5-4. KIPP Texas Vendor Packet - Federal Funds Packet.pdf

Hello - KIPP Texas is pleased to potentially be working with you as a vendor! To facilitate KIPP Texas’ review of your organization, the attached Vendor Packet must be completed in its entirety. Please read this cover page in full, as it contains important information, and note that omission of any information may result in delays and/or denial in obtaining KIPP Texas Approved Vendor status.

The entire Vendor Packet must be submitted at the time the proposal is due, no exceptions. Failure to accurately complete the Vendor Packet within this timeline will result in automatic termination of the vendor review process and may result in the inability to reapply for approval as an Approved Vendor for a period of time.

The Vendor Packet should take ~20 minutes to complete, as the information requested is industry standard for any counterparty.

Optional Items:

1) Vendor Information Form

a) Rationale: used to determine corporate status, confirm legal entity, and provide contact information to support payment(s)

b) Anticipated time to complete: 5 minutes

2) Conflict of Interest & No DEI Duties

a) Rationale: identifies potential risks associated with pre-existing relationships between vendors and KIPP Texas’

Board and/or Officers

b) Anticipated time to complete: 4 minutes

3) W-9 Form

a) Rationale: the Internal Revenue Service requires that KIPP Texas obtain this form

b) Anticipated time to complete: 0 minutes, as every business should have on file

4) Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form

5) Felony Conviction Notification

6) Certificate of Residency

7) Service Provider Certifications (required only for Services)

a) Rationale: Texas law requires compliance with reporting requirements, prohibits employment of individuals on the Do Not Hire Registry, requires completion of pre-service affidavits, and protects KIPP Texas’ students by identifying background check requirements related to individuals who will be present on a KIPP Texas campus

b) Anticipated time to complete: 7 minutes

8) EDGAR Certifications

9) ACH Authorization

a) This form is currently optional, as our vendors are being set up to receive check payments by default.

b) If your business requires ACH payments, please fill this out in its entirety and let us know when you submit your packet so that we can flag your profile for ACH verification.

c) Note that ACH verification must happen via phone call and payments will remain as checks until your account is verified.

d) Anticipated time: 2 minutes

KIPP Texas’ due diligence process may take up to three weeks and cannot begin until a Vendor Packet is completed in its entirety. Upon completion of the due diligence process, a vendor will be notified via email as to if it has obtained Approved Vendor status with KIPP Texas; until this written confirmation is received, a vendor is not permitted to accept any requests for goods and/or services for KIPP Texas. Payment will not be provided for any goods and/or services initiated prior to formal notification of Approved Vendor status from KIPP Texas’ Vendor Onboarding team.

Please contact us at vendor.info@kipptexas.org with any questions. Thank you and we look forward to your response!

Below are the items required, as well as the rationale and anticipated time to complete:

Rev Sept 2025 mailto:vendor.info@kipptexas.org

KIPP Texas Vendor Packet - Goods and/or Services

All vendors doing business with KIPP Texas (KIPP) must complete and submit a Vendor Packet that consists of the following documents:

1. Vendor Information Form

2. Conflict of Interest & No DEI Duties

3. W-9 Form

4. Debarment, Suspension, Ineligibility or Voluntary Exclusion Certification Form

5. Felony Conviction Notification

6. Certificate of Residency

7. Service Provider Certifications

8. EDGAR Certifications

9. ACH Authorization

Please note that omission of any information may result in delays in obtaining KIPP Texas Approved Vendor status

KIPP Texas Vendor Information Form

Zip Code:

Primary Address:

City:

State:

Country:

Phone: Fax:

Zip Code:

- Fax:

Phone:

Check here if remittance address is same as primary Remittance Address:

City:

State:

Country:

Phone:

Contact Name:

Total Number of Employees:

Primary KIPP Texas contact (person requesting goods and /or services)

PAYMENT METHOD - I am requesting payment via:

Check (default) ACH (requires additional verification)

Please note that KIPP Texas's default payment method is check. ACH requires additional verification via phone call. Until verified, payment will be mailed as a paper check. Please ensure that if you check ACH, you fill out the optional ACH form in its entirety & include supporting documentation (voided check or bank letter).

Will any of the goods and/or services provided require your company's personnel to be physically present on a KIPP campus? (Select one)

Yes No Potentially

*Note that primary address cannot be a PO Box

Title:

Contact Email:

Email for Payment Receipts, if different than contact email:

Years in Business:

Goods or services provided by your company:

Please note: If requesting ACH, payment receipts will be emailed to the email address on the ACH form, if different than above. Check here if payment email is for receipts only

Legal Name:

Trade Name (dba):

Website:

Is this business a franchise? Yes No

In which of KIPP Texas's regions does your company provide goods/services? Please select all that apply.

