HomeMy WebLinkAboutRFP - 10240 HVAC Inspection and Maintenance Services - ResidentialRFP 10240 HVAC Inspection and Maintenance Services - Residential Page 1 of 15
REQUEST FOR PROPOSAL
10240 HVAC INSPECTION AND MAINTENANCE SERVICES - RESIDENTIAL
RFP DUE: 3:00 PM MT (Mountain Time), November 25, 2025
The City of Fort Collins is requesting proposals from qualified Service Providers to provide HVAC
Inspection Services at income qualified residential housing throughout various neighborhoods
across the City of Fort Collins.
As part of the City’s commitment to sustainability, proposals must be submitted online through
the Rocky Mountain E-Purchasing System (RMEPS) at http://www.bidnetdirect.com/colorado/city-
of-fort-collins. Note: please ensure adequate time to submit proposals through RMEPS. Proposals
not submitted by the designated Opening Date and Time will not be accepted by RMEPS.
All questions should be submitted, in writing via email, to Dennis Ralph, Senior Buyer at
dralph@fcgov.com, with a copy to Emily Olivo, Project Manager, at eolivo@fcgovc.om, no
later than 3:00 PM MT on November 12, 2025. Please format your e-mail to include: RFP 10240
HVAC Inspection and Maintenance Services - Residential in the subject line. Questions received
after this deadline may not be answered. Responses to all questions submitted before the
deadline will be addressed in an addendum and posted on the Rocky Mountain E-Purchasing
System webpage.
Rocky Mountain E-Purchasing System hosted by BidNet
A copy of the RFP may be obtained at http://www.bidnetdirect.com/colorado/city-of-fort-collins.
This RFP has been posted utilizing the following Commodity Code(s):
91000 Building Maintenance, Installation and Repair Services
99247 HVAC System Testing, Balancing and/or Trouble Shooting Services
Prohibition of Unlawful Discrimination: The City of Fort Collins, in accordance with the
provisions of Title VI of the Civil Rights Act of 1964 (78 Stat. 252, 42 US.C. §§ 2000d to 2000d-
4) and the Regulations, hereby notifies all bidders that it will affirmatively ensure that any contract
entered into pursuant to this advertisement, disadvantaged business enterprises will be afforded
full and fair opportunity to submit bids in response to this invitation and will not be discriminated
against on the grounds of race, color, or national origin in consideration for an award.
The City strictly prohibits unlawful discrimination based on an individual’s gender (regardless of
gender identity or gender expression), race, color, religion, creed, national origin, ancestry, age
40 years or older, marital status, disability, sexual ori entation, genetic information, or other
characteristics protected by law. For the purpose of this policy “sexual orientation” means a
person’s actual or perceived orientation toward heterosexuality, homosexuality, and bisexuality.
The City also strictly prohibits unlawful harassment in the workplace, including sexual
harassment. Further, the City strictly prohibits unlawful retaliation against a person who engages
in protected activity. Protected activity includes an employee complaining that he or she has been
discriminated against in violation of the above policy or participating in an employment
Financial Services
Purchasing Division
215 N. Mason St. 2nd Floor
PO Box 580
Fort Collins, CO 80522
970.221.6775
fcgov.com/purchasing
RFP 10240 HVAC Inspection and Maintenance Services - Residential Page 2 of 15
discrimination proceeding.
The City requires its Service Providers to comply with the City’s policy for equal employment
opportunity and to prohibit unlawful discrimination, harassment and retaliation. This requirement
applies to all third-party Service Providers and their subcontractors/subconsultants at every tier.
Public Viewing Copy: The City is a governmental entity subject to the Colorado Open Records
Act, C.R.S. §§ 24-72-200.1 et seq. (“CORA”). Any proposals submitted hereunder are subject to
public disclosure by the City pursuant to CORA and City ordinances. Professionals may submit
one (1) additional complete proposal clearly marked “FOR PUBLIC VIEWING.” In this version of
the proposal, Professionals may redact text and/or data that it deems confidential or proprietary
pursuant to CORA. All pricing will be considered public records subject to disclosure under CORA
and as such pricing cannot be redacted from the “FOR PUBLIC VIEWING” version of the
proposal. Failure to provide a public viewing copy will be considered a waiver of any claim of
confidentiality under CORA without regard to how the applicant’s proposal or certain pages of the
proposal are marked confidential, proprietary, or similar. Such statement does not necessarily
exempt such documentation from public disclosure if required by CORA, by order of a court of
appropriate jurisdiction, or other applicable law. Generally, under CORA, trade secrets,
confidential commercial information and financial data i nformation may not be disclosed by the
City. Proposals may not be marked “Confidential” or ‘Proprietary’ in their entirety. By responding
to this RFP, Professionals hereby waives any and all claims for damages against the City for the
City’s good faith compliance with CORA. All provisions and pricing of any contract resulting
from this request for proposal will be public information.
