2026-0431 Mandatory Forms.pdf

Subcontractor and/or Supplier Identification

Solicitation No. 2026-0431 Fire Systems Inspections, Parts and Service (re-bid)

Bidder: _______________________________________________________

The Bidder shall indicate below the name of each subcontractor and/or supplier the bidder will use in the performance of the contract. The Bidder shall specify the work to be performed by the subcontractor or the materials to be provided by the supplier, the amount of the subcontract or purchase order, and the percentage of the contract the Bidder will expand throughout the life of the project. Any changes in subcontractor and/or supplier listed below may require additional approval according to the terms and conditions.

NOTE: Subcontractors listed in Reference Section must appear on this list.

Name Address & Phone

Number Service /Supplies Subcontract Value % of Contract

Total

*Use as many forms as needed

2026-0215 Fire Systems Inspections, Parts and Service

Non-Collusion and Business Disclosure Affidavit P a g e | 1

Purchasing & Strategic Sourcing Department

Non-Collusion and Business Disclosure Affidavit

THIS IS AN OFFICIAL PURCHASING & STRATEGIC SOURCING DEPARTMENT DOCUMENT – RETAIN WITH

PROCUREMENT FILE

Before me, the undersigned official, on this day, personally appeared ____________________________________, a person known to me to be the person whose signature appears below; whom after being duly sworn upon his/her oath deposed and said:

1. I am over the age of 18, have never been convicted of a crime and am competent to make this affidavit.

2. I am a duly authorized representative of the following company or firm (the “Offeror”) which is submitting a response to 2026-0431 Fire Systems Inspections, Parts and Service (Re-bid))

_______________________________________________________________ (Name of Offeror).

3. BY SUBMITTING THIS BID, I CERTIFY THAT OFFEROR AND ITS AGENTS, OFFICERS OR EMPLOYERS

HAVE NOT DIRECTLY OR INDIRECTLY ENTERED INTO ANY AGREEMENTS, PARTICIPATED IN ANY

COLLUSION, OR OTHERWISE TAKEN ANY ACTION IN RESTRAINT OF FREE COMPETITIVE BIDDING

IN CONNECTION WITH THIS PROPOSAL OR WITH ANY CITY OFFICIAL.

4. I have listed in Paragraph 10 below all the names the Offeror uses and has used in the past and certify that I have disclosed all such names, including any assumed (DBA) names.

5. Certificate of Organization. In completing this Affidavit, I have attached a copy of the organization certificate issued by the Secretary of State of the state in which the company was organized (i.e. Certificate of Formation, Certificate of Good Standing, Statement of Operation or Registration and/or a copy of Assumed Name Certificate if the Offeror/Offeror used a trade name in the Solicitation documents is other than the name under which company was organized).

6. Material Change in Organization or Operation. Except as described in Paragraph 10 below, I certify that Offeror is not currently engaged nor does it anticipate that it will engage in any negotiation or activity that will result in the merger, transfer of organization, management reorganization or departure of key personnel within the next twelve (12) months that may affect the Offeror’s ability to carry out the contract with the City of El Paso.

7. Debarment/Suspension. Except as described in Paragraph 10 below, I certify that Offeror and its subcontractors, officers or agents are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from any covered transactions by any federal, state or local department or agency. If such an event has occurred, state in Paragraph 10 below, the reason for or the circumstances surrounding the debarment or suspension, including but, not limited to, the name of the governmental entity, the period of time for such debarment or suspension and provide the name and current phone number of a governmental contact person familiar with the debarment or suspension.

I understand the Offeror is obligated to immediately inform the City in the event that the Offeror is included in such a debarment/suspension list during the performance of this Contract with the City of El Paso.

8. Default/Termination of Contracts. Except as described in Paragraph 10 below, I certify that, within the last 24 months, there are no Contract(s) between the Offeror and a governmental entity that have been terminated, with or without the Offeror’s default. If such a contract has been terminated within the last 24 months, state in Paragraph 10 below the reason for or circumstances surrounding the termination.

2026-0215 Fire Systems Inspections, Parts and Service

Non-Collusion and Business Disclosure Affidavit P a g e | 2

9. Taxpayer Identification. In completing this Affidavit, I have also attached a copy of a completed Form W-9 that shows the Offeror’s taxpayer identification number (Employer Identification Number or Social Security Number). I understand that failure to provide this information may require the City to withhold 20% of payments due under the contract and pay that amount directly to the IRS.

