2-AISDP 0005 - REPRESENTATIONS AND CERTIFICATIONS (1).pdf

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Attached to
Property Insurance
Solicitation number
3716-27.10
Issued by
Ector County, Amarillo City, Texas

About this file

This is a Representations and Certifications form (Index No. AISDP-0005) for offerors responding to a property insurance solicitation issued by Amarillo Independent School District (AISD) in Texas. The form requires offerors to certify their small business status and provide documentation of any Historically Underutilized Business (HUB) or Minority, Women, Veteran Business Enterprise (MWVBE) certifications. Offerors must complete either Section 1 (if certified as a HUB or MWVBE) by listing their business classification and certifying agency, or Section 2 (if not certified) by indicating whether they will subcontract work to certified HUB or MWVBE firms and specifying the percentage of work to be subcontracted. The form requires the offeror's authorized representative to sign and certify under penalty of law that all representations and certifications are accurate, current, and complete.

The AISD solicitation seeks comprehensive property insurance coverage for both Amarillo Independent School District and Ector County Independent School District under an interlocal agreement, with proposals requiring coverage and premium information for both districts and separate billing arrangements. This form serves as a compliance document to verify small business participation and certification status but does not establish specific pricing terms, set-asides, or contract duration details, which would be found in the broader RFP documentation. All communications regarding the solicitation must be submitted through Bonfire.

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Index No. AISDP-0005 Page No. 1 of 1 Issue No. 001

REPRESENTATIONS AND CERTIFICATIONS

OFFEROR NAME: SOLICTATION #

CLAUSE NO. 1 OFFEROR SMALL BUSINESS REPRESENTATION

1. If Offeror is a Historically Underutilized Business (HUB) and/or Minority, Women, Veteran Business Enterprise (MWVBE), then complete Section 1.

2. If Offeror is NOT a HUB or MWVBE completed Section 2.

SECTION 1 - Offeror is a certified HUB or MWVBE

Offeror, list business HUB or MWVBE classification below and what group you have been certified by. Attach all current certifications to this form.

Business Classification Certifying Agency

SECTION 2 – Offeror IS NOT a certified HUB or MWVBE

☐ Offeror will not be subcontracting out any work related to this solicitation with a certified HUB or MWVBE.

☐ Offeror WILL be subcontracting out some work related to this solicitation with a certified HUB or MWVBE.

Percentage of Work to be subcontracted to a certified HUB or MWVBE

BY SIGNING BELOW, THE OFFEROR CERTIFIED, UNDER PENALTY OF LAW, THAT THE

REPRSENTATIONS AND CERTIFICATIONS IN CLAUSE 1 ARE ACCURATE, CURRENT AND

COMPLETE.

SIGNATURE:

(Print Name)

TITLE: DATE:

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