RFP Exhibit A

ELECTRICIANSPECIALTY CONTRACTOR

REQUEST FOR PROPOSAL RESPONSE FORM

Please complete this form electronically and then print for submission with your application. The information fields will expand as you type. Please provide the following information in the fields provided below:

Legal Name of Applicant Company
Street Address
City, State & Zip Code
Contact Person and Title
Email Address
Phone and Fax Numbers
Program Location (if different than above)

Please provide the following information:

Oregon CCB License Number
Certified Lead-Based Paint Renovation (LBPR) Contractor License Status (enter “pending” if not obtained yet)
CCB Residential Bond expiration date
Building Codes Division License Number
Employer Identification Number
Please provide explanations within the field for each question, as requested, or attach additional pages to this response. / Yes / No
  1. Can the applicant company perform all the bid items we have listed in Exhibit B?
If no, please explain.
Explanation of “No” response:
  1. Is the applicant company currently involved in or does it have pending any legal actions?
If yes, please explain.
Explanation of “Yes” response:
  1. Has the applicant company filed for bankruptcy in the past five years?
If yes, please explain.
Explanation of “Yes” response:
  1. Does any employee or official of NeighborImpact or member of any NeighborImpact Advisory Board have any financial or other interest in the applicant company?
If yes, please explain.
Explanation of “Yes” response:
  1. Does the applicant company have (or will you be able to obtain) all the levels of insurance and bonding required in this RFP?

  1. Does your proposal comply with the requirements contained within the RFP?
A “No” response may disqualify the proposal from further consideration.
  1. Did outside individuals or agencies assist with preparation of this proposal?
If “Yes”, please identify and indicate how it was developed, including credentials of the developer.
Explanation of “Yes” response:
  1. Does the applicant company guarantee that, in connection with this proposal, the prices and/or cost data have been arrived at independently, without consultation, communication or agreement for the purpose of restricting competition?
If no, please explain.
Explanation of “No” response:
  1. Does the applicant company guarantee that the fees for services quoted in response to this RFP are not in excess of those which would be charged any other individual for the same services performed by your organization?
If no, please explain.
Explanation of “No” response:
  1. Does the applicant company have a lead license and certified renovator on staff?
If “Yes”, provide the number of certified renovators on staff:
  1. Is the applicant company registered as a minority or woman-owned business?

  1. In the last year, did the applicant company subcontract with minority or woman-owned businesses and if so, to what extent?
Explanation:

Please be specific when answering the questions below.

  1. Please describe the applicant company’s electrician experience.
  1. What percentage of the applicant company’s business is repair or replacement vs. new construction? Please describe any experience with retrofit and weatherization.
  1. What percentage of the applicant company’s business is with stick-built homes, mobile homes and multifamily buildings? Please describe your experience with each type of structure.
  1. How many employees does the applicant company employ full-time and how many years of experience does your average crew member have?
  1. Please describe the experience of your key staff (field and office staff).
  1. Describe the applicant company’s capacity to accept work orders from NeighborImpact. How will the applicant company ensure availability to complete projects during the contract period?
  1. What are the applicant company’s policies and procedures for dealing with a disgruntled client who calls your company?
  1. When a permit is pulled, what percentage of jobs pass the first inspection?

What is the process for internal inspections?

  1. Has the applicant company worked on projects funded by government grants? □Yes □ No

Please describe the government grant project(s), the contract amount and how long the project lasted.

  1. Please describe the applicant company’s experience working with low-income clients.
  1. Please list any industry certifications held by the applicant company’s employees.
  1. Please list any partnerships or contracts the applicant company has with area agencies or other organizations that serve low-income populations.
  1. Does the applicant company have a drug testing policy/procedure? □Yes □ No

Please explain the process, frequency of testing, what results would disqualify an employee and who makes that determination.

  1. Does the applicant company conduct background checks on all field employees? □Yes □ No

Please explain the process, what results would disqualify an employee and who makes that determination.

  1. Please provide contact information for 3 professional references that can provide information on your performance on projects similar in technical detail or scope to the work proposed under this RFP.

I certify that to the best of my knowledge the information contained in this proposal is accurate and complete and that I have the legal authority to commit this agency to a contractual agreement. I realize the final funding for any service is based upon funding levels and the approval of NeighborImpact.

I certify that this agency has never been debarred or suspended or otherwise excluded from or are ineligible for participation in Federal Assistance programs under Executive Order 12549 “Debarment and Suspension” and we will not contract with a subcontractor that is debarred or suspended.

I, the undersigned, have read and reviewed all of the above statements and attest, to the best of my knowledge, that they are correct and that I have the legal authority to commit this organization to a contractual agreement.

Printed Name, Chief Administrator of Applicant Company

Signature, Chief Administrator of Applicant CompanyDate

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