Houston Austin Dallas San Antonio Outside of KIPP Texas Regions

PLEASE SELECT THE BEST CATEGORY OF GOODS/SERVICES PROVIDED BY YOUR COMPANY:

Contracted Services:

● Academics Services

● Child Nutrition / Food

Service

● Clinical Supervision

● Consultants

● Copy Machines

● Equipment Repair Services

● Financial Services

● Fundraising Services

● HR Services

● Insurance Services

● IT Services

● Law Enforcement Officer

● Legal Services

● Mailing Services

● Marketing Services

● Massage Therapists

● Medical

● Printing Services

● Professional Coaching

● Professional Development

● Recruitment Support

● Security Guards

● School Picture Day Services

● Shredding Services

● SpEd

● Translation Services

● Video Marketing

● Other Services

Curriculum:

● Arts

● CTE

● ELA

● Math

● PE / Athletics

● Science

● Social Studies

● World Languages

● Other

Entertainment/Events:

● A/V Equipment Rental

● Bakeries

● Balloons

● Catering

● Decor

● DJs

● Floral

● Furniture Rental

● Meet Entry Fees

● Meeting Space

● Party Rental

● Performers

● Photography

● Recruitment Booths

● Stage Rental

● Team Retreat /

Corporate Team Building

● Venue

● Other Entertainment

● Other Rental

Facilities:

● Carpentry

● Cleaning Services

● Construction Services

(Architects / GCs)

● Electrician Services

● Elevator Service / Inspection

● Equipment Rental

● Facilities Supplies

● Fire Safety & Systems

● Flags / Flagpoles

● Flooring

● Furniture, Fixtures, &

Equipment

● Glass / Mirror

● Handyman

● HVAC

● Landscaping

● Large Scale Sports Equipment

● Locksmith

● Painting

● Pest Control

● Plumbing

● Roofing

● Security Cameras / Systems

● Storage Units

● Other Facilities

Partnerships:

● Community Partners

● Government Entity

● Organizations

● School Districts

● Universities

Supplies:

● Academic Supplies

● Apparel

● Athletic Apparel

● Audio-Visual Equipment

● Band Instruments

● Book Publisher

● Cheer Uniforms / Supplies

● Customized Goods / Branded

Products

● Dance Apparel/Supplies

● Embroidery

● Fine Art Supplies

● Graduation

● Janitorial Supplies

● Medical Supplies

● Office Supplies

● Robotics

● School Supplies

● Signage

● Sports Equipment

● Student IDs

● Trophies / Awards

● Yearbook

● Other Supplies

Technology:

● Digital Subscriptions

● SaaS

● Software

● Technology Supplies

● Other Technology

Travel:

● Buses

● Field Trips

● Hotels

● Moving

● Other Travel

If other, please describe:

CONFLICT OF INTEREST & NO DEI DUTIES

KIPP Texas is required to comply with Texas Local Government Code Chapter 176, Disclosure of Certain Relationships with Local Government Officers. Any vendor who does business with KIPP or who seeks to do business with KIPP must complete the new Conflict of Interest Questionnaire (CIQ) whether or not a conflict of interest exists. A conflict of interest exists in the following situations:

1) If the vendor has an employment or other business relationship with a local government officer of KIPP or a family member of the officer, as described by section 176.003(a)(2)(A) of the Texas Local Government Code; or

2) If the vendor has given a local government officer of KIPP, or a family member of the officer, one or more gifts with the aggregate value of $100, excluding any gift accepted by the officer or a family member of the officer if the gift is: (a) a political contribution as defined by Title 15 of the Election Code; or (b) a gift of food accepted as a guest; or

3) If the vendor has a family relationship with a local government officer of KIPP, a family member of the officer, or any KIPP Texas employee.

“Vendor” means a person who enters or seeks to enter into a contract with a local governmental entity, including a charter school. The term includes an agent of a vendor. The term includes an officer or employee of a state agency when that individual is acting in a private capacity to enter into a contract. The term does not include a state agency except for Texas Correctional Industries. Texas Local Government Code 176.001(7).

“Business relationship” means a connection between two or more parties based on commercial activity of one of the parties.

The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Texas Local Government Code 176.001(3).

