11-3202600043 Form-1- Execution of Response (1).docx

FORM 1 – EXECUTION OF RESPONSE

3202600043 Employer Child Care Solutions Respondent must complete the following information, sign, and return this page. By signing below, Respondent acknowledges receipt of all TWC terms and conditions in the RFP—including all Attachments, agrees to provide the items/services described in this RFP, and agrees to abide by all TWC Terms and Conditions as specified in this RFP, its Attachments, and in any Contract resulting from an award.

Any exceptions taken to the Terms and Conditions as set forth in this document must be identified in detail and accompany the Proposal. Any exceptions not identified in detail at the time the Proposal is submitted will not be considered. Please complete the following:

No exceptions taken OR Yes, exception taken due to (state your reason(s)):

or "No")

Please attach additional forms if additional space is needed. Please label any relevant pages with this same Attachment number and the RFP Number.

Signature of person authorized to contractually bind the organization and enter into a Contract with TWC affirms that:

(1) the Respondent meets the Minimum Qualifications identified in Section 5.5 – Minimum Qualifications of the RFP;

(2) if awarded a Contract under this Solicitation, Respondent affirms its obligations regarding Subcontractors, as identified in Section 6.13 – Subcontractor Information of the Solicitation;

(3) Other Respondent will notify TWC of a change in financial condition prior to the award of the Contract and during the Contract term and any renewal thereof.

Signature: Date Signed:

Printed name of person signing above:

RESPONDENT SUBCONTRACTOR INTERESTS

Respondent does not at this time hold any financial interest in a Subcontractor that may perform work under an executed Contract entered into with TWC should Respondent be the Successful Respondent.

Respondent holds a financial interest in a proposed Subcontractor that may perform work.

RESPONDENT INFORMATION

Name of Respondent:

Mailing Address:

Billing Address (if different from above):

City, State & Zip Code:

Phone No./Fax No.:

E-Mail Address:

Employer Identification No.:

Texas Identification No.:

RESPONDENT POINT OF CONTACT FOR PROPOSAL

Name of Contact:

Mailing Address:

Billing Address (if different from above):

City, State & Zip Code:

Phone No./Fax No.:

E-Mail Address:

RESPONDENT POINT OF CONTACT FOR CONTRACT

Respondent Legal Name:

Other business names used:

Mailing Address:

Billing Address (if different from above):

City, State & Zip Code:

Phone No./Fax No.:

E-Mail Address:

To minimize identity theft, every company/individual MUST have an Employer Identification Number (EIN), also known as a federal tax identification number prior to award of a contract. For information on obtaining your EIN, you may call 800-829-4933 or visit the following website: https://www.irs.gov/businesses/small-businesses-self- employed/apply-for-an-employer-identification-number-ein-online The Texas Identification Number (TIN) is the payee identification number assigned and used by the Texas Comptroller of Public Accounts to process payment for goods/services. Enter this number in the space provided above if number is not pre-printed. If this number is not known, please visit https://mycpa.cpa.state.tx.us/coa/. To obtain a TIN, please visit https://fmx.cpa.texas.gov/fm/pubs/payment/payee_setup/?s=forms_payee _maint&p=app_tin.

Check here if you are a sole ownership or partnership. Check below to claim a preference under Statute:

Goods produced or offered by a Texas bidder that is owned by a Texas resident service-disabled veteran.

Goods produced in Texas or offered by a Texas bidder that is not owned by a Texas resident service-disabled veteran.

Agricultural products grown in Texas.

Agricultural products offered by Texas bidder.

Services offered by a Texas bidder that is owned by a Texas resident service-disabled veteran.

Services offered by a Texas bidder that is not owned by a Texas resident service- disabled veteran.

Texas vegetation native to the region.

USA produced supplies, materials or equipment.

Products of persons with mental or physical disabilities.

Products made of recycled, remanufactured, or environmentally sensitive materials including recycled steel.

Energy Efficient Products.

Rubberized asphalt paving material. Recycled motor oil and lubricants.

Products produced at facilities located on formerly contaminated property.

Products and services from economically depressed or blighted areas. Vendors that meet or exceed air quality standards.

Recycled or reused computer equipment of other manufacturers. Foods of higher nutritional value.

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