5-3 Acceptance and Disclosures Form.pdf

ACCEPTANCE AND DISCLOSURES FORM

As utilized herein, the term "Vendor" shall mean that entity submitting a bid/proposal to Gallup McKinley County

Schools (GMCS) in response to the attached solicitation.

ACCEPTANCE OF CONDITIONS GOVERNING PROCUREMENT

The Vender certifies that they have read and understand all general and special conditions and bid/proposal documents, and that they accept these conditions and submit the attached response in full compliance with these conditions, specifications, applicable scope of work, and contract. The Vendor agrees that the bid/proposal will remain firm for the period of up to 60 days in order to allow the District adequate time to evaluate the qualifications submitted.

CONFLICT OF INTEREST

The authorized Person, Firm and/or Corporation states that to the best of his/her belief and knowledge: No employee or board member of GMCS (or close relative), with the exception of the person(s) identified below, has a direct or indirect financial interest in the Vendor or in the proposed transaction. Vendor neither employs, nor is negotiating to employ any GMCS employee, board member or close relative, with the exception of the person(s) identified below. Vendor did not participate, directly or indirectly, in the preparation of specifications upon which the quote or offer is made.

CERTIFICATION OF NON-COLLUSION

Vendor certifies under penalty of perjury that its response to this procurement solicitation is in all respects bona fide, fair, and made without collusion or fraud with any person, joint venture, partnership, corporation or other business or legal entity.

Initials of Authorized Representative _________

DEBARMENT/SUSPENSION STATUS

The Vendor certifies that it is not suspended, debarred or ineligible from entering into contracts with the Federal Government, or any State agency or local public body, or in receipt of a notice or proposed debarment from any Federal or State agency or local public body. The vendor agrees to provide immediate notice to the GMCS Procurement Department in the event of being suspended, debarred or declared ineligible by any department or agency of the Federal government, or any agency of local public body of the State of New Mexico, or upon receipt of a notice of proposed debarment that is received after the submission of the quote or offer but prior to the award of the purchase order or contract.

CERTIFICATION

The undersigned hereby certifies that he/she has read the above ACCEPTANCE, CONFLICT OF INTEREST, NONCOLLUSION and DEBARMENT/SUSPENSION status requirements and that he/she understands and will comply with these requirements. The undersigned further certifies that they have the authority to sign, bind, and certify compliance for the Vendor named and that the information contained in this document is true and accurate to the best of their knowledge.

Signature Date

Name of Signatory Title

Email