Community Needs Assessment Services

RFP No. 0401-26-CNAS
Attachment C
ATTACHMENT C - TECHNICAL PROPOSAL (STEP ONE) REQUIRED SUBMITTAL FORMS
ONLY ELECTRONIC PROPOSAL SUBMITTALS WILL BE ACCEPTED.
Complete and Submit the Following Forms: Completed, Signed & Dated Where Indicated:
1. Attachment C1 - Offer Form
2. Attachment C2 - Authority to Transact Business in Virginia
3. Attachment C3 - Company Information
4. Attachment C4 - References
5. Attachment C5 - Trade Secret/Proprietary Information Identification
Digital signatures are acceptable
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RFP No. 0401-26-CNAS
ATTACHMENT C1 - OFFER FORM
REQUEST FOR PROPOSALS (RFP)
Date: April 23, 2026
RFP NUMBER: 0401-26-CNAS
RFP SUBJECT: COMMUNITY NEEDS ASSESMENT SERVICES
DUE DATE AND TIME: by no later than June 1, 2026 @ 4:00 p.m. prevailing local time
PROPOSALS TO BE ELECTRONICALLY SUBMITTED ONLY TO:
Cordell Myers, Purchasing Agent
cmyers@fallschurchva.gov
Phone (571) 666-1809
with copy to Purchasing@fallschurchva.gov
SEE ATTACHMENT B FOR ELECTRONIC PROPOSAL SUBMISSION REQUIREMENTS
-------------------------------------------------------------------------------------------------------------------------------------------
Please type or legibly print.
OFFER
In compliance with this Request for Proposal and to all the conditions imposed herein, the undersigned
offers and agrees to furnish the goods and/or services in accordance this RFP, the attached forms and
associated Proposal.
____________________________________ By: __________________________________
Firm's Legal Name Authorized Representative - Signature
____________________________________ Name: ________________________________
Street Address (not PO Box)
____________________________________ Title: _________________________________
City
_________________________ Zip: ________ Date: _________________________________
State
Phone: _____________________ Email: ___________________________________________
The City of Falls Church is committed to the letter and spirit of the Americans with Disabilities Act. This
document will be made available in alternate format upon request. Call 703 248-5007 (TTY 711).
The City of Falls Church does not discriminate against faith-based organizations in accordance with the
Code of Virginia, 2.2-4343.1 or against any Bidder because of race, religion, color, sex, national origin,
age, disability, or any other basis prohibited by state law relating to discrimination in employment.
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RFP No. 0401-26-CNAS
Attachment C2 AUTHORITY TO TRANSACT BUSINESS IN VA FORM
VIRGINIA STATE CORPORATION COMMISSION (SCC) REGISTRATION INFORMATION
THIS FORM MUST BE SUBMITTED WITH YOUR PROPOSAL. FAILURE TO INCLUDE THIS FORM
MAY RESULT IN REJECTION OF YOUR PROPOSAL PACKAGE.
The Offeror's Name: _________________________________________________________
Legal Name of Company (as listed on W-9)
(Check only ONE Box below)
is a corporation or other business entity with the following SCC identification number:
_______________________________________________
This IS NOT the same as a Tax ID Number (TIN)
-OR-
is not a corporation, limited liability company, limited partnership, registered limited liability partnership,
or business trust -OR-
is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary
and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting
any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia
before they become contracts, and not counting any incidental presence of the business entity in Virginia
that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which
such goods were sold and shipped into Virginia from business entity's out-of-state location) -OR-
is an out-of-state business entity that is including with this bid/proposal an opinion of legal counsel which
accurately and completely discloses the undersigned business entity's current contacts with Virginia and
describes why those contacts do not constitute the transaction of business in Virginia within the meaning
of 13.1-757 or other similar provisions in Titles 13.1 or 50 of the Code of Virginia. Falsification of such
statement may be cause for debarment.
Please check the following box if you have not checked any of the foregoing options but currently have
pending before the SCC an application for authority to transact business in the Commonwealth of Virginia
and wish to be considered for a waiver to allow you to submit the SCC identification number after the due
date for bids/proposals:

If this bid/proposal for goods or services is accepted by the City of Falls Church, the undersigned agrees
that the requirements of the Code of Virginia Section 2.2-4311.2 have been met.
Any Bidder/Offeror described herein that fails to provide the required information or for whom such signed
exception is not considered valid by the City, may not receive an award unless a waiver is granted, in
writing, by the City Manager or his designee.
____________________________________________________ ______________________
Authorized Signature Date
_________________________________________________________________________
Print or Type Name and Title
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RFP No. 0401-26-CNAS
Attachment C3 - COMPANY INFORMATION
1. Legal Name of Business: _________________________________________________________
Other Business Names (including dba(s), T/As), etc.) used during past ten (10) years, if
applicable:
______________________________________________________________________________
2. Type of Business: Sole Proprietorship; Partnership; Corporation; LLC
Other: __________________________ (Specify if other)
3. Name/Title of Owner or Chief Executive Officer:_______________________________________
4. Federal DBE firm? NO YES DBE# ____________
5. Virginia SWAM firm? NO YES SWAM# _____________
6. Registered on SAM.GOV website? NO; YES; IF YES, provide your Unique Entity ID
__________
7. How many persons does the firm currently employ? ______ Full-time _________ Part-time
8. Address of local office from which work will be provided, if applicable:
_____________________________
9. If applicable - is all the equipment required by this RFP and/or necessary to efficiently and
effectively perform the services under this RFP operative and presently in the firm's equipment
inventory?
YES NO. If NO, explain.__________________________________________________
10. Subcontractors to be utilized if contract is awarded.
Please note that Contractor will be required to submit copies of Subcontractor licensing as
applicable and obtain City approval of specific Subcontractors prior to beginning work.
Subcontractor's Name Types of Work To Be Performed % Of Total Work To Be Performed
11. Is the firm currently removed from a vendor's list or debarred, suspended or otherwise excluded
from conducting business or submitting bids/proposals on contracts by any Commonwealth of
Virginia agency or local government, or agency of the Federal government See Section entitled
"Debarment/Exclusion Status"? YES NO
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RFP No. 0401-26-CNAS
If YES, explain and provide information regarding the debarment, suspension or exclusion and the
associated state, local or federal government agency or jurisdiction contact information (name,
title, telephone number and email address).
Attach a separate page if needed.
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RFP No. 0401-26-CNAS
ATTACHMENT C4 - COMPANY REFERENCES
NAME OF COMPANY: _________________________________
REFERENCES
Provide at least three (3) references (other than the City) for contracts/projects of similar scope
and comparable size to this RFP. References should be for current work or projects completed
within the last two (2) years. The City may be included in addition to the three (3) references
requested.
Please Type or print legibly.
1. Firm's Name: _____________________________________________________________
Contact Name & Title: _______________________________________________________
Email Address: __________________________________ Phone number: ______________
Project Title/Description: ________________________________________________
Date Completed: __________________ Contract Amount: $___________
*************************************************************************************************************
2. Firm's Name: _____________________________________________________________
Contact Name & Title: _______________________________________________________
Email Address: _____________________________________ Phone number: _____________
Project Title/Description: ______________________________________________________
Date Completed: __________________ Contract Amount: $___________
*************************************************************************************************************
3. Firm's Name: _____________________________________________________________
Contact Name & Title: _______________________________________________________
Email Address: _____________________________________ Phone number: _____________
Project Title/Description: ______________________________________________________
Date Completed: __________________ Contract Amount: $___________
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RFP No. ____________
Attachment C4
You may include brief detail on any projects, add other references and/or examples of
experience
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RFP No. ___________
Attachment C5 - TRADE SECRET/PROPRIETARY INFORMATION IDENTIFICATION
Name of Company:
A. Trade secrets or proprietary information submitted by an Offeror/Bidder in response to a
solicitation shall not be subject to public disclosure under the Virginia Freedom of Information
Act; however, the Offeror/Bidder must invoke the protections of 2.2-4342F of the Code of
Virginia, in writing, either before or at the time the data, material or other information (hereinafter
"information") is submitted.
B. The trade secrets or proprietary information to be protected from disclosure must be clearly
identified in the original Proposal/Bid document by some distinct method such as highlighting or
underlining and must indicate only the specific words, figures, or paragraphs that constitute a
trade secret or proprietary information. In addition, a redacted copy of the Proposal/Bid, labeled
"Redacted" with the specific proprietary or trade secret information blacked-out must be submitted
with the Proposal/Bid.
C. The Bidder/Offeror must also list such trade secrets or proprietary information in the Proposal/Bid
including page number(s) and section(s) on this form and clearly state the justifiable reason why
protection from disclosure is necessary. Such general terms as "confidential", "proprietary" or "not
public information" without reasonable justification is not acceptable.
D. A Bidder/Offeror shall not designate as trade secret or proprietary information (i) an entire
Proposal/Bid, (ii) any portion of a Proposal/Bid that does not contain trade secrets or proprietary
information; or (iii) line-item prices or total Bid/Proposal prices (Code of Virginia Section 2.2-
4342(F)(c). Any Proposal/s in contradiction to this requirement If the Offeror/Bidder refuses to
withdraw such a prohibited classification designation, the Proposal/Bid will be rejected.
E. The City shall not be responsible for an Offeror's/Bidder's failure to clearly identify information
considered trade secret or proprietary or if Offeror/Bidder fails to properly redact (blackout)
information in the redacted copy of their Proposal/Bid even if such information is listed on this
attachment. The redacted copy will be provided to the public/third parties as requested and
permitted under the Virginia Freedom of Information Act.
F. Does your Proposal/Bid contain any information that is considered by the undersigned as
proprietary or trade secret? Please check (X) one of the following boxes:
NO, I certify that none of the information included with this Proposal/Bid is considered
trade secret or proprietary.
YES, I certify that this Proposal/Bid contains information considered trade secret or
proprietary and all such information is specifically identified on this form.
If the "YES" box is checked the Offeror/Bidder must:
(1) Submit a redacted copy of the Proposal/Bid with the specific proprietary or trade secret
information blacked-out in addition to the requirement in paragraph B above with regard
to the original Proposal/Bid document; and
(2) Clearly identify on the form below, the specific information considered as trade secret
or proprietary information. List each page number, section, or other information
sufficient to make the information readily identifiable; and the justifiable reason for
protection from disclosure.
Authorized Signature: ______________________________________________
Printed Name & Title: ______________________________________________
Date: _____________________________
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RFP No. ____________
Name of Offeror/Bidder:
TRADE SECRET/PROPRIETARY INFORMATION IDENTIFICATION
PAGE REASON(S) FOR WITHHOLDING FROM
SECTION/TITLE
NUMBER(S) DISCLOSURE
Add pages if necessary
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