section iii: attachments - houston independent school district · web viewwhere applicable, all...

Section III: Attachments

Please include all original completed forms with the original copy of your RFP and two (2) USB drives.

MODIFICATIONS TO THE CONTENT OF THIS DOCUMENT WILL DEEM YOUR PROPOSAL NON-RESPONSIVE.

Attachments:

FORM A: Vendor Information

FORM B: MWBE Instructions and Participation Report

FORM C: Form not applicable.

FORM D: Form not applicable.

FORM E: General Certifications

FORM F: Price Schedule (if applicable) (should be placed in tab 7)

FORM G: EDGAR Certifications

FORM H: Exceptions

FORM I: Conflict of Interest Instructions and Questionnaire (Form CIQ)

FORM J: Instructions for Completion of Disclosure of Interested Persons Certification (HB 1295)

FORM K: IRS Form W 9‐

FORM L: Certificate of Insurance (Acord Form) or a letter from its insurance provider stating that Respondent can provide the levels of insurance required in this RFP.

FORM M: Acknowledgement Form

APPENDIX B: Master Service Agreement (MSA) and Data Sharing Agreement (DSA)

FORM A: VENDOR INFORMATION

This Form A is required. See HISD Policy CHE (Local).

LEGAL NAME OF VENDOR: ___________________________________________________________________

DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER: _____________________________________________

TYPE OF BUSINESS/DESCRIPTION OF PRODUCTS AND/OR SERVICES PROVIDED:_____________________________________________________________________________________________________________________________________________________________

VENDOR MAILING ADDRESS: __________________________________________________________________

CITY: _____________________________ STATE: ______________ ZIP CODE: ______________________

VENDOR STREET ADDRESS: __________________________________________________________________

CITY: _____________________________ STATE: ______________ ZIP CODE: ______________________

TELEPHONE: __________________________________ FAX: ______________________________________

CONTACT PERSON’S NAME: ___________________________________________________________________

CONTACT PERSON’S TELEPHONE NUMBER: _______________________ FAX: ___________________________

CONTACT PERSON’S E-MAIL ADDRESS: ___________________________________________________________

1. TYPE OF BUSINESS ENTITY: ☐ PUBLICLY TRADED CORPORATION ☐ PRIVATE CORPORATION ☐ LIMITED PARTNERSHIP ☐ PARTNERSHIP ☐ SOLE PROPRIETORSHIP ☐ NOT FOR PROFIT ENTITY

2. NUMBER OF FULL TIME EMPLOYEES: _________________ NUMBER OF PART TIME EMPLOYEES: _______________

3. IS VENDOR IS A RESIDENT BIDDER? ☐ YES ☐ NOA RESIDENT BIDDER REFERS TO A PERSON WHOSE PRINCIPAL PLACE OF BUSINESS IN THE STATE OF TEXAS,INCLUDING A VENDOR WHOSE ULTIMATE PARENT COMPANY OR MAJORITY OWNER HAS ITS PRINCIPAL PLACE OF BUSINESS IN THIS STATE.

4. CITY AND STATE OF VENDOR'S PRINCIPAL PLACE OF BUSINESS: __________________________________________ IF NOT TEXAS, DOES THE STATE HAVE PREFERENTIAL TREATMENT ON BIDS? ☐ YES ☐ NO

IF YES, WHAT PERCENTAGE: ____________%

5. NUMBER OF YEARS VENDOR HAS BEEN IN CONTINUOUS OPERATION:______________________________________

6. NUMBER OF YEARS VENDOR HAS BEEN IN BUSINESS UNDER ITS PRESENT BUSINESS NAME: _____________________

7. HAS VENDOR CONDUCTED BUSINESS WITH THE DISTRICT UNDER ANOTHER NAME? ☐ YES ☐ NO

IF YES, PROVIDE OTHER NAME(S):_______________________________________________________

________________________________________________________________________________

8. NUMBER OF YEARS DOING BUSINESS WITH HISD: __________________________________________________________________

9. DOES VENDOR HAVE A PARENT COMPANY OR SUBSIDIARY THAT CURRENTLY CONDUCTS OR THAT HAS PREVIOUSLY CONDUCTED BUSINESS WITH THE DISTRICT? ☐ YES ☐ NO

IF YES, NAME OF PARENT COMPANY AND/OR SUBSIDIARY: ____________________________________________________

______________________________________________________________________________________________

10. DO YOU HAVE EXPERIENCE WITH OTHER SCHOOL DISTRICTS? ☐ YES ☐ NO

IF YES, NAMES OF SCHOOL DISTRICTS___________________________________________________________________

_______________________________________________________________________________________________

11. DOES VENDOR HAVE ANY OWNERS, PRINCIPAL SHAREHOLDERS OR STOCKHOLDERS, OFFICERS, AGENTS, SALESPEOPLE OR KEY EMPLOYEES WHO HAVE BEEN MEMBERS OF THE HISD BOARD OF EDUCATION DURING THE LAST 5 YEARS? ☐ YES ☐ NO

IF YES, NAME(S) AND TITLE(S): ________________________________________________________________________

12. DOES ANY OFFICER, PARTNER, OWNER, SALES REPRESENTATIVE AND/OR SPOUSE WORK FOR HISD? ☐ YES ☐ NO

13. DOES VENDOR HAVE ANY OWNERS, PRINCIPAL SHAREHOLDERS OR STOCKHOLDERS, OFFICERS, AGENTS, SALESPEOPLE OR KEY EMPLOYEES WHO ARE DISTRICT EMPLOYEES OR WHO ARE MEMBERS OF A DISTRICT EMPLOYEE’S IMMEDIATE FAMILY WHO EITHER WORK OR WHO MAY POTENTIALLY WORK ON THIS CONTRACT WITH THE DISTRICT? ☐ YES ☐ NO

IF YES, NAME(S) AND TITLE(S): ________________________________________________________________________

______________________________________________________________________________________________

14. NAMES OF AUTHORIZED AGENTS, INCLUDING ANY PERSON OR ENTITY AUTHORIZED TO ‘ACT WITH’ OR ‘ACT ON YOUR BEHALF,’ SUCH AS CONSULTANTS, SUB-CONTRACTORS, RE-SELLERS, LOBBYISTS, CONFIDANTS, ETC., WHETHER COMPENSATED OR NOT COMPENSATED: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

15. DOES VENDOR HAVE RELATIONSHIP(S) WITH ANY POLITICAL ACTION COMMITTEES? ☐ YES ☐ NO

IF YES, NAME(S) OF OF PAC(S)_______________________________________________________________________

16. HAS VENDOR (INCLUDING ANY OWNER, PRINCIPAL SHAREHOLDER OR STOCKHOLDER, OFFICER, AGENT, SALESPERSON, OR EMPLOYEE) BEEN INVOLVED IN PAST, PENDING, OR PRESENT LITIGATION INVOLVING THE DISTRICT? ☐ YES ☐ NO

IF YES, PLEASE PROVIDE THE STYLE AND STATUS OF THE CASE AS WELL AS THE TYPE OF LITIGATION: ____________________

______________________________________________________________________________________________

17. FINANCIAL AND BUSINESS REFERENCES, INCLUDING BANK WITH WHICH VENDOR CONDUCTS BUSINESS:

NAME OF BANK WITH WHICH VENDOR CONDUCTS BUSINESS: ___________________________________________________

BANK OFFICER: _____________________________ OFFICER’S PHONE NUMBER: _______________________________

NAME OF OTHER BANKING/FINANCIAL INSTITUTION(S): _______________________________________________________

_______________________________________________________

18. NAME OF INSURANCE COMPANIES:INSURANCE COMPANIES INSURANCE COMPANIES

19. HISD ENCOURAGES THE PARTICIPATION OF MINORITY AND WOMEN OWNED BUSINESES. IS VENDOR A MINORITY AND/OR WOMAN OWNED COMPANY? ☐ YES ☐ NO

IF YES, WHAT PERCENTAGE OF OWNERSHIP IS MINORITY OR WOMAN OWNED _____________%

20. CHECK ONE OF THE FOLLOWING: ☐ VENDOR WILL PROVIDE GOODS AND SERVICES WITH OWN WORK FORCE ☐ VENDOR WILL PURCHASE GOODS DIRECTLY FROM THE MANUFACTURER OR OTHER SUPPLIER

21. HISD CAN ONLY DO BUSINESS WITH EQUAL OPPORTUNITY EMPLOYERS.

DO YOU ADVERTISE AS AN EQUAL OPPORTUNITY EMPLOYER? ☐ YES ☐ NO

DO YOU HAVE A WRITTEN NON-DISCRIMINATORY POLICY OF EMPLOYMENT? ☐ YES ☐ NO

HAS THIS POLICY BEEN CIRCULATED THROUGHOUT YOUR ORGANIZATION? ☐ YES ☐ NO

PERSON TO CONTACT REGARDING EQUAL OPPORTUNITY INFORMATION ISSUES:

NAME: _______________________________________ TITLE: ____________________________________

-----QUESTIONS REGARDING PROCUREMENT E-COMMERCE SOLUTIONS---- MORE INFORMATION REGARDING THE FOLLOWING QUESTIONS AND HISD’S E-PROCUREMENT SYSTEM MAY BE FOUND ON THE DISTRICT’S WEBSITE AT [PROVIDE LINK TO PROCUREMENT E-COMMERCE SOLUTIONS FORMERLY ON PAGE 28 OF TEMPLATE]

22. NAME OF CONTACT PERSON REGARDING IT ISSUES IN YOUR COMPANY: __________________________________________________

23. IS VENDOR PARTICIPATING IN THE OPTIONAL E-COMMERCE METHOD DESCRIBED IN SECTION 3.4 OF THIS RFP? ☐ YES ☐ NO

24. CAN VENDOR PROVIDE HISD WITH PERIODIC PREFORMATTED FLAT FILE UPDATES OF YOUR CATALOG? ☐ YES ☐ NO

25. DOES VENDOR HAVE E-COMMERCE CAPABILITY? ☐ YES ☐ NO

26. DOES VENDOR HAVE PUNCH-OUT CATALOGS IN PLACE TODAY? ☐ YES ☐ NO

27. DOES VENDOR HAVE ANY INTERNAL ELECTRONIC CATALOGS WITH ANY CUSTOMERS? ☐ YES ☐ NO

28. IS VENDOR CAPABLE OF PROVIDING A DEDICATED WEBSITE WITH YOUR CATALOG WITH HISD’S PRICING? ☐ YES ☐ NOIF YES, CAN YOUR WEBSITE INTERFACE WITH SAP PUBLIC SECTION 7.0 / ECC 6.0 OPEN CATALOG INTERFACE (OCI) COMPLIANT? ☐ YES ☐ NO

I ATTEST THAT I HAVE ANSWERED THE QUESTIONS REGARDING VENDOR INFORMATION TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE.

______________________________________________OFFICER’S SIGNATURE

______________________________________________PRINTED NAME

______________________________________________TITLE

FORM B: MWBE INSTRUCTIONS

DO NOT SUBMIT EXAMPLE DOCUMENT

Please refer to Attachment B-MWBE Participation Report. MWBE Submission is required and must be submitted with the SOQ submission. Failure to submit this report shall cause the submission to be marked non-responsive. Do not Mark N/A on this Document. All question reference this document should be reference to the Houston Independent School District Business Assistance Office at 713-556-7273.

FORM E: GENERAL CERTIFICATION FORMS

CERTIFICATION OF CODE OF SILENCE

The Board of Education (Board) has adopted a “Code of Silence” policy (Board Policy CAA (Local)) attached by URL link hereto and incorporated by reference.

The “Code of Silence" prohibits any communication regarding any RFP, bid, or other competitive solicitation between:

Any person who seeks an award from the District or its affiliated entities (including, but not limited to, the HISD Foundation and the HISD Public Facility Corporation), including a potential vendor or vendor's representative, and

Board members, the Superintendent of Schools, senior staff members, principals, department heads, directors, managers, or other District representatives who have influence in the evaluation or selection process.

The “Code of Silence” time period shall begin when the RFP is issued and ends upon the execution of the Contract. During the “Code of Silence,” campaign contributions, gifts, donations, loans, and any other items of value are prohibited between these parties, including candidates who have filed for election to the Board.

I hereby certify that I have reviewed Board Policy CAA (Local) pertaining to the “Code of Silence,” I and agree and understand that non-compliance with the “Code of Silence” policy may result in disqualification.

________ Initials of Authorized Representative of Vendor

CERTIFICATION OF COMPLIANCE WITH TEXAS FAMILY CODE PROVISION

As per Section 14.52 of the Texas Family Code, added by S.B. 84, Acts, 73rd Legislature, R.S. (1993), all bidders must complete and submit with the bid the following: I, the undersigned Vendor, do hereby acknowledge that NO sole proprietor, partner, majority shareholder of a corporation, or an owner of 10% or more of another business entity is 30 days or more delinquent in paying child support under a court order or a written repayment agreement. I understand that under this provision, a sole proprietorship, partnership, corporation or other entity in which a sole proprietor, partner, majority shareholder or a corporation, or an owner of 10% or more of another entity is 30 days or more delinquent in paying child support under a court order or a written repayment agreement is NOT eligible to bid or receive a state contract.


CERTIFICATION OF AUTHORIZATION, PERMITS, AND BUSINESS CERTIFICATES REQUIREMENT

For the duration of the Contract, Vendor must have and maintain current licenses, permits, fees, business certificates and similar authorizations required by the City of Houston, Harris Country, and the State of Texas to conduct business and provide awarded goods and/or services to the District. Upon the request of the District, Vendor shall provide copies of all licenses, business certificates permits and fees as being paid and current that are required to do business by the city, county and State for the type of business Vendor provides, or seeks to provide, to the District.

Vendor understands and agrees to abide by the Authorization, Permits, and Business Certificates Requirement above. Vendor certifies that it has all current licenses, certificates, similar authorizations required by the City of Houston, Harris County, and the State of Texas to conduct business and/or provide awarded goods and/or services to the District.


CERTIFICATION OF ANTITRUST CERTIFICATION STATEMENT –Texas Government Code Section 2155.005

My initials below affirms under penalty of perjury of the laws of the State of Texas that:1. I am duly authorized to execute this Submission/Contract on my own behalf or on behalf of the company, corporation,

firm, partnership or individual (Vendor) listed below;2. In connection with this submission, neither I nor any representative of Vendor have violated any provision of the Texas

Free Enterprise and Antitrust Act, Tex. Bus & Comm. Code Chapter 15;3. In connection with this bid, neither I nor any representative of the Vendor have violated any federal antitrust law; and4. Neither I nor any representative of Vendor have directly or indirectly communicated any of the contents of this

submission to a competitor of Vendor or any other company, corporation, firm, partnership or individual engaged in the same line of business as Vendor.

http://www.houstonisd.org/HISDConnectEnglish/Images/PDF/CAA(LOCAL)%20-%20marked%20version.pdf


CERTIFICATION REGARDING HAZARD ANALYSIS AND CRITICAL CONTROL POINTS (HACCP)

All products purchased by HISD must be manufactured in compliance with HACCP regulations. Vendor certifies that: all products on this submission are processed and packaged in a HACCP compliant plant. Vendor agrees Vendor further understands that HISD requires processors to maintain records and monitoring logs pertaining to HACCP compliance, at a minimum, in the following Key Areas of HACCP compliance:

Hazard Analysis Critical Control Points established and limits set Planned procedures in place to correct

processes when deviation may occur Detailed and accurate record keeping Verification procedures Equipment installation and maintenance Master cleaning and sanitation schedule

Orientation for all employees Ongoing training on food safety and HACCP procedures Separation of food and chemical products Refrigerated dock receiving and loading Master cleaning and sanitation schedule Time/Temperature monitoring Pest Control

Vendor further understands and agrees that documentation and monitoring logs must be verified by an acceptable third party auditing firm or government agency and provided to HISD upon request. Vendor also understands and agrees that if a processor loses inspection/processing rights or has a recall involving product sold to HISD, Vendor must notify HISD within 24-48 hours.


CERTIFICATION OF VENDOR (AND IF APPLICABLE, SUBCONTRACTOR) NATIONWIDE CRIMINAL BACKGROUND CHECKS

Pursuant to sections 22.085 and 22.0834 of the Texas Education Code Sections 22.085 and 22.0834 and HISD Policy CJA (Legal), Vendor hereby certifies that all of Vendor’s employees, subcontractors and volunteers (including those hired before January 1, 2008) who have, or will have, continuing duties related to the contracted services, and who have, or will have, direct contact with students, have passed a national criminal history background record information review as required by those sections and by HISD Policy CJA (Legal). Vendor understands that if an employee subcontractor, or volunteer has a Disqualifying Criminal History, the District may elect not to enter into this Contract or may elect to cancel the Contract.

