LEARNING SCHOOLS OF TEXAS
d/b/a CARPE DIEM SAN ANTONIO
Request for Proposals
Internet Access, Telecommunications & Telecommunications Services, Internal Connections Other
than Basic Maintenance, and
Basic Maintenance of Internal Connections
E-Rate Funding Year 17
470# 924200001230851
Posting Date: February 26, 2014
Proposal Due Date:
March 26, 2014 at 4:00 PM.
Mail, deliver, or E-Mail complete proposal to:
Learning Schools of Texas d/b/a Carpe Diem Schools
nick.fleege@carpediemsanantonio.com
ATTN: Nick Fleege
C/O Schulman, Lopez & Hoffer, LLP
517 Soledad St.
San Antonio, TX 78205
E-Mail: nick.fleege@carpediemsanantonio.com
SPECIFIC TERMS, CONDITIONS AND INSTRUCTIONS
The undersigned authorized representative of the proposing organization indicated below hereby acknowledges:
1.
2.
3.
4.
5.
6.
7.
That he/she is authorized to enter into contractual relationships on behalf of the proposing organization indicated below,
and
That he/she has carefully examined this RFP Invitation, the accompanying RFP Forms, and all Terms and Conditions
associated with this RFP Invitation, and
That he/she proposes to supply any products or services submitted under this RFP Invitation in strict compliance with
the all Terms and Conditions associated with this RFP Invitation, unless any exceptions are noted in writing with this
Proposal response, and
That if any part of this RFP is accepted, he/she will furnish all products or services awarded under this Proposal in strict
compliance with all Terms and Conditions associated with this RFP Invitation, unless any exceptions are noted in writing
with this Proposal response, and
That the individual, firm and/or any principal of the firm on whose behalf this proposal is submitted is qualified to provide
products and services and who are current participants in the Schools and Library Program of the Universal Service Fund
(“E-Rate”), and
That the individual, firm and/or any principal of the firm on whose behalf this proposal is submitted is not listed on the
Federal Government’s “List of Parties Excluded from Federal Procurement and Non-procurement Programs” published
by the U.S. General Services Administration (GSA) effective and compliance with the FCC “Red Light Rule” as of the
date of opening of this proposal, and agrees to notify Learning Schools of Texas of any debarment inquiries or
proceedings by any federal, state or local governmental entity that exist or may arise between the date of this submission
and such time as an award has been made under this procurement action, and
That the proposing organization in compliance with all federal, state, and local environmental codes, laws, and statutes.
_____________________________________________
______________________________________________
Name of Proposing Organization
Date
_____________________________________________
______________________________________________
Address
Signature of Authorized Representative
_____________________________________________
______________________________________________
City, State, Zip
Printed Name of Authorized Representative
_____________________________________________
______________________________________________
Telephone Number of Authorized Representative
Position or Title of Authorized Representative
_____________________________________________
Fax Number of Authorized Representative
RETURN THIS PAGE IN SEALED BID/PROPOSAL PACKAGE
FORM A
STANDARD TERMS AND CONDITIONS
1.
RFP SUBMISSION: Proposal must be submitted utilizing
this document only and must reach Learning Schools of
Texas (“School”) Business Office on or before the hour
on the date specified. Late submittals will be returned
unopened. Faxed or emailed proposals will not be
accepted.
2.
REJECTION/AWARD: School reserves the right to reject
any and/or all submittals, to award contracts as may appear
advantageous to School and to waive all formalities in the
procurement process. Written notice of award mailed or otherwise
furnished to the successful respondent results in a binding contract
without further action by either party.
3.
10.
CONTRACTUAL
RELATIONSHIP: Nothing herein
shall be construed as creating the relationship of employer
or employee between School and the Contractor or between
the Center and the Contractor’s employees. The Center shall
not be subject to any obligation or liabilities if the Contractor
or his employees, incurred
in the performance of the contract unless otherwise herein
authorized. Neither the Contractor nor its employees shall
be entitled to any of the benefits established for Center employees,
nor be covered by School’s Workers’ Compensation Program.