10. Additional Information (state the number of paragraph above which corresponds to the information provided)

(Attach additional pages if needed)

Attached are the following:

Certificate of Organization (required by Paragraph 5) Taxpayer Identification (required by Paragraph 9)

I understand that by providing false information on this Affidavit, I could be found guilty of a Class A misdemeanor or state jail felony under the Texas Penal Code, Section 37l10. In addition, by providing false information on this Affidavit, the Offeror it could be considered not responsible on this and future solicitations, and such determination could result in the discontinuation of any/all business or contracts with the Offeror by the City of El Paso.

Signature

SUBSCRIBED AND SWORN to before me on this ___________ day of ______________________, 20 .

Notary Public

Printed Name

Commission Expires

(Rev. Sept. 2009)

2026-0431 Fire Systems Inspections, Parts and Service (Re-bid)

Indebtedness Affidavit P a g e | 1

City of El Paso Purchasing & Strategic Sourcing Department

INDEBTEDNESS AFFIDAVIT

THIS IS AN OFFICIAL PURCHASING & STRATEGIC SOURCING DEPARTMENT DOCUMENT – RETAIN WITH THE

PROCUREMENT FILE

Before me, the undersigned authority, on this day personally appeared ____________________________________ [FULL NAME] (hereafter “Affiant”), a person known to me to be the person whose signature appears below, whom after being duly sworn upon his/her oath deposed stated as follows:

1. Affiant is authorized and competent to give this affidavit and has personal knowledge of the facts and matters herein stated.

2. Affiant is an authorized representative of the following company or firm:

___________________________________________ [Contracting Entity’s Corporate or Legal Name] (hereafter, “Contracting Entity”).

3. Affiant is submitting this affidavit in response to the following solicitation:

[2026-0215 Fire Systems Inspections, Parts and Service] which is expected to be in an amount that exceeds $25,000.

4. Contracting Entity is organized as a business entity as noted below (check box as applicable):

For Profit Entity (select below): For Non-Profit Entity (select below):

Sole Proprietorship Non-Profit Corporation Corporation Unincorporated Association Partnership Limited Partnership Joint Venture Limited Liability Company Other (Specify type in space provided below):

5. The information shown below is true and correct for the Contracting Entity and all owners of 5% or more of the Contracting Entity and, where the Contracting Entity is a non-profit entity, the required information has been shown for each officer. [Note: In all cases, use FULL name, business and residence addresses and telephone numbers.]

Contracting Entity:

Name

Business Address [No./Street]

Indebtedness Affidavit P a g e | 2

City/State/Zip Code

Telephone Number Resident Address (if applicable) City/State/Zip Code

Telephone Number

Federal Tax ID Number

Texas Sales Tax Number

5% Owner(s)** (If none, state “None”):

Name

Business Address [No./Street]

City/State/Zip Code

Telephone Number Resident Address (if applicable) City/State/Zip Code

Telephone Number

**Attach additional pages if necessary to supply the required names and addresses.

6. Affiant understands that in accordance with Ordinance No. 016529 of the City of El Paso (the “City”), the City may refuse to award a contract to or enter into a transaction with an apparent low bidder or successful proposer that is indebted to the City.

7. Affiant understands that the term “Debt” shall mean any sum of money, which is owed to the City by a Contracting Entity, Owner, or Vendor, that exceeds one hundred dollars ($100.00) and that has become Delinquent, as defined hereinafter. Such Debt shall include but not be limited to: (i) property taxes; (ii) hotel/motel occupancy taxes; and (iii) license and permit fees.

8. Affiant understands that the term “Delinquent” shall mean any unpaid Debt that is past due for sixty

(60) days or more and, which is not currently subject to challenge, protest, or appeal.

9. Affiant represents that to the best of its knowledge, the Contracting Entity is not indebted to the City in any amounts as described in Item No. 7 above, as of the date of the submittal. If the Contracting Entity is indebted to the City, the following represents the type and estimated amount of indebtedness:

10. If the Contracting Entity is indebted to the City, describe any payment arrangements that have been entered into to settle the Debt.

11. In the event that the City refuses to do business with a Contracting Entity due to any indebtedness listed above or as determined by the City Financial Services Department, the Contracting Agency may appeal this determination in accordance with the appeal regulations in Ordinance 016529.

Indebtedness Affidavit P a g e | 3

Affiant certifies that he is duly authorized to submit the above information on behalf of the Contracting Entity, that Affiant is associated with the Contracting Entity in the capacity noted above and has personal knowledge of the accuracy of the information provided herein; and that the information provided herein is true and correct to the best of Affiant’s knowledge and belief. Affiant understands that providing false information on this form shall be grounds for debarment and discontinuation of any/all business with the City of El Paso.

Signature

SUBSCRIBED AND SWORN to before me on this _____________ day of _________________________, 20_____.

Notary Public

Printed Name

Commission Expires

City of El Paso Purchasing & Strategic Sourcing Department

Certification Regarding Terrorist Organizations & Boycotting of Israel for

2026-0215 Fire Systems Inspections, Parts and Service

THIS IS AN OFFICIAL PURCHASING DOCUMENT – RETAIN WITH THE PROCUREMENT FILE

I, _______________________________________________ (Full Name) the undersign representative of ____________________________________________ (Company Name) (herein after referred as Vendor) hereby Certifies that:

1. It is not a company identified on the Texas Comptroller’s list of companies known to have contracts with, or provide supplies or services to, a foreign organization designated as a Foreign Terrorist Organization by the U.S. Secretary of State.

2. Vendor further certifies and verifies that neither Vendor, nor any affiliate, subsidiary or parent company of Vendor, if any (the “Vendor Companies”), boycotts Israel and Vendor agrees that Vendor and Vendor Companies will not boycott Israel during the term of this agreement. For purposes of this Agreement, the term “boycott” shall mean and include terminating business activities or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory.

(See Texas Government Code Chapter 2270.002 and 2252.151-154.)

Signature

Date

Certification Regarding Boycotting of Energy Company

2026-0431 Fire Systems Inspections, Parts and Service (Re-bid)

THIS IS AN OFFICIAL PURCHASING DOCUMENT – RETAIN WITH THE PROCUREMENT FILE

I, (Full Name) the undersign representative of _________________________________________________ (Company Name) (herein after referred as Vendor) hereby Certifies that:

1. It is not a company identified on the Texas Comptroller’s list of companies known to boycott energy companies, as defined in Texas Government Code Chapter 809.

2. Vendor further certifies and verifies that neither Vendor, nor any affiliate, subsidiary or parent company of Vendor, if any (the “Vendor Companies”), boycotts energy companies and Vendor agrees that Vendor and Vendor Companies will not boycott energy companies during the term of this agreement pursuant to the provisions of Texas Government Code Chapter 809. For purposes of this Agreement, the term “boycott energy company” shall have the meaning defined in Texas Government Code Chapter 809.

Signature

Cert re: Boycott of Energy Companies ǀ 21-1044-1638 ǀ 1121835 ǀ (rev 2021.09)

Certification Regarding Discrimination Against Firearm & Ammunition Industries

2026-0431 Fire Systems Inspections, Parts and Service (Re-bid)

THIS IS AN OFFICIAL PURCHASING DOCUMENT – RETAIN WITH THE PROCUREMENT FILE

I, (Full Name) the undersign representative of _________________________________________________ (Company Name) (herein after referred as Vendor) hereby Certifies that:

1. neither Vendor, nor any affiliate, subsidiary or parent company of Vendor, if any (the “Vendor Companies”), does not have a written or unwritten internal practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association based solely on its status as a firearm entity or firearm trade association; and

2. Vendor agrees that Vendor and Vendor Companies will not discriminate during the term of the contract against a firearm entity or firearm trade association based solely on its status as a firearm entity or firearm trade association during the term of this agreement pursuant to the provisions of Texas Government Code Chapter 2274.

For purposes of this Agreement, the term “"Discriminate against a firearm entity or firearm trade association” shall have the meaning defined in Texas Government Code Chapter 2274.

Signature

Cert re: Non-Discrimination against a firearm entity or firearm trade association ǀ 21-1044-1638 ǀ 1121836 ǀ (rev 2021.09)

Contract Award

PURCHASING – Environmental Services