10-Prohibited Contracts Form.pdf
PDF 117 KB Posted
- Attached to
- Water Treatment Coagulant
- Solicitation number
- WU-08-26
- Issued by
- Travis County, Texas
About this file
This is a Verification Related to Prohibited Contracts Form issued by the City of San Angelo, Texas Purchasing Division for use in conjunction with a water treatment coagulant supply contract. The form requires the contracting company's declarant to provide identifying information including name, date of birth, address, and position held, and must be executed under penalty of perjury. The City of San Angelo, Texas Water Production Plant is soliciting bids for the testing and supply of coagulant to meet the requirements of the Water Utilities Department for potable water treatment, with a mandatory pre-qualification product testing component included in the bid requirements.
The form establishes five primary contractual prohibitions that the contracting company must certify compliance with throughout the contract term. The contractor must verify that it does not and will not have contracts with entities known to have relationships with foreign terroristic organizations as identified by the Texas Comptroller; will not boycott Israel; will not boycott energy companies in accordance with Texas Government Code Section 2274.002; and will not have practices, policies, guidance, or directives that discriminate against firearm entities or firearm trade associations under Senate Bill 19. The contractor is also required to promptly notify the City of San Angelo of any changes in circumstances relevant to these provisions during the course of the contract. The declaration must be signed and dated with the county and state of execution clearly identified.
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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
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