“Family relationship” means a relationship between a person and another person within the third degree by consanguinity or the second degree by affinity, as those terms are defined by Subchapter B, Chapter 573, Government Code. Texas Local Government Code 176.001(2-a).

“Local government officer” means: (A) a member of the governing body of a local governmental entity; (B) a director, superintendent, administrator, president, or other person designated as the executive officer of a local governmental entity; or

(C) an agent of a local governmental entity who exercises discretion in the planning, recommending, selecting, or contracting of a vendor. Texas Local Government Code 176.001(4).

If you have a conflict of interest with any KIPP Texas employee, agent, board member, or related party you must submit a Conflict of Interest Questionnaire - Form CIQ

You can find the form here: https://www.ethics.state.tx.us/data/forms/conflict/CIQ.pdf

Please answer the following four questions. Please note that failure to properly disclose any information below may lead to criminal prosecution.

Are you a current employee of KIPP Texas?

Have you ever been an employee of KIPP Texas?

Are you related, in any way, to a board member of KIPP Texas or any employee of KIPP Texas?

I agree to notify KIPP Texas immediately if a gift or favor is offered to my company or any employee of my company by a KIPP Texas employee.

Yes

Yes No

No

Yes No

Yes No 6 of 23

CERTIFICATION REGARDING NO DIVERSITY, EQUITY, AND INCLUSION DUTIES

For purposes of this certification, “diversity, equity, and inclusion duties” means (1) influencing hiring or employment practices with respect to race, sex, color, or ethnicity except as necessary to comply with state or federal antidiscrimination laws; (2) promoting differential treatment of or providing special benefits to individuals on the basis of race, color, or ethnicity; (3) developing or implementing policies, procedures, trainings, activities, or programs that reference race, color, ethnicity, gender identity, or sexual orientation except: (A) for the purpose of student recruitment efforts by colleges and universities designated as historically black colleges and universities in collaboration with open-enrollment charter schools; or (B) as necessary to comply with state or federal law; and (4) compelling, requiring, inducing, or soliciting any person to provide a diversity, equity, and inclusion statement or giving preferential consideration to any person based on the provision of a diversity, equity, and inclusion statement.” TEX. EDUC. CODE § 11.005(a). In accordance with Texas Education Code § 11.005, Vendor hereby certifies that it does not and will not engage in diversity, equity, and inclusion duties at, for, or on behalf of KIPP Texas. Vendor acknowledges that if Vendor engages in DEI duties, the Vendor’s Agreement with KIPP Texas is subject to termination; any appeal of any termination shall be governed by KIPP Texas’ member of the public complaint/grievance policy/procedures.

______ Initials of Authorized Representative of Vendor

CERTIFICATION REGARDING VENDOR’S CONFLICT OF INTEREST

For purposes of this certification, “Vendor” means “a company, individual, contractor, subcontractor, or professional services provider with whom an open-enrollment charter school enters into an agreement, contract, memorandum of understanding, interlocal agreement, fee schedule, retainer, or similar instrument for goods or services.” TEX. EDUC. CODE § 11.067(a).

Vendor acknowledges that it commits a criminal offense if Vendor bids on or receives a contract from KIPP Texas if any individual serving on KIPP Texas’ Board of Directors (1) has a substantial interest in the Vendor or a subcontractor hired by the Vendor (meaning the trustee owns more than 10% of the voting interest in the Vendor or has a direct or indirect participating interest by shares, stock, or otherwise, regardless of whether voting rights are included, in more than 10% of the profits, proceeds, or capital gains of the Vendor); (2) is related in the second degree by consanguinity or affinity to an individual who has a substantial interest in the Vendor; or (3) has received or has been promised a gift or in-kind services with a value of more than $250.

______ Initials of Authorized Representative of Vendor

Form W-9 (Rev. March 2024)

Request for Taxpayer Identification Number and Certification

Department of the Treasury Internal Revenue Service Go to www.irs.gov/FormW9 for instructions and the latest information.

Give form to the requester. Do not send to the IRS.

Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.

P ri n t o r ty p e

S ee

S p ec if ic In st ru ct io n s on p ag e

3.

1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregarded entity’s name on line 2.)

2 Business name/disregarded entity name, if different from above.

3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check only one of the following seven boxes.

Individual/sole proprietor C corporation S corporation Partnership Trust/estate

LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) Note: Check the “LLC” box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner.

