2-Required Procurement Forms-Shredding.docx

CONTRACT REQUIREMENTS

ECPA considers this request for proposals legally binding and will require that resulting vendors’ proposals be incorporated by reference into any subsequent contracts or purchase orders between the vendor and the individual participating entities. It should be understood by the vendors that this means the individual participating entities expect the vendors to satisfy substantially all of the requirements listed herein.

Minimally, the contract or purchase orders MUST contain the following language and respective components:

1. Applicable and Governing Law Clause The agreement shall be subject to the laws of the State of Indiana. All duties of either party shall be legally performable in Indiana. The applicable law for any legal disputes arising out of this contract shall be the law of (and all actions hereunder shall be brought in) the State of Indiana.

2. Entire Agreement Clause This agreement, including appendices and referenced attachments, constitutes the entire agreement between the parties and superseded all proposals, presentations, representations, and communications, whether oral or in writing, between the parties on this subject.

3. Notices Clause All notices or communications required or permitted as a part of this agreement shall be in writing (unless another verifiable medium is expressly authorized) and shall be deemed delivered when:

· Actually received, or

· Upon receipt by sender of certified mail, return receipt signed by an employee or agent of the party, or

· If not actually received, ten (10) days after deposit with the United States Postal Service authorized mail center with proper postage (certified mail, return receipt requested) affixed and addressed to the respective other party at the address set out or such other address as the party may have designated by notice or agreement amendment to the other party.

Consequences to be borne due to failure to receive a notice due to improper notification by the intended receiving party of a new address will be borne by the intended receiving party.

4. Nondiscrimination Pursuant to the Indiana Civil Rights Law, specifically IC § 22-9-1-10, and in keeping with the purposes of the federal Civil Rights Act of 1964, the Age Discrimination in Employment Act, and the Americans with Disabilities Act, the Contractor covenants that it shall not discriminate against any employee or applicant for employment relating to this Contract with respect to the hire, tenure, terms, conditions or privileges of employment or any matter directly or indirectly related to employment, because of the employee's or applicant's race, color, national origin, religion, sex, age, disability, ancestry, status as a veteran, or any other characteristic protected by federal, state, or local law ("Protected Characteristics"). The Contractor certifies compliance with applicable federal laws, regulations, and executive orders prohibiting discrimination based on the Protected Characteristics in the provision of services. Breach of this paragraph may be regarded as a material breach of this Contract, but nothing in this paragraph shall be construed to imply or establish an employment relationship between the State and any applicant or employee of the Contractor or any subcontractor.

5. Force Majeure In the event that either party is unable to perform any of its obligations under this contract or to enjoy any of its benefits because of natural disaster or decrees of governmental bodies not the fault of the affected party (hereinafter referred to as a “Force Majeure Event”), the party who has been so affected shall immediately or as soon as is reasonably possible under the circumstances give notice to the other party and shall do everything possible to resume performance. Upon receipt of such notice, all obligations under this contract shall be immediately suspended. If the period of nonperformance exceeds thirty (30) days from the receipt of notice of the Force Majeure Event, the party whose ability to perform has not been affected may, by giving written notice, terminate this contract.

6. Non-Collusion Acceptance By submitting a bid, the person named on the electronic bid form declares that he/she has authority to offer the prices bid and can confirm the following: “I certify that this bid is made without prior understanding, agreement, or connection with any corporation, firm or person submitting a bid for the same materials, supplies or equipment and is in all respect fair and without collusion or fraud. I understand that collusive bidding is a violation of State and Federal law and can result in fines, prison sentences and civil damage awards.” This statement and the Non-Collusion Affidavit form must be included in your submission. This form MUST be notarized to be accepted. Please send the original, signed Non-Collusion Affidavit to:

7. Employment Eligibility Verification (E-Verify) As required by IC § 22-5-1.7, the vendor swears or affirms under the penalties of perjury that the vendor does not knowingly employ an unauthorized alien. The vendor further agrees that:

· The vendor shall enroll in and verify the work eligibility status of all his/her/its newly hired employees through the E-Verify program as defined in IC § 22-5-1.7. The vendor is not required to participate should the E-Verify program cease to exist. Additionally, the vendor is not required to participate if the vendor is self-employed and does not employ any employees.

· The vendor shall not knowingly employ or contract with an unauthorized alien. The vendor shall not retain an employee or contract with a person that the vendor subsequently learns is an unauthorized alien.

· The vendor shall require his/her/its subcontractors, who perform work under this contract, to certify to the vendor that the subcontractor does not knowingly employ or contract with an unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify program. The vendor agrees to maintain this certification throughout the duration of the term of a contract with a subcontractor.

8. Termination for Convenience This contract may be terminated, in whole or in part, by ECPA for any reason ECPA determines that such termination is in its best interest. Termination of services shall be affected by delivery to the vendor of a Termination Notice at least ninety (90) days prior to the termination effective date, specifying the extent to which performance of services under such termination becomes effective. The vendor shall be compensated for services properly rendered prior to the effective date of termination. ECPA will not be liable for services performed after the effective date of termination. The vendor shall be compensated for services herein provided but in no case shall total payment made to the vendor exceed the original contract price or shall any price increase be allowed on individual line items if canceled only in part prior to the original termination date.

9. Termination for Default With the provision of ninety (90) days’ notice to the vendor, ECPA may terminate this contract in whole or in part if the vendor fails to:

· Correct or cure any breach of this contract

· Deliver the supplies or perform the services within the time specified in this contract or any extension;

· Make progress so as to endanger performance of this contract; or

· Perform any of the other provisions of this contract.

If ECPA terminates this contract in whole or in part, it may acquire, under the terms and in the manner ECPA considers appropriate, supplies or services similar to those terminated, and the vendor will be liable to ECPA and participating entities for any excess costs for those supplies or services. However, the vendor shall continue the work not terminated.

ECPA and participating entities shall pay the contract price for completed supplies delivered and services accepted. The vendor and ECPA shall agree on the amount of payment for manufacturing materials delivered and accepted and for the protection and preservation of the property. ECPA may withhold from these amounts any sum ECPA determines to be necessary to protect ECPA against loss because of outstanding liens or claims of former lien holders.

10. Fair and Open Competition This solicitation is intended to promote fair and open competition. If the language, specifications, terms, and conditions or any combination thereof restricts or limits the requirements in this solicitation to a single source, it must be the responsibility of the interested vendor to notify Kelly Taylor, Director of Cooperative Programs, CIESC in writing, at ktaylor@ciesc.org so as to be received within five (5) business days after the date the solicitation is issued by ECPA. The solicitation may or may not be changed, but a review of such notification will be made prior to the award of contract.

11. Historically Underutilized Business (HUB) Statement It is the intent of the ECPA to provide maximum practicable opportunities in its solicitations to minority firms, women's business enterprises and labor surplus area firms. ECPA’s contractors, suppliers and subcontractors, and vendors of goods, equipment services, and professional services shall not discriminate on the basis of race, color, religion, national origin, handicap, or sex in the award and/or performance of contracts. However, competition and quality of work remains the ultimate determining factor in contractor, subcontractor, vendor, service, professional service, and supplier utilization. All vendors, suppliers, professionals, and contractors doing business or anticipating doing business with CIESC shall support, encourage, and implement affirmative steps toward our common goal of establishing equal opportunity in the procurement process.

12. Supplier Diversity-Minority and Women’s Business Enterprises (M/WBE) It is the policy of the ECPA through its Supplier Diversity Initiative to increase business opportunities for Minority and Women’s Business Enterprises (M/WBEs) (7CFR3016.36(e)). Our commitment is to maximize M/WBE participation through the development of mutually beneficial business relationships with these enterprises. Proposals that have been certified as Targeted Small Business (TSB) Program are required to indicate their TSB status when responding to the RFP.

13. Tax Exemption All purchases made by Indiana public school districts and other participating entities are exempt from all state and federal taxes. Exemption certificates will be provided upon request by each entity.

14. Evidence of Insurance The respondent agrees to maintain at no additional cost to ECPA the following insurances until the termination of services under this Agreement:

· Workers’ compensation coverage that meets or exceeds legal requirements;

· Professional liability insurance coverage with minimum limits of $1,000,000.00; and

· A minimum Commercial General Liability limit of $1,000,000.00.

