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Form C <br />Proposer Questionnaire <br />Instructions: Use this form and attach additional pages as necessary to respond to each of the following <br />questions. <br />GENERAL CONTACT INFORMATION <br />Name of Proposer: <br />Name of Parent Company (if applicable): <br />Address: <br />Telephone: <br />Email: <br />Website: <br />Name of Contact Person: <br />Title: <br />Authorized Signature: <br />Date: <br />REFERENCES <br />On separate page(s), provide a minimum of three collection references for current or past government <br />agency customers (cities, counties, school districts, housing authorities, etc.). References should include the <br />name of the government agency, the capacity (total number of households served), the contract structure <br />between the organization and the government agency being serviced, the type and frequency of service <br />provided, and any other relevant information. <br />Mounds View <br />Request for Proposals Residential Solid Waste and Recycling Services <br />Page F-4 <br />MU210\313\952165.v1 <br />