluation Criteria a through
d on this form.
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 D-REFERENCES
Please list three (3) Government references, other than the City of Denton, who can verify the quality of service your company provides for each of the specific professional services
to be considered. 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.