INDEMIFICATION: Contractor shall indemnify, defend and
hold harmless School, its officers, agents and employees, from
and against any and all loss, cost, damage, expense and claims,
including attorney’s fees and liability of any kind of any acts
or omission of Contractor, its officers, agents or employees,
in performance of contract, so long as the sole negligence of
the Center is not the cause of the loss, claim, damage expense
or cost.
11.
contract can be discharged in whole or in part a waiver or
renunciation of the claim or right unless the waiver or
renunciation is supported by consideration and is in writing signed
by the aggrieved party.
14.
MODIFICATIONS: The contract may only be modified by a
written agreement signed by both of the parties or their duly
authorized agents.
15.
INTERPRETATION OF EVIDENCE: No course of prior
dealings between the parties and no usage of the trade shall be
relevant to supplement or explain any term used in a contract.
Acceptance or acquiescence in a course of performance rendered
under a contract shall not be relevant to determine the meaning
of the contract even though the accepting or acquiescing party
has knowledge of the performance and opportunity for objection.
Whenever a term defined by the Uniform Commercial Code is
used in the contract, the definition contained in the Code is to
control.
16.
APLLICABLE LAW: This contract shall be governed by the
policies of the School School Board, laws of the State of Texas
and the Uniform Commercial Code. Wherever the term “Uniform
Commercial Code” is used, it shall be construed as meaning the
Uniform Commercial Code as adopted in the State of Texas as
effective and in force on the date of this contract. School Board
Policies can be accessed by contacting School.
17.
ADVERTISING: Contractor shall not advertise or publish,
without School’s prior consent, the fact that School has entered
into any contract, except to the extent necessary to comply with
proper request for information from an authorized representative
of the federal, state or local government.
PAYMENT TERMS: Unless a prompt payment discount
with a payment term of at least 10 days is offered and
accepted by School, payment terms shall be Net 30 days from
date of acceptance or receipt of a properly prepared and
submitted invoice, whichever is later.
8.
WAIVER: No claim or right arising out of a breach of any
UNDUE INFLUENCE: In order to ensure the integrity
of the selection process, vendor’s officers, employees,
agents or other representatives shall not lobby or attempt
to influence a vote or recommendation related to the
vendor’s response, directly or indirectly, through any contact
with school board members or other Center officials from the
date this solicitation is released until the award of a contract
by School’s Board of Directors.
7.
13.
USE OF BRAND NAMES: The use of brand and
manufacturer’s names is for the purpose of brevity in
establishing type and quality of merchandise and is not
restrictive. Manufacturer, trade and/or brand name must be
indicated for each article and when omitted, Center will consider
bid to be as specified. Illustrations and complete description must
be included with the bid if bidding other than specified.
6.
ASSIGNMENT-DELEGATION: No right or interest in this
contract shall be assigned or delegation of any obligation
made by the Contractor without the written permission of
the Center. Any attempt assignment or delegation by the
Contractor shall be wholly void and totally ineffective for all
purposes unless made in conformity with this paragraph.
PROPOSAL ERRORS: Proposals will represent a true and
correct statement and shall contain no cause for claim of
omission or error. Request for withdrawal of proposal is
allowed based on proof of mechanical error: however vendor
may be removed from approved vendor list.
5.
12.
SUPPLEMENTAL INFORMATION: All supplemental
information required by the proposal documents must be included
with the response. Failure to provide complete and accurate
information may disqualify vendor from consideration.
4.
Contractor, or any agent or representative of the Contractor,
to any officer or employee of the School with a view toward
securing a contract or securing favorable treatment with respect
to the awarding or amending, or the making of any
determination with respect to the performing of such a
contract. In the event this contract is cancelled by the
Center pursuant to this provision, School shall be entitled, in
addition to any other rights and remedies, to recover or withhold
the amount of the cost incurred by the Contractor in providing
such gratuities.