With respect to any of the insurance policies provided by the respondent pursuant to this agreement which are “claims made” policies, in the event at any time any such policies are cancelled or not renewed, the respondent shall provide a substitute insurance policy(ies) with terms and conditions and in amounts which comply with the terms of this agreement and which provides for retroactive coverage to the date of cancellation or nonrenewal to fill any gaps in coverage which may exist due to the cancellation or nonrenewal of the prior “claims made” policy(ies). With respect to all “claims made” policies, which are renewed, the respondent shall provide coverage retroactive to the date of commencement of work under this agreement. Prior to the commencement of performance of this agreement, firm shall furnish to ECPA a certificate of liability insurance evidencing all required coverage in at least the limits required herein naming the ECPA as additional insured under the Comprehensive Liability Coverage and providing that no policies may be cancelled without ten (10) days advance written notice to ECPA. Said policies shall remain in full force and effect until the expiration of the terms of the firm or until completion of all duties to be performed hereunder by the firm, whichever shall occur later.

FEDERAL CONTRACT PROVISIONS

This contract may be used by public agencies, including educational institutions, which are recipients of federal funds. As such, the awarded Supplier(s) must comply with applicable provisions of the Education Department General Administrative Regulations (EDGAR) and the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (2 CFR Part 200) when federal funds are used to make purchases under this agreement.

1. Debarment and Suspension Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) must not be made to parties listed on the government wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), “Debarment and Suspension.” SAM Exclusions contain the names of parties debarred, suspended, or otherwise excluded by districts, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order 12549.

Vendor certifies that the vendor and/or any of its subcontractors or principals have not been debarred, suspended, or declared ineligible by any agency of the State of Indiana or any agency of the Federal government or as defined in the Federal Acquisition Regulation. Vendor will immediately notify CIESC if the vendor is debarred or placed on the Consolidated List of Debarred, Suspended, and Ineligible Contractors by a federal entity. By signing this agreement, the bidder is testifying that they are not debarred, suspended, or has any ineligible or voluntary exclusion with the U.S. Department of Agriculture or any other Federal or State Agency. All responses will be verified on the SAM.GOV Website.

2. Equal Employment Opportunity Except as otherwise provided under 41 CFR Part 60, all participating agency purchases or contract that meet the definition of “federally assisted construction contract” in 41 CFR Part 60-1.3 shall be deemed to include the equal opportunity clause provided under 41 CFR Part 60-1.4(b), in accordance with Executive Order 11246.

3. Davis Bacon Act Under this Act, vendors shall be required to pay wages to laborers and mechanics at a rate not less than the minimum wages specified in a wage determination made by the Secretary of Labor. In addition, vendors shall be required to pay wages not less than once a week. The recipient shall place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation and the award of a contract shall be conditioned upon the acceptance of the wage determination. The recipient shall report all suspected or reported violations to the Federal awarding agency.

4. Copeland “Anti-Kickback” Act The contract must include a provision for compliance with the Copeland “Anti- Kickback” Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, “Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States”). The Act provides that each contractor or sub recipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non- Federal entity must report all suspected or reported violations to the Federal awarding agency.

5. Contract Work Hours and Safety Standards Act Where applicable, for all participating agency purchases in excess of $100,000 that involve the employment of mechanics or laborers, the vendor agrees to comply with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, vendors are required to compute the wages of every mechanic and laborer based on a standard workweek of 40 hours. Work in excess of the standard workweek is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the workweek. The requirements of the 40 U.S.C. 3704 applies to construction work and provides that no laborer or mechanic must be required to work in surroundings or under working conditions that are unsanitary, hazardous, or dangerous. These requirements do not apply to the purchase of supplies, materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence.

6. Rights to Inventions Made Under a Contract or Agreement Contracts or agreements for the performance of experimental, developmental, or research work shall provide for the rights of the Federal Government and the recipient in any resulting invention in accordance with 37 CFR part 401, “Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements,” and any implementing regulations issued by the awarding agency.

7. Clean Air and Water Statement Compliance with all applicable standards, orders, or requirements issued under the Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended—Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non-Federal award to agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Vendor certifies that none of the facilities it uses to produce goods provided under the contract are on the Environmental Protection Authority (EPA) List of Violating Facilities. Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA).

8. Byrd Anti-Lobbying Amendment Byrd Anti-Lobbying Amendment (31 U.S.C. 1352), vendors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying with non-Federal funds that take place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non-Federal award. Per CFR 7.3018 - A Lobbying Certification and Disclosure must be completed for all bids $100,000 and over.

