4-AISDP 0005 - REPRESENTATIONS AND CERTIFICATIONS (1).pdf

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Attached to
Career and Technical Education (CTE) Student Growth Assessment and Teacher Incentive Allotment (TIA) and Support and Implementation Services
Solicitation number
3710-26.03
Issued by
Upton County, Amarillo City, Texas

About this file

This is a Representations and Certifications form (Index No. AISDP-0005) required as part of the Career and Technical Education (CTE) Student Growth Assessment and Teacher Incentive Allotment (TIA) and Support and Implementation Services solicitation issued by Amarillo Independent School District (ISD) in Texas. The form establishes the offeror's small business status and certification requirements. Offerors must declare whether they are certified Historically Underutilized Businesses (HUBs) and/or Minority, Women, Veteran Business Enterprises (MWVBEs), and if so, must provide their business classification and certifying agency documentation. The form requires offerors to certify their representations under penalty of law and obtain authorized signature, printed name, title, and date from the responsible party.

For offerors that are not certified HUBs or MWVBEs, the form requires disclosure of subcontracting intentions with certified HUB or MWBE vendors, including the percentage of work to be subcontracted if applicable. This certification document is a mandatory component of the proposal submission process and serves to establish compliance with the state and local small business enterprise requirements governing the Amarillo ISD procurement for CTE assessment solutions and Teacher Incentive Allotment support services.

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Index No. AISDP-0005 Page No. 1 of 1 Issue No. 001

REPRESENTATIONS AND CERTIFICATIONS

OFFEROR NAME: SOLICTATION #

CLAUSE NO. 1 OFFEROR SMALL BUSINESS REPRESENTATION

1. If Offeror is a Historically Underutilized Business (HUB) and/or Minority, Women, Veteran Business Enterprise (MWVBE), then complete Section 1.

2. If Offeror is NOT a HUB or MWVBE completed Section 2.

SECTION 1 - Offeror is a certified HUB or MWVBE

Offeror, list business HUB or MWVBE classification below and what group you have been certified by. Attach all current certifications to this form.

Business Classification Certifying Agency

SECTION 2 – Offeror IS NOT a certified HUB or MWVBE

☐ Offeror will not be subcontracting out any work related to this solicitation with a certified HUB or MWVBE.

☐ Offeror WILL be subcontracting out some work related to this solicitation with a certified HUB or MWVBE.

Percentage of Work to be subcontracted to a certified HUB or MWVBE

BY SIGNING BELOW, THE OFFEROR CERTIFIED, UNDER PENALTY OF LAW, THAT THE

REPRSENTATIONS AND CERTIFICATIONS IN CLAUSE 1 ARE ACCURATE, CURRENT AND

COMPLETE.

SIGNATURE:

(Print Name)

TITLE: DATE:

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