Service Providers Registration: The City requires new Service Providers receiving awards from
the City to submit IRS form W-9 and requires all Service Providers to accept Direct Deposit
(Electronic) payment. If needed, the W-9 form and the Vendor Direct Deposit Authorization Form
can be found on the City’s Purchasing website at www.fcgov.com/purchasing under Vendor
Reference Documents. Please do not submit these documents with your proposal, however,
if you take exception to participating in Direct Deposit (Electronic) payments please clearly note
such in your proposal as an exception. The City may waive the requirement to participate in
Direct Deposit (Electronic) payments at its sole discretion.
Sales Prohibited/Conflict of Interest: No officer, employee, or member of City Council, shall
have a financial interest in the sale to the City of any real or personal property, equipment,
material, supplies or services where such officer or employee exercises directly or indirectly any
decision-making authority concerning such sale or any supervisory authority over the services to
be rendered. This rule also applies to subcontracts with the City. Soliciting or accepting any gift,
gratuity favor, entertainment, kickback or any items of monetary value from any person who has
or is seeking to do business with the City of Fort Collins is prohibited.
Collusive or Sham Proposals: Any proposal deemed to be collusive or a sham proposal will be
rejected and reported to authorities as such. Your authorized signature of this proposal assures
that such proposal is genuine and is not a collusive or sham proposal.
The City of Fort Collins reserves the right to reject any and all proposals and to waive any
irregularities or informalities.
Utilization of Award by Other Agencies: The City of Fort Collins reserves the right to allow
other state and local governmental agencies, political subdivisions, and/or school districts to
utilize the resulting award under all terms and conditions specified and upon agreement by all
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parties. Usage by any other entity shall not have a negative impact on the City of Fort Collins in
the current term or in any future terms.
The selected Service Provider shall be required to sign the City’s Agreement prior to commencing
services (see sample attached to this document).
Sincerely,
Gerry Paul
Purchasing Director
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I. BACKGROUND & OBJECTIVE / OVERVIEW
A. Objective
The City of Fort Collins is requesting proposals from qualified Service Providers to provide
HVAC Inspection Services at income qualified residential housing throughout various
neighborhoods across the City of Fort Collins.
The Work Order maximum for this solicitation is Sixty Thousand Dollars ($60,000.00.)
B. Background
Healthy Homes is continuing an assessment process to promote education and
awareness around the health impacts of poor indoor air quality (IAQ). The home
assessments also include low or no cost recommendations and the resourcing of small-
scale interventions to reduce indoor air pollution and its health impacts and increase
energy efficiency and resilience (home comfort).
Accordingly, the City is requesting proposals from qualified Service Provider(s) to
support providing identified home interventions that will improve indoor air quality,
energy efficiency and comfort in homes.
Healthy Homes indoor Air Quality program is piloting a new home assessment process
across underrepresented neighborhoods in the Fort Collins community.
As part of the assessment process, trained, volunteer Healthy Homes Educators will
conduct in-home assessments with the goal to promote education and awareness
around the health impacts of poor indoor air quality. As part of this process, the Healthy
Homes educators will identify additional interventions that the home could benefit from
that will be resourced through grant funding. These resources include, but not limited to:
• Portable Air Cleaners
• Simple air sealing and weatherstripping projects around doors, windows and some
piping
• Furnace filters
• HVAC cleaning and safety checks
As one of the home interventions, the City is looking to pay for HVAC system inspection
and safety checks. Housing types served include single family homes, apartments
townhomes and mobile homes, and it is expected that Spanish will be the primary
language spoken in many homes reached. The goal of this RFP is to identify a qualified
Service Provider to provide HVAC cleaning and safety checks and support basic air
sealing and weatherization projects.
It is required that a resident 18 years of age or older is present while the inspection
services are rendered.
