5-Form A - Respondents Execution of Offer-Proposal v2.1.pdf

FORM A

RESPONDENT’S EXECUTION OF PROPOSAL AND ASSURANCES (WITH

CERTIFICATION)

Social Security Numbers are CONFIDENTIAL and excepted from disclosure under the Texas Public Information Act

Form A – Respondent’s Execution of Proposal and Assurances (with Certification) Page 1 of 5 Revised March 2022

Respondent represents and warrants that all statements and information prepared and submitted in this document are current, complete, true, and accurate. If any assurance is shown to be false, any contract awarded to Respondent may be terminated, payment withheld, and the Respondent shall be liable to the Office of the Attorney General (OAG) for attorney’s fees and the costs necessary to complete the contract, including the cost of advertising and awarding a subsequent contract.

By submitting this Offer, Respondent represents and warrants that the individual submitting this document and the documents made part of this Response is authorized to sign such documents on behalf of the Respondent and to bind the Respondent under any contract that may result from the submission of this Offer.

1. Antitrust: Pursuant to 15 U.S.C. §1, et seq., and Texas Business & Commercial Code §15.01, et seq., neither the Respondent nor the firm, corporation, partnership, or institution represented by the Respondent, or anyone acting for such a firm, corporation, partnership, or institution, has violated Texas antitrust laws or federal antitrust laws or communicated its Response directly or indirectly to a competitor of the Respondent or any other company, firm, corporation, partnership, or individual or related entities of the same, or the Respondent, engaged in the same line of business as the Respondent.

2. Child Support: Under §231.006, Family Code, the Respondent certifies that the individual or business entity named in this Response is not ineligible to receive the specified grant, loan, or payment and acknowledges that the contract may be terminated and payment withheld if this certification is inaccurate. If the certificate is shown to be false, the Respondent shall be liable to the OAG for attorney’s fees and the costs necessary to complete the contract, including the cost of advertising and awarding a subsequent contract.

3. Executive Head of a State Agency: Pursuant to §669.003, Government Code, the OAG may not enter into a contract with a person who employs a current or former executive head of the OAG until four years has passed since that person was the executive head of the OAG. Respondent assures the OAG that it may enter a contract with the OAG in compliance with this law. If the Respondent employs a former executive head of the OAG, the Respondent must complete the following information in order for its Response to be evaluated:

Name of Former Executive:

Name of State Agency:

Date of Separation:

Position with Respondent:

Date of Employment with Respondent:

4. Financial Participation Prohibited: Section 2155.004, Government Code, prohibits the OAG from accepting a Response that includes proposed financial participation by a person who received compensation from the OAG to participate in preparing this solicitation or the specifications contained in this solicitation. Respondent certifies:

“Under §2155.004, Government Code, the Respondent certifies that the individual or business entity named in this Response is not ineligible to receive the specified contract and acknowledges that the contract may be terminated and payment withheld if this certification is inaccurate.”

Social Security Numbers are CONFIDENTIAL and excepted from disclosure under the Texas Public Information Act

Form A – Respondent’s Execution of Proposal and Assurances (with Certification) Page 2 of 5

5. Prior Disaster Relief Contract Violation: Sections 2155.006 and 2261.053, Government Code, prohibits the OAG from accepting a bid or awarding a contract to any person who, in the past five years, has been convicted of violating a federal law or assessed a penalty in connection with a contract involving relief for Hurricane Rita, Hurricane Katrina, or any other disaster, as defined by §418.004, Government Code, occurring after September 24, 2005. Respondent certifies:

“Under §§2155.006 and 2261.053, Government Code, the Respondent certifies that the individual or business entity named in this Response is not ineligible to receive the specified contract and acknowledges that the contract may be terminated and payment withheld if this certification is inaccurate.”

6. Lobbying Prohibition: The Respondent represents and warrants that payment to the Respondent and the Respondent’s receipt of appropriated or other funds under any contract resulting from this solicitation are not prohibited by §556.005 or §556.008, Government Code, relating to the prohibition of using state funds for lobbying activities.

7. Debts and Delinquencies: As required by §2252.903, Government Code, the Respondent agrees that any payments due under the contract resulting from this solicitation shall be applied towards any debt or delinquency including, but not limited to, delinquent taxes, delinquent student loan payments, and delinquent child support.

8. Dealings with Public Servants: The Respondent has not given, offered to give, nor intends to give at any time hereafter, any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted Response.