9. Solid Waste Disposal Act A Non-Federal entity that is a state agency or agency of a political subdivision of a state and its contractors must comply with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines.

10. Energy Policy and Conservation Act Compliance with mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Public Law 94-163, 89 Stat.871).

11. Record Retention Compliance with 2 CFR 200.334 with mandatory standards and policies relating to retention requirements. Financial records and supporting documentation in accordance with generally accepted accounting principles and procedures which sufficiently and properly document and calculate all charges billed to the participating entities throughout the term of the contract for a period of at least three years from the date of final payment or completion of any required audit, whichever is later.

12. Termination for Cause or Convenience Termination for cause and for convenience by the grantee or subgrantee including the manner by which it will be affected and the basis for settlement. (All contracts in excess of $10,000)

Pursuant to Federal Rule (B) above, when a Participating Agency expends federal funds, the Participating Agency reserves the right to immediately terminate any agreement in excess of $10,000 resulting from this procurement process in the event of a breach or default of the agreement by Offeror as detailed in the terms of the contract.

13. Buy American Act Offeror certifies that its products comply with all applicable provisions of the Buy America Act and agrees to provide such certification or applicable waiver with respect to specific products to any Participating Agency upon request. Purchases made in accordance with the Buy America Act must still follow the applicable procurement rules calling for free and open competition.

14. Procurement of Recovered Materials (2 CFR 200.322) Offeror shall make maximum use of products containing recovered materials, consistent with maintaining a satisfactory level of competition and meeting performance requirements, as outlined in the EPA’s Comprehensive Procurement Guidelines and applicable federal/state laws.

Vendor Acknowledgement of Contract Terms

Vendor Certification Vendor Initial if AGREE to terms

1. Debarment and Suspension

2. Equal Employment Opportunity

3. Davis Bacon Act

4. Copeland “Anti-Kickback” Act

5. Contract Work Hours and Safety Standards Act

6. Right to Inventions Made Under a Contract or Agreement

7. Clean Air and Water Act

8. Byrd Anti-Lobbying Amendment

9. Solid Waste Disposal Act

10. Energy Policy & Conservation Act

11. Record Retention

12. Termination for Cause or Convenience

13. Buy American Act

14. Procurement of Recovered Materials

15. Supplier Administration Agreement

PROPOSAL SIGNATURE PAGE

By signing below, I agree:

Pursuant to notices given, the undersigned offers a bid to the Educational Cooperative Purchasing Alliance in accordance with the requirements stated herein. Determination of award will be based upon factors stated herein and judgment of the proposals best meeting the requirements of the program. Any changes or alterations in the specified items or failure to respond to any requirement may lead to the rejection of the bid. Respondent understands that this bid is a legal commitment of pricing and terms, and that such pricing may only be withdrawn with the written approval of the ECPA. Failure to honor pricing, terms and conditions as proposed may result in ECPA pursuing all appropriate action, including action against the bid surety and/or prohibition of future business with the ECPA. Bids are to be provided on the bid response forms provided (or utilizing the same format)

Acceptance of any response will be based on the assumption that the respondent fully understands the specifications and conditions, and accepts them without reservation.

I agree by signing below that I am authorized to bind the proposing organization to all commitments made herein, and if selected, agree to provide “Secure Shredding and Document Destruction for Indiana’s K12 School Districts” as specified.

Signature

Title

Company Name

Date

NON-COLLUSION AFFIDAVIT

The undersigned offeror or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be offered by any person nor to prevent any person from making an offer nor to induce anyone to refrain from making an offer and that this offer is made without reference to any other offer.

Offeror (Firm)

Signature of Offeror or Agent

Subscribed and sworn to before me this ________ day of _________________, ______

My Commission Expires: _________________ _______________________________ Notary Public

County of Residence __________________

Source: IC 5-22-16-6

E-Verify Program The Indiana General Assembly in 2011 adopted Indiana Code 22-5-1.7-11. This statute requires the Educational Cooperative Purchasing Alliance to obtain from its vendors certification that the vendor does not knowingly employ an unauthorized alien and it participates in the E-verify program. As part of your proposal response, please read the declaration below, then sign and return it with your response. This must be included in your bid response to be considered a responsible and responsive bidder.

