PART III: Attachments OF BUSINESS/DESCRIPTION OF PRODUCTS AND/OR SERVICES PROVIDED: ... Robert Tesoro - Houston ... and the State of Texas to conduct business …

RFP #18-01-05 Grease Trap and Collection Services

PART III: Attachments

Revised 01/10/2018

Please include all original completed forms with the original version of your RFP and one electronic copy on the required USB Drive.

Attachments:

☐ FORM A: Supplier Information

☐ FORM B: M/WBE Instructions and Participation Report (Part II of RFP Downloads)

☐ FORM C: Certificate of Insurance (Acord Form)

☐ FORM D: Reference Survey Instructions

☐ FORM E: Reference Survey

☐ FORM F: General Certifications

☐ FORM G: EDGAR Certifications

☐ FORM H: Exceptions

☐ FORM I: Conflict of Interest Instructions AND Form CIQ (even if no conflict exists)

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

☐ FORM K: Criminal History Background Check Certification

☐ FORM L: Compliance with Buy American Provision

☐ FORM M: Acknowledgement Form

☐ FORM N: Master Service Agreement (MSA) (Part V of RFP Downloads)

☐ FORM O: IRS Form W‐9 (Must be on the NEW 2017 IRS form)

☐ FORM P: Price Schedule (Must be in Excel Format on USB Drive)(Part IV of RFP Downloads)


FORM A: SUPPLIER INFORMATION

This Form A is required. See HISD Policy CHE (Local). LEGAL NAME OF SUPPLIER: DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER: TYPE OF BUSINESS/DESCRIPTION OF PRODUCTS AND/OR SERVICES PROVIDED: SUPPLIER MAILING ADDRESS:

CITY: ____________________ _________ STATE: ______________ ZIP CODE: ____________________ __ SUPPLIER 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 SUPPLIER IS A RESIDENT BIDDER? ☐ YES ☐ NO A RESIDENT BIDDER REFERS TO A PERSON WHOSE PRINCIPAL PLACE OF BUSINESS IN THE STATE OF TEXAS, INCLUDING A SUPPLIER WHOSE ULTIMATE PARENT COMPANY OR MAJORITY OWNER HAS ITS PRINCIPAL PLACE OF BUSINESS IN THIS STATE.

4. CITY AND STATE OF SUPPLIER'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 SUPPLIER HAS BEEN IN CONTINUOUS OPERATION:

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

7. HAS SUPPLIER 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 SUPPLIER 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___________________________________________________________________


(FORM A CONTINUED)__________________________________________________________________________________

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

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

16. HAS SUPPLIER (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 SUPPLIER CONDUCTS BUSINESS:

Name of bank with which supplier 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 BUSINESSES. IS SUPPLIER 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: ☐ SUPPLIER WILL PROVIDE GOODS AND SERVICES WITH OWN WORK FORCE

☐ SUPPLIER 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


(FORM A CONTINUED)

PERSON TO CONTACT REGARDING EQUAL OPPORTUNITY INFORMATION ISSUES:

NAME: _______________________________________ TITLE: ____________________________________

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

______________________________________________ OFFICER’S SIGNATURE ______________________________________________ PRINTED NAME ______________________________________________ TITLE

FORM B: M/WBE INSTRUCTIONS

Please refer to Attachment B – M/WBE Participation Report that is located on HISD’s Procurement Web Site.

FORM C: CERTIFICATE OF INSURANCE (ACORD FORM)

Please include the Certificate of Insurance (Acord Form) or a Letter from its insurance provider stating that proposer can provide the levels of insurance required in this RFP.