Other (see instructions)

3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions

4 Exemptions (codes apply only to certain entities, not individuals;

see instructions on page 3):

Exempt payee code (if any)

Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any)

(Applies to accounts maintained outside the United States.)

5 Address (number, street, and apt. or suite no.). See instructions.

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter.

Social security number or

Employer identification number

Part II Certification

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue

Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

Sign Here

Signature of

U.S. person Date

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

What’s New Line 3a has been modified to clarify how a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax classification of its owner. Otherwise, it should check the “LLC” box and enter its appropriate tax classification.

New line 3b has been added to this form. A flow-through entity is required to complete this line to indicate that it has direct or indirect foreign partners, owners, or beneficiaries when it provides the Form W-9 to another flow-through entity in which it has an ownership interest. This change is intended to provide a flow-through entity with information regarding the status of its indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1065).

Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS is giving you this form because they

Cat. No. 10231X Form W-9 (Rev. 3-2024)

The following certifications are required for all Vendors who are Service Providers

TEX. EDUC. CODE CH. 22A CERTIFICATION REGARDING REQUIREMENT TO REPORT MISCONDUCT AND PROHIBITION OF INDIVIDUALS LISTED ON REGISTRY

Vendor hereby certifies that pursuant to Texas Education Code Section 22A.052, no employee or subcontractor of Vendor who has or will have direct contact with students has engaged in or will engage in, with a student or minor, any of the following misconduct: abuse; commission of an unlawful act; involvement or solicitation of a romantic relationship; solicitation or engaging in sexual contact with a student or minor;

inappropriate communications; failure to maintain appropriate boundaries. Vendor acknowledges that if Vendor becomes aware of any evidence of misconduct by an employee or subcontractor, Vendor agrees to immediately report such to a District official and to cooperate with the investigation of the alleged misconduct by KIPP Texas, TEA/SBEC, and/or law enforcement.

Vendor further certifies that pursuant to Texas Education Code Section 22A.151, no person who is listed on TEA’s registry of persons not eligibility for provision of services to educational entities may act as a service provider for KIPP Texas and agrees not to employ, as an employee, contractor, or subcontractor, any person to act as a service provider for KIPP Texas who is listed on the registry.

______ Initials of Authorized Representative of Vendor

TEX. EDUC. CODE CH. 22A PRE-SERVICE AFFIDAVIT

Pursuant to Texas Education Code Section 22A.055, any person who will act as a service provider for KIPP Texas, using the form adopted by TEA, must consent for release of the person’s employment records and a pre-service affidavit with specified disclosures. Vendor shall ensure that each employee and subcontractor providing services to the District completes the pre-service affidavit, available at:

https://tea.texas.gov/texas-educators/investigations/pre-employment-affidavit-for-educators. If a determination is made that a person providing services failed to disclose information required to be disclosed under Section 22A.055, the person against whom the determination is made shall not be permitted to act as a service provider for KIPP Texas and is grounds for termination of Vendor’s Agreement with KIPP Texas.

______ Initials of Authorized Representative of Vendor

TEX. EDUC. CODE CH. 22 NATIONAL CRIMINAL HISTORY RECORD INFORMATION CERTIFICATION

Background: Texas Education Code Chapter 22 requires that criminal history records be obtained regarding covered employees of entities that contract with a school district to provide services to the school district (“Contractors”) and entities that contract with school district contractors (“Subcontractors”). Covered employees with disqualifying criminal histories are prohibited from serving at a school district. Contractors/Subcontractors shall (1) complete this form certifying compliance with the requirements of Texas Education Code Chapter 22 to KIPP Texas; and (2) require that each of their subcontractors complies with the requirements of Texas Education Code Chapter 22.

Criminal history records will be obtained by either the Contractor/Subcontractor or KIPP Texas, as follows:

(1) Contractor/Subcontractor: The only Contractors/Subcontractors who will be granted access to obtain criminal history record information are those “qualified school contractors” that (1) contract or subcontract to provide services to KIPP Texas; and (2) are determined eligible by the Texas Department of Public Safety (DPS) to obtain criminal history record information under the National Child Protection Act of 1993 (34 U.S.C. § 40101 et seq.) (NCPA), specifically, those contractors/subcontractors who provide “care or care placement services” and are based in Texas, for an employee, applicant for employment, or volunteer of the “qualified school contractor.” All “qualified school contractors” are required to obtain their covered employees’ criminal histories, certify compliance to KIPP Texas, and obtain similar certifications from their subcontractors. Before or immediately after employing or securing the services of a person who is a “covered employee” (as defined below) the Contractor/Subcontractor shall send or ensure that the employee sends to DPS all information that is required by DPS for obtaining the person’s national criminal history record information, which may include (but is not limited to) a complete set of the person’s fingerprints and a recent electronic digital image photograph of the person, as required by DPS. DPS shall obtain the person’s national criminal history record information (“CHRI”) and report the results through the criminal history clearinghouse as provided by Texas Government Code 411.0845. For more information or to set up an account, Contractor/Subcontractor should contact the Texas Department of Public Safety’s Crime Records Service at 512.424.2474.

Contractor/Subcontractor shall obtain all CHRI that relates to all covered employees through the criminal history clearinghouse as provided by Texas Government Code 411.0845. In addition, Contractor/Subcontractor shall require that each of its subcontracting entities obtains all criminal history record information that relates to its covered employees, if the subcontracting entity is also a “qualified school contractor.” Contractor/Subcontractor shall: (1) provide KIPP Texas with a fitness determination (as set forth below) as to each covered employee, based on all criminal history record information obtained; and (2) certify to KIPP Texas that

Contractor/Subcontractor has received all CHRI relating to a person who is employed by or under a current offer of employment by Contractor/Subcontractor.

(2) KIPP Texas: All Contractors/Subcontractors who are not “qualified school contractors” are required to follow the instructions listed below, so that KIPP Texas may obtain their covered employees’ CHRI, as applicable. Contractor/Subcontractor shall also require that any of its subcontracting entities that are not “qualified school contractors” follow the instructions listed below, so that KIPP Texas may obtain their covered employees’ CHRI. Contractor/Subcontractor is responsible for the payment of all fingerprinting costs. Should KIPP Texas pay any costs of fingerprinting Contractor/Subcontractor employees, Contractor agrees to reimburse KIPP Texas for such costs; in the event Contractor fails to reimburse KIPP Texas for the costs of fingerprinting Contractor/Subcontractor employees, Contractor agrees that KIPP Texas may deduct such costs from any payment due and owing by KIPP Texas to Contractor.

Definitions:

• Covered employees: Employees of a Contractor/Subcontractor who have or will have continuing duties related to the service to be performed at a school district and have or will have direct contact with students. KIPP Texas will be the final arbiter of what constitutes continuing duties and direct contact with students.

• Continuing duties related to contracted services: Work duties that are performed pursuant to a contract to provide services to a school entity on a regular, repeated basis rather than infrequently or one-time only. See 19 Tex. Admin. Code §153.1101(2).

• Direct contact with students: The contact that results from activities that provide substantial opportunity for verbal or physical interaction with students that is not supervised by a certified educator or other professional district employee. Contact with students that results from services that do not provide substantial opportunity for unsupervised interaction with a student or students, such as addressing an assembly, officiating a sports contest, or judging an extracurricular event, is not, by itself, direct contact with students. However, direct contact with students does result from any activity that provides substantial opportunity for unsupervised contact with students, which might include, without limitation, the provision of coaching, tutoring, or other services to students. See 19 Tex. Admin. Code § 153.1101(7).

• Public Works Contractor: An entity that contracts directly or subcontracts with an entity that contracts with a school district to provide construction services to the school district.

• Exception for Certain Public Works Contractors’ Employees and Applicants: The criminal history record information requirements outlined above do not apply to an employee or applicant for employment of a public works contractor (as defined above) if: (1) the public work does not involve the construction, alteration, or repair of an instructional facility as defined by Texas Education Code Section 46.001; (2) the employee’s duties will be completed not later than the seventh (7th) day before a new instructional facility will be used for instruction; or (3) for an existing instructional facility, the work area contains sanitary facilities and is separated from all areas used by students by a secure barrier fence at least six (6) feet high, and the Contractor adopts, informs employees of, and enforces a policy prohibiting employees and any subcontractor’s employees from interacting with students or entering areas used by students.

• Disqualifying criminal history: (1) a conviction or other criminal history information designated by KIPP Texas; or (2) (2) a felony or misdemeanor offense that would prevent a person from being employed under Texas Education Code § 22A.157, that is: if a person has been (a) convicted or placed on deferred adjudication community supervision for an offense requiring registration as a sex offender; the sale, distribution, or display of harmful material to a minor; improper relationship between educator and student; a felony offense of public indecency; a felony offense of public indecency; a felony offense involving school property; or an equivalent crime in another state; or (b) convicted of a Title 5 felony or an equivalent crime in another state.

• Types of Criminal History Record Information: National criminal history record information (“CHRI”) from the Texas Department of Public Safety criminal history clearinghouse. KIPP Texas and/or Contractor/Subcontractor may obtain from any law enforcement or criminal justice agency all CHRI that relates to a covered employee.

On behalf of (“Contractor/Subcontractor”), I, the undersigned authorized signatory for Contractor/Subcontractor, certify to KIPP Texas (and, in the case of a Subcontractor, certify to Contractor and KIPP Texas) that [check one]:

OPTION A: Vendor/Subcontractor certifies that none of the employees of Vendor/Subcontractor are covered employees, as defined above. For each covered employee who is employed by or under a current offer of employment by Vendor/Subcontract, Vendor/Subcontractor certifies to KIPP Texas that it will timely complete the “Vendor Criminal History Background Check Certification” form and submit such to KIPP Texas. If this box is checked, I further certify that Vendor/Subcontractor has taken precautions or imposed conditions to ensure that its employees will not become covered employees. Vendor/Subcontractor will ensure that these precautions or conditions continue to exist throughout the time that the contracted services are provided. If KIPP Texas, in its sole discretion, determines that employees of Vendor/ Subcontractor are covered employees, as defined above, Vendor/ Subcontractor will provide KIPP Texas with the name, date of birth, and any other requested information of such covered employees so that KIPP Texas may obtain CHRI on the covered employees, upon request by KIPP Texas.

OPTION B: Vendor/Subcontractor certifies that some or all of the employees of Vendor/Subcontractor are covered employees, but the criminal history record information requirements do not apply to its employees or applicants for employment because:

(1) Vendor/Subcontractor is a public works contractor (an entity that contracts directly or subcontracts with an entity that contracts with a school district to provide construction services to the school district); and

(2) the public work does not involve the construction, alteration, or repair of an instructional facility as defined by Texas Education Code Section 46.001; the employee’s duties will be completed not later than the seventh (7th) day before a new instructional facility will be used for instruction; or for an existing instructional facility, the work area contains sanitary facilities and is separated from all areas used by students by a secure barrier fence at least six (6) feet high, and the Vendor adopts, informs employees of, and enforces a policy prohibiting employees and any subcontractor’s employees from interacting with students or entering areas used by students.

If Option B is selected, Vendor/Subcontractor further certifies to KIPP Texas that:

(a) Vendor/Subcontractor shall ensure that the conditions or precautions that resulted in the determination that the criminal history record information requirements do not apply to its employees or applicants for employment continue to exist throughout the time that the contracted services are provided;

(b) For each covered employee who is employed by or under a current offer of employment by Vendor/Subcontractor, Vendor/Subcontractor will timely complete the “Vendor Criminal History Background Check Certification” form and submit such to KIPP Texas; and

(c) If KIPP Texas, in its sole discretion, determines that the conditions in paragraph (1) and/or (2) above are not satisfied as to Vendor/ Subcontractor, Vendor/ Subcontractor will provide KIPP Texas with the name, date of birth, and any other requested information of its covered employees so that KIPP Texas may obtain CHRI on the covered employees, upon request by KIPP Texas.

OPTION C: Vendor/Subcontractor certifies that some or all of the employees of Vendor/Subcontractor are covered employees, and Vendor/Subcontractor is a “qualified school contractor.” For each covered employee who is employed by or under a current offer of employment by Vendor/ Subcontractor, Vendor/ Subcontractor certifies to KIPP Texas that it will timely complete the “Vendor Criminal History Background Check Certification” form and submit such to KIPP Texas. If this option is selected, I further certify that:

(1) Vendor/ Subcontractor certifies to KIPP Texas that Vendor/ Subcontractor has received all criminal history record information relating to a person who is employed by or under a current offer of employment by Vendor/ Subcontractor. Vendor/Subcontractor provides KIPP Texas with the following fitness determination as to each covered employee, based on all CHRI obtained: None of the covered employees has a disqualifying criminal history;

(2) If Vendor/ Subcontractor at any time receives information that a covered employee subsequently has a reported disqualifying criminal history, Vendor/ Subcontractor will immediately remove the covered employee from contract duties and notify KIPP Texas in writing within 3 business days; and

(3) Upon request by KIPP Texas, Vendor/ Subcontractor will provide KIPP Texas with the name, date of birth, and any other requested information of covered employees so that KIPP Texas may obtain CHRI on the covered employees.

OPTION D: Vendor/Subcontractor certifies that some or all of the employees of Vendor/Subcontractor are covered employees, and Vendor/Subcontractor is not a “qualified school contractor.” If this option is selected, I further certify that:

(1) For each covered employee who is employed by or under a current offer of employment by Vendor/Subcontractor, Vendor/Subcontractor certifies to KIPP Texas that will timely complete the “Vendor Criminal History Background Check Certification” form and submit such to KIPP Texas, providing the following information regarding each covered employee as required by DPS in order to provide CHRI, so that KIPP Texas may obtain the covered employees’ CHRI: (a) Full name (first, middle, and last); (b) Date of birth; (c) Sex; (d) number assigned to any form of unexpired identification card issued by Texas or another state, D.C., or a U.S. territory that includes the person’s photograph; (e) if the employee has ever been fingerprinted by a public school district in Texas (and if so, the name of the school district); and (f) the person’s written consent to the release of his or her criminal history record information;

(2) Vendor/ Subcontractor shall provide KIPP Texas’s “Texas Fingerprint Service Code Form” document to all covered employees and ensure that they schedule fingerprinting appointments in a timely manner. Vendor/ Subcontractor shall be solely responsible to send or ensure that each covered employee sends to DPS all information that may be required by DPS for obtaining national criminal history record information, which may include, but is not limited to, a complete set of the person’s fingerprints and a recent electronic digital image photograph of the person. Any covered employee whose CHRI is not received by KIPP Texas at least ten (10) KIPP Texas business days prior to the start of the services to be performed by Vendor/ Subcontractor at KIPP Texas is subject to exclusion from service, in KIPP Texas’s sole discretion, until his or her CHRI can be obtained and reviewed by KIPP Texas. Vendor/Subcontractor is responsible for the payment of all fingerprinting costs. Because Vendor/ Subcontractor is not a “qualified school contractor,” it will not be permitted to view the CHRI obtained by KIPP Texas;

(3) DPS shall obtain the person’s national criminal history record information and report the results through the criminal history clearinghouse as provided by Texas Government Code 411.0845. Vendor/ Subcontractor agrees that KIPP Texas will obtain all CHRI that relates to a covered employee through the criminal history clearinghouse as provided by Texas Government Code

411.0845. Vendor/ Subcontractor agrees that KIPP Texas will review each covered employee’s CHRI, to determine, in KIPP Texas’s sole discretion, whether any covered employee(s) should be prohibited from serving at KIPP Texas. KIPP Texas will notify Vendor/ Subcontractor of its determination; and

(4) If KIPP Texas at any time receives information that a covered employee subsequently has a reported disqualifying criminal history or should be prohibited from serving at KIPP Texas, in KIPP Texas’s sole discretion, KIPP Texas will notify Vendor/ Subcontractor of its determination. Vendor/ Subcontractor will immediately remove the covered employee from contract duties.

Upon contract award and/or initiation of PO/contract from KIPP Texas, the Vendor shall complete KIPP Texas’s “Contractor Criminal History Background Check Certification” form, providing the following information regarding each covered employee as required by DPS in order to provide criminal history record information, so that KIPP Texas may obtain the covered employees’ criminal history record information: (a) Full name (first, middle, and last); (b) Date of birth; (c) Sex; (d) number assigned to any form of unexpired identification card issued by Texas or another state, KIPP Texas of Columbia, or a U.S. territory that includes the person’s photograph; (e) if the employee has ever been fingerprinted by a public school district in Texas (and if so, the name of the school district); and (f) the person’s written consent to the release of his or her criminal history record information. Contractor/Subcontractor shall be solely responsible to send or ensure that each covered employee sends to DPS all information that may be required by DPS for obtaining national criminal history record information, which may include, but is not limited to, a complete set of the person’s fingerprints and a recent electronic digital image photograph of the person.

If, during the term of the contract with KIPP Texas, Contractor/Subcontractor employs additional covered employees or assigns new covered employees to perform services at KIPP Texas, Contractor shall immediately notify KIPP Texas and provide KIPP Texas with all of the information listed in the preceding paragraph as to each additional covered employee, so that KIPP Texas may obtain the additional covered employees’ CHRI. If, during the term of the contract with KIPP Texas, Contractor/Subcontractor ceases to employ a covered employee in connection with an KIPP Texas contract, whose information was previously provided to KIPP Texas, Contractor/Subcontractor shall immediately notify KIPP Texas of the same and provide KIPP Texas with each former covered employee’s (a) Full name (first, middle, and last); (b) Date of birth; (c) Sex; and (d) number assigned to any form of unexpired identification card issued by Texas or another state, KIPP Texas of Columbia, or a U.S.

territory that includes the person’s photograph, so that KIPP Texas may unsubscribe from that individual’s criminal history record.

If KIPP Texas, in its sole discretion, objects to the assignment of a covered employee for any reason, including, but not limited to, on the basis of the covered employee’s CHRI and/or insufficient qualifications, lack of experience, and the like, Contractor/Subcontractor agrees to discontinue using that covered employee to provide services at KIPP Texas.

I also certify to KIPP Texas (and, in the case of a Subcontractor, certify to Contractor and KIPP Texas) on behalf of Contractor/Subcontractor that Contractor/Subcontractor has required its subcontractors to comply with Texas Education Code Chapters 22 and 22A and obtained certifications from its subcontractors of such compliance. Noncompliance or misrepresentation regarding this certification may be grounds for contract termination.

Signature Title Date

Debarment, Suspension, Ineligibility or Voluntary Exclusion

Certification Form

NAME Doing business as (DBA)

ADDRESS Applicable Procurement or Solicitation #, if any:

Federal Employer Tax Identification #:

This certification is submitted as part of a request to contract.

Instructions For Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier Covered Transactions

I. READ CAREFULLY BEFORE SIGNING THE CERTIFICATION. Federal regulations require contractors and bidders to sign and abide by the terms of this certification, without modification, in order to participate in certain transactions directly or indirectly involving federal funds.

1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below.

2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

3. The prospective lower tier participant shall provide immediate written notice to the department, institution or office to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or had become erroneous by reason of changed circumstances.

4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meaning set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations.

5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under the applicable CFR, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.

6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled ``Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction,'' without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under applicable CFR, debarred, suspended, ineligible, or voluntarily excluded from covered transactions, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the List of Parties Excluded from Federal Procurement and Non-procurement Programs.

8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business activity.

9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under applicable CFR, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier Covered Transactions

The prospective lower tier participant certifies, by submission of this proposal or contract, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this form.

Bidder or Contractor Signature: _______________________________________ Date: _____________

Print Name and Title: __________________________________________________________________

Felony Conviction Notification

State of Texas Legislative Senate Bill No. 1, Section 44.034, codified as Texas Education Code § 44.034, Notification of Criminal History, Subsection (a), states “a person or business entity that enters into a contract with a school district must give advance notice to KIPP Texas if the person or owner or operator of the business entity has been convicted of a felony.” The notice must include a general description of the conduct resulting in the conviction of a felony.

Subsection (b) states “a school district may terminate a contract with a person or business entity if KIPP Texas determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. KIPP Texas must compensate the person or business entity for services performed before the termination of the contract.”

This notice is not required of a publicly held corporation.

I, the undersigned for the firm named below, certify that the information concerning notification of felony convictions has been by me and the following information furnished is true to the best of my knowledge.

Company: ___________________________

Company Official: ______________________________

A. My firm is a publicly held corporation; therefore, this reporting requirement is not applicable.

Signature of authorized agent: ____________________________________________________

B. My firm is not owned or operated by anyone who has been convicted of a felony.

Signature of authorized agent: ____________________________________________________

C. My firm is owned or operated by the following individual(s) who has/have been convicted of a felony.

Name of individual (s): ____________________________________________________________

Details of conviction (s): ____________________________________________________________

Signature of authorized agent:_________________________________________________________

Certificate of Residency

The State of Texas has passed a law concerning non-resident contractors. This law can be found in Texas Government Code under Chapter 2252, Subchapter A. This law makes it necessary for KIPP to determine the residency of its bidders/proposers for construction related services. In part, this law reads as follows:

“Section: 2252.001

(3) ‘Non-resident bidder’ refers to a person who is not a resident.

(4) ‘Resident bidder’ refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state.

Section: 2252.002 “A governmental entity may not award a governmental contract to a nonresident bidder unless the nonresident underbids the lowest bid submitted by a responsible resident bidder by an amount that is not less than the greater of the following:

(1) The amount by which a resident bidder would be required to underbid the nonresident bidder to obtain a comparable contract in the state in which the nonresident’s principal place of business is located; or

(2) The amount by which a resident bidder would be required to underbid the nonresident bidder to obtain a comparable contract in the state in which a majority of the manufacturing relating to the contract will be performed.

A governmental entity may not award a governmental contract to a nonresident bidder…