5-1. Attachment D - Agreement Certification Form.pdf

This is an Agreement Certification Form (Attachment D) related to a Disaster and/or Storm Recovery Services solicitation issued by the City of Liberty Hill, Texas. The form serves as a required submission component for respondents bidding on clearing and removal of eligible debris on an as-needed basis following disaster or storm events. The debris removal services must comply with Federal Emergency Management Agency (FEMA) Publication 325, all applicable State and Federal Disaster Specific Guidance documents, and directions provided by the City of Liberty Hill. Respondents must complete the form in its entirety and submit it as part of their solicitation response, with incomplete forms being rejected from consideration.

The Agreement Certification Form requires respondents to identify any requested changes to the original agreement language, provide justification for modifications, and obtain authorization from a company representative with binding authority to execute the contract. If no changes are requested, respondents need only complete the respondent name and solicitation number fields and mark the change request fields as "N/A." The form explicitly states that additions, deletions, or modifications that alter the legal or material nature of the original agreement language will not be accepted, and multiple forms may be submitted if necessary, provided they are sequentially numbered. All submissions must include the original agreement language alongside any proposed alternative language or justification to ensure clarity and compliance with the solicitation requirements.