GRATUITIES: School may, by written notice to the Contractor,
cancel any agreement without liability to School if it is
determined by School that gratuities, in the
form
of
entertainment, gifts, or otherwise, were offered or given by the
18. LEGAL VENUE: Both parties agree that venue for any
litigation arising from the contract shall lie in San Antonio, Bexar
County, Texas.
19. FUND AVAILABILITY: Any contract resulting from this
solicitation is contingent upon the continued availability of
appropriations and is subject to cancellation, without penalty,
either in whole or in part, if funds are not appropriated by the
School School Board or otherwise not made available to School.
20. TERMINATION: School reserves the right to terminate all or
any part of the undelivered portion of any order resulting from this
bid solicitation with thirty (30) days written notice; upon default
by the vendor, for delay or nonperformance by the vendor or, if it
is deemed in the best interest of School, for convenience.
E-RATE SERVICES RFP
SPECIFIC TERMS, CONDITIONS AND INSTRUCTIONS
1. NOTICE: The School is requesting these Proposals to address statutory competitive requirements and
to determine the most cost effective service(s) for the School. The School, however, may or may not
enter into an Agreement resulting from this RFP.
2. SCOPE OF SERVICES REQUIRES:
New installation, setup, and monthly delivery of internet service
Location: a currently vacant lot at 29.429025, -98.624894
Requirements: 100MBps for 330 users with the potential to increase to 200MBps for 650 users
3. WRITTEN INQUIRIES
Respondents may make written inquiries concerning this RFP to obtain clarification of the
requirements. Questions should be brought to the attention of:
Nick Fleege at: nick.fleege@carpediemsanantonio.com
Inquiries must be submitted to no later than the date and time specified by the Deadline for Questions
listed in the Schedule of Events. Questions received by this deadline, and corresponding answers,
will be posted on the School’s web page located at http://www.carpediemschools.com/sanantonio/
for all Vendors to access and review by issuance of written FAQS. The FAQs will be updated
weekly. Transmission and confirmation of receipt of questions is the responsibility of the
Respondent(s). Requests for verbal or telephone clarification will be declined and will be nonbinding. http://rmacademy.org/
Form 470 # 924200001230851.
4. RIGHTS OF THE SCHOOL
The School reserves the right to require additional information from Respondents and to conduct
necessary investigations to determine service or product reliability, Respondent performance and to
determine the accuracy of Respondent information. Respondents may be required to provide
Manufacturers Specification Sheets, General Descriptions, Operating Manuals, System Layout
Drawings and/or other support documentation so as to insure a clear understanding of the project
offered.
The School reserves the right to cancel any contract due to non-appropriations and lack of E-Rate
funding without penalty.
The School reserves the right to award none, one, or multiple Vendors.
The School reserves the right to terminate this solicitation and to reissue a subsequent solicitation,
and/or remedy technical errors in the process
4.1
Period of Performance
The period of performance shall begin no earlier than July 1, 2014 and end no later than June 30,
2015.
4.2
RFP Information and Work Conditions
4.2.1
All Respondents are expected to carefully examine the RFP documents. Any
uncertainties or inconsistencies should be brought to the attention of the individual identified in
Section 4.5 of this RFP. It is believed that all information necessary to complete a response is included
in this RFP. It is the responsibility of the Respondent to obtain clarification of any information
contained herein that is not fully understood.
4.2.2
The Respondent shall not interfere or disrupt the day-to-day operations of the School,
its staff, its students, or other contractors and consultants working for the School.
4.2.3
The Respondent, by and through the submission of a Proposal, agrees to be held
responsible for:
● Having examined the Request for Proposal and all referenced applicable decisions
of authorities having jurisdiction over the work herein, statutory authority, and local
policy;
● Having become familiar with the nature and Scope of Work required by the School;
and
● Identifying any local conditions that may affect the labor availability,
administrative rules and other factors that may impact the School’s timeline for
completion of services.
4.2.4
Nothing in the RFP shall relieve the Respondent of the Scope of Work and associated
work described within. The Respondent shall, in all cases, be solely responsible for the performance
of all Deliverables in accordance with and resulting contract milestones.
4.2.5
The Proposal MUST take prime contractor responsibility, including the management
and performance of any and all subcontractors, products, and services provided.
4.3
Addenda
Only substantive items, as determined by the School, will be addressed in the form of written
addenda, which, if issued, will be posted on the School E-Rate web portal. Failure of any
Respondent to review any such addendum or interpretation shall not relieve the Respondent from
any obligations under their Proposal submitted.
4.4
Proposal Submission
4.4.1
All Proposals are due by 4:00 P.M. on March 26, 2014. Any Proposal received after this
time and date will be rejected. It is the sole responsibility of the Respondent to ensure his Proposal is
received by this deadline. No excuses are acceptable and the determination of the Superintendent is
final.
4.4.2
All information requested must be provided by Respondent for the Proposal to be
responsive.
4.4.3
Exceptions, substitutions and clarifications to the RFP requirements must be clearly
stated and described in detail in the Proposal. For all substitutions and clarifications, state the nature
of the exception or clarification and any alternate recommendation that will meet the intent of the
School in accordance with the instructions in Section 5, “Proposal Contents” for format requirements.
4.4.4
An authorized officer of the Respondent must sign the Proposal. Signature on the
Proposal form will signify agreement and compliance with all requirements set forth in this
solicitation except where specifically noted in the written response. In addition, the Respondent’s
signature on the form will indicate the following:
●
All data presented in the Proposal is accurate and reliable;
● Information given by the Respondent will constitute good and sufficient cause for
rejection of the Proposal;
● Agreement that all costs, including the costs of subcontractors, either direct or indirect,
incurred in the preparation of the Proposal, are the sole responsibility of the Respondent;
● Guarantees that the prices quoted have been established without collusion with other
eligible Respondent(s) and without effort to preclude the School from obtaining the
lowest possible competitive price; and
● Guarantees that the Respondent has strictly adhered to the federal gifting policy
regarding this potential sale.
4.4.5
Each Respondent in submitting a Proposal represents that:
● The Respondent has read and understands the RFP and its Proposal is made in
accordance with the Scope of Work. Respondent is familiar with the local conditions under
which work is to be performed;
● The Proposal is based upon the materials, labor, systems, and equipment required in
the RFP; and
● The Respondent acknowledges a waiver of their right, if any, to recover its costs
incurred in preparation or submission of a Proposal or in anticipation of a contract.
4.5
Proposal Requirements and Conditions
In submitting its Proposal, Respondent understands and agrees to be bound by terms and conditions
set forth by this RFP:
4.5.1
Submit ONE (1) signed, original Proposal via delivery or regular mail to:
Learning Schools of Texas
ATTN: Nick Fleege
C/O Schulman, Lopez & Hoffer, LLP
517 Soledad St.
San Antonio, TX 78205
or via E-Mail (with all signature pages signed and scanned clearly to show Respondent execution)
to ________________ no later than the Proposal Submission Deadline.
The Proposal shall be identified on the face of its container or in the subject of its transmittal E-Mail
as follows:
E-Rate FUNDING YEAR 17 Proposal
470#
924200001230821
4.5.2
No Proposal will be accepted after 4:00 P.M. on March 26, 2014.
LATE
PROPOSALS WILL NOT BE ACCEPTED and will be AUTOMATICALLY REJECTED.
4.6
Withdrawing Proposals
Proposals deposited with the School can be withdrawn prior to the time set for opening Proposals.
Request for non-consideration of Proposals must be made in writing to the Carl Tanton and received
by the School prior to the time set for opening Proposals. The Proposal may not be withdrawn after
Proposals have been opened, and the Respondent, in submitting the same, warrants and guarantees
that its Proposal has been carefully reviewed and checked and that it is in all things true and
accurate and free of mistakes and that such Proposal will not and cannot be withdrawn because of
any mistake committed by Respondent.