FORM D: REFERENCE SURVEY INSTRUCTIONS

Proposer must complete and return Form D as part of this RFP. The Evaluation Committee considers Proposer’s reputation and quality of Proposer’s goods or services in the evaluation of this Proposal. To aid in this process, the District requests that Proposer send the attached Form E, Reference Survey to three (3) valid references. Proposer must fill out the top portion of Form D, “Supplier Name” on each Survey. No other portion of the Survey may be completed by Proposer. It is Proposer’s sole responsibility to ensure that Surveys are sent to Proposer’s desired references. Recipients must return the completed survey to HISD by one of the methods outlined on the Survey. The District will not accept a Survey returned by Proposer or a Survey returned after the assigned deadline, 2 p.m. on Tuesday, March 27, 2018. While Proposer may choose its recipients, more weight is given to the following references:

Clients who are governmental entities, and, in particular, school districts; and Clients provided with similar goods and/or services as called for by this RFP;

Please provide the name and contact information of all references to whom Proposer intends to send the Survey. (1) ________________________________________ ________________________________________ Name of Entity or Business Contact Name

________________________________________ ________________________________________ Email Address Mailing Address

________________________________________ ________________________________________ Phone Number Goods and/or services provided (2) ________________________________________ ________________________________________ Name of Entity or Business Contact Name


________________________________________ ________________________________________ Phone Number Goods and/or services provided (3) ________________________________________ ________________________________________ Name of Entity or Business Contact Name


________________________________________ ________________________________________ Phone Number Goods and/or services provided


FORM E: REFERENCE SURVEY

To Whom It May Concern: The Houston Independent School District (HISD) has implemented a process to collect Supplier performance evaluations. HISD may use the information provided in its assessment of the above Supplier in order to determine a responsive and responsible procurement. The Supplier listed above has chosen to participate in this process and listed you as a past or present client for whom it has provided goods and/or services. HISD would greatly appreciate your completion of the survey below. (I) Please evaluate the performance of the Supplier based on the scale unit listed, with the 10 (or 15) as the highest, as

applicable. If you do not have sufficient knowledge of Supplier’s past and/or current performance in a particular area, please leave it blank.

TOTAL POINTS (out of 100) : ____________

(II) How long have you done business with the Supplier? _______________________________________________________

(III) Please provide a brief description of the goods and/or services provided to you by the Supplier and include any additional information you believe might assist HISD in its evaluation (attach additional sheets if necessary): __________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

NO. CRITERIA UNIT SCORE 1 Ability to Manage Cost (1-15) 2 Quality of Product(s) and/or Services (1-15) 3 Quality of Customer Service (1-10) 4 Quick Response Time (1-10) 5 Ability to Maintain Confidentiality (1-10) 6 Close Out Process (invoicing, no unexpected fees) (1-10) 7 Communication (1-10) 8 Ability to Follow Rules, Regulations, and Requirements (1-10) 9 Overall Customer Satisfaction Based on Performance (comfort level using company

again) (1-10)

To the Attention of: Robert Tesoro - Houston Independent School District Request for Proposals #18-01-05 Grease Trap Services Vendor Name: _______________________________________________________________________

Thank you for your time and effort, it is greatly appreciated! Please sign below and return this completed survey directly to Houston I.S.D. via email to [email protected] before 2 p.m. on Tuesday, March 27, 2018. ______________________________________ _______________________________________ _ ___________ District / Company Name Printed Name of Evaluator Signature of Evaluator Date


FORM F: 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 supplier or supplier'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 Supplier 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 Supplier, 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.

________ Initials of Authorized Representative of Supplier CERTIFICATION OF AUTHORIZATION, PERMITS, AND BUSINESS CERTIFICATES REQUIREMENT

For the duration of the Contract, Supplier 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, Supplier 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 Supplier provides, or seeks to provide, to the District.

Supplier understands and agrees to abide by the Authorization, Permits, and Business Certificates Requirement above. Supplier 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.

________ Initials of Authorized Representative of Supplier

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 Proposal/Contract on my own behalf or on behalf of the company, corporation, firm, partnership or individual (Supplier) listed below;

2. In connection with this proposal, neither I nor any representative of Supplier 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 Supplier have violated any federal antitrust law; and 4. Neither I nor any representative of Supplier have directly or indirectly communicated any of the contents of this proposal

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



(FORM F CONTINUED) CERTIFICATION REGARDING HAZARD ANALYSIS AND CRITICAL CONTROL POINTS (HACCP)

All products purchased by HISD must be manufactured in compliance with HACCP regulations. Supplier certifies that: all products on this proposal are processed and packaged in a HACCP compliant plant. Supplier agrees Supplier 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

Supplier 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. Supplier also understands and agrees that if a processor loses inspection/processing rights or has a recall involving product sold to HISD, Supplier must notify HISD within 24-48 hours.

