2-04 25-196-B Bidder Forms.pdf

BIDDER FORMS FOR NO. 25-196-B

ACTIVATED CARBON AND EXCHANGE SERVICES

BID SUBMITTALS ARE DUE PRIOR TO:

Thursday, September 11, 2025, at 10:00 AM Central

BID MAY BE SUBMITTED ELECTRONICALLY TO (Registration is free):

ntmwd.bonfirehub.com

DOCUMENTS MAY BE DELIVERED TO:

NORTH TEXAS MUNICIPAL WATER DISTRICT

PROCUREMENT DEPARTMENT

501 E. BROWN STREET

WYLIE, TX 75098

DOCUMENTS MAY BE MAILED TO:

PROCUREMENT DEPARTMENT

PO BOX 2408

WYLIE, TX 75098

NORTH TEXAS MUNICIPAL WATER DISTRICT CONTACT:

Hannah Mulla hmulla@ntmwd.com

25-196-B Activated Carbon and Exchange Services Bidder Forms

BID SIGNATURE FORM

The undersigned Bidder agrees that this bid becomes the property of the North Texas Municipal Water District (“NTMWD”) after the official opening of this bid.

Bidder represents that it has read the bid documents in their entirety, understands the specifications contained in the bid documents, and that the prices submitted in response to this request for bid have been carefully reviewed and are submitted as correct and final. Bidder further certifies and agrees to furnish all products and/or services at the prices offered by Bidder and upon conditions in the specifications of the submittal.

Bidder represents that this bid has not been prepared in collusion with any other Bidder or any employee of NTMWD, and that the contents of this bid have not been communicated to any other bidder or to any employee of NTMWD prior to the official opening of this bid.

Bidder hereby assigns to NTMWD any and all claims for overcharges associated with this contract which arise under the antitrust laws of the United States, 15 USCA Section 1 et seq., and which arise under the antitrust laws of the State of Texas, Tex. Bus. & Com. Code, Section 15.01, et seq.

Bidder affirms that Bidder has read and understands the specifications and any attachments contained in this bid package. Failure to sign and return this form may result in the rejection of the entire bid.

AUTHORIZED REPRESENTATIVE

Signature: _____________________________________________________

Title: _____________________________________________________

Date: _____________________________________________________

Printed Name: _____________________________________________________

COMPANY INFORMATION

Name of Company: _____________________________________________________

Address: _____________________________________________________

Tel. No: _____________________________________________________

E-Mail Address: _____________________________________________________

AFTER HOURS EMERGENCY CONTACT

Name: _____________________________________________________

Tel. No: _____________________________________________________

E-Mail Address: _____________________________________________________

THIS FORM MUST BE SIGNED AND SUBMITTED WITH BID RESPONSE

COOPERATIVE PURCHASING PROVISION

As permitted under Title 8, Chapter 271, Subchapter F., Section 271.101 and 271.102 V.T.C.A. and Title 7, Chapter 791, Subchapter C., Section 791.025, V.T.C.A., other local governmental entities may wish to also participate under the same terms and conditions contained in any contract with Bidder. Each local governmental entity wishing to participate must enter into an Interlocal Agreement with NTMWD and have prior authorization from the Bidder. If such participation is authorized, all purchases or services will be issued directly from, and shipped directly to, the local governmental entity requiring said products or services. NTMWD shall not be held responsible for any orders placed, deliveries made, or payment for products or services ordered by these entities.

Each entity reserves the right to determine their participation in any contract with Bidder.

Is Bidder willing to allow other governmental entities to piggyback off this contract, if awarded, under the same terms and conditions? Bidders will not be penalized for not agreeing to this provision.

____________Yes _________No

SECONDARY AWARD

NTMWD may award multiple contracts to different Bidders. NTMWD may use the secondary vendor if the primary vendor is unable to respond within the stated callout time periods and/or does not have the capacity for the specified project. The primary vendor is the first contact. Use of the secondary must be approved, in writing, by NTMWD.

1) In the event the secondary vendor(s) are called upon, they will offer the goods and services at the bid prices, or better. Any attempt to increase the original bid price may be cause to remove the vendor from the contract. This in no way negatively affects the status of the primary vendor.

2) Would you, the Bidder, be willing to accept a secondary award based on the above?

_________Yes _________No

OUT-OF-STATE CERTIFICATION

As defined by Section 2252.001 of the Texas Government Code, a “nonresident Bidder/Proposer” means a Bidder/Proposer whose principal place of business is not in Texas, but excludes a contractor whose ultimate parent company or majority owner has its principal place of business in Texas.

( ) I certify that my company is a “Resident Bidder”:

Company Name

( ) I certify that my company qualifies as a “Non-Resident Bidder”

(Note: You must furnish the following information)

Indicate the following information for your “Resident State” (the state in which your principal place of business is located):

Company Name Address

City State Zip

A. Does your “resident state” require Bidders whose principal place of business is in Texas to underprice Bidders whose resident state is the same as yours by a prescribed amount or percentage to receive a comparable contract?

( ) Yes

( ) No

B. What is the prescribed amount or percentage?

$ or %

By signature below, I certify that the above is true and correct and that I am authorized by my company to make such certifications.