“Disqualifying Criminal History” means: (1) a conviction or other criminal history information designated by HISD; (2) a felony or misdemeanor offense that would prevent a person from being employed under Texas Education Code § 22.085(a), that is: if at the time of the offense, the victim was under 18 or was enrolled in a public school: (a) a felony offense under Title 5, Texas Penal Code; (b) an offense on conviction for which a defendant is required to register as a sex offender under Chapter 62, Texas Code of Criminal Procedure; or (c) an offense under federal law or the laws of another state that is equivalent to (a) or (b).

Vendor further certifies that:(1) Vendor will immediately remove an employee, subcontractor, or volunteer from contract duties and notify HISD in writing

within 3 business days if:

a. Vendor receives information that an employee, subcontractor, or volunteer has a reported criminal history, orb. HISD objects to the assignment of an employee, subcontractor, or volunteer on the basis of the individual(s)

criminal history review information (CHRI).

(2) Upon request, Vendor will provide HISD with the name and any other requested information of an employee, subcontractor, or volunteer so that HISD may obtain the CHRI on the individual(s).


CERTIFICATION OF FELONY CONVICTION NOTIFICATION

Pursuant to section 44.034 of the Texas Education Code, a person or business entity entering into a contract and/or agreement with HISD must give advance notice to HISD if the person or an owner or operator of the business entity has been convicted of a felony. The disclosure should include a general description of the conduction resulting in the conviction of a felony. HISD may terminate a contract with a person of business entity if HISD determines that the person or the business entity failed to give notice as required by section 44.034 or misrepresented the conduct resulting in the conviction. In such a case, HISD will compensate the person or business entity for services performed before the termination of the contract.

---THIS NOTICE IS NOT REQUIRED OF A PUBLICLY HELD-CORPORATION ---Please check the following as applicable:

☐ Vendor is a publicly held corporation; therefore the above reporting requirement does not apply.

☐ Vendor is not owned nor operated by anyone who has been convicted of a felony.

☐ Vendor is operated or owned by the following individual(s) who has/have been convicted of a felony:

Name of Individual(s): ___________________________________________________________________________

Detail of conviction(s), attach additional pages if necessary: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________


CERTIFICATION OF INSURANCE REQUIREMENT

I, the undersigned Vendor, do hereby certify that I shall maintain all insurance policies required by and in accordance with Section 5.27 of this RFP. I further understand and agree that I must make the certificates of insurance and insurance policies available to HISD upon request.


CERTIFICATION OF NON-COLLUSION STATEMENT

I, the undersigned Vendor, do hereby certify that:

a) All statements of fact in such submission are true.b) Such Submission was not made in the interest of or on behalf of any undisclosed person, partnership, company,

association, organization or corporation.c) Such Submission is genuine and not collusive or sham.d) Vendor has not, directly or indirectly by agreement, communication or conference with anyone, attempted to induce

action prejudicial to the interest of the District or of any other bidder or anyone else interested in the proposed procurement.

e) Vendor did not, directly or indirectly, collude, conspire, connive or agree with anyone else that said bidder or anyone else would submit a false or sham bid or submission, or that anyone should refrain from bidding or withdraw his bid or submission.

f) Vendor did not, in any manner, directly or indirectly seek by agreement, communication or conference with anyone to raise or fix the bid or submission price of said bidder or of anyone else, or to raise or fix any overhead, profit or cost element of his bid or submission price, or that of anyone else.

g) Vendor did not, directly or indirectly, submit his bid or submission price or any breakdown thereof, or the contents thereof, or divulge information on data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, or to any individual or group of individuals, except to the District, or to any person or persons who have a partnership or other financial interest with said Respondent in his business.

h) Vendor did not provide, directly or indirectly to any officer or employee of the District any gratuity, entertainment, meals, or anything of value, whatsoever, which could be construed as intending to invoke any form of reciprocation or favorable treatment.

i) No officer or principal of the undersigned Vendor is related to any officer or employee of the District by blood or marriage within the third degree or is employed, either full or part time, by the District either currently or within the last two (2) years.

j) No officer or principal of the undersigned Vendor nor any subcontractor to be engaged by the principal has been convicted by a court of competent jurisdiction of any charge of fraud, bribery, collusion, conspiracy or any other act in violation of any state or federal anti-trust law in connection with the bidding, award of, or performance of any public work contract and/or agreement with any public entity.

k) I have answered the questions regarding non-collusion truthfully and to the best of my knowledge.


VENDOR AGREES TO COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, RULES, REGULATIONS, AND ORDINANCES. IT IS FURTHER ACKNOWLEDGED THAT VENDOR CERTIFIES COMPLIANCE WITH ALL PROVISIONS, LAWS, ACTS, REGULATIONS, ETC. AS SPECIFICALLY NOTED ABOVE.

Vendor’s Name: _______________________________________________________________________________________

Address, City, State, and Zip Code: ________________________________________________________________________

Phone Number: ____________________________________ Fax Number: ____________________________________ Printed Name and Title of Authorized Representative: __________________________________________________________

Email Address: ________________________________________________________________________________________

Signature of Authorized Representative: _____________________________________________________________________

Date: ___________________________

FORM F (PRICE SCHEDULE)

Proposer shall submit pricing as identified in Part II Section 2.7. PRICING SHEETS INCLUDING ELECTRONIC SUBMITTAL REQUIREMENTS. Include the cover page and the first 10 pages (if applicable) of the Hard Copy of Form F under Tab 7 of the proposal. Include Form F in the ORIGINAL EXCEL format on both copies of the USB Drive submission. Pricing cannot be changed or altered after Response Submission.

PRICING SHEETS INCLUDING ELECTRONIC SUBMITTAL REQUIREMENTS.