4.7
Consideration of Proposals
After Proposals are opened, the Proposals will be evaluated on the criteria listed in section 6.2,
“Criteria.” The School reserves the right to reject any and all Proposals, to re-issue the RFP, modify
or change the form of the solicitation or any combination thereof, to waive technicalities, or
proceed to contract for service otherwise in the best interest of the School. E-Rate Program rules
will be strictly enforced and adhered to during all phases of the project by both the School and
Respondent.
4.8
Rejection of Proposals
The School reserves the right to reject any or all Proposals for any of the following specific reasons:
4.8.1
Respondent does not have a SPIN from the SLD/USAC.
4.8.2
Proposals received after the Proposal Submission Deadline as reflected on the cover page and in
Sections 4.3 and 4.11.
4.8.3
Proposal containing any irregularities as defined in Section 4.14, “Irregular Proposals,” above.
4.8.4
Respondent, any subcontractor or supplier, or the surety on any bond given, or to be given is in
litigation with the School, or where such litigation is contemplated or imminent, in the sole opinion
of the School.
4.8.5
Proposal is incomplete or missing forms described within the Proposal or this RFP, and/or the
Respondent fails to respond to Request(s) for Information within the three (3) day time limit.
4.8.6
Proposal does not have documented ability to provide discounted billing as required by the
SLD/USAC. Please see section 6.5.2 on “Terms of Payment.”
4.9
Disqualification of Respondents
Respondents may be disqualified and their Proposals not considered, among other reasons,
for any of the following reasons:
4.9.1
Respondent does not have a SPIN from the SLD/USAC.
4.9.2
Reason for believing collusion exists among Respondents.
4.9.3
Respondent does not include specific pricing for requested services/products identified in this
RFP. These types of Proposals may be considered spam and disqualified as such.
4.9.4
Where the Respondent, any subcontractor or supplier, or the surety on any bond given, or to be
given, is in litigation with the School, or where such litigation is contemplated or imminent, in
the sole opinion of the School.
4.9.5
The Respondent being in arrears on any existing contract or having defaulted on a previous
contract.
4.9.6
Insufficient resources, which in judgment of the School will prevent or hinder promptly
providing of additional services, if awarded.
4.9.7
Respondent does not have documented ability to discount bills as required by the SLD/USAC.
Please see section 6.5.2 on “Terms of Payment.”
4.9.8
Respondent is currently ‘red lighted’ by the federal government. All Respondents are to be in good
standing with all federal regulations.
5. FORMAT & ORGANIZATION OF SUPPORT MATERIALS
Please address each of the following sections in your RFP. Your submittal should be submitted
with tabs dividing each section of the response.
Responses shall contain the following information and be submitted in the order shown below.
Proposal Section
1. Cover Sheet
Section Contents
The cover sheet should include: (1) Company Name; (2) Company
Address/Phone Number/Fax Number; (3) SPIN and (4) School Form 470 #
____________________.
2. Contact
Information
Name, title, email, and phone number(s) of agent(s) representing Vendor
and who is the best direct contact for information requests, points of
clarification, and negotiation. (Form A)
Specific and detailed description of firm qualifications and proposed
methodology to perform required services. See also Scope of Work Section
for additional requirements.
Completed cost schedule on Company letterhead including alternate
Proposal costs and/or multiple year contract pricing, breakdown of costs,
detailed descriptions and purposes, proper category alignment (e.g.
separating basic maintenance from internal connections), and clearly
distinguishing the cost of E-Rate ineligible products/services from E-Rate
eligible products/services, pursuant to the 2014 Eligible Services List
available at www.usac.org/sl.
Detailed description of the implementation of the project including: (1)
Timeline for project completion; (2) Resources required to achieve success;
and (3) Warranty information for all components included in the Proposal,
as applicable.
School requires all Consultants to carry professional liability, general
liability, auto liability and umbrella liability, and worker’s
compensation/employer’s liability insurance coverage. Professional
liability insurance should remain in force during the term of contract
and for one year following substantial completion of a project. Please
state the carrier, agent, amount, expiration date and length of time you
have maintained coverage for professional liability, general liability,
auto
liability
and
umbrella
liability,
and
worker’s
compensation/employer’s liability insurance coverage. Provide a
sample certificate of insurance.
3. Proposal
4. Cost Schedule
5. General
Implementation
6. Insurance
Requirements
7. References
8. Felony Conviction
Disclosure
9. Out of State
Certification
10. Conflict of Interest
Questionnaire
One complete form (see Attachment A).
Complete all portions of this form and submit with your Proposal and
supporting documentation (see Attachment B).
Complete this form in its entirety (see Attachment C).
Complete this form in its entirety (see Attachment D).
6. EVALUATION AND SELECTION PROCESS
6.1
Overview
The School will consider all applicable factors in determining which Proposal is in the best interest
of the School. The School reserves the right to reject any, all, or any part of the Proposal and to accept
any advantage considered beneficial to the School. The School reserves the right to waive any
information or minor technicalities or to accept a Proposal deemed to be the most cost-effective solution
in the best interests of the School.
6.2
Criteria
The following criteria will be used to evaluate each Proposal. A major deficiency in any one area may
disqualify a Proposal submission. In assessing the relative value and quality of each Proposal, a
Decision Matrix will be utilized in which point values will be assigned in a range from zero to the
maximum point weighing for each classification. The maximum score is 100 points.
EVALUATION MATRIX
Criteria
Price of the eligible products and services
Price of the ineligible products, services, and fees, including long-term cost to the School
Prior experience with Vendor
Ability to meet School’s needs as described herein and within the Form 470
Vendor’s reputation and quality of services/products
Flexible USAC invoicing: i.e. the ability to accommodate both Forms 472 and 474
6.3
Opening of Proposal
At 10:00 A.M. on March 28, 2014, all Proposals will be opened and listed aloud. Responses
received after opening time will be rejected. The Proposals will be reviewed by the School evaluation
team at a later date and time to ascertain which Proposals address all requirements for the Request
for Proposal. The team may interview selected Vendors or submit Requests for Information to clarify
information contained within a Proposal or to remedy minor omissions of or inconsistencies with
the requirements contained herein. The evaluation team will then score each criteria contained in
the “Evaluation Matrix” for each Proposal, rank Vendors pursuant thereto, and thereby make their
recommendation to the Superintendent for the award of a contract.
6.4
Award of Contract
Award of contract for each Scope of Work, if it is awarded, will be made by the School to the
Respondent whose Proposal is determined to be the most cost-effective solution in the best interests of
the School. No award will be made until after investigations are made as to the responsibilities of
the Respondents. Further, awarding of the contract is conditional and dependent on E-Rate funding
and School discretion. In any contract resulting from this RFP, the School retains the right to terminate
the contract, in whole or in part, at any time, with a written 30-day notice to the Respondent for reasons
enumerated in Section 6.5.8, “Termination,” below.
The Award of contract may be to one, all, some, or none of the Respondents at the sole discretion of
the School.
APPLICATION SIGNATURE
Until a contract resulting from this process is executed, no employee, agent or representative of any
professional services provider shall make available or discuss its proposal with the media in any
form, electronic or printed, and elected or appointed official or officer of School, or any employee,
agent or other representative of School, unless specifically allowed to do so by the Purchasing
Department.
The information contained herein is true and accurate to the best of my knowledge. By signing
below, the firm agrees to allow School to check references given and that the information regarding
the size and scope of each project is accurate. Further, the signature below certifies that this RFP
has been completed with no consultation, collaboration or conversation with other firms competing
on the same project.