II. SCOPE OF PROPOSAL
A. Scope of Work
Task 1: Provision of HVAC Cleaning and Safety Checks
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City staff and trained volunteer educators will be conducting Healthy Homes assessments
various neighborhoods. Upon completion of assessments in a given neighborhood, Staff
will host neighborhood installation event days with the awarded Service Provider(s).
The Service Provider(s) would be expected to coordinate with City staff before each install
event day to receive a list of the homes that will be receiving HVAC cleaning and safety
checks in a given neighborhood. It is anticipated that there will be between 5-8 homes that
will require HVAC services during a given installation event. Scope of services include:
• HVAC preventative maintenance, including cleaning and a safety inspection with
an agreed upon maximum price per home across all housing types being served
through the assessment process (Mobile Homes, Single family homes,
apartments, and townhomes)
o Services to include, as applicable, but not limited to:
• Clean or replace filters
• Clean condenser and evaporator coils
• Clean drain lines
• Clear drain pans of any standing water
• Replace worn pulleys and belts
• Inspect ducts for mold, dust, and debris
• Observe humidity levels and adjust appropriately
• Check refrigerant charge and for leaks
• Test thermostats and controls to make sure temperatures and timer
functions are correctly set
• Check electrical system and connections
• Check fan motor
• Check blowers and blades for proper airflow
• Lubricate motors bearings and moving parts
• Inspect cabinet for leaks and check cabinet door for secure closure
• Check for debris around the outside unit
• Install/Removal of portable A/C or Heat unit
• A written report provided to the City and home occupant documenting the work
that was performed as well as any additional HVAC maintenance or repairs that
could be recommended to ensure the system works properly at each address. The
format of the written report to be mutually agreed by the parties.
• Courteous and professional customer service when interacting with community
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members, and the ability to communicate effectively with Spanish-speaking
community members
Task 2: Completion of Air Sealing and Weatherstripping projects
Air Sealing and weatherstripping will be provided as part of the home interventions. While not
the primary focus of this RFP, the City anticipates the need for additional support to complete
basic air sealing and weatherstripping projects and would like to learn from interested Service
Providers about the ability to support this service during the above mentioned neighborhood
event days.
B. Minimum Qualifications
Registered business with Colorado Secretary of State
No Exceptions with the Federal System for Award Management (SAM.gov)
Current HVAC Certificate/License
Spanish Speaking
C. Anticipated Schedule
The following represents the City’s target schedule for the RFP. The City reserves the
right to amend the target schedule at any time.
• RFP issuance: November 4, 2025
• Question deadline: 3:00 PM MT on November 12, 2025
• Proposal due date: 3:00 PM MT on November 25, 2025
• Interviews (if necessary): Week of December 8th, 2025
• Award of Contract (tentative): December 2025
D. Interviews
In addition to submitting a written proposal, the top-rated Service Providers may be
interviewed by the RFP assessment team and asked to participate in an oral presentation
to provide an overview of the company, approach to the project and to address questions.
The evaluation criteria for the oral interviews will be the same as the criteria for the written
evaluations and is included in Section IV.
Instead of traditional in-person interviews for the optional interview session, the City may
opt to use alternate methods including, but not limited to remote interviews through a
platform such as Microsoft Teams or Zoom.
E. Subcontractors/Subconsultants
Service Provider will be responsible for identifying any subcontractors and/or
subconsultants in their proposal. Please note that the City will contract solely with the
awarded Service Provider; therefore, subcontractors and/or subconsultants will be the
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responsibility of the Service Provider.
F. Current standards
All work and/or materials must meet current standards in force by recognized technical
and professional societies, trade and materials supply associations, institutes and
organizations, bureaus and testing laboratories, and national, federal, state, county , and
local laws, codes and ordinances.
G. Fees, Licenses, Permits
The successful Service Provider shall be responsible for obtaining any necessary
licenses, fees or permits without additional expense to the City. All vehicles and equipment
shall be properly licensed and insured, carry the appropriate permits and be placarded as
required by law.
H. Laws and Regulations
The Service Provider agrees to comply fully with all applicable local, State of Colorado
and Federal laws and regulations and municipal ordinances to include American
Disabilities Act (ADA).
