10-Prohibited Contracts Form.pdf

PDF 117 KB Posted

Attached to
Land Exchange on River
Solicitation number
RE-03-26
Issued by
Travis County, Texas

About this file

This is a Prohibited Contracts Verification Form issued by the City of San Angelo, Texas Purchasing Division in connection with a land exchange proposal for future development. The form requires the contracting company's declarant to provide personal identification information, including name, date of birth, and address, as well as the declarant's position with the contracting company. The form establishes the framework for contractual compliance with multiple Texas state statutes and procurement regulations.

The form mandates that contracting companies verify five key compliance certifications: (1) the company does not have contracts with or provide services to entities associated with foreign terroristic organizations as identified by the Texas Comptroller; (2) the company does not boycott Israel and will not do so during the contract term; (3) pursuant to Senate Bill 13, the company does not boycott energy companies and will not do so for the contract duration; (4) pursuant to Senate Bill 19, the company does not discriminate against firearm or ammunition industries and maintains no policies or directives that do so; and (5) the company commits to promptly notifying the City of San Angelo of any changes in circumstances relevant to these provisions. The declarant must execute the form under penalty of perjury, providing the county, state, date, month, and year of execution along with a signature.

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Text version

CITY OF SAN ANGELO, TEXAS

PURCHASING DIVISION

72 West College Avenue, San Angelo, Texas 76903

325.657.4219 • sapurch@cosatx.us

Verification Related to Prohibited Contracts

CITY OF SAN ANGELO, TEXAS

My name is “Declarant”;

FIRST MIDDLE LAST

My date of birth is ; and, BIRTHDAY

My address is , .

STREET CITY STATE

, and .

ZIP CODE COUNTRY

My position with , contracting company, is .

CONTRACTING COMPANY OFFICE HELD

(1) The foregoing named contracting Company does not now and will not during the term of this contract, have contracts with or provide supplies or services to, an entity or company known to have contracts with or to provide supplies or services to a foreign terroristic organization or with an entity or company identified as providing such on a list prepared and maintained by the Texas Comptroller pursuant to Subchapter “F”, Sections 2252.151 et. seq., Chapter 2252 “Contracts with Governmental Entity” of the Texas Government Code; neither is contracting Company identified as an entity providing such supplies or services on said list.

(2) The foregoing named contracting Company does not boycott Israel; and will not boycott Israel during the term of the contract with the City of San Angelo.

(3) Entities that Boycott Energy Companies. In accordance with Senate Bill 13, Acts 2021, 87th Leg., R.S., pursuant to Section 2274.002 of the Texas Government Code (relating to prohibition on contracts with companies boycotting certain energy companies), the foregoing named contracting Company represents and warrants that it does not, and will not for the duration of the Contract, boycott energy companies.

(4) Entities that Discriminate Against Firearm and Ammunition Industries. In accordance with Senate Bill 19, Acts 2021, 87th Leg., R.S., pursuant to Section 2274.002 of the Texas Government Code (relating to prohibition on contracts with companies that discriminate against firearm and ammunition industries), The foregoing named contracting Company verifies that it does not, and will not for the duration of the Contract, have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association.

(5) If circumstances relevant to this provision change during the course of the Contract the City of San Angelo shall be promptly notified.

I declare under penalty of perjury that the foregoing is true and correct.

Executed in County, State of , on the

COUNTY OFFICE HELD

day of , 20

DAY MONTH YEAR

Declarant Signature mailto:sapurch@cosatx.us

File details come from the government source that posted it. Updated .