1-05 - Offeror Acknowledgment.pdf
PDF 124 KB Posted
- Attached to
- RFP 2026-015 Dental & Vision Insurance Benefits
- Solicitation number
- RFP 2026-015
- Issued by
- Johnson County, Texas
About this file
This is an Offeror Acknowledgment form for the City of Burleson, Texas, related to RFP 2026-015 for Dental & Vision Insurance Benefits. The form requires proposers to acknowledge compliance with five Texas state legislation requirements: HB 89 (prohibiting boycotts of Israel), SB 252 (prohibiting business with Iran, Sudan, or foreign terrorist organizations), SB 13 (prohibiting boycotts of energy companies), SB 19 (prohibiting discrimination against firearm entities or associations), and SB 2116 (restricting ownership or control by citizens or entities from China, Iran, North Korea, Russia, or designated countries). The dental and vision insurance coverage is intended for all eligible full-time employees, retirees, and their dependents.
Proposers must confirm agreement or disagreement with each compliance requirement by selecting "Yes, we agree" or "No, we do not agree" for each statute. The form requires an authorized vendor representative to sign, print their name and title, and date the document, certifying that they have read and understood all contents and affirm the accuracy and truthfulness of the information provided. No specific pricing information, funding amounts, contract term details, renewal options, or response deadlines are included in this acknowledgment form itself.
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Text version
Offeror Acknowledgment
Compliance with HB 89: Proposer agrees per HB 89 vendor shall not boycott Israel at any time while providing products or services to the City of Burleson.
Yes, we agree No, we do not agree
Compliance with SB 252: Proposer agrees per SB 252 vendor shall not do business with Iran, Sudan or a foreign terrorist organization while providing products or services to the City of Burleson.
Yes, we agree No, we do not agree
Compliance with SB 13: Proposer agrees per SB 13 vendor does not boycott energy companies as those terms are defined in the Texas Government Code § 809.001, and will not boycott energy companies during the term of any contract with the City of Burleson.
Yes, we agree No, we do not agree
Compliance with SB 19: Proposer agrees per SB 19 vendor does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association as those terms are defined in the Texas Government Code § 2274.001, and that vendor will not so discriminate during the term of any contract with the City of Burleson.
Yes, we agree No, we do not agree
Compliance with SB 2116: Proposer agrees per SB 2116 it is not owned by or the majority of its stock or other ownership interest is held or controlled by i) individuals who are citizens of China, Iran, North
Korea, Russia, or a designated country as defined by Texas Government Code § 2275.0101; or ii) a company or other entity, including a governmental entity, that is owned or controlled by citizens of or is directly controlled by the government of China, Iran, North Korea, Russia, or a designated country; nor is it headquartered in China, Iran, North Korea, Russia, or a designated country
Yes, we agree No, we do not agree
I acknowledge that my signature affixed hereto verifies that I have read and understood the contents of this document, and I affirm the accuracy and truthfulness of the information provided therein
Vendor:
By:
Name:
Title:
Date:
File details come from the government source that posted it. Updated .