RFP Grant Management Disaster Recovery

Management Rating Sheet Sub-grantee Date of Rating Name of Respondent Evaluator's Name Experience -- Rate the respondent for experience in the following areas: Max.Pts. Score Comments: Subtotal, Experience 40 Work Performance Max.Pts. Score Comments: Subtotal, Performance 30 NOTE: Information necessary to assess the respondent on these criteria should be gathered by contacting past/currnt clients. Capacity to Perform Max.Pts. Score Comments: Subtotal, Capacity to Perform 10 Proposed Cost Factor Max.Pts. Score A= Lowest Proposal $ B=Bidder's Proposal $ A +B X 20 equals Respondent's Score Subtotal, Proposed Cost 20 TOTAL SCORE Factor Max.Pts. Score O Experience 40 QO Work Performance 30 O Capacity to Perform 10 O Proposed Cost . 20 Total Score 100 CERTIFICATE OF INTERESTED PARTIES FORM 1295 OFFICE USE ONLY Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. 3 Provide the identification number used by the governmental! entity or state agency fo t; c identify the contract, and provide a description of the services, goods, or other property to be provided wghtoe contract. y t ANature of Interest (check applicable) Name of interested Party City, State, Country {place of business} & uNSWORN PFE My name is SY : , and my date of bath is ati . _.__ 5 (street) i ad = {city} (State) (zip coe) {county) der penalty of pegury that the foregoing is tue and correct. Executed in County, State of .on the day of 20 {month} {year} Signature of authorized agent of contracting business entity (Dectarant} ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission verrviethcs.siate.b.us Revised