5-C. submission forms.pdf

Rev. 06/20

ACKNOWLEDGEMENT FORM

By submission of this proposal, the undersigned certifies that:

a. I have carefully read the Solicitation Information and Instructions, Standard Terms and Conditions, and any Special Terms and Conditions listed in this document;

b. I have returned signed copies of the required response forms;

c. I agree to furnish all goods and services specified on the Katy ISD Proposal Form at the prices and transportation costs as proposed;

d. This proposal has been independently arrived at without collusion with any other Bidder or any other competitor;

e. This proposal has not been knowingly disclosed and will not be knowingly disclosed, to any other

Bidder, competitor or potential competitor, prior to the opening of responses for this project;

f. No attempt has been or will be made to induce any other person, partnership, or corporation to submit or not submit a response;

g. The undersigned certifies that he/she is fully informed regarding the accuracy of the statements contained in this certification, and the penalties herein are applicable to the Bidder as well as to any person signing on his/her behalf;

h. Bidder warrants it has no interest, and shall acquire no interest that would directly or indirectly conflict in any manner or degree with the performance of this proposal. For violation or breach of this warranty, Katy ISD shall have the right to annul this contract without liability;

i. As required by Local Government Code 176.006, the undersigned acknowledges the requirement of filing a Conflict of Interest Questionnaire if there are any facts that would require such to be filed, and acknowledges the fact that the CIQ form is available for download at https://www.ethics.state.tx.us/forms/conflict/ or can be obtained directly from the Katy ISD Purchasing Department, 6301 S. Stadium Lane, Katy, Texas 77494.

j. The undersigned certifies that to his/her knowledge no Katy ISD employee has any personal or beneficial interest whatsoever in the service or property described herein.

k. The undersigned acknowledges that this document, as well as any submitted documents and any negotiations, when properly accepted by the District will be an integral part of any contract awarded as a result of the response submitted.

l. The undersigned acknowledges that any employees performing services under the contract awarded as a result of this RFP will meet the minimum requirements as stated in Education Code

22.0834 and the Contractor will submit required Criminal History Certification form before the contract term begins.

The undersigned agrees to comply with all federal, state, and local laws, rules, regulations, and ordinances as applicable.

AUTHORIZED SIGNATURE PRINT NAME

TITLE DATE

https://www.ethics.state.tx.us/forms/conflict/

COMPANY NAME AUTHORIZED SIGNATURE DATE

DEVIATION FORM

All deviations to the solicitation must be noted on this sheet. In the absence of an entry on this Deviation Form, the Vendor assures the District of their full compliance with the specifications, terms, and conditions as written in the solicitation. This form may be duplicated as needed.

THIS DEVIATION FORM MUST BE SIGNED BY EACH VENDOR IF DEVIATIONS

ARE SUBMITTED WITH THIS PROPOSAL.

ITEM NO. PAGE NO.

Individual Presenters Company Consultants Rentals - In-District

Private Lesson Tutors Individual Consultants

As determined by contract

Inflatable Bouncers Carnival Rides

Small Projects Less than

Days and/or $10,000

Medium Projects $10,000 to < $25,000

Large Projects Equal to or Greater than $25,000

BI & PD Each Occurrence Not Required 1,000,000 1,000,000 300,000 1,000,000 1,000,000 1,000,000 BI & PD General Aggregate Not Required 1,000,000 1,000,000 600,000 1,000,000 1,000,000 1,000,000

Not Required 1,000,000 1,000,000 600,000 1,000,000 1,000,000 1,000,000 Not Required 1,000,000 1,000,000 300,000 1,000,000 1,000,000 1,000,000 Not Required 1,000,000 1,000,000 300,000 1,000,000 1,000,000 1,000,000 Not Required 100,000 100,000 50,000 100,000 100,000 100,000 Not Required 5,000 5,000 5,000 5,000 5,000 5,000

Not Required Bodily Injury Each Person Not Required 100,000 100,000 100,000 100,000 1,000,000 1,000,000 Bodily Injury Each Accident Not Required 300,000 300,000 300,000 300,000 2,000,000 2,000,000 Property Damage Each Occurrence Not Required 100,000 100,000 100,000 100,000 $250,000 $250,000

Not Required 1,000,000 3,000,000

Not Required Not Required Not required Not required

Not Required 1,000,000

One times the contract amount for contracts exceeding $1M up to

$25M.

$1M minimum.

5,000,000

Not Required Required Required Required Required Required Required Not Required 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000

Not Required No No No No No No

Not Required N/A N/A N/A Full Insurable Value of Project

Full Insurable Value of Project N/A

Not Required N/A N/A N/A 1,000,000 1,000,000 N/A

As Requested based on project. As determined by contract N/A N/A N/A N/A N/A

A-VII A-VII A-VII A-VII A-VII A-VII

Not Required 30 Days 30 Days 30 Days 30 Days 30 Days 30 Days

N/A N/A N/A If Requested If Requested If Requested N/A N/A N/A N/A N/A 100% 100% N/A N/A N/A N/A N/A 100% 100% N/A

Yes

Construction, Installation, Renovation, Building Modifications, Service, Maintenance or Repair Projects

Katy Independent School District Insurance Requirements for Independent Contractors

Policy Type Charter Bus Service

Commercial General Liability

Products & Completed Operations Personal & Adv Injury Sexual Assault and Molestation Fire & Legal Liability Medical Expenses

Commercial Auto Liability

Combined Single Limit

Umbrella Liability (Excess)

Over GL, Auto & Workers' Comp

Workers' Compensation Employers Liability Do you accept accident policies & waivers in lieu of workers comp?

Builders' Risk/Installation Floater

Owners' & Contractor's Protective Liability

Professional Errors & Omissions Liability for certified professionals

Insurance Company "AM Best" Rating

Cancellation Notice

Bonds Bid Bond Payment Bond Performance Bond

Other Bodily Injury & Property Damage Injury Releases

CJ (R)(E) ‐‐ E ‐‐ Revised: 11‐16‐2021

KATY 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.

KATY 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 KISD from entering into a contract resulting from this RFCSP with a business entity unless the business entity submits a Disclosure of Interested Parties

(Form 1295) to KISD 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 KISD 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 KISD by attaching the completed form to the vendor’s solicitation response.

KISD 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 KISD 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 KISD.

Instructional Videos for Business Entities-click on link below;

• Logging in the First Time

• How to Create a Certificate https://www.ethics.state.tx.us/filinginfo/videos/Form1295/FirstLogin-Business/Form1295Login-Business.html https://www.ethics.state.tx.us/filinginfo/videos/Form1295/CreateCertificate/CreateCertificate.html

Controlling Name of Interested Party

Nature of interest

City, State, Country (place of business) Intermediary

(check applicable)

CERTIFICATE OF INTERESTED PARTIES 1295FORM

OFFICE USE ONLY

Complete Nos. 1 - 4 and 6 if there are interested parties.

Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.

Name of business entity filing form, and the city, state and country of the business entity's place of business.

Name of governmental entity or state agency that is a party to the contract for which the form is being filed.

Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract.

Certificate Number:

Date Filed:

Date Acknowledged:

CERTIFICATION OF FILING

Signature of authorized agent of contracting business entity

My name is _______________________________________________________________, UNSWORN DECLARATION

Check only if there is NO Interested Party.5

My address is _______________________________________________, _______________________, and my date of birth is _______________________.

Executed in ________________________________________County, I declare under penalty of perjury that the foregoing is true and correct.

(street) (state) (zip code) (country)

(year)(month)

State of ________________, on the _____day of ___________, 20_____.

(city)

(Declarant)

Version V1.1.191b5cdcwww.ethics.state.tx.usForms provided by Texas Ethics Commission

What is an Interested Party?

Examples of Interested Parties;

ENTER KATY INDEPENDENT SCHOOL DISTRICT (WE

ARE THE GOVERNMENT ENTITY)

ENTER YOUR BUSINESS NAME, CITY, STATE, COUNTY

PLEASE COMPLETE THIS

ENTIRE SECTION

Draft https://www.ethics.state.tx.us/resources/FAQs/FAQ_Form1295.php#Q2 https://www.ethics.state.tx.us/resources/FAQs/FAQ_Form1295.php#Q3 https://www.ethics.state.tx.us/resources/FAQs/FAQ_Form1295.php#Q2 https://www.ethics.state.tx.us/resources/FAQs/FAQ_Form1295.php#Q2 b1660315 Sticky Note CERTIFICATE # GENERATED BY 1295 WEBSITE. THIS FORM MUST BE COMPLETED ONLINE, PRINTED, DO NOT NEED TO NOTARIZE. SUBMITT WITH BID DOCS.

b1660315 Typewritten Text

EXAMPLE** RFP CONTRACT # AND TITLE-for example;

RFP 2227YS- Fine Arts- Clinicians/Technicians and Accompanist**

Katy Independent School District

Bodily Injury and Property Damage Waiver

BE IT KNOWN, for good consideration, the undersigned, Releasor:

Name of Releaser

Street Address of Releaser

City, State, Zip of Releaser

Jointly and severally hereby forever release, discharge and acquit Releasee:

Katy Independent School District 6301 S. Stadium Lane Katy, TX 77494

From any and all contracts, claims, suits, actions or liabilities both in law and in equity specifically arising from, relating to or otherwise described as and limited to:

Event leading to release

Date of Original Contract

This release applies only to the foregoing matters and extends to no other debt, account, agreement, obligations, cause of action, liability or undertaking by and between the parties, which, if existing, shall survive this release and remain in full force and effect and undisturbed by this specific release.

This release shall be binding upon and inure to the benefit of the parties, their successors, assigns and personal representatives as follows:

Contractor School/Department Official

Printed Name Position

Signature of Releaser Signature of Katy ISD Administrator

Date Date

CJ (R)(E) – F – Revised: 09-02-2010

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor doing business with local governmental entity

FORM CIQ

OFFICE USE ONLY

Date Received

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.

1 Name of vendor who has a business relationship with local governmental entity.

Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)

3 Name of local government officer about whom the information is being disclosed.

Name of Officer

4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.

Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary.

A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor?

Yes No

B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity?

Yes No

5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an

Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).

Signature Date ownership interest of one percent or more.

Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/14/2024

Name of signatory

Revised 8/14/2024Form provided by Texas Ethics Commission www.ethics.state.tx.us

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor doing business with local governmental entity

A complete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.

Local Government Code § 176.001(1-a): "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.

Local Government Code § 176.003(a)(2)(A) and (B):

(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:

(2) the vendor:

(A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that

(i) a contract between the local governmental entity and vendor has been executed;

or

(ii) the local governmental entity is considering entering into a contract with the vendor;

(B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that:

(i) a contract between the local governmental entity and vendor has been executed; or

(ii) the local governmental entity is considering entering into a contract with the vendor.

Local Government Code § 176.006(a) and (a-1)

(a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and:

(1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A);

(2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or

(3) has a family relationship with a local government officer of that local governmental entity.

(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of:

(1) the date that the vendor:

(A) begins discussions or negotiations to enter into a contract with the local governmental entity; or

(B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or

(2) the date the vendor becomes aware:

(A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a);

(B) that the vendor has given one or more gifts described by Subsection (a); or

(C) of a family relationship with a local government officer.