E-Procurement Solutions

HISD uses SAP-SRM as its e-Procurement system for the purchase of goods and services. As an extension of SRM, HISD uses an internal catalog aka “Hosted catalog” or external catalog aka “Punch-out catalog” system where HISD requestors are able to view and order using board approved supplier catalogs, thereby facilitating a shopping cart experience similar to Internet shopping. This should reduce the time it takes to receive a purchase order and to ensure that suppliers with contract(s) are being fully utilized. Please refer to Form F 16-11-26 .

Proposer(s) are to complete the Form F 16-11-26 Catalog Option and may choose to implement an Internal Catalog or a “Punch-out Catalog”. Submissions must be made by electronic form (Excel format) with the appropriate attachments and must be included in the electronic proposal (via USB flash drive properly labeled with Proposer’s company name and project number). Electronic media supplied will not be returned and becomes property of the District.

HISD is working to increase the number of Catalogs to purchase goods and services as this will become the preferred method HISD will utilize to purchase goods for the entire District.

HISD reserves the right to select and determine the appropriate and most advantageous suppliers for the above electronic catalog solutions. HISD requests all suppliers to consider the resources and skills necessary within their companies to meet the electronic catalog requirements of HISD. These include, but are not limited to, ongoing catalog maintenance, customization of any current websites, and any new software needing to be purchased and implemented for successful catalog implementation and management. Additionally, HISD reserves the right to invoke corrective action, up to and including termination of the supplier’s contract, in the event that suppliers cause technical problems with the catalog system or use the system inappropriately by selling unauthorized items or making price changes without the prior approval of the Procurement Services Department.

Please attach copy of FORM F to TAB 7

FORM G: EDGAR CERTIFICATIONS

The following certifications and provisions are required and apply when HISD expends federal funds for any contract resulting from this procurement process. Accordingly, the parties agree that the following terms and conditions apply to the Contract between the District and [name of vendor] (“Vendor”) in all situations where Vendor has been paid or will be paid with federal funds:

REQUIRED CONTRACT PROVISIONS FOR NON-FEDERAL ENTITY CONTRACTS UNDER FEDERAL AWARDS APPENDIX II TO 2 CFR PART 200

(A) Contracts for more than the simplified acquisition threshold currently set at $150,000, which is the inflation adjusted amount determined by the Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 U.S.C. 1908, must address administrative, contractual, or legal remedies in instances where contractors violate or breach contract terms, and provide for such sanctions and penalties as appropriate.

Pursuant to Federal Rule (A) above, when HISD expends federal funds, HISD reserves all rights and privileges under the applicable laws and regulations with respect to this procurement in the event of breach of contract by either party.

Does Vendor agree? YES ________ Initials of Authorized Representative of Vendor

(B) Termination for cause and for convenience by the grantee or subgrantee including the manner by which it will be effected and the basis for settlement. (All contracts in excess of $10,000)

Pursuant to Federal Rule (B) above, when HISD expends federal funds, HISD reserves the right to immediately terminate any agreement in excess of $10,000 resulting from this procurement process in the event of a breach or default of the agreement by Vendor in the event Vendor fails to: (1) meet schedules, deadlines, and/or delivery dates within the time specified in the procurement solicitation, contract, and/or a purchase order; (2) make any payments owed; or (3) otherwise perform in accordance with the contract and/or the procurement solicitation. HISD also reserves the right to terminate the contract immediately, with written notice to vendor, for convenience, if HISD believes, in its sole discretion that it is in the best interest of HISD to do so. Vendor will be compensated for work performed and accepted and goods accepted by HISD as of the termination date if the contract is terminated for convenience of HISD. Any award under this procurement process is not exclusive and HISD reserves the right to purchase goods and services from other vendors when it is in HISD’s best interest.


(C) Equal Employment Opportunity. Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of “federally assisted construction contract” in 41 CFR Part 60-1.3 must include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, “Equal Employment Opportunity” (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, “Amending Executive Order 11246 Relating to Equal Employment Opportunity,” and implementing regulations at 41 CFR part 60, “Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor.”

Pursuant to Federal Rule (C) above, when HISD expends federal funds on any federally assisted construction contract, the equal opportunity clause is incorporated by reference herein.

Does Vendor agree to abide by the above? YES ________ Initials of Authorized Representative of Vendor

(D) Davis-Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program legislation, all prime construction contracts in excess of $2,000 awarded by non-Federal entities must include a provision for compliance with the Davis-Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented by Department of Labor regulations (29 CFR Part 5, “Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction”). In accordance with the statute, contractors must be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. In addition, contractors must be required to pay wages not less than once a week. The non-Federal entity must place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The non-Federal entity must report all suspected or reported violations to the Federal awarding agency. The contracts must also include a provision for compliance with the Copeland “Anti-Kickback” Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, “Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States”). The Act provides that each contractor or subrecipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or

repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non-Federal entity must report all suspected or reported violations to the Federal awarding agency.

Pursuant to Federal Rule (D) above, when HISD expends federal funds during the term of an award for all contracts and subgrants for construction or repair, Vendor will be in compliance with all applicable Davis-Bacon Act provisions.


(E) Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, all contracts awarded by the non-Federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence.

Pursuant to Federal Rule (E) above, when HISD expends federal funds, Vendor certifies that Vendor will be in compliance with all applicable provisions of the Contract Work Hours and Safety Standards Act during the term of an award for all contracts by HISD resulting from this procurement process.


(F) Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the definition of “funding agreement” under 37 CFR §401.2 (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that “funding agreement,” the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, “Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements,” and any implementing regulations issued by the awarding agency.

Pursuant to Federal Rule (F) above, when federal funds are expended by HISD, Vendor certifies that during the term of an award for all contracts by HISD resulting from this procurement process, Vendor agrees to comply with all applicable requirements as referenced in Federal Rule (F) above.


(G) Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended—Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non-Federal award to agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251- 1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA).

