REQUEST FOR PROPOSALS For Bad Debt Collection Services For ...

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Request for Proposals No. 1204-946-33-3797 Bad Debt Collection ServicesPROFILE OF FIRM FORM (Page 1 of 2)(1) Prime ____ Joint Venture/Partner____ Sub-contractor _____ (This form shall be completed by and for each).(2) Name of Firm:____________________________ Telephone:_____________ Fax: ____________(3) Street Address, City, State, Zip:______________________________________________________(4) Identify Principals/Partners in FirmNAME TITLE % OFOWNERSHIP(5) Please indicate the operating structure of your company. Publicly Held Privately Held Government Non-Profit Partnership SoleCorporation Corporation Agency Organization Proprietorship(6) Proposer’s Diversity Statement: You must check all of the following that apply to the ownership of this firmandenter where provided the correct percentage (%) of ownership of each:Minority- (MBE), or Woman-Owned (WBE) Business Enterprises qualify by virtue of 51% or more ownershipand active management by one or more of the following:African **Native Hispanic Asian/Pacific Hasidic Asian/IndianAmerican American American American Jew American_______% _______% _______% ________% ______% _______%Woman-Owned Woman-Owned Disabled Caucasian Other (Specify):(MBE) (Caucasian) Veteran American (Male)_______% _______% ______% _______% _____%Is the business 51% or more owned by a public housing resident? ___ Yes ___ No. If yes, provide name andaddress of the public housing facility:Facility Name:Facility Address:City:SWMBE Certification Number: ______________________________________________________________Certification Agency: ____________________________________________________________________(NOTE: A CERTIFICATION/NUMBER IS NOT REQUIRED – ENTER IF AVAILABLE)HOUSING AUTHORITY OF THE CITY OF SAN ANTONIO, TEXAS (210-477-6059)Page 33
Request for Proposals No. 1204-946-33-3797 Bad Debt Collection ServicesPROFILE OF FIRM FORM (Page 2 of 2)(8) Federal Tax ID Number:(9) City of San Antonio Business License No.:(10) State of Texas License Type and No.:(11) Has your firm or any member of your firm been a party to litigation with a public entity? If yes, when, withwhom and state the circumstances and any resolution.(12) Has your firm or any member of your firm ever sued or been sued by the San Antonio Housing Authority orits affiliated entities? If yes, when and state the circumstances and any resolution of the lawsuit.(13) Has your firm or any member of your firm ever had a claim brought against because of breech of contract ornonperformance? If yes, when and state the circumstances and any resolution of the matter.(14) Debarred Statement: Has this firm, or any principal(s) ever been debarred from providing any servicesby the Federal Government, any state government, the State of Texas, or any local government agencywithin or without the State of Texas? Yes No Initials_______If "Yes," please attach a full detailed explanation, including dates, circumstances and current status.(15) Disclosure Statement: Does this firm or any principals thereof have any current, pastpersonal or professional relationship with any Commissioner or Officer of SAHA? Yes No Initials_______If "Yes," please attach a full detailed explanation, including dates, circumstances and current status.(16) Non-Collusive Affidavit: The undersigned party submitting this proposal hereby certifies that such proposalis genuine and not collusive and that said Offerer has not colluded, conspired, connived or agreed, directlyor indirectly, with any Offerer or person, to put in a sham proposal or to refrain from proposing, and has notin any manner, directly or indirectly sought by agreement or collusion, or communication or conference, withany person, to fix the proposal price of affiant or of any other Offerer, to fix overhead, profit or cost elementof said proposal price, or that of any other Offerer or to secure any advantage against the SAHA or anyperson interested in the proposed contract; and that all statements in said proposal are true.Initials_______(17) Verification Statement: The undersigned Offerer hereby states that by completing and submitting this formhe/she is verifying that all information provided herein is, to the best of his/her knowledge, true andaccurate, and agrees that if the SAHA discovers that any information entered herein is false, that shallentitle the SAHA to not consider nor make award or to cancel any award with the undersigned party.Initials_______(18) In performing this contract, the contractor(s) shall comply with any and all applicable federal, state or locallaws including but not limited to: Occupational Safety & Health, Equal Employment Opportunity, Immigrationand Naturalization, The Americans with Disabilities Act, State Tax and Insurance Law, and the Fair HousingAct.Initials____________________________ _________ ___________________Signature Date Printed Name CompanyHOUSING AUTHORITY OF THE CITY OF SAN ANTONIO, TEXAS (210-477-6059)Page 34
Page 3: Request for Proposals No. 1204-946-
Page 6 and 7: Request for Proposals No. 1204-946-
Page 31 and 32: SCOPE OF WORKThe SAHA is seeking pr
Page 37 and 38: (b) The Contractor agrees to includ
Page 39 and 40: (1) Agency and legislative liaison
Page 41 and 42: apprenticeship and training positio
Page 49 and 50: Employment: Thirty percent (30%) of
Page 51 and 52: At least $400,000, but less than $5
Page 53 and 54: Section 3 residents and Business Co
Page 55 and 56: SAN ANTONIO HOUSING AUTHORITYSECTIO
Page 57 and 58: ATTACHMENT ASECTION 3 PROGRAM GOOD
Page 59 and 60: Attachment BSAN ANTONIO HOUSING AUT
Page 62 and 63: Contractor’s Quarterly Section 3
Page 64 and 65: Contractor’s Section 3 Compliance
Page 66 and 67: Job Codes Definitions- Attachment C
Page 68 and 69: APPLICANT “SECTION 3” CERTIFICA

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