2-Prohibited Contracts Form.pdf
PDF 117 KB Posted
- Attached to
- Trucks: Dump Trucks and Haul Truck
- Solicitation number
- FS-01-26
- Issued by
- Upshur 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 a truck procurement opportunity involving approximately 2 dump trucks and 1 haul truck to be purchased within the first 12 months of the contract award, with second-year quantities remaining unknown. The form requires declarants to provide personal identification information, including name, date of birth, address, and position with the contracting company, and serves as a certification document for bid submission.
The form establishes five primary compliance requirements that contracting companies must verify and certify: (1) the company does not have contracts with or provide supplies or services to foreign terroristic organizations as identified by the Texas Comptroller; (2) the company does not boycott Israel and will not do so during the contract term; (3) the company does not boycott energy companies as required by Senate Bill 13; (4) the company does not discriminate against firearm and ammunition industries as required by Senate Bill 19; and (5) the company will promptly notify the City of San Angelo of any changes in circumstances relevant to these provisions. The declarant must execute the form under penalty of perjury, with signature and date completion required before submission.
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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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