Pursuant to Federal Rule (G) above, when federal funds are expended by HISD, Vendor certifies that during the term of an award for all contracts by HISD resulting from this procurement process, Vendor agrees to comply with all applicable requirements as referenced in Federal Rule (G) above.


(H) Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) must not be made to parties listed on the government wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), “Debarment and Suspension.” SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549.

Pursuant to Federal Rule (H) above, when federal funds are expended by HISD, Vendor certifies that during the term of an award for all contracts by HISD resulting from this procurement process, Vendor certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency.


(I) Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non-Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non-Federal award.

Pursuant to Federal Rule (I) above, when federal funds are expended by HISD, Vendor certifies that during the term and after the awarded term of an award for all contracts by HISD resulting from this procurement process, the vendor certifies that it is in compliance with all applicable provisions of the Byrd Anti-Lobbying Amendment (31 U.S.C. 1352). The undersigned further certifies that:

(1) No Federal appropriated funds have been paid or will be paid for on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of congress, or an employee of a Member of Congress in connection with the awarding of a Federal contract, the making of a Federal grant, the making of a Federal loan, the entering into a cooperative agreement, and the extension, continuation, renewal, amendment, or modification of a Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying”, in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all covered sub-awards exceeding $100,000 in Federal funds at all appropriate tiers and that all subrecipients shall certify and disclose accordingly.


RECORD RETENTION REQUIREMENTS FOR CONTRACTS INVOLVING FEDERAL FUNDS

When federal funds are expended by HISD for any contract resulting from this procurement process, Vendor certifies that it will comply with the record retention requirements detailed in 2 CFR § 200.333. Vendor further certifies that it will retain all records as required by 2 CFR § 200.333 for a period of three years after grantees or subgrantees submit final expenditure reports or quarterly or annual financial reports, as applicable, and all other pending matters are closed.


CERTIFICATION OF COMPLIANCE WITH THE ENERGY POLICY AND CONSERVATION ACT

When HISD expends federal funds for any contract resulting from this procurement process, Vendor certifies that it will comply with the mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (42 U.S.C. 6321 et seq.; 49 C.F.R. Part 18).

Does Vendor agree? YES ________ Initials of Authorized Representative of VendorCERTIFICATION OF EQUAL EMPLOYMENT STATEMENT

It is the policy of HISD not to discriminate on the basis of race, color, national origin, gender, limited English proficiency or handicapping conditions in its programs. Vendor agrees not to discriminate against any employee or applicant for employment to be employed in the performance of this Contract, with respect to hire, tenure, terms, conditions and privileges of employment, or a matter directly or indirectly related to employment, because of age (except where based on a bona fide occupational qualification), sex (except where based on a bona fide occupational qualification) or race, color, religion, national origin, or ancestry. Vendor further agrees that every subcontract entered into for the performance of this Contract shall contain a provision requiring non-discrimination in employment herein specified, binding upon each subcontractor. Breach of this covenant may be regarded as a material breach of the Contract.


CERTIFICATION OF COMPLIANCE WITH BUY AMERICA PROVISIONS

HISD has a preference for domestic end products for supplies acquired for use in the United States when spending federal funds (purchases that are made with non-federal funds or grants are excluded from the Buy America Act). Vendor certifies that it is in compliance with all applicable provisions of the Buy America Act.


CERTIFICATION OF ACCESS TO RECORDS – 2 C.F.R. § 200.336

Vendor agrees that the District’s Inspector General or any of their duly authorized representatives shall have access to any books, documents, papers and records of Vendor that are directly pertinent to Vendor’s discharge of its obligations under the Contract for the purpose of making audits, examinations, excerpts, and transcriptions. The right also includes timely and reasonable access to Vendor’s personnel for the purpose of interview and discussion relating to such documents.


CERTIFICATION OF APPLICABILITY TO SUBCONTRACTRS

Vendor agrees that all contracts it awards pursuant to the Contract shall be bound by the foregoing terms and conditions.



Vendor’s Name: _______________________________________________________________________________________



Email Address: ________________________________________________________________________________________


Date: ___________________________

FORM H: EXCEPTION FORM

All deviations and exceptions to this RFP must be expressly stated in this Exception Form (additional pages to this form may be added if necessary). The District reserves the right to reject exceptions or exclude documents from any exception(s). In the absence of any entry on this Exception Form, the Proposer(s) assures HISD of their full agreement and compliance with all specifications, terms and conditions, requirements and obligations of the RFP. THIS EXCEPTION FORM MUST BE SIGNED BY EACH RESPONDENT(S) WHETHER THERE ARE EXCEPTIONS LISTED OR NOT, AND SUBMITTED WITH THE SUBMISSION.

SECTION #, PARAGRAPH # (OR SUBSECTION #) AND PAGE

EXCEPTION

Vendor Name

Officer’s Signature

Printed Name

Date

FORM I: CONFLICT OF INTEREST CERTIFICATION AND

CONFLICT OF INTEREST QUESTIONNAIRE (CIQ) INSTRUCTIONS

I. CONFLICT OF INTEREST CERTIFICATION

The Board of Education (Board) has adopted a “Conflict of Interest Disclosures” policy (Board Policy BBFA (Local)) attached by URL link hereto and incorporated by reference.

http://www.houstonisd.org/HISDConnectEnglish/Images/PDF/BBFA_Local.pdf

HISD is required to comply with Texas Local Government Code Chapter 176, Disclosure of Certain Relationships with Local Government Officers as well as the conflict of interest standards set forth in EDGAR, 2 C.F.R. § 200.318 when HISD expends federal funds. No employee, officer, or agent may participate in the selection, award, or administration of a contract if he or she has a real or apparent conflict of interest. HISD local government officers must disclose conflicts of interest by completing Form CIS, Local Government Officer Conflicts Disclosure Statement.