________ Initials of Authorized Representative of Supplier CERTIFICATION OF SUPPLIER (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), Supplier hereby certifies that all of Supplier’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). Supplier 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).

Supplier further certifies that:

(1) Supplier will immediately remove an employee, subcontractor, or volunteer from contract duties and notify HISD in writing within 3 business days if:

a. Supplier receives information that an employee, subcontractor, or volunteer has a reported criminal history, or b. 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, Supplier 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).

________ Initials of Authorized Representative of Supplier 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 ---


(FORM F CONTINUED) Please check the following as applicable: ☐ Supplier is a publicly held corporation; therefore the above reporting requirement does not apply. ☐ Supplier is not owned nor operated by anyone who has been convicted of a felony. ☐ Supplier 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 Supplier, 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.

________ Initials of Authorized Representative of Supplier CERTIFICATION OF NON-COLLUSION STATEMENT

I, the undersigned Supplier, do hereby certify that: a) All statements of fact in such proposal are true. b) Such Proposal was not made in the interest of or on behalf of any undisclosed person, partnership, company, association,

organization or corporation. c) Such Proposal is genuine and not collusive or sham. d) Supplier 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) Supplier 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 proposal, or that anyone should refrain from bidding or withdraw his bid or proposal. f) Supplier did not, in any manner, directly or indirectly seek by agreement, communication or conference with anyone to

raise or fix the bid or proposal price of said bidder or of anyone else, or to raise or fix any overhead, profit or cost element of his bid or proposal price, or that of anyone else.

g) Supplier did not, directly or indirectly, submit his bid or proposal 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 Proposer in his business.

h) Supplier 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 Supplier 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 Supplier 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.


SUPPLIER AGREES TO COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, RULES, REGULATIONS, AND ORDINANCES. IT IS FURTHER ACKNOWLEDGED THAT SUPPLIER CERTIFIES COMPLIANCE WITH ALL PROVISIONS, LAWS, ACTS, REGULATIONS, ETC. AS SPECIFICALLY NOTED ABOVE. Supplier Name Address, City, State, and Zip Code Phone Number Email Address Printed Name and Title of Authorized Representative

Signature of Authorized Representative Date


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 __________________________________________________________ (“Supplier”) in all situations where Supplier 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 Supplier agree? YES ________ Initials of Authorized Representative of Supplier

(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 Supplier in the event Supplier 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 Supplier, for convenience, if HISD believes, in its sole discretion that it is in the best interest of HISD to do so. Supplier 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 Supplier s 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 Supplier agree to abide by the above? YES ________ Initials of Authorized Representative of Supplier

(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


(FORM G CONTINUED) 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, Supplier 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, Supplier certifies that Supplier 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, Supplier certifies that during the term of an award for all contracts by HISD resulting from this procurement process, Supplier 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, Supplier certifies that during the term of an award for all contracts by HISD resulting from this procurement process, Supplier 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, Supplier certifies that during the term of an award for all contracts by HISD resulting from this procurement process, Supplier 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.



(FORM G CONTINUED) (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, Supplier certifies that during the term and after the awarded term of an award for all contracts by HISD resulting from this procurement process, the Supplier 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, Supplier certifies that it will comply with the record retention requirements detailed in 2 CFR § 200.333. Supplier 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.

Does Supplier agree? YES ________ Initials of Authorized Representative of Supplier CERTIFICATION OF COMPLIANCE WITH THE ENERGY POLICY AND CONSERVATION ACT

When HISD expends federal funds for any contract resulting from this procurement process, Supplier 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 Supplier agree? YES ________ Initials of Authorized Representative of Supplier CERTIFICATION 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. Supplier 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. Supplier 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.



