5-2 - Proposal Affidavit rev.081325 fillable.pdf

PROPOSAL AFFIDAVIT

The undersigned makes the following certifications or represents that it satisfies the requirements of one or more exceptions to the Texas Government Code provisions listed below:

1. Consultant Certification Regarding Boycotting Israel. Pursuant to Chapter 2271, Texas Government Code, Firm certifies that it

(1) is a sole proprietorship or company with fewer than ten (10) employees; or (2) does not currently boycott Israel and will not boycott Israel during the term of this Agreement.

1.1. Exception: This provision only applies to contracts for goods and services between a governmental entity and a Company with ten (10) or more full-time employees with a value of $100,000 or more that is to be paid wholly or partly from public funds of the governmental entity.

2. Consultant Certification Regarding Business with Certain Countries and Organizations. Pursuant to Subchapter F, Chapter 2252, Texas Government Code, Firm certifies it (1) is a “Company,” as that term is defined in Texas Government Code Section 806.001; and (2) is not engaged in business with Iran, Sudan, a foreign terrorist organization, or any company that is identified on a list prepared and maintained under Texas Government Code Section 806.051, 807.051, or 2252.153.

2.1. Exception: A company that the United States government affirmatively declares to be excluded from its federal sanction’s regime relating to Sudan, its federal sanctions regime relating to Iran, or any federal sanctions regime relating to a foreign terrorist organization is not subject to contract prohibition under this subchapter.

3. Consultant Certification Regarding Boycotting Energy Companies. Pursuant to Chapter 2276, Texas Government Code, Firm certifies that either (1) is a sole proprietorship or company with fewer than ten (10) employees; or (2) Firm does not currently boycott energy companies and will not boycott energy companies during the Term of this Agreement.

3.1. Exception: This provision only applies to contracts for goods and services between a governmental entity and a Company with ten (10) or more full-time employees with a value of $100,000 or more that is to be paid wholly or partly from public funds of the governmental entity.

4. Consultant Certification Regarding Boycotting Firearm and Ammunition Industries. Pursuant to Chapter 2274, Texas Government Code, Firm certifies that either (1) Consultant is a sole proprietorship or company with fewer than ten (10) employees;

or (2) Firm does not currently boycott firearm and ammunition industries and will not boycott firearm and ammunition industries during the term of this Agreement.

4.1. Exception: This provision only applies to contracts for goods and services between a governmental entity and a Company with ten (10) or more full-time employees with a value of $100,000 or more that is to be paid wholly or partly from public funds of the governmental entity.

5. Consultant Certification Regarding Doing Business in Texas. Firm certifies that it has not been debarred from doing business in the State of Texas.

6. Interlocal Agreement Adoption of Awarded Contracts. In support of this collaborative effort, all awards made by Williamson County may be adopted by other agencies. By signing below, you acknowledge other entities will be able to piggyback from County awarded contracts and solicitations. This does not apply to Professional Services.

I hereby certify that the foregoing Proposal has not been prepared in collusion with any other Respondent or other person or persons engaged in the same line of business prior to the official opening of this Proposal. Further, I certify that the Respondent is not now, nor has been for the past six (6) months, directly or indirectly concerned in any pool or agreement or combination, to control the price of services/commodities Proposal on, or to influence any person or persons to submit a Proposal or not to submit a Proposal thereon.

Firm acknowledges this Agreement may be terminated and payment withheld if this certification is inaccurate. For purposes of this form, the terms have the meanings assigned by Texas Government Code sections referenced above.

Signed By: ___________________________________ Title: _________________________________________________

Company Name: ______________________________Date: _________________________________________________

Name: ______________________________________ Email:_________________________________________________

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