I. Work Orders
The awarded Service Provider(s) will be required to sign the City’s Work Order Type
Agreement, a sample of which is attached as Section VI for reference purposes. In the
event that the City has agreements with multiple Service Providers for the Work, the City
reserves the right to request proposals for individual Work Order assignments from the
awarded Service Providers or assign Work Orders directly to a Service Provider at its sole
discretion. Selection for individual Work Orders may be based on, but not l imited to,
availability, approach, prior experience, firm capability, and cost.
Individual Work assignments will be requested and agreed to utilizing the City’s Work
Order (included in the Agreement). Each Work Order must include a start and completion
date, total cost and a Scope of Work. Subsequent supporting documentation pages may
include a project schedule, deliverables, hours, cost detail supporting total cost, and
personnel details. Fees outlined in the Work Order will conform with those stated in the
Agreement.
No Work Order over $7,500 will be considered valid until signed, at a minimum, by the
Service Provider, project manager and Purchasing Department representative.
Depending on the cost and nature of the Work, additional signature authorization may be
required. Any changes to the dates, cost or scope of any Work Order must be agreed
upon in writing utilizing the City’s Change Order (included in the Agreement) and will not
be considered valid until signed, at a minimum, by the Service Provider, project manager
and Purchasing Department representative.
J. Invoicing and Payment
Invoices should be emailed monthly to invoices@fcgov.com with a copy to the Project
Manager. The cost of the work completed shall be paid to the Service Provider each month
following the submittal of a correct invoice by the Service Provider indicating the project
name, Purchase Order number, task description, hours worked, personnel/work type
category, hourly rate for each employee/work type category, date of the work performed
specific to the task, percentage of that work that has been completed by task, 3 rd party
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supporting documentation with the same detail and a brief progress report.
Payments will be made using the prices stated in the Work Order and Agreement. In the
event a service is requested which is not stated in the Work Order and/or Agreement, the
Service Provider and the City will negotiate an appropriate unit price for the service prior
to the Service Provider initiating such work.
The City pays invoices on Net 30 terms.
III. PROPOSAL SUBMITTAL
Please limit the total length of your proposal to a maximum of fifty (50) 8 ½ x 11” pages
(excluding cover pages, table of contents, dividers and Acknowledgement form). Font shall
be a minimum of 10 Arial and margins are limited to no less than .5” for sides and top/bottom.
Extended page sizes, such as 11” x 17”, count as a single page and may be used for detailed
pricing. Links to other files or websites shall not be permitted. Proposals that do not conform
to these requirements may be rejected.
Service Providers are required to provide detailed written responses to the following items in
the order outlined below. The responses shall be considered technical offers of what Service
Providers propose to provide and shall be incorporated in the contract award as deemed
appropriate by the City. A proposal that does not include all the information required may be
deemed non-responsive and subject to rejection.
Responses must include all the items in the order listed below. It is suggested that the Service
Providers include each of the City’s questions with their response.
The City of Fort Collins shall not reimburse any firm for costs incurred in the preparation and
presentation of their proposal.
A. Cover Letter / Executive Summary
The Executive Summary should highlight the content of the proposal and features of the
program offered, including a general description of the program and any unique aspects
or benefits provided by your firm.
Indicate your availability to participate in the interviews/demonstrations on the proposed
dates as stated in the Schedule section.
B. Service Provider Information
1. Describe the Service Provider’s business and background
2. Number of years in the business
3. Details about ownership
4. An overview of services offered and qualifications
5. Size of the firm
6. Location(s) of offices. If multiple, please identify which will be the primary for our
account.
7. Primary contact information for the company including contact name(s) and title(s),
mailing address(s), phone number(s), and email address(s).
C. Scope of Proposal
1. Provide a detailed narrative of the services proposed if awarded the contract per the
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scope above. The narrative should include any options that may be beneficial for the
City to consider.
2. Describe how the project would be managed and who would have primary
responsibility for its timely and professional completion.
3. Briefly describe the approach to execute the scope of work to include the methods and
assumptions used, and any exceptions and/or risks.
4. Describe the methods and timeline of communication your firm will use with the City’s
Project Manager and other parties.
5. Identify what portion of work, if any, may be subcontracted or outsourced to
subconsultants. Include all applicable information herein requested for each Service
Provider.