(FORM G CONTINUED) 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). Supplier certifies that it is in compliance with all applicable provisions of the Buy America Act.

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

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

Supplier 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 Supplier that are directly pertinent to Supplier’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 Supplier’s personnel for the purpose of interview and discussion relating to such documents.


CERTIFICATION OF APPLICABILITY TO SUBCONTRACTRS

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


SUPPLIER AGREES TO COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, RULES, REGULATIONS, AND ORDINANCES. IT IS FURTHER ACKNOWLEDGED THAT SUPPLIER CERTIFIES COMPLIANCE WITH ALL PROVISIONS, LAWS, ACTS, REGULATIONS, ETC. AS SPECIFICALLY NOTED ABOVE. Supplier’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 H: EXCEPTION FORM

All deviations and exceptions to the RFP must be expressly stated in this Exception Form (additional pages to this form may be added if necessary). In the absence of any entry on this Exception Form, Supplier assures HISD of its full agreement and compliance with all specifications, terms and conditions, requirements and obligations of the RFP. All exceptions must detail the section number, paragraph number, page number, and the specific language excepted.

YOU MUST SIGN AND SUBMIT THIS FORM WITH YOUR PROPOSAL REGARDLESS OF WHETHER THERE ARE EXCEPTIONS LISTED OR NOT.

Supplier 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. 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 Supplier 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, Supplier must sign and complete the new Conflict of Interest Questionnaire (CIQ) and submit the CIQ with its proposal. In accordance with Chapter 176 of the Texas Local Government Code, any Supplier 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 Supplier 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 Supplier 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 Supplier a family relationship with a local government officer of HISD. “Supplier” means a person who enters or seeks to enter into a contract with a local governmental entity. The term includes an agent of a Supplier. 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 Supplier. Texas Local Government Code 176.001(4).


(FORM I CONTINUED) “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).

SUPPLIER MUST SIGN AND SUBMIT FORM CIQ EVEN IF NO CONFLICT EXISTS. If no conflict exists, Supplier 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 proposal may result in disqualification. Name of Authorized Representative: ________________________________________________________________________ Signature of Authorized Representative: _____________________________________________________________________

Date: ___________________________


Signature of vendor doing business with the governmental entity Date

OFFICE USE ONLY

CONFLICT OF INTEREST QUESTIONNAIRE (Form I continued) FORM CIQ For vendor doing business with local governmental entity

Name of Officer

Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015

This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor.

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 the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)

Name of vendor who has a business relationship with local governmental entity.

Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary.

A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor?

Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more.

B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity?

Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).

Yes

Yes No

No

Date Received

6

1

4

3

2

5

7

Name of local government officer about whom the information is being disclosed.


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, and attached to Supplier’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; or b) 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 Supplier s must electronically complete, print, sign, notarize, and submit Form 1295 with their proposals even if no interested parties exist. Proposers 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. Proposers must use the filing application on the Texas Ethics Commission’s website to enter the required information on Form 1295. Proposers 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. The completed Form 1295 with the certification of filing must be filed with HISD by attaching the completed form to the Supplier’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 30th 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 Supplier. An evaluation committee will select the Supplier (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 proposal is not selected, we will request you to withdraw your 1295 form from the Texas Ethics Commission website.


FORM K: CRIMINAL HISTORY BACKGROUND CHECK CERTIFICATION

TO: Office of Ethics and Compliance Houston Independent School District Vendors - Check ONE option below: NO direct contact with students As required by the Houston Independent School District contract, RFP #18-01-05 Grease Trap and Collection Services, I hereby certify that NO employee and/or subcontractor will have direct contact with any student at HISD as defined under 19 Texas Administrative Code 153.1101. WITH direct contact with students As required by the Houston Independent School District contract RFP #18-01-05 Grease Trap and Collection Services, I hereby certify that the list of employees and/or subcontractors below MAY/WILL have direct contact with students at HISD as defined under 19 Texas Administrative Code 153.1101.

Texas Administrative Code 153.1101. (7) Direct contact with students--The contact that results from activities that provide substantial opportunity for verbal or physical interaction with students that is not supervised by a certified educator or other professional district employee. Contact with students that results from services that do not provide substantial opportunity for unsupervised interaction with a student or students, such as addressing an assembly, officiating a sports contest, or judging an extracurricular event, is not, by itself, direct contact with students. However, direct contact with students does result from any activity that provides substantial opportunity for unsupervised contact with students, which might include, without limitation, the provision of coaching, tutoring, or other services to students.

Name* Date of Birth 1

2 3 4 5 6 7 8 9 10 11 12

*Attach additional pages as necessary

Vendor Name Name & Title of Authorized Representative Signature of Authorized Representative Date Taxpayer Identification Number

FOR INTERNAL USE ONLY

NO STUDENT CONTACT DIRECT STUDENT CONTACT Name of person receiving document Date Received by OEC Signature of person receiving document


FORM L : COMPLIANCE WITH BUY AMERICAN PROVISION

The Houston Independent School District (“HISD” or the “District”) participates in the National School Lunch

Program and School Breakfast Program and is required under the Buy American provision (7 C.F.R. § 210.21(d)) to

use the nonprofit food service funds, to the maximum extent practical, to buy domestic commodities or products. 7

C.F.R. § 210.21(d)) defines a “domestic commodity or product” as one that is either produced in the U.S. or is processed

in the U.S. substantially using agricultural commodities that are produced in the U.S. “Substantially” means that over

51 percent of the final processed product consists of agricultural commodities that were grown domestically.

Vendor certifies that, in compliance with the Buy American provision, all products listed as 51% or more U.S.

Domestic submitted for award with this contract are domestic commodities or products as defined by 7 C.F.R.

§ 210.21(d).

YES ________ Initials of Authorized Representative of Vendor

If “NO”, complete the bottom portion of this document for EACH item not in compliance.

REQUEST FOR EXCEPTION FROM THE BUY AMERICAN PROVISION

Exceptions to the Buy American provision are utilized by HISD as a last resort; however, an exception may be

approved upon request. If Vendor did not certify compliance with the Buy American provision above, it may request

an exception by checking one or both of the following grounds for an exception:

The product is not produced or manufactured in the U.S. in sufficient and reasonable available

quantities of a satisfactory quality. Product country of origin: _________________________________

The costs of a U.S. product are significantly higher than the non‐domestic product.

Vendor certifies that it submits this request for an exception from the Buy American provision in good faith and

with the reasonable belief that: (a) the product is not produced or manufactured in the U.S. in sufficient and

reasonable available quantities of a satisfactory quality; and/or (b) the costs of a U.S. product are significantly

higher than the non‐domestic product.

YES ________ Initials of Authorized Representative of

Vendor

Vendor further agrees that, if HISD determines that it does not qualify for one of the exceptions to the Buy

American provision listed above, Vendor is ineligible for this Contract.

YES ________ Initials of Authorized Representative of

Vendor

For Houston ISD Use Only

Procurement Manager: Date: Approve

Signature: Reject

Bidder Name:

Line Item #:

Mfg. Item #

Pack Size:

Mfg. Item Name/Description:

Authorized Vendor Representative Name: Authorized Vendor Representative Signature:


FORM M: ACKNOWLEDGEMENT FORM RFP Due Date / Bid Opening: 2 p.m. on Tuesday, March 27, 2018. 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 PROPOSAL/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 that I have received and read the following parts of the proposal in its entirety:

Documents Initials Part I: General Terms and Conditions Part II: Request for Proposals - Scope of Work Part III: Attachments

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 N: MASTER SERVICE AGREEMENT Download Form N: Master Service Agreement as Part V of the RFP downloads.

FORM O: FORM W-9

Download the W-9 in the project folder and submit the completed form. Your W-9 must the newest form revised November 2017, older W-9 forms will not be accepted.

FORM P: PRICING SCHEDULE

Download the “Form O: Price Schedule” as Part IV of the RFP downloads. This must be submitted in both your proposal hard copy and in Excel format on the required USB drive.