9. Audit Exceptions: The Respondent has no unresolved audit exceptions with the OAG. An unresolved audit exception is an exception for which the Respondent has exhausted all administrative and/or judicial remedies and refuses to comply with any resulting demand for payment.

10. Suspension and Debarment: The Respondent certifies that the responding entity and its principals are eligible to participate in this transaction and have not been subjected to suspension, debarment, or similar ineligibility determined by any federal, state, or local governmental entity and that Respondent is in compliance with the State of Texas statutes and rules relating to procurement. Entities ineligible for federal procurement are listed at System for Award Management (SAM) at https://sam.gov/content/home.

11. No Conflicts of Interest: The Respondent represents and warrants that it has no actual or potential conflicts of interest in providing the requested items to the OAG under the solicitation and any resulting contract, if any, and that Respondent’s provision of the requested items under the solicitation and any resulting contract, if any, would not reasonably create an appearance of impropriety.

12. Contracting Information Responsibilities: To the extent applicable, Respondent represents and warrants that, if a contract is awarded under this Offer, it will comply with the requirements of §552.372(a) of the Texas Government Code. Except as provided by §552.374(c) of the Texas Government Code, the requirements of Subchapter J, Chapter 552 of the Government Code, may apply to the contract, and Respondent agrees that the contract can be terminated if the Respondent knowingly or intentionally fails to comply with a requirement of that Subchapter.

13. Entities That Boycott Israel: Pursuant to §§ 2271.001 and 2271.002, Government Code, the Respondent certifies that they (1) do not boycott Israel and (2) will not boycott Israel during the term of the contract.

14. Foreign Terrorist Organizations: In accordance with Texas Government Code, Chapter 2252, Subchapter F, the Respondent hereby represents and warrants that it is not a company identified on the lists prepared and maintained under Texas Government Code §§ 2270.0052 (companies with business operations in Sudan), 2270.0102 (companies with business operations in Iran), or

2270.0152 (companies known to have contracts with or provide supplies or services to a foreign terrorist organization). Notwithstanding the foregoing, a company that the United States https://sam.gov/content/home

Social Security Numbers are CONFIDENTIAL and excepted from disclosure under the Texas Public Information Act

Form A – Respondent’s Execution of Proposal and Assurances (with Certification) Page 3 of 5 government affirmatively declares to be excluded from its federal sanctions regime relating to Sudan, Iran, or a foreign terrorist organization is not subject to contract prohibition under this clause. A company claiming such exemption must submit the official copy of the declaration.

15. Excluded Parties: Respondent certifies that it is not listed in the prohibited vendors list authorized by Executive Order No. 13224, “Blocking Property and Prohibiting Transactions with Persons who Commit, Threaten to Commit, or Support Terrorism” published by the United States Department of the Treasury, Office of Foreign Assets Control.

16. Critical Infrastructure: To the extent applicable, pursuant to §2275.0102, Government Code, the Respondent certifies that neither it nor its parent company nor any affiliate of Respondent or its parent company, is: (1) majority owned or controlled by citizens or governmental entities of China, Iran, North Korea, Russia, or any other country designated by the Governor under Texas Government Code §2275.0103, or (2) headquartered in any of those countries.

17. Energy Company Boycotts: To the extent the Respondent is required pursuant to §2276.002, Government Code, the Respondent certifies that it does not and shall not for the duration of any resulting contract hereunder boycott energy companies as the term is defined under §809.001(1), Government Code or that the verification required by §2276.002, Government Code does not apply to the contract.

18. Firearm Entities and Trade Associations Discrimination: To the extent the Respondent is required pursuant to §2274.002, Government Code, the Respondent certifies that it (1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association, and (2) will not for the duration of any resulting contract hereunder, discriminate against a firearm entity or firearm trade association, as the term is defined under §2274.001(3), Government Code or that the verification required by §2274.002, Government Code does not apply to the contract.

19. Cybersecurity Training: To the extent applicable, the Respondent hereby certifies that all employees, agents, subcontractors, officers, and/or any other users authorized by the Respondent that have access to a state computer system or database shall complete a cybersecurity training program certified under §2054.519, Government Code at the frequency prescribed by §2054.5192(c). The Respondent further certifies and agrees to maintain evidence of any such completed cybersecurity training and shall upon OAG request, furnish evidence of the completed cybersecurity training to OAG in the frequency, manner, and form prescribed by OAG.

20. Data Management and Security Controls: To the extent applicable, in accordance with §2054.138 of the Texas Government Code, Respondent certifies that it will comply with the security controls required under any contract resulting from this Offer and will maintain records and make them available to Agency as evidence of Respondent’s compliance with the required controls.

21. Cloud Computing: To the extent applicable, pursuant to §2054.0593(d)-(f), Government Code, relating to cloud computing state risk and authorization management program, the Respondent represents and warrants that it complies with the requirements of the state risk and authorization management program and Respondent agrees that throughout the term of the contract it shall maintain its certifications and comply with the program requirements in the performance of the contract.

22. COVID-19 Vaccine Passport Prohibition: The Respondent certifies that it does not require its customers to provide any documentation certifying the customer’s COVID-19 vaccination or post-transmission recovery on entry to, to gain access to, or to receive service from the Respondent’s business. The Respondent acknowledges that such a vaccine or recovery requirement would make the Respondent ineligible for a state-funded contract.

23. Human Trafficking Prohibition: Under §2155.0061 of the Texas Government Code, the Respondent certifies that the individual or business entity named in this Offer or contract is not ineligible to receive the specified contract and acknowledges that this contract may be terminated and payment withheld if this certification is inaccurate.

Social Security Numbers are CONFIDENTIAL and excepted from disclosure under the Texas Public Information Act

Form A – Respondent’s Execution of Proposal and Assurances (with Certification) Page 4 of 5

24. E-Verify: Respondent certifies that it utilizes and will continue to utilize the U.S. Department of Homeland Security’s E-Verify system to determine the eligibility of: (1) all persons employed to perform duties within Texas during the term of the contract; and (2) all persons, including subcontractors, assigned by Respondent to perform work pursuant to the contract within the United States of America.

25. Texas Bidder: Respondent certifies that if a Texas address is shown as the address of the Respondent on this Offer, Respondent qualifies as a Texas Bidder as defined in §2155.444(c) of the Texas Government Code.

26. Disclosure of Prior State Employment: If the Contract is related to “consulting services,” as the term is defined in Subsection 2254.021(1) of the Texas Government Code, Respondent hereby certifies that it does not employ an individual who has been employed by OAG or another agency at any time during the two years preceding the submission of the response or, in the alternative, Respondent has disclosed in its response the following: (i) the nature of the previous employment with OAG or the other agency; (ii) the date the employment was terminated; and (iii) the annual rate of compensation for the employment at the time of its termination.

27. Former Agency Employees: In accordance with Section 2252.901 of the Texas Government Code, Respondent represents and warrants that none of its employees including, but not limited to, those authorized to provide services under the Contract, were former employees of the OAG during the twelve (12) month period immediately prior to the date of execution of the Contract.

28. Terms and Conditions Attached: Any terms and conditions attached to an Offer will not be considered unless specifically referred to in the Offer.

Corporations submitting Responses to the OAG shall provide the following information:

Federal Employer ID#: Corporate Charter #:

Entity Name: Telephone Number:

Street Address: FAX Number:

City/State/Zip: E-mail Address:

Responses must include names and Social Security Numbers of each person with at least 25% ownership of the business entity submitting the Response. Respondents must complete the following:

Name Social Security Number

Failure of an organization to provide the above information shall result in the disqualification of the response.

Social Security Numbers are CONFIDENTIAL and excepted from disclosure under the Texas Public Information Act

Form A – Respondent’s Execution of Proposal and Assurances (with Certification) Page 5 of 5

RESPONDENT ACKNOWLEDGMENT AND CERTIFICATION

Respondent hereby certifies that it has received, reviewed, and accepted the solicitation and the included statement of work, terms, requirements, and conditions. The Respondent hereby acknowledges that it can meet all of the requirements as stated in the solicitation excluding any requirements it took exception to, as explicitly set forth in its Response.

The Respondent also certifies that the information included in its Response and on this form is, to the best of its knowledge, complete and accurate and that it shall update all such information at any time that such information changes. The Respondent certifies that the person signing this form is authorized to sign on its behalf and, as proof, submits the Corporate Board of Director’s Resolution, or similar document authoriz ing the representative to enter into contracts on the Respondent’s behalf.

Signature of Authorized Representative

Printed Name of Authorized Representative

Title of Authorized Representative

Full Name of Respondent Entity

Date

Solicitation Number

Response Opening Date