Procurement Portal
EVALUATIONAir Medical Transport Service
4. Vendor Questionnaire
Please submit all downloaded forms in PDF format
Our firm understands that we are not to embed any documents, links, or reference content in another location within the questionnaire, as they will not be accessible or evaluated.
When a document is required to be uploaded, it should be in pdf format and unlocked.
Explanatory Note: The purpose of this question is to confirm the Bidder’s or Offeror’s acknowledgement and acceptance of the terms and conditions of the Solicitation, subject to any exceptions or modifications to terms or conditions that are expressly requested or that have been requested and approved prior to submission of the Offer. All exceptions or modifications to the Solicitation, regardless of whether Organization Name (also referred to as the District) approved such items prior to submission of the Offer, must be clearly set forth in this question.
The Offeror, acknowledges and accepts all terms and conditions of the Solicitation, except as expressly noted below or in the additional pages attached hereto. As used in this question, “terms and conditions of Solicitation” means all terms, conditions, specifications, certifications and warranties set forth in the documents that comprise the Solicitation, including the Uniform Instructions for Offers, Special Rules for Offers (if any), General Terms and Conditions of Contract, Special Requirements of Solicitation (if any), Specifications/Scope of Work, and Solicitation Addendums (if any).
Chapter 176 of the Texas Local Government Code mandates the public disclosure of certain information concerning persons doing business or seeking to do business with Parker County Hospital District, including affiliations and business and financial relationships such persons may have with Parker County Hospital District officers.
By doing business or seeking to do business with PCHD, you acknowledge that you have been notified of the requirements of Chapter 176 of the Texas Local Government Code and that you are solely responsible for complying with them.
This document may be found in the "Attachments" section.
The Offeror, by the undersigned representative, requests that the specific information, described below and identified on the page or pages of the Offer in which it appears, be treated as confidential information and protected from disclosure to the public.
1. Description of specific information that is the subject of the request.
2. The reason or reasons why the information should be treated as confidential.
Enter N/A if this does not apply
You the Vendor do confirm that your persons, corporation, or company who makes the accompanying Proposal, having first been duly sworn, deposes and says:
That such Proposal is genuine and not sham or collusive, nor made in the interest of, or behalf of, any persons not herein named, and that the Offeror has not directly or indirectly induced or solicited any other Offeror to put in a sham proposal, or any other person, firm or corporation to refrain from offering, and that the Offeror has not in any manner sought by collusion to secure for itself an advantage over any other Offeror.
Please complete a CIQ form and upload here with your response. This form can found in the "Attachments" section.
Please upload your complete W-9 HERE. This form can be found in the "Attachments" section.
Please upload your complete COI HERE
Please Upload your RFP Response HERE.
These questions will be utilized to confirm information you provide
Please enter your company's Legal Name and/or dba Name:
In 2015, the Texas Legislature adopted House Bill 1295, which added Section 2252.908 of the Government Code. The law states that a government entity may not enter into certain contracts with a business entity unless the business entity submits a disclosure of interested parties to the government entity. The disclosure of interested parties will be submitted online via Form 1295 through the Texas Ethics Commission website and must be submitted to the governmental entity prior to any signed contract and/or vote by the governing authority.
Business Entity must complete Form 1295 in electronic format on the Texas Ethics Commission website:
Upon receipt of a completed Interested Parties Disclosure Form, Texas Ethics Commission issues a Certification of Filing to the Business Entity and the Business Entity download and print the Form 1295. An authorized agent of the business entity will need to sign the printed copy of the form.
At the time of submission of the solicitation to the District, the Business Entity must submit the completed Form 1295 with the Certification of Filing with their Proposal/Proposal (i.e.: Proposal, RFP, RFQ, ITB, etc.) to the District.
You will have to upload the completed form 1295 here as well as upload it to the state website listed in the documents referenced section.