Company Name

Signature of Authorized Company Official Date

VENDOR SUPPLEMENTAL FORM

1. In what state was your business formed?

2. Provide the following information for the person authorized to execute contracts on behalf of your organization:

Name Title

Mailing Address City State Zip

E-Mail Address: Phone: __________________________

3. Provide the following information for the contact person authorized to implement this contract on behalf of your organization:

E-Mail Address: Phone: __________________________

4. Provide the following information for the person authorized to receive notices and communications regarding this contract on behalf of your organization:

E-Mail Address: Phone: __________________________

5. Select and complete one of the following:

a. Sole Proprietorship

Legal name of Sole Proprietor:

Business Address:

b. General Partnership Legal name of Partnership:

Business Address:

c. Limited Partnership Legal name of Limited Partnership:

Names of General Partners:

Business address:

d. Corporation Legal name of Corporation:

Business Address

e. Limited Liability Company Legal name of Limited Liability Company:

f. Other Entity (not listed) Legal name and type of Company:

6. a. Are you a publicly traded business? No Yes – where traded:

b. Are you a wholly owned subsidiary of a publicly traded business?

No

Yes; which publicly traded business?

In signing this form, I acknowledge that I have read the above and state that the information contained therein is true and correct.

Signature: Date:

Print Name: Print Title:

REFERENCES

Three (3) references shall be submitted, other than NTMWD, who can verify your performance as a vendor.

References shall be from customers for whom your firm has provided the same goods and/or services in similar size and scope as NTMWD needs specified in this bid request within the past three (3) years. References may be checked by NTMWD. Inaccurate, obsolete, or negative responses from the listed references may result in the rejection of your submittal. Additional pages may be attached, if needed.

1. GOVERNMENT/COMPANY NAME:

ADDRESS:

CONTACT PERSON & TITLE:

PHONE NUMBER & EMAIL ADDRESS:

DATE(S) OF SERVICE:

SCOPE OF WORK:

2. GOVERNMENT/COMPANY NAME:

3. GOVERNMENT/COMPANY NAME:

PROHIBITION ON CONTRACTS WITH

COMPANIES BOYCOTTING CERTAIN ENERGY COMPANIES

Texas Government Code, Chapter 809, prohibits entering into contracts with companies boycotting energy companies. A governmental entity may not enter a contract with a company for goods or services unless the contract contains a written verification from the company that; (i) it does not boycott energy companies; and (ii) will not boycott energy companies during the term of the contract.

I, , the (Name of Certifying Official) (Title or Position of Certifying Official) of , do hereby verify on behalf of said company to the (Name of Company)

North Texas Municipal Water District that said company does not boycott energy companies and will not boycott energy companies (as such terms are defined in Texas Government Code Section 809.001) during the term of this contract.

Signature of Certifying Official

Title

Date

PROHIBITION ON CONTRACTS WITH

COMPANIES THAT DISCRIMINATE AGAINST FIREARM & AMMUNITION INDUSTRIES

Texas Government Code, Chapter 2274, prohibits entering into contracts with companies that discriminate against a firearm entity or firearm trade association. A governmental entity may not enter a contract with a company for goods or services unless the contract contains a written verification from the company that it; (i) does not have a practice, policy, guidance or directive that discriminates against a firearm entity or firearm trade association; and (ii) will not discriminate against a firearm entity or firearm trade association during the term of the contract.

I, , the (Name of Certifying Official) (Title or Position of Certifying Official) of , do hereby verify on behalf of said company to the (Name of Company)

North Texas Municipal Water District that said company; (i) does not have a practice, policy, guidance or directive that discriminates against a firearm entity or firearm trade association (as such terms are defined in Texas Government Code Section 2274.001); and (ii) will not discriminate against a firearm entity or firearm trade association during the term of the contract (as such terms are defined in Texas Government Code Section 2274.001).

Signature of Certifying Official

Title

Date

CERTIFICATE OF INTERESTED PARTIES

Texas Government Code section 2252.908 provides that a governmental entity or state agency may not enter into certain contracts with a business entity unless the business entity submits a disclosure of interested parties form to the governmental entity or state agency at the time the business entity submits the signed contract to the governmental entity or state agency. The form discloses any interested parties who have a controlling interest in the business entity (10% or more ownership; a member of the board of directors or other governing body of a business entity of which the board or other governing body is composed of not more than 10 members; or service as an officer of a business entity that has four or fewer officers) and/or an intermediary interest in the business entity (actively participate in facilitating the contract or negotiating the terms of the contract with a governmental entity or state agency, including a broker, intermediary, advisor, attorney, or representative of or agent of the business entity), if any.

The Texas Ethics Commission was required to adopt rules necessary to implement that law, prescribe the disclosure of interested parties form, and post a copy of the form on the commission’s website. The commission adopted the Certificate of Interested Parties form (Form 1295) on October 5, 2015 and new rules (Chapter 46) on November 30, 2015.

The successful Bidder will be required to submit a signed 1295 form to NTMWD prior to signing a contract with NTMWD.

THE FILING PROCESS

1. Prior to award by NTMWD, your firm will be required to log in to the Texas Ethics Commission and fill out the Electronic Filing Application, https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm

2. The “identification number” to be used on the 1295 form for this procurement is 25-196-B.

3. Once submitted, the system will generate an electronic Form 1295 displaying a Certificate Number. Your firm must print, sign and notarize Form 1295.

4. Within ten (10) business days from notification of pending award by the North Texas Municipal Water District, the completed Form 1295 must be submitted to NTMWD.

All prospective Bidders shall familiarize themselves with this requirement and agree to provide the completed Form 1295 if selected as the successful Bidder for this procurement.