I hereby certify that I have read Board Policy BBFA (Local) pertaining to “Conflict of Interest Disclosures,” and I agree and understand that the failure of a Board member to disclose a conflict of interest may result in the debarment of a Vendor for 24 months.


II. CONFLICT OF INTEREST QUESTIONNAIRE (CIQ) INSTRUCTIONS

HISD is required to comply with Texas Local Government Code Chapter 176, Disclosure of Certain Relationships with Local Government Officers. H.B. 23 significantly changed the laws relating to Conflict of Interest Disclosures as well as the corresponding forms and required disclosures. As of September 1, 2015, Vendor must sign and complete the new Conflict of Interest Questionnaire (CIQ) and submit the CIQ with its submission.

In accordance with Chapter 176 of the Texas Local Government Code, any vendor who does business with HISD or who seeks to do business with HISD must fill out the new Conflict of Interest Questionnaire (CIQ) whether or not a conflict of interest exists. A conflict of interest exists in the following situations:

1) If the vendor has an employment or other business relationship with a local government officer of HISD or a family member of the officer, as described by section 176.003(a)(2)(A) of the Texas Local Government Code; or

2) If the vendor given a local government officer of HISD, or a family member of the officer, one or more gifts with the aggregate value of $100, excluding any gift accepted by the officer or a family member of the officer if the gift is: (a) a political contribution as defined by Title 15 of the Election Code; or (b) a gift of food accepted as a guest; or

3) If the vendor a family relationship with a local government officer of HISD.

“Vendor” means a person who enters or seeks to enter into a contract with a local governmental entity. The term includes an agent of a vendor. The term includes an officer or employee of a state agency when that individual is acting in a private capacity to enter into a contract. The term does not include a state agency except for Texas Correctional Industries. Texas Local Government Code 176.001(7).

“Business relationship” means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Texas Local Government Code 176.001(3).

“Local government officer” means: (A) a member of the governing body of a local governmental entity; (B) a director, superintendent, administrator, president, or other person designated as the executive officer of a local governmental entity; or (C) an agent of a local governmental entity who exercises discretion in the planning, recommending, selecting, or contracting of a vendor. Texas Local Government Code 176.001(4).

“Family relationship” means a relationship between a person and another person within the third degree by consanguinity or the second degree by affinity, as those terms are defined by Subchapter B, Chapter 573, Government Code. Texas Local Government Code 176.001(2-a).

VENDOR MUST SIGN AND SUBMIT FORM CIQ EVEN IF NO CONFLICT EXISTS.If no conflict exists, Vendor must fill out Box 1 and write N/A in Box 3.

I hereby certify that I have read Form I, Conflict of Interest Questionnaire (CIQ) Instructions, and I agree and understand that the failure to disclose a conflict of interest and/or the failure to sign and submit Form CIQ, even if no conflict exists, with this submission may result in disqualification.

Name of Authorized Representative: ________________________________________________________________________


Date: ___________________________

COMPANY NAME

CORPORATE OFFICER’S SIGNATURE

PRINTED NAME

TITLE

Affiant certifies that he or she is duly authorized to submit the above information on behalf of the Proposer, that Affiant is associated with the Proposal in the capacity noted above and has personal knowledge of the accuracy of the information provided herein, and that the information provided herein is true and correct to the best of Affiant’s knowledge and belief.

Affiant

SWORN TO AND SUBSCRIBED before me this _____day of ______________, 20___.

(seal) Notary Public

FORM J: HISD CERTIFICATE OF INTERESTED PARTIES – FORM 1295

Certificate of Interested Parties (Form 1295 – must be filled out electronically with the Texas Ethics Commission’s online filing application, printed out, signed, notarized, and attached to vendor’s response to this solicitation.

Houston ISD (“HISD”) is required to comply with House Bill 1295, which amended the Texas Government Code by adding Section 2252.908, Disclosure of Interested Parties. Section 2252.908 prohibits HISD from entering into a contract resulting from this RFP with a business entity unless the business entity submits a Disclosure of Interested Parties (Form 1295) to HISD at the time business entity submits the signed contract. The Texas Ethics Commission has adopted rules requiring the business entity to file Form 1295 electronically with the Texas Ethics Commission.

“Interested Party” means a person: a) who has a controlling interest in a business entity with whom HISD contracts; orb) who actively participates in facilitating the contract or negotiating the terms of the contract,

including a broker, intermediary, adviser, or attorney for the business entity.

“Business Entity” means an entity recognized by law through which business is conducted, including a sole proprietorship, partnership, or corporation.

As a “business entity,” all vendors must electronically complete, print, sign, notarize, and submit Form 1295 with their submissions even if no interested parties exist.

Respondents must file Form 1295 electronically with the Texas Ethics Commission using the online filing application, which can be found at https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm. Respondents must use the filing application on the Texas Ethics Commission’s website to enter the required information on Form 1295. Respondents must print a copy of the completed form, which will include a certification of filing containing a unique certification number. The Form 1295 must be signed by an authorized agent of the business entity, and the form must be notarized.

https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm

The completed Form 1295 with the certification of filing must be filed with HISD by attaching the completed form to the vendor’s solicitation response.

HISD must acknowledge the receipt of the filed Form 1295 by notifying the Texas Ethics Commission of the receipt of the filed Form 1295 no later than the 30 th day after the date the contract binds all parties to the contract. After HISD acknowledges the Form 1295, the Texas Ethics Commission will post the completed Form 1295 to its website with seven business days after receiving notice from HISD. The acknowledgement of your 1295 form does not guarantee that you will be selected as an approved vendor. An evaluation committee will select the vendor(s) for the project and the Board of Education will approve it during the next available board meeting. An award or regret letter will be sent once the selection and approval process is complete. In the event that your submission is not selected, we will request you to withdraw your 1295 form from the Texas Ethics Commission website.