Declaration

1. I have reviewed Ind. Code 22-5-1.7 sections 11 through 13 and have sufficient knowledge of the personnel practices of the Business Entity to execute this Declaration on behalf of the Business Entity.

2. The Business Entity has legal counsel and has had the opportunity to consult that counsel, and accordingly, it has not relied on the Governmental Entity’s advice or counsel in complying with the legal requirements addressed in this Declaration.

3. The Business Entity is enrolled in and uses the federal E-Verify program to verify the eligibility to work of all newly hired employees of the Business Entity.

4. The Business Entity does not knowingly employ applicants or retain in its employ a person whose immigration status makes them ineligible to work for the Business Entity.

5. The Business Entity has verified that any subcontractors utilized to deliver services to the Governmental Entity through the Business Entity’s contract with the Governmental Entity use the E-Verify system and do not knowingly employ persons whose immigration status makes them ineligible to work for the subcontractor.

6. As an authorized agent of the Business Entity, I acknowledge that Ind. Code 22-5-1.7-13 requires that the Business Entity’s compliance with the terms of this Declaration be incorporated into the Business Entity’s contract for services with the Governmental Entity, and if the Business Entity fails to remedy a violation of this provision of its contract for services with the Governmental Entity within the thirty (30) day period prescribed in Ind. Code 22-5-1.7-12(b), violation of this term of that contract for services requires termination of that contract and that the Business Entity is liable to the Governmental Entity for actual damages.

I declare under penalty of perjury, a Class D Felony, that the foregoing representations are true.

Business Entity Name: Date:

Agent’s Printed Name:

Agent’s Signature:

Debarment and Suspension Statement

CERTIFICATION THAT CONTRACTOR, ITS PRINCIPALS OR SUB-RECIPIENTS ARE NOT SUSPENDED OR DEBARRED FROM DOING BUSINESS WITH THE FEDERAL GOVERNMENT

By signing below, respondent certifies that the responding contractor, its principals and/or sub-recipients are not suspended or debarred by the Federal Government, nor is any known suspension or debarment procedure pending. Contractor agrees to notify ECPA in writing of any suspension or debarment, or potential suspension or debarment proceeding. Failure to report any suspension or debarment, or any potential suspension or debarment will be sufficient cause to terminate this contract and report such termination to Federal Authorities. The contractor representative certifies that he/she has the authorization to make such certification and to bind the contractor to all representations herein.

Respondent’s Company

Respondent’s Company Unique Entity ID

Respondent’s Printed Name Respondent’s Printed Title

Respondent’s Signature Date

CERTIFICATION REGARDING LOBBYING

Applicable to Grants, Sub-grants, Cooperative Agreements, and Contracts Exceeding $100,000 in Federal Funds.

Submission of this certification is a prerequisite for making or entering into this transaction and is imposed by section 1352, Title 31, U.S. Code. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The undersigned certifies, to the best of his or her knowledge and belief, that:

Name/Address of Organization Name/Title of Submitting Official Signature Date

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

1. Type of Federal Action: _____

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. Status of Federal Action: _____

a. bid/offer/ application

b. initial award

c. post-award

3. Report Type: _____

a. initial filing

b. material change

For Material Change Only: Year _____ Quarter _____ Date of Last Report _________

4. Name and Address of Reporting Entity:

Prime

Subawardee

Tier, if known:

Congressional District, if known:

5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

Congressional District, if known:

CFDA Number, if applicable: ________________

10. a. Name and Address of Lobbying Entity: 10. b. Individuals Performing Services (including address if different from (last name, first name, MI) No. 10,a.)

(Attach Continuation Sheet(s) SF-LLL-A If Necessary) (if individual, last name, first name, middle)

11. Amount of Payment (check all that apply):

$ _________________ Actual $ _____________ Planned

13. Type of payment (check all that apply):

___ a. retainer

___ b. one-time fee

___ c. commission

___ d. contingent fee

___ e. deferred

___ f. other; specify:

12. Form of Payment (check all that apply):

___ a. cash

___ b. in-kind; specify:

Nature __________________________

Actual __________________________

14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or member(s) contracted for Payment indicated in Item 11:

(Attach Continuation Sheet(s) SF-LLL-A, if necessary)

Print Name: __________________________________________

Title: _______________________________________________

Telephone: ___________________________________________

Date: ________________________________________________

CONTINUATION SHEET SF-LLL-A

Reporting Entity: ___________________________________________________________________ Page _____ of _____

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. Section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Use of SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

1. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee; e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

1. If the organization filing the report in item 4 checks "Subawardee", then enters the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known.

2. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, the Department of Transportation, United States Coast Guard.

3. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

4. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) Number, Invitation for Bid (IFB) Number; grant announcement number; the contract, grant or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes; e.g., "RFP-DE-90-001."

5. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

6. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action.

7. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI).

8. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made.

9. Check all that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment.

10. Check all that apply. If other, specify nature.

11. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted.

Clean Air and Water Certificate Applicable if the contract exceeds $100,000 or the Contracting Officer has determined that the orders under an indefinite quantity contract in any one year will exceed $100,000 or a facility to be used has been the subject of a conviction under the Clean Air Act (41 U.S.C. 1857c-8(c)(1) or the Federal Water Pollution Control Act 33 1319(d) and is listed by EPA or the contract is not otherwise exempt.

Name of Distributor

THE COMPANY AGREES AS FOLLOWS:

A. To comply with all the requirements of Section 114 of the Clean Air Act, as amended (41 U.S.C. 1857, et seq., as amended by Public Law 91-604) and Section 308 of the Federal Water Pollution Control Act (33 U.S.C. 1251, et seq., as amended by Public Law 92-500), respectively, relating to inspection, monitoring, entry, reports and information as well as other requirements specified in Section 114 and Section 308 of the Air Act and the Water Act, respectively, and all regulations and guidelines issued there under before the award of this contract.

B. That no portion of the work required by this prime contract will be performed in a facility listed on the Environmental Protection Agency List of Violating Facilities on the date when this contract was awarded unless and until the EPA eliminates the name of such facility or facilities from such listing.

C. To use his/her best efforts to comply with clean air standards and clean water standards at the facilities in which the contract is being performed.

D. To insert the substance of the provisions of this clause in any nonexempt subcontract, including this paragraph.

THE TERMS IN THIS CLAUSE HAVE THE FOLLOWING MEANINGS:

A. The term "Air Act" means the Clean Air Act, as amended (41 U.S.C. 1957 et seq., as amended by Public Law 91-604).

B. The term "Water Act" means Federal Water Pollution Control Act, as amended (33 U.S.C. 1251 et seq., as amended by Public Law 92-500).

C. The term "Clean Air Standards" means any enforceable rules, regulations, guidelines, standards, limitations, orders, controls, prohibitions, or other requirements which are contained in, issued under, or otherwise adopted pursuant to the Air Act or Executive Order 11738, an applicable implementation plan as described in section 110(d) of the Clean Air Act (42 U.S.C. 1957c-5(d)), an approved implementation procedure or plan under Section 111(c) or Section 111(d), respectively, of the Air Act (42 U.S.C. 1857c-6(c) or (d)), or approved implementation procedure under Section 112(d) of the Air Act (42 U.S.C. 1857c-7(d)).

D. The term "Clean Air Standards" means any enforceable limitation, control, condition, prohibition, standard, or other requirement which is promulgated pursuant to the Water Act or contained in a permit issued to a discharger by the Environmental Protection Agency or by a State under an approved program, as authorized by Section 402 of the Water Act (33 U.S.C. 1342) or by local government to ensure compliance with pretreatment regulations as required by Section 307 of the Water Act (33 U.S.C. 1317).

E. The term "Compliance" means compliance with clean air or water standards. Compliance shall also mean compliance with a schedule or plan ordered or approved by a court of competent jurisdiction, the Environmental Protection Agency or an Air or Water Pollution Control Agency in accordance with the requirements of the Air Act or Water Act and regulations issued pursuant thereto.

F. The term "facility" means any building, plant, installation, structure, mine, vessel, or other floating craft, location or sites of operations, owned, leased or supervised by the Food Service Management Company.

Signature of Vendor’s Title Date Authorized Representative

EXCEPTIONS TO TERMS, CONDITIONS AND SPECIFICATIONS

Company Name Any exceptions to the Terms, Conditions, Specifications or Proposal Forms contained herein shall be noted in writing and included with the proposal submittal.

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