________________________________________________
NAME (Please print or type)
TITLE
________________________________________________
SIGNATURE
_____________________
DATE
ATTACHMENT A
LISTING OF CLIENTS
Company Name
Address
Contact Name
Phone
E-mail
Phone
E-mail
Phone
E-mail
Company Name
Address
Contact Name
Company Name
Address
Contact Name
Felony Conviction Disclosure Statement
State of Texas Legislative Senate Bill No. 1, Section 44.034, Notification of Criminal History,
Subsection (1), states “a person or business entity that enters into a contract with a school district
must give advance notice to School if the person or an owner or operator has been convicted of
a felony. A notice must include a general description of the conduct resulting in the conviction
of a felony.
Subsection (b) states “a school district may terminate a contract with a person or business entity
if the district determines that the person or business entity failed to give notice as required by
Subsection (a) or misrepresented the conduct resulting in the conviction. The district must
compensate the person or business entity for services performed before the termination of the
contract.
I, the undersigned agent for the firm named below, certify that the information concerning
notification of felony conviction has been reviewed by me and the following information
furnished is true to the best of my knowledge.
___________________________________________________________________________
Vendor’s Name
___________________________________________________________________________
Signature of Authorized Company Official
___________________________________________________________________________
Authorized Company Official’s Name (Please Print)
My firm is a publicly held corporation; therefore, this reporting requirement is not
applicable.
My firm is not owned or operated by anyone who has been convicted of a felony.
My firm is owned or operated by the following individual(s) who has/have been
convicted of a felony:
___________________________________________________________________________
___________________________________________________________________________
Out of State Certification
As defined by Texas House Bill 602, a “nonresident Proposer” means a Proposer whose principal place of
business is not in Texas, but excludes a contractor whose ultimate parent company or majority owner has its
principal place of business in Texas.
I certify that my company is a “Resident Proposer”:
Company Name (Please Print)
I certify that my company qualifies as a “Nonresident Proposer”
(NOTE: You must furnish the following information :)
Indicate the following information for your “Resident State”: (The state your principal place of business is
located in)
A.
___________________________________________
Company Name
_______________________________________
Address
___________________________________________
City
___________
State
_________________________
Zip Code
Does your “resident state” require Proposers whose principal place of business is in Texas to give preference to
Proposers whose resident state is the same as yours by a prescribed amount or percentage to receive a
comparable contract? (“Resident State” means the state in which the principal place of business is located.)
Yes
No
B.
What is the prescribed amount or percentage?
$_______________or_______________%
Certification: I certify that the information provided above is correct .
Signature of Authorized Representative
___________________________________________________
Name (Please Print)
Title
___________________________
RETURN THESE PAGES IN SEALED RFP PACKAGE
3.
DISCLOSURE: CONFLICT OF INTEREST Questionnaire
CONFLICT OF INTEREST QUESTIONNAIRE
FORM
CIQ
For vendor or other person doing business with local governmental entity
This questionnaire is being filed in accordance with chapter 176 o f the Local
Government Code by a person doing business with the governmental entity.
By law this questionnaire must be filed with the records administrator of the
local government not later than the 7th business day after the date the person
becomes aware of facts that require the statement to be filed. See Section
176.006, Local Government Code.
OFFICE USE ONLY
Date Received
A person commits an offense if the person violates Section 176.006, Local
Government Code. An offense under this section is a Class C misdemeanor.
Name of person doing business with local governmental entity.
Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than
September 1 of the year for which an activity described in Section 176.006(a), Local Government Code, is pending and
not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.)
Name each employee or contractor of the local governmental entity who makes recommendations to a local government officer
of the governmental entity with respect to expenditures of money AND describe the affiliation or business relationship.
Name each local government officer who appoints or employs local government officers of the governmental entity for which
this questionnaire is filed AND describe the affiliation or business relationship.
Name of local government officer with whom filer has affiliation or business relationship. (Complete this section only if the
answer to A, B, or C is YES.)