Examplee

FORM K: W9- REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION )

Example

FORM L: CERTIFICATE OF INSURANCE (ACORD FORM)

THE RESPONDENT(S) MUST PROVIDE THE ACORD INSURANCE FORM, OR A LETTER FROM THE INSURANCE CARRIER ON THE INSURANCE CARRIER’S LETTERHEAD INDICATING COMPLIANCE IN ACCORDANCE WITH PART I GENERAL TERMS AND

CONDITIONS, SECTION 1.25 INSURANCE.

UPON RECEIPT OF A LETTER OF INTENT TO AWARD FROM RISK MANAGEMENT/PROCUREMENT SERVICES, THE RESPONDENT MUST SUBMIT TO RISK MANAGEMENT AND PROCUREMENT SERVICES THE ACTUAL ACORD FORM PRIOR TO BEING RECOMMENDED TO THE BOARD OF EDUCATION FOR CONTRACT APPROVAL.

THE RESPONDENT WILL HAVE THREE ( 3 ) BUSINESS DAYS FROM THE DATE OF NOTIFICATION TO SUBMIT THEIR CERTIFICATES OF INSURANCE; FAILURE TO

PROVIDE ALL THE REQUIREMENTS WILL CAUSE YOUR SUBMISSION TO BE NON-RESPONSIVE.

ALL QUESTIONS REFERENCING THIS DOCUMENT SHOULD BE DIRECTED TO THE HOUSTON INDEPENDENT SCHOOL DISTRICT RISK MANAGEMENT DEPARTMENT AT

713-556-9225.

FAILURE TO PROVIDE EITHER THE ACORD FORM OR MEMO OF INSURABILITY AT THE TIME OF SUBMISSION SHALL CAUSE YOUR PROPOSAL TO BE CONSIDERED NON-

RESPONSIVE.

LETTER FROM INSURANCE CARRIER – SAMPLE ACORD INSURANCE FORM

Date Houston Independent School District Attn: HISD Sourcing Specialist 4400 West 18th Street Houston, TX 77092 RE: RFP Name and Project Number

Supplier’s Name The undersigned certifies Supplier will be able to provide an Acord certificate of insurance confirming the coverages indicated below within three days from a letter of intent to award from HISD Procurement Services. All coverages would be placed with carriers rated A VII or better and licensed to do business in the State of Texas. I have marked the applicable box for each section.

X COVERAGES LIMITS

WORKERS’ COMPENSATION SECTION

Workers’ Compensation Employers’ Liability Waiver of Subrogation and Alternate Employer provisions in favor of HISD

Statutory $100,000 per Accident

Supplier has employees, but none in the State of Texas Workers’ Compensation Employers’ Liability Waiver of Subrogation in favor of HISD

Statutory

$100,000 per Accident

Supplier has no Employees Workers’ Compensation does not apply

Not Applicable

AUTOMOBILE LIABILITY SECTION

Automobile Liability covering All Owned, Hired & Non-Owned Autos, including Additional Insured and Waiver of Subrogation in favor of HISD.

$1,000,000 CSL

Supplier owns no vehicles in the company name -- Automobile Liability covering Hired & Non-Owned Autos, including Additional Insured and Waiver of Subrogation in favor of HISD.

$1,000,000 CSL

COMMERCIAL GENERAL LIABILITY SECTION

Commercial General Liability, including Additional Insured and Waiver of Subrogation in favor of HISD

$1,000,000 per Occurrence

Sincerely, Insurance Agent

SAMPLE

APPENDIX BMASTER SERVICE AGREEMENT (MSA) & DATA SHARING AGREEMENT (DSA)

Refer to attachment “APPENDIX B” for MSA and DSA.

NO DEVIATIONS OR EXCEPTIONS TO THIS FORM WILL BE ACCEPTED. THE PROPOSER(S) ASSURES HISD OF THEIR FULL AGREEMENT AND COMPLIANCE WITH ALL SPECIFICATIONS, TERMS AND CONDITIONS, REQUIREMENTS AND OBLIGATIONS

OF THE RFP. MASTER SERVICE AGREEMENT AND DATA SHARING AGREEMENT MUST BE SIGNED BY EACH PROPOSER(S) ON PAGE 9, PAGE 12, PAGE 15 AND PAGE 20. THE

MSA AND DSA MUST BE RETURNED WITH THE RFP RESPONSE SUBMISSION.

FAILURE TO PROVIDE THESE DOCUMENTS WITH THE REQUIRED SIGNATURES COULD CAUSE YOUR PROPOSAL TO BE CONSIDERED NON-RESPONSIVE.

FORM M: ACKNOWLEDGEMENT FORM

RFP Number:

Project Name:

RFP/ Due Date / Bid Opening:

THIS ACKNOWLEDGEMENT FORM MUST BE SIGNED AND RETURNED WITH YOUR PROPOSAL RESPONSE TO ACKNOWLEDGE AND AFFIRM AGREEMENT TO ALL OF THE STATEMENTS AND TERMS & CONDITIONS CONTAINED IN THIS REQUEST FOR QUALIFICATION. THE AUTHORIZED SUPPLIER REPRESENTATIVE MANUALLY SIGNING THIS ACKNOWLEDGEMENT FORM WARRANTS THAT THEY ARE IN RECEIPT OF THE FULL REQUEST FOR PROPOSAL AND ARE DULY AUTHORIZED TO COMMIT ON BEHALF OF THEIR COMPANY TO CONTRACTUAL OBLIGATIONS AND PRICING.

I hereby acknowledge and affirm received and read the following parts of the proposal in its entirety:

Part I: General Terms and Conditions

Part II: Request for Proposals - Scope of Work

Part III: Attachments


Vendor’s Name: _______________________________________________________________________________________



Email Address: ________________________________________________________________________________________


Date: ___________________________

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