1-APPENDIX D -Required Forms -RFP 26-001 SIP Trunking and Transport Services-FINAL.pdf

Save as: 3.1 Company Information [FIRM NAME] Complete all areas, mark as n/a if not applicable.

Company Name:

Company Address:

Contact Name:

Contact Title:

Contact Phone:

Contact E-Mail:

Authorized Signature: _______________________________

Printed Name and Title:______________________________

Company Name:____________________________________

Date:_____________________________________________

COMPANY INFORMATION

Provide the primary contact regarding this solicitation process.

Expiration of Certification?

Certifying Agency:

HUB Certified?

HUB Information:

RFP #26-001: SIP Trunking and Transport Services APPENDIX D -Required Forms Tarrant County College District

Save as: 3.2 Ts & Cs Agreement -[FIRM NAME] Complete all areas, mark as “n/a” if not applicable.

I hereby agree to the terms and conditions outlined in this solicitation without modification of any kind and will adhere to such terms and conditions if awarded the business as described herein. I further understand that when a Purchase Order is released, I am bound by the terms and conditions of that Purchase Order, Blanket Purchase Order, and those of this solicitation, and in the event there is a conflict between the two, the terms of IFB shall take precedence.

ANY EXCLUSION(S), QUALIFICATION(S), EXCEPTION(S) TO THIS RFQ MUST BE

IDENTIFIED UNDER THIS TAB. NO EXCLUSION(S), QUALIFICATION(S),

EXCEPTION(S) WILL BE ACCEPTED AFTER THE RESPONSE HAS BEEN

SUBMITTED TO THIS IFB.

Authorized Signature: _______________________________

Printed Name and Title:______________________________

Company Name:____________________________________

Date:_____________________________________________

AGREEMENT TO TERMS AND CONDITIONS OF SOLICITATION

RFP #26-001 SIP Trunking and Transport Services

Save as: 3.3 Certifications/Representations -[FIRM NAME]

The Bidder certifies they (will ____, will not ____) be the actual distributor/provider of the goods or services for which this bid is submitted.

The Bidder certifies they (have ____, have not ____) employed or retained any company or person (other than a full-time employee working solely for the Bidder) to solicit or secure this contract, and they (have ____, have not ____) paid or agreed to pay any company or person (other than a full-time employee working solely for the Bidder) any fee, commission, percentage, or brokerage fee contingent upon award of this contract. Furthermore, the Bidder agrees to furnish information relating to the above requested by the Executive Director of Procurement, Tarrant County College District, including such amount of fee, percentage, commission, or other compensatory amount.

The Bidder certifies they operates as; an individual ____; a partnership ____; an unincorporated firm ____; or corporation _____, incorporated under the laws of the State of ____________.

The Bidder certifies they are (subject to ____, exempt from ____) payment of Texas franchise taxes. If subject to franchise taxes they certify the Bidder's franchise taxes are current. By completing this portion of the form, the Bidder acknowledges that making a false statement as to corporate franchise tax status shall be considered a material breach of the contract and shall be grounds for cancellation of the contract.

Date: Signature Title: Printed:

AUTHORITY TO SIGN

When the Bidder is an individual, a partnership, or unincorporated firm, and this Bid is signed by other than the owner or a partner, the following MUST be completed and signed by the owner, a partner, or if a limited partnership, the general partner.

I, _________________________, certify that I am ____________________ of ____________________, the firm identified as Bidder herein, and that ________________________, who signed this on my behalf, was duly authorized and empowered to sign and submit bids on behalf of me/my firm.

Date: Signature Title: Printed:

When the Bidder is a corporation and if this Bid is signed by other than a duly authorized officer of the corporation, the following must be completed and signed by a duly authorized officer of such corporation. Or a copy of the corporate authority of the individual signing the Bid to bind the corporation can be furnished with the Bid.

I, _________________________, certify that I am ____________________ of ____________________, the corporation identified as Bidder herein, and that _________________________, who signed this Bid was duly empowered by its Board to sign and submit bids binding upon the Corporation.

Date: Signature Title: Printed:

RFP #26-001: SIP Trunking and Transport Services APPENDIX D -Required Forms

Tarrant County College District

CERTIFICATIONS / REPRESENTATIONS

DISTRIBUTOR, CONTINGENCY FEE, TYPE OF BUSINESS and FRANCHISE TAX

Save as: 3.4 Felony -[FIRM NAME]

Pursuant to the Texas Education Code (V.T.C.A. Education Code 44.034)

(a) A person or business entity that enters into a contract with a school district must give advance notice to the district if the person or an owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony.

(b) 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.

(c) The section does not apply to a publicly held corporation.

The undersigned affirms that he/she is duly authorized to provide this information by the person(s) or business entity making the quote and the information provided below concerning felony convictions has been personally and thoroughly reviewed and verified and is, therefore, current, true and accurate to the best of my knowledge.

___ my firm is a publicly held corporation; this reporting requirement is not applicable

___ my firm is neither owned nor 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:

Name(s) of Felon(s):

Detail(s) of Conviction:

Authorized Signature:

Printed Name and Title:

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FELONY CONVICTION NOTIFICATION FORM

Pick One

RFP #26-001: SIP Trunking and Transport Services

Save as: 3.5 Resident Certification -[FIRM NAME]

The 1985 Texas Legislature passed HB 620 relating to bids by nonresident firms. The pertinent portion of the Act has been extracted and is as follows:

• Non-Resident Bidder – means a bidder whose principal place of business is not in this state but excludes a contractor whose ultimate parent company or majority owner has its principal place of business in this state.

• Texas Resident Bidder – means a bidder whose principal place of business is in this state and includes a contractor whose ultimate parent company or majority owner has its principal place of business in this state.

The state or a governmental agency of the state may not award a contract for general construction, improvements, services or public works projects or purchases of supplies, materials, or equipment to a nonresident bidder unless the nonresident’s bid is lower than the lowest bid submitted by a responsible Texas resident bidder by the same amount that a Texas resident bidder would be required to underbid a nonresident bidder to obtain a comparable contract in the state in which the nonresident’s principal place of business is located.

I certify that __________________________________________________ is a Resident Bidder of Texas as defined in HB 620.

City & County:

Signature:

Printed Name:

I certify that __________________________________________________ is a Non-Resident Bidder of Texas, as defined in HB 620, and our principal place of business is:

City & State:

Signature:

Printed Name:

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NON-RESIDENT / RESIDENT CERTIFICATION

Pick One

- A-

Pick One

- B -

RFP #26-001: SIP Trunking and Transport Services

Save as: 3.6 Boycotting Israel -[FIRM NAME] Complete all areas.

The undersigned affirms that he/she is duly authorized to provide this information by the person(s) or business entity making the proposal and the information provided below-concerning companies that boycott Israel thoroughly reviewed and verified and is, therefore, current, true and accurate to the best of my knowledge.

Pursuant to the provisions of Subtitle F, Title 10, Texas Government Code, Section 2270.001:

(1) “Boycott Israel” means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes, and

(2) “Company” means a for-profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly-owned subsidiary, a majority-owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit.”

Does not boycott Israel currently, and Will not boycott Israel during the term of the contract with Tarrant County College District.

Name of Business Entity:

Authorized Signature:

Printed Name and Title:

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PROHIBITION ON CONTRACTS WITH COMPANIES

BOYCOTTING ISRAEL

Required

Required

RFP #26-001: SIP Trunking and Transport Services

Save as: 3.7 Boycotting Energy -[FIRM NAME]

If Respondent is required to make a verification pursuant to Section 2274.002 of the Texas Government Code, Respondent verifies that Respondent does not boycott energy companies and will not boycott energy companies during the term of the Contract. If Respondent does not make that verification, Respondent must so indicate in its Response and state why the certification is not required.

Exemption criteria includes the following:

1. Company employs less than 10 full-time employees; AND

2. Value of the contract is less than $100,000

3. Term "company" does not include a sole proprietorship.

“Boycott energy company” means, without an ordinary business purpose, refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations with a company because the company: (A) engages in the exploration, production, utilization, transportation, sale, or manufacturing of fossil fuel-based energy and does not commit or pledge to meet environmental standards beyond applicable federal and state law; or (B) does business with a company described by Paragraph (A).”