This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has affiliation or other
relationship. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the
questionnaire?
Yes
No
B. Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of the local government
officer named in this section AND the taxable income is not from the local governmental entity?
Yes
No
C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as
an officer or director, or holds an Ownership of 10 percent or more?
Yes
No
D. Describe each affiliation or business relationship.
Signature of person doing business with the governmental entity Date
4. NON COLLUSIVE PROPOSAL CERTIFICATE & ACKNOWLEDGMENT
By submission of this proposal, the Vendor certifies that: (a) the proposal has been independently arrived at without collusion with
any other vendor or with any competitor. (b) The proposal has not been knowingly disclosed and shall not be knowingly disclos ed,
prior to the opening of proposals for this project, to any other vendor, competitor or potential competitor. (c) No attempt has been
or will be made to induce any other person, partnership or corporation to submit or not to submit a proposal. (d) The person signing
this proposal certifies that he has fully informed himself regarding the accuracy of the statements contained in this certification and
under the penalties being applicable to the Vendor as well as to the person signing in its behalf.

I certify that the above information is true and correct.
YES
5.
CERTIFICATION REGARDING DEBARMENT SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION - LOWER TIER
COVERED TRANSACTIONS
This certificate is required by the regulations implementing Executive Order 12549,
Debarment and Suspension, 7 CFR Part 3017, Section 3017.510, Participants'
responsibilities. The regulations were published as Part IV of the January 30, 1989, Federal
Register (pages 4722-4733). Copies of the regulations may be obtained by contacting the
Department of Agriculture agency with which this transaction originated.
1) The prospective lower tier participant certifies, by submission of this proposal, that
neither it nor its principals is presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in this transaction by a
Federal department or agency.
2) Where the prospective lower tier participant is unable to certify to any of the statements
in this certification, such prospective participant shall attach an explanation to this proposal.
PR/Award # or Project Name:

Check applicable box
I (We) certify that our company has not been debarred and is not
participating in lobbying activities.

See attached explanation and complete disclosure forms.
6.

CLEAN AIR & WATER ACT CERTIFICATION (This is a Federal requirement)
I certify that my company is in compliance with all applicable standards, orders or
regulations issued pursuant to
the Clean Air Act of 1970, as amended ( 42 U.S.C. 1857(h), Section 508 of the Clean
Water Act, as amended
(33 U.S.C. 1368), Executive Order 117389 and Environmental Protection Agency
Regulation, 40 CFR Part 15 as
required under OMB Circular A-102, Attachment O, Paragraph 14 (1) regarding
reporting violations to the
grantor agency and to the United States Environmental Protection Agency Assistant
Administrator for the
Enforcement.
7.
CERTIFICATION REGARDING LOBBYING for FEDERAL FUNDS Applicable to grants, Subgrants, Cooperative Agreements, and Contracts
Exceeding $100,000 in Federal Funds.
Submission of this certifications a prerequisite for making or entering into this transaction
and is imposed by section 1352, Title 31, U.S. Code. This certification is a material
representation of fact upon which reliance was placed when this transaction was made or
entered into. Any person who fails to file the required certification shall be subject to a civil
penalty of not less than $10,000 and not more than $100,000 for each such failure.
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid by or 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,
SF-LLL“Disclosure of Lobbying Activities” Form in accordance with its instructions
(see following page).
(3) The undersigned shall required that the language of this certification be included in the
award documents for all covered subawards exceeding $100,000 in Federal funds at all
appropriate tiers and that all subrecipients shall certify and disclose accordingly.

Check applicable box

I (We) certify that our company has not been debarred and is not
participating in lobbying activities.

See attached explanation and complete disclosure forms.
I (We) the undersigned, agent for the firm, named below certify that all information in the above
certifications 1 through 8 are true and correct to the best of my knowledge.
Name/Title:
Original Signature:
Company Name:
Date