D. Firm Capability and Assigned Personnel
Provide relevant information regarding previous experience related to this or similar
projects, to include the following:
1. Provide an Organization Chart/Proposed Project Team: An organization chart
containing the names of all key personnel and subconsultants with titles and their
specific task assignment for this Agreement shall be provided in this section.
2. A list of qualifications for your firm and qualifications and experience of the specific
staff members proposed to perform the services described above.
3. References. Provide a minimum of one similar project with public agencies in the last
5 years that have involved the staff and subcontractors/subconsultants proposed to
work on this project. Include the owner’s name, title of project, beginning price, ending
price, contact name, email and phone number, subconsultants on the team and a brief
description of the work and any change orders. The Service Provider authorizes the
City to verify any and all information contained herein and hereby releases all those
concerned providing information as a reference from any liability in connection with
any information provided.
4. Provide any information that distinguishes Service Provider from its competition and
any additional information applicable to this RFP that might be valuable in assessing
Service Provider’s proposal.
E. Sustainability/TBL Methodology
In concise terms (no more than two pages), please describe your organization’s
commitment to sustainability and supporting values.
Each element of the TBL sustainability criteria will receive equal consideration in
determining the final Sustainability/TBL score.
1. Address how your firm strives to incorporate all three aspects (social,
environmental, and economic) of Triple Bottom Line (TBL) sustainable practices
into the workplace. Provide examples along with any metrics used to measure
success within your firm.
2. Also provide examples of how your firm has incorporated all three aspects of TBL
sustainable practices in previous similar projects on which your firm has been the
prime Service Provider.
Some examples are provided below:
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a. Environmental – Experience delivering projects / programs focused on
environmental health priorities in the areas of climate resiliency, water quality
and watershed protection, regulatory performance, management systems,
air quality, renewable energy, sustainable building and design, construction
materials management, and solid waste reduction.
b. Economic – Experience working and delivering projects with an emphasis
on strategic financial planning, job creation, business development, asset
management, various project delivery methods, value engineering, regional
partnerships, transparency, stakeholder engagement, strategic investments,
aging infrastructure, repurposing of existing facilities, and competing
financial priorities.
c. Social - Experience working and delivering projects, programs, and/or
initiatives that support Equity, Diversity, and Inclusion throughout your firm’s
workplace, including leadership, and supply chain. Examples of this may be
demonstration of working within cultural and language gaps, development of
diversity programs, diverse project teams, equitable opportunity vendor
supply chain, and how your firm has applied an equity lens to processes
such as recruitment, hiring, purchasing, career pathways, salaries, and staff
engagement.
F. Cost and Work Hours
In your response to this proposal, please provide the following:
1. Schedule of Rates: Provide a schedule of billing rates by category of employee and
job title to be used during the term of the Agreement. This fee schedule will be firm for
at least one (1) year from the date of the Agreement. The fee schedule will be used as
a basis for determining fees should additional services be necessary. Include a per
meeting rate in the event additional meetings are needed. A fee schedule for
subconsultants/subcontractors, if used, shall be included.
G. Sample Agreement
Included with this request for proposals is a sample Agreement that the City intends to
use for obtaining the services of the Service Provider. The Service Provider is required to
review this Agreement and indicate any objections to the terms of the contract. If revisions
to the contractual terms are requested, provide suggested revisions.
H. Acknowledgement
The Acknowledgement form is attached as Section V. Complete the attached form
indicating the Service Provider hereby acknowledges receipt of the City of Fort Collins
Request for Proposal and acknowledges that the Service Provider has read and agrees
to be fully bound by all of the terms, conditions and other provisions set forth in the RFP.
IV. REVIEW AND ASSESSMENT CRITERIA
A. Proposal and Interview Criteria
Service Providers will be evaluated on the following criteria. This set of criteria will be the
basis for review and assessment of the written proposals and optional interview session.
At the discretion of the City, interviews of the top-rated Service Providers may be
conducted.
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The rating scale shall be from 1 to 10, a rating of 1 doesn’t meet minimum requirements,
a rating of 5 means the category fulfills the minimum requirements, and 10 exceeds
minimum requirements in that category.
WEIGHTING
FACTOR CATEGORY STANDARD QUESTIONS
2.0 Scope of Proposal
Does the proposal address all elements of the
RFP? Does the proposal show an
understanding of the project objectives,
methodology to be used and results/outcomes
required by the project? Are there any
exceptions to the specifications, Scope of Work,
or agreement? Can the work be completed in
the necessary time? Can the target start and
completion dates be met? Are other qualified
personnel available to assist in meeting the
project schedule if required? Is the project team
available to attend meetings as required by the
Scope of Work?
