2-Local Attachments I - V.pdf

Please review ATTACHMENTS I through V on the following pages and provide signatures where necessary.

ATTACHMENT I:

HOUSE BILL 89 VERIFICATION (REVISED)

I, ____________________________________, [Person Name] the undersigned representative of

_____________________________________________________ [Company or Business Name]

(hereafter referred to as Company) being an adult over the age of eighteen (18) years of age, does hereby depose and verify that the Company named above, under the provisions of Texas Government Code Chapter

2271:

1. Does not currently boycott the country of Israel; and

2. Will not boycott the country of Israel during the term of the contract with City of Buda, Texas.

Pursuant to Section 2270.001, Texas Government Code:

1. “Boycott Israel” means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes; and

2. “Company” means a for-profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit.

3. Pursuant to Section 2270.002 of the Texas Government Code, Respondent certifies that either

a. it meets an exemption criterion under Section 2270.002; or

b. it does not boycott Israel and will not boycott Israel during the term of the contract resulting from this solicitation.

Respondent shall state any facts that make it exempt from the boycott certification in its Response. (HB 793 –exemptions).

EXEMPTIONS APPLY TO THE FOLLOWING:

A. Contract between a governmental entity and a company with less than 10 full-time employees

B. Contract has a value of less than $100,000 paid wholly or partly from public funds of the governmental entity

Signature: _____________________________________________________ Date: _________________

ATTACHMENT II:

CONFLICT OF INTEREST QUESTIONNAIRE

Rev Aug 25 2022

ATTACHMENT III:

HISTORICALLY UNDERUTILIZED BUSINESS CERTIFICATION

Historically Underutilized Businesses (HUBs), minority or women-owned or disadvantaged businesses enterprises (M/W/DBE) are encouraged to participate in the solicitation process. The City recognizes the certifications of the State of Texas Program administered by the Texas Comptroller of Public Accounts.

For consideration of points in the evaluation process, an offeror who is certified by the Comptroller as a

HUB with active status should complete the information at the bottom of this page.

Companies seeking information concerning HUB certification should contact:

State of Texas HUB Program

Texas Comptroller of Public Accounts

Lyndon B. Johnson State Office Building

111 East 17th Street

Austin, Texas 78774

(512) 463-6958 http://www.window.state.tx.us/procurement/prog/hub/

Vendor CMBL Information as Registered with Texas Comptroller’s Office

Vendor ID from CMBL: _______________________________

Vendor Name from CMBL: ______________________________________________________________

HUB Status is active: _____ yes _____ no

Date HUB Status Expires: _________________

Acknowledgment

By signing its submission, Offeror acknowledges that it has read and understands the above requirements for acceptance of the Offeror’s proposals.

Name of Offeror: ______________________________________________________________________

Signature of Authorized Representative: ____________________________________________________

Date:

http://www.window.state.tx.us/procurement/prog/hub/

ATTACHMENT IV:

DISCLOSURE OF BUSINESS RELATIONSHIPS WITH IRAN, SUDAN, OR A FOREIGN

TERRORIST ORGANIZATION

Texas S.B. 252 (Effective 9/1/2017): provides that (1) the City may not enter into a governmental contract with a Provider that is identified on a list prepared and maintained by the comptroller and that does business with Iran, Sudan, or a foreign terrorist organization; and (2) a company that the United States government affirmatively declares to be excluded from its federal sanctions regime relating to Sudan, its federal sanctions regime relating to Iran, or any federal sanctions regime relating to a foreign terrorist organization is not subject to contract prohibition under this subchapter.

By signing below, Offeror acknowledges that it has read and understands that it does not appear on the list maintained by the Texas Comptroller of Public Accounts.

Name of Offeror: ______________________________________________________________________

Signature of Authorized Representative: ___________________________________________________

Date:

ATTACHMENT V: