3-Required Forms.pdf

ATTACHMENT E

Required Forms

Bidders shall execute the following required forms. Upload the signed original with the bid into Bonfire.

A. CONFLICT OF INTEREST QUESTIONNAIRE (provide proof of ONLINE submittal)

B. W-9 FORM

C. FELONY CONVICTION NOTICE FORM

D. SUSPENSION AND DEBARMENT CERTIFICATION

E. TEXAS GOVERNMENT CODE CHAPTER 2270 VERIFICATION FORM

F. TEXAS GOVERNMENT CODE CHAPTER 2271 and CHAPTER 2274

VERIFICATION FORM

G. CERTIFICATE OF INTERESTED PARTIES – FORM 1295 (required post award)

H. PROPOSAL GUARANTEE / BID BOND

This information can be found on the District’s website: https://www.austinisd.org/cp

For vendor doing business with local governmental entity

This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.

This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).

By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.

A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code.

An offense under this section is a misdemeanor.

To access the CIQ electronic form and submit online, go to the district’s website:

https: //www.austinisd.org/cp/ciq-online https://www.austinisd.org/cp https://www.austinisd.org/cp/ciq-online

Certification

Vendor must submit a current Form W-9 Request for Taxpayer Identification

Number and Certification with their response to this solicitation.

Austin ISD must obtain certification of your taxpayer identification number (TIN) to establish a record in our vendor database and to report income paid to you.

By submitting a Form W-9, you are certifying that the Tax ID number you are providing is correct and accurate.

http://www.irs.gov/pub/irs-pdf/fw9.pdf http://www.irs.gov/pub/irs-pdf/fw9.pdf

25CSP025/ 23-0048-RDRGZ

FELONY CONVICTION NOTICE FORM

Statutory citation covering notification of criminal history of contractor is found in the Texas Education Code §44.034.

FELONY CONVICTION NOTIFICATION

I, the undersigned agent for the firm named below, certify that the information concerning notification of felony convictions has been reviewed by me and the following information furnished is true to the best of my knowledge.

VENDOR’S NAME:

AUTHORIZED COMPANY OFFICIAL’S NAME:

A. My firm is a publicly-held corporation, therefore, this reporting requirement is not applicable.

Signature of Company Official:

B. My firm is not owned nor operated by anyone who has been convicted of a felony.

Signature of Company Official:

C. My firm is owned or operated by the following individual(s) who has/have been convicted of a felony.

Name of Felon(s):

(attach additional sheet if necessary)

Details of Conviction(s):

(attach additional sheet if necessary)

Signature of Company Official:

25CSP025/ 23-0048-RDRGZ

SUSPENSION AND DEBARMENT CERTIFICATION

Federal Law (A-102 Common Rule and OMB Circular A-110) prohibits non-federal entities from contracting with or making subawards under covered transactions to parties that are suspended or debarred or whose principals are suspended or debarred. Covered transactions include procurement contracts for goods or services equal to or in excess of $25,000 and all nonprocurement transactions (e.g., subawards to subrecipients).

Contractors receiving individual awards of $25,000 or more and all subrecipients must certify that their organization and its principals are not suspended or debarred by a federal agency.

Before an award of $25,000 or more can be made by your firm, you must certify that your organization and its principals are not suspended or debarred by a federal agency.

I, the undersigned agent for the firm named below, certify that neither this firm nor its principals are suspended or debarred by a federal agency.

VENDOR’S NAME:

Signature of Company Official:

Date Signed:

Printed name of company official signing above:

AUSTIN INDEPENDENT SCHOOL DISTRICT

TEXAS GOVERNMENT CODE CHAPTER 2270 VERIFICATION FORM

25CSP025 / 23-0048-RDRGZ

Texas Government Code Chapter 2270 prohibits the District from entering into a contract for goods or services that (a) has a value of $100,000 or more that is to be paid wholly or partly from public funds and (b) is with a for-profit company, not including a sole proprietorship, that has 10 or more full time employees unless the contract contains a written verification from the company that it does not boycott Israel and will not boycott Israel during the term of the contract.

The following definitions apply to Texas Government Code Section 2270.001:

(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 limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit. State law requires any firm entering into an agreement or contract with the Authority to complete the foregoing verification.

By signing below, the authorized representative hereby verifies that the company:

(1) Does not boycott Israel; and

(2) Will not boycott Israel during the term of the contract.

SIGNED BY:

Print Name & Title:

Company Name:

Date Signed:

Rev. 7/19/2021

Solicitation Number: 25CSP025 Renovations at Rodriguez Elementary School

AUSTIN INDEPENDENT SCHOOL DISTRICT

TEXAS GOVERNMENT CODE CHAPTER 2271 and CHAPTER 2274

VERIFICATION FORM

Texas Government Code Chapters 2271 and 2274 prohibit the District from entering into a contract for goods or services that (a) has a value of $100,000 or more that is to be paid wholly or partly from public funds and (b) is with a company that has 10 or more full time employees unless the contract contains written verifications from the company that it does not boycott Israel, does not boycott energy companies, or discriminate against a firearm entity or firearm trade association; and will not boycott Israel, will not boycott energy companies, or discriminate against a firearm entity or firearm trade association during the term of the contract.

The following definitions apply to this verification:

(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 organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit. State law requires any firm entering into an agreement or contract with the Authority to complete the foregoing verification. “Company” does not include a sole proprietorship.

(3) "Discriminate against a firearm entity or firearm trade association": (A) means, with respect to the entity or association, to: (i) refuse to engage in the trade of any goods or services with the entity or association based solely on its status as a firearm entity or firearm trade association; (ii) refrain from continuing an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; or (iii) terminate an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; and (B) does not include: (i) the established policies of a merchant, retail seller, or platform that restrict or prohibit the listing or selling of ammunition, firearms, or firearm accessories; and (ii) a company ’s refusal to engage in the trade of any goods or services, decision to refrain from continuing an existing business relationship, or decision to terminate an existing business relationship: (aa) to comply with federal, state, or local law, policy, or regulations or a directive by a regulatory agency; or (bb) for any traditional business reason that is specific to the customer or potential customer and not based solely on an entity ’s or association ’s status as a firearm entity or firearm trade association.”

Rev. 11/16/2021

(4) “Boycott energy company" means, without an ordinary business purpose, 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 with a company because the company: (A) engages in the exploration, production, utilization, transportation, sale, or manufacturing of fossil fuel-based energy and does not commit or pledge to meet environmental standards beyond applicable federal and state law; or (B) does business with a company described by Paragraph (A).”

By signing below, the authorized representative hereby verifies that the company:

(Texas Government Code 2271)

(1) Does not, and will not for the duration of the contract, boycott Israel; or

(2) The verification required by Texas Government Code 2271.002 does not apply to the contract.

(Texas Government Code 2274)

(1) Does not, and will not for the duration of the contract, boycott energy companies;

or

(2) The verification required by Section 2274.002 of the Texas Government Code that the company does not, and will not for the duration of the contract, boycott energy companies does not apply to the contract.

(3) 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; or

(4) The verification required by Section 2274.002 of the Texas Government Code that the company 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 does not apply to the contract.

Exemption from verification criteria includes the following:

1. Company employs less than 10 full-time employees; AND

2. Value of the contract is less than $100,000.

SIGNED BY:

Print Name & Title:

Company Name:

Date Signed:

Rev. 11/16/2021

AUSTIN ISD CERTIFICATE OF INTERESTED PARTIES – FORM 1295

Certificate of Interested Parties (Form 1295 – must be filled out electronically with the Texas Ethics Commission’s online filing application, printed out, signed, and attached to vendor’s response to this solicitation.

AUSTIN ISD is required to comply with House Bill 1295, which amended the Texas Government Code by adding Section 2252.908, Disclosure of Interested Parties. Section 2252.908 prohibits AISD from entering into a contract resulting from this CSP with a business entity unless the business entity submits a Disclosure of Interested Parties (Form 1295) to AISD at the time business entity submits the signed contract. The Texas Ethics Commission has adopted rules requiring the business entity to file Form 1295 electronically with the Texas Ethics Commission.

“Interested Party” means a person:

a) who has a controlling interest in a business entity with whom AISD contracts; or

b) who actively participates in facilitating the contract or negotiating the terms of the contract, including a broker, intermediary, adviser, or attorney for the business entity.

“Business Entity” means an entity recognized by law through which business is conducted, including a sole proprietorship, partnership, or corporation.

As a “business entity,” all vendors must electronically complete, print, sign, and submit Form 1295 with their proposals even if no interested parties exist.

Proposers must file Form 1295 electronically with the Texas Ethics Commission using the online filing application, which can be found at:

https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm

Proposers must use the filing application on the Texas Ethics Commission’s website to enter the required information on Form 1295. Proposers must print a copy of the completed form, which will include a certification of filing containing a unique certification number. The Form 1295 must be signed by an authorized agent of the business entity.

The completed Form 1295 with the certification of filing must be filed with AISD by attaching the completed form to the vendor’s solicitation response.

AISD must acknowledge the receipt of the filed Form 1295 by notifying the Texas Ethics Commission of the receipt of the filed Form 1295 no later than the 30th day after the date the contract binds all parties to the contract. After AISD acknowledges the Form 1295, the Texas Ethics Commission will post the completed Form 1295 to its website with seven business days after receiving notice from AISD.

http://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm