5-Attachment E- Required Forms.pdf

ATTACHMENT E

Austin ISD Contract & Procurement Services

Required Forms

Bidders shall execute the following required forms. Upload the signed original with the bid into Bonfire.

I. CONFLICT OF INTEREST QUESTIONNAIRE (provide proof of ONLINE submittal)

II. W-9 FORM

III. FELONY CONVICTION NOTICE FORM

IV. SUSPENSION AND DEBARMENT CERTIFICATION

V. TEXAS GOVERNMENT CODE CHAPTER 2270, 2271 and CHAPTER 2274

VERIFICATION FORM

VI. CERTIFICATE OF INTERESTED PARTIES FORM 1295

VII. PROPOSAL GUARANTEE / BID BOND

VIII. CERTIFICATE OF INSURANCE

Conflict of Interest Questionnaire (CIQ)

This information can be found on the District’s website: https://www.austinisd.org/cp

For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.

This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).

By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.

A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor.

To access the CIQ electronic form and submit online, go to the district’s website: https: //www.austinisd.org/cp/ciq-online https://www.austinisd.org/cp https://www.austinisd.org/cp/ciq-online

Form W-9 Request for Taxpayer Identification Number and Cert.

Vendor must submit a current Form W-9 Request for Taxpayer Identification Number and Certification with their response to this solicitation.

Austin ISD must obtain certification of your taxpayer identification number (TIN) to establish a record in our vendor database and to report income paid to you. By submitting a Form W-9, you are certifying that the Tax ID number you are providing is correct and accurate.

FELONY CONVICTION NOTICE FORM

Statutory citation covering notification of criminal history of contractor is found in the Texas Education Code §44.034.

FELONY CONVICTION NOTIFICATION

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

Please checkmark ONE of the three options shown below (A, B, or C), as appropriate.

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

B. My firm is not owned nor operated by anyone who has been convicted of a felony.

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

(Attach additional sheet if necessary; enter N/A if Not Applicable)

Name of Felon(s): _________________________________________________________

Details of Conviction(s):____________________________________________________

VENDOR’S NAME:

Signature of Company Official:

Date Signed:

Printed name of company official signing above:

SUSPENSION AND DEBARMENT CERTIFICATION

Federal Law (A-102 Common Rule and OMB Circular A-110) prohibits non-federal entities from contracting with or making subawards under covered transactions to parties that are suspended or debarred or whose principals are suspended or debarred. Covered transactions include procurement contracts for goods or services equal to or in excess of $25,000 and all non-procurement transactions (e.g., subawards to subrecipients).

Contractors receiving individual awards of $25,000 or more and all subrecipients must certify that their organization and its principals are not suspended or debarred by a federal agency.

Before an award of $25,000 or more can be made by your firm, you must certify that your organization and its principals are not suspended or debarred by a federal agency.

I, the undersigned agent for the firm named below, certify that neither this firm nor its principals are suspended or debarred by a federal agency.

VENDOR’S NAME:

Signature of Company Official:

Printed name of company official signing above:

AUSTIN INDEPENDENT SCHOOL DISTRICT

TEXAS GOVERNMENT CODE CHAPTER 2271 and CHAPTER 2274

VERIFICATION FORM

Texas Government Code Chapters 2271 and 2274 prohibit the District from entering into a contract for goods or services that (a) has a value of $100,000 or more that is to be paid wholly or partly from public funds and (b) is with a company that has 10 or more full time employees unless the contract contains written verifications from the company that it does not boycott Israel, does not boycott energy companies, or discriminate against a firearm entity or firearm trade association; and will not boycott Israel, will not boycott energy companies, or discriminate against a firearm entity or firearm trade association during the term of the contract.

The following definitions apply to this verification:

(1) "Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes; and

(2) "Company" means a for-profit organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit. State law requires any firm entering into an agreement or contract with the Authority to complete the foregoing verification. “Company” does not include a sole proprietorship.

(3) "Discriminate against a firearm entity or firearm trade association": (A) means, with respect to the entity or association, to: (i) refuse to engage in the trade of any goods or services with the entity or association based solely on its status as a firearm entity or firearm trade association; (ii) refrain from continuing an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; or (iii) terminate an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; and (B) does not include: (i) the established policies of a merchant, retail seller, or platform that restrict or prohibit the listing or selling of ammunition, firearms, or firearm accessories; and (ii) a company ’s refusal to engage in the trade of any goods or services, decision to refrain from continuing an existing business relationship, or decision to terminate an existing business relationship: (aa) to comply with federal, state, or local law, policy, or regulations or a directive by a regulatory agency; or (bb) for any traditional business reason that is specific to the customer or potential customer and not based solely on an entity ’s or association ’s status as a firearm entity or firearm trade association.”

(4) “Boycott energy company" means, without an ordinary business purpose, refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations with a company because the company: (A) engages in the exploration, production, utilization, transportation, sale, or manufacturing of fossil fuel-based energy and does not commit or pledge to meet environmental standards beyond applicable federal and state law; or (B) does business with a company described by Paragraph (A).”

By signing below, the authorized representative hereby verifies that the company:

(Texas Government Code 2271)

(1) Does not, and will not for the duration of the contract, boycott Israel; or

(2) The verification required by Texas Government Code 2271.002 does not apply to the contract.

(Texas Government Code 2274)

(1) Does not, and will not for the duration of the contract, boycott energy companies;

or

(2) The verification required by Section 2274.002 of the Texas Government Code that the company does not, and will not for the duration of the contract, boycott energy companies does not apply to the contract.

(3) Does not, and will not for the duration of the contract, have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; or

(4) The verification required by Section 2274.002 of the Texas Government Code that the company does not, and will not for the duration of the contract, have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association does not apply to the contract.

Exemption from verification criteria includes the following:

1. Company employs less than 10 full-time employees; AND

2. Value of the contract is less than $100,000.

SIGNED BY:

Print Name & Title:

Company Name:

Rev. 11/16/2021

AUSTIN ISD CERTIFICATE OF INTERESTED PARTIES – FORM 1295

Certificate of Interested Parties (Form 1295 – must be filled out electronically with the Texas Ethics Commission’s online filing application, printed out, signed, and attached to vendor’s response to this solicitation.

AUSTIN ISD is required to comply with House Bill 1295, which amended the Texas Government Code by adding Section 2252.908, Disclosure of Interested Parties. Section

2252.908 prohibits AISD from entering into a contract resulting from this CSP with a business entity unless the business entity submits a Disclosure of Interested Parties (Form 1295) to AISD at the time business entity submits the signed contract. The Texas Ethics Commission has adopted rules requiring the business entity to file Form 1295 electronically with the Texas Ethics Commission.

“Interested Party” means a person:

a) who has a controlling interest in a business entity with whom AISD contracts; or

b) who actively participates in facilitating the contract or negotiating the terms of the contract, including a broker, intermediary, adviser, or attorney for the business entity.

“Business Entity” means an entity recognized by law through which business is conducted, including a sole proprietorship, partnership, or corporation.

As a “business entity,” all vendors must electronically complete, print, sign, and submit Form 1295 with their proposals even if no interested parties exist.

Proposers must file Form 1295 electronically with the Texas Ethics Commission using the online filing application, which can be found at:

https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm

Proposers must use the filing application on the Texas Ethics Commission’s website to enter the required information on Form 1295. Proposers must print a copy of the completed form, which will include a certification of filing containing a unique certification number. The Form 1295 must be signed by an authorized agent of the business entity.

The completed Form 1295 with the certification of filing must be filed with AISD by attaching the completed form to the vendor’s solicitation response.

AISD must acknowledge the receipt of the filed Form 1295 by notifying the Texas Ethics Commission of the receipt of the filed Form 1295 no later than the 30th day after the date the contract binds all parties to the contract. After AISD acknowledges the Form 1295, the Texas Ethics Commission will post the completed Form 1295 to its website with seven business days after receiving notice from AISD.

http://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm

BID BOND COVER SHEET

Instructions: In addition to submitting a copy of your Bid Bond with your solicitation, AISD requests that you submit the original copy as well.

As there may be delays and/or oversights outside of the control of the Proposer and Procurement, AISD is requesting that you submit this cover sheet with your electronic submission. AISD must be in receipt of the original Bid Bond no later than 24 hours after the bid due date.

Note: This cover sheet is not a replacement for AISD being in actual receipt of the original Bid Bond.

Name of Proposer (Company):

Solicitation Number:

Solicitation due date and time:

Proof of delivery (Check the one that applies):

Certified Mail (certified receipt attached)

Regular Mail (picture of stamped and addressed envelope attached)

Courier (receipt attached)

In-person delivery to Central Office:

Received by AISD Staff Member Name:

AISD Staff Member Signature:

CONSTRUCTION FORM AISD/Proposal/Bid Bond (Rev. January ‘21)

AUSTIN INDEPENDENT SCHOOL DISTRICT

PROPOSAL/BID BOND

KNOW ALL BY THESE PRESENTS: that the undersigned Principal and Surety are firmly bound to Austin Independent School District (“AISD”) in the principal sum of:

Dollars ($ ).

Now the condition of this bond is this: that, whereas the undersigned principal has submitted to AISD a proposal or bid to enter into a certain contract whereunder principal undertakes to perform the following-described work of construction, alteration or repair for _____________________________.

NOW, THEREFORE, if the principal shall, within ten (10) days following acceptance by the Board of Trustees of AISD of such proposal or bid and award by said Board to said principal of said contract, execute and return such further contract documents as may be required by the terms of the proposal or bid accepted, and within five (5) days after execution of such contract documents, deliver its safety program manual, the safety plan for the Project, and the bonds and insurance documents, as required by the terms of the proposal or bid accepted, then this obligation shall be null and void, otherwise it shall remain in full force and the amount hereof shall be paid to and retained by AISD as liquidated damages for principal’s failure to do so.

Principal:

By:

Title: Date:

Surety:

By:

Title: Date:

AUSTIN ISD CERTIFICATE OF INTERESTED PARTIES – FORM 1295