5.0 Firm Capability &
Assigned Personnel
Does the firm have the resources, financial
strength, capacity and support capabilities
required to successfully complete the project on-
time and in-budget? Has the firm successfully
completed previous projects of this type and
scope? Do the persons who will be working on
the project have the necessary skills and
qualifications? Are sufficient people of the
requisite skills and qualifications assigned to the
project?
1.0 Sustainability/TBL
Methodology
Does the firm demonstrate a commitment to
Sustainability and incorporate Triple Bottom Line
methodology in both their Scope of Work for the
project, and their day-to-day business operating
processes and procedures?
Does the firm demonstrate a commitment to all
three aspects (social, environmental, and
economic) of the Triple Bottom Line (TBL)
methodology of sustainability for this project and
in their company value system as evidenced by
their day-to-day business operating processes,
practices and procedures?
2.0 Cost & Work Hours
Does the proposal included detailed cost break-
down for each cost element as applicable and
are the line-item costs competitive? Do the
proposed cost and work hours compare
favorably with the Project Manager's estimate?
Are the work hours presented reasonable for the
effort required by each project task or phase?
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V. ACKNOWLEDGEMENT
This form may not be redlined and must be submitted with your proposal. Failure to adhere
to these requirements may result in your proposal being rejected.
Service Provider hereby acknowledges receipt of the City of Fort Collins Request for Proposal
and acknowledges that it has read and agrees to be fully bound by all of the terms, conditions
and other provisions set forth in the RFP 10240 HVAC Inspections and Maintenance Services
- Residential and sample Agreement except as otherwise noted. Additionally, Service Provider
hereby makes the following representations to City:
a. All of the statements and representations made in this proposal are true to the best of the
Service Provider’s knowledge and belief.
b. Service Provider commits that it is able to meet the terms provided in this proposal.
c. This proposal is a firm and binding offer, for a period of 90 days from the date hereof.
d. Service Provider further agrees that the method of award is acceptable.
e. Service Provider also agrees to complete the proposed Agreement with the City of Fort
Collins within 10 days of notice of award. If contract is not completed and signed within
10 days, City reserves the right to cancel and award to the next highest rated firm.
f. Service Provider acknowledges receipt of addenda.
g. Service Provider acknowledges no conflict of interest.
h. Service Provider acknowledges that the City is a governmental entity subject to the
Colorado Open Records Act, C.R.S. §§ 24-72-200.1 et seq. (“CORA”). Any proposals
submitted hereunder are subject to public disclosure by the City pursuant to CORA and
City ordinances. Professionals may submit one (1) additional complete proposal clearly
marked “FOR PUBLIC VIEWING.” In this version of the proposal, Professionals may
redact text and/or data that it deems confidential or proprietary pursuant to CORA . All
pricing will be considered public records subject to disclosure under CORA and as such
pricing cannot be redacted from the “FOR PUBLIC VIEWING” version of the proposal.
Failure to provide a public viewing copy will be considered a waiver of any claim of
confidentiality under CORA without regard to how the applicant’s proposal or certain
pages of the proposal are marked confidential, proprietary, or similar. Such statement
does not necessarily exempt such documentation from public disclosure if required by
CORA, by order of a court of appropriate jurisdiction, or other applicable law. Generally,
under CORA, trade secrets, confidential commercial information and financial data
information may not be disclosed by the City. Proposals may not be marked “Confidential”
or ‘Proprietary’ in their entirety. By responding to this RFP, Service Providers hereby
waives any and all claims for damages against the City for the City’s good faith compliance
with CORA. All provisions and pricing of any contract resulting from this request
for proposal will be public information.
Legal Firm Name:
Physical Address:
Remit to Address:
Phone:
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Name of Authorized Agent of Firm:
Signature of Authorized Agent:
Primary Contact for Project:
Title: Email Address:
Phone: Cell Phone:
NOTE: ACKNOWLEDGMENT IS TO BE SIGNED & RETURNED WITH YOUR PROPOSAL.
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VI. SAMPLE AGREEMENT (FOR REFERENCE ONLY – DO NOT SIGN ) SEE ATTACHED