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