I, _________________________________, the ________________________________

(Name of Certifying Official) (Title or Position of Certifying Official) of ___________________________________, (Name of Company) do hereby verify, on behalf of said company, to the Tarrant County College District that said company: (check one)

1. does not Boycott energy companies and will not Boycott energy companies (as that term is defined in Texas Government Code Section 809.001) during the term of this contract;

2. Company is a sole proprietorship;

3. Company employs less than 10 full-time employees; AND the value of the contract is less than $100,000.

Signature of Certifying Official

Title Date of Certification

PROHIBITION ON CONTRACTS WITH COMPANIES THAT

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PROHIBITION ON CONTRACTS WITH COMPANIES

BOYCOTTING CERTAIN ENERGY COMPANIES

Pick One

RFP #26-001: SIP Trunking and Transport Services

Save as: 3.8 Firearms Companies -[FIRM NAME]

If Respondent is required to make a verification pursuant to Section 2274.002 of the Texas Government Code, Respondent verifies that it (1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association and (2) will not discriminate during the term of the contract against a firearm entity or firearm trade association. If Respondent does not make that verification, Respondent must so indicate in its Response and state why the verification is not required.

Exemption criteria includes the following:

1. Company employs less than 10 full-time employees; AND

2. Value of the contract is less than $100,000

“Discriminate against a firearm entity or firearm trade association (A) means, with respect to the entity or association, to: (i) refuse to engage in the trade of any goods or services with the entity or association based solely on its status as a firearm entity or firearm trade association; (ii) refrain from continuing an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; or (iii) terminate an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; and (B) does not include: (i) the established policies of a merchant, retail seller, or platform that restrict or prohibit the listing or selling of ammunition, firearms, or firearm accessories; and (ii) a company ’s refusal to engage in the trade of any goods or services, decision to refrain from continuing an existing business relationship, or decision to terminate an existing business relationship: (aa) to comply with federal, state, or local law, policy, or regulations or a directive by a regulatory agency; or (bb) for any traditional business reason that is specific to the customer or potential customer and not based solely on an entity ’s or association ’s status as a firearm entity or firearm trade association.”

I, _________________________________, the ________________________________

(Name of Certifying Official) (Title or Position of Certifying Official) of ___________________________________, (Name of Company) do hereby verify, on behalf of said company, to the Tarrant County College District that said company: (check one)

1. does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association and (2) will not discriminate during the term of the contract against a firearm entity or firearm trade association.

2. Company employs less than 10 full-time employees; AND Value of the contract is less than $100,000

Signature of Certifying Official

Title Date of Certification

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PROHIBITION ON CONTRACTS WITH COMPANIES THAT DISCRIMINATE

AGAINST FIREARMS ENTITY OR TRADE ASSOCIATION

Pick One

RFP #26-001: SIP Trunking and Transport Services

Save as: 3.9 Responsibility -[FIRM NAME]

To be considered a responsible bidder, at a minimum, a bidder must certify they meet the following conditions. The company may be requested to submit additional written evidence verifying that the vendor meets the minimum requirements described. Failure to provide any requested additional information may result in the vendor being declared non-responsive and the solicitation response being rejected.

Yes No (Check One)

____ ____ 1. Finance: Our company has adequate financial resources or the ability to obtain such resources as required during the performance of any resulting contract.

____ ____ 2. Schedule: Our company is able to comply with the required performance schedule, taking into account all existing business commitments, and will not take on additional business commitments that would interfere with the company’s ability to comply with the schedule.

____ ____ 3. Performance: Our company has a satisfactory record of past performance which includes zero (0) litigation in the past ten (10) years concerning breach of contract. Within the past five (5) years, our company has had zero (0) change orders extending the contract period due to a non-owner-initiated request. If “No”, explain on a separate page.

____ ____ 4. Personnel: Our company has the necessary personnel and management capability to perform any resulting contract.

____ ____ 5. Type of Work: Our company is a qualified and established firm which is regularly engaged in the type of business necessary to fulfill the contract requirements.

____ ____ 6. Delinquent Taxes: Our company is not delinquent in any tax owed to the State of Texas under Chapter 171, Tax Code; and is not delinquent in taxes to

TCCD.

____ ____ 7. Eligibility: Our company is otherwise qualified and eligible to receive an award of contract under applicable laws and regulations.

To the Tarrant County College District, I do hereby certify, on behalf of said company, that the above statements are true and correct. We will be responsive to any additional requests to further certify we are a responsible bidder.

Print Name of Certifying Official Title

Signature Date

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RESPONSIBILITY

RFP #26-001: SIP Trunking and Transport Services