5-REQUIRED FORMS for BONFIRE UPDATED 9.15.25.pdf

Rev. 04/24

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

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

d. 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.

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

f. 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.

g. 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, Klein ISD shall have the right to annul this contract without liability.

h. 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 Klein ISD Purchasing Department, 7200 Spring Cypress Rd Klein TX 77379.

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

j. 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 because of the response submitted.

k. The undersigned acknowledges that any employees performing services under the contract awarded as a result of this bid/proposal 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

Rev 04/24 CERTIFICATION SHEET The following provision does not apply to a contract involving federal funds.

For a proposal to be considered, the following information must be provided.

FAILURE TO COMPLETE MAY RESULT IN DISQUALIFICATION

Company Name:

Mailing address:

City: State: Zip Code:

Telephone: Fax:

Email address:

In business under present name years and months

COMPLETE THE APPROPRIATE SECTION BELOW:

OR

“Resident bidder” refers to a person whose primary 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.

I CERTIFY THAT MY COMPANY IS A “RESIDENT BIDDER”:

MR. MRS. MS.

(Circle One) NAME (PLEASE PRINT)

POSITION

SIGNATURE DATE

RESIDENT BIDDER

I CERTIFY THAT MY COMPANY IS A “NONRESIDENT BIDDER” AND THE ABOVE INFORMATION IS TRUE AND CORRECT:

MR. MRS. MS.

(Circle One) NAME (PLEASE PRINT)

POSITION

SIGNATURE DATE

%YES NO If “YES”, What is that amount or percentage?

“Nonresident bidder” refers to a person who is not a resident.

IF YOU QUALIFY AS A “nonresident bidder”, you must furnish the following information:

What is your resident state? (The state your principal place of business is located.)

Does your “residence state” require bidders whose principal place of business is in Texas to under bid vendors whose residence state is the same as yours by a prescribed amount or percentage to receive a comparable contract? “Residence state” means the state in which the principal place of business is located.

NONRESIDENT BIDDER

Rev 04/24 CLEAN AIR AND WATER ACT

I, , am in compliance with all applicable (vendor name) standards, orders or regulations issued pursuant to the Clean Air Act of 1970, as Amended (42 U.S.C. 1857 (h)), Section 508 of the Clean Water Act, as amended (33 U.S.C. 1368), Executive Order 117389 and Environmental Protection Agency Regulation, 40 CFR Part 15 as required under OMB Circular A-102, Attachment O, Paragraph 14(1) regarding reporting violations to the grantor agency and to the United States Environmental Protection Agency Assistant Administrator for the Enforcement.

Company Authorized Representative (Print)

Signature Date

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 of

Form provided by Texas Ethics Commission www.ethics.state.tx.us Rev. 044/24

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.

Rev. 04/24 Page 1 of 2

CRIMINAL HISTORY REQUIREMENTS FOR SCHOOL DISTRICT

CONTRACTORS AND SUBCONTRACTORS

I. Background: Texas Education Code Chapter 22 requires entities that contract with school districts and their subcontractors to review criminal history information on covered employees. Covered employees with disqualifying criminal histories are prohibited from serving in a school district. Contractors must certify to Klein ISD that they have complied and must obtain similar certifications from their subcontractors.

II. Definitions:

Covered Employees: Employees of a contractor who have or will have continuing duties related to the contracted service(s) to be performed at a school district and have or will have the opportunity for direct contact with students.

Klein ISD will be the final arbiter of what constitutes continuing duties and direct contact with students.

Public Works Exception to Covered Employees: Covered employees do not include employees of a contracting or subcontracting entity that is providing engineering, architectural, or construction services on a project to design, construct, alter, or repair a public work 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 more than seven (7) days before a new instructional facility will be used for instruction; or (3) for an existing instructional facility, the work area contains sanitary facilities separated from all areas used by students by a 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: A felony or misdemeanor offense that would prevent a person from being employed under Texas Education Code § 22.085(a); that is, if at the time of the offense, the victim was under 18 or was enrolled in a public school including:

a. a felony offense under Title 5, Texas Penal Code;

b. an offense on conviction for which a defendant is required to register as a sex offender under Chapter 62, Texas

Code of Criminal Procedure; or

c. an offense under federal law or the laws of another state that is equivalent to (a) or (b).

III. Recent Changes to Access Policies: School contractors are no longer permitted access to national criminal history record information (NCHRI) through the Texas Department of Safety (DPS) Clearinghouse unless specifically authorized by the National Child Protection Act (NCPA).

Contractors that are considered qualified entities under the NCPA must create an account with DPS to access NCHRI through the DPS clearinghouse. You may contact the DPS for questions regarding access and assistance with creating accounts and obtaining criminal histories.

School contractors that no longer are eligible to access NCHRI through the DPS clearinghouse may review and certify state criminal history information to the extent available outside of the DPS clearinghouse for those persons employed before January 1, 2008.

All other persons for whom NCHRI is required to be reviewed but whose national criminal history information cannot be accessed by the school contractor will be fingerprinted by the District using the Local Education Entity (LEE) Fast Pass option so that NCHRI can be reviewed before providing services.

Rev. 04/24 Page 2 of 2

AGREEMENT WITH KLEIN INDEPENDENT SCHOOL DISTRICT

Regarding Criminal History Review for Vendors/Contractors

On behalf of (“Contractor”), I, the undersigned authorized signatory for Contractor, certify to the Klein ISD the following in regards to contractor and/or contractor’s employees or subcontractors [please check one below]:

NONE OF CONTRACTOR’S EMPLOYEES ARE COVERED EMPLOYEES. IF

THIS BOX IS CHECKED, I FURTHER CERTIFY THAT CONTRACTOR HAS TAKEN

PRECAUTIONS OR IMPOSED CONDITIONS TO ENSURE THAT ITS EMPLOYEES

WILL NOT BECOME COVERED EMPLOYEES. CONTRACTOR WILL MAINTAIN

THESE PRECAUTIONS OR CONDITIONS THROUGHOUT THE TIME THE

CONTRACTED SERVICES ARE PROVIDED.

SOME OR ALL OF CONTRACTOR’S EMPLOYEES ARE COVERED

EMPLOYEES. IF THIS BOX IS CHECKED, I FURTHER CERTIFY THAT:

1) Contractor has complied with the requirements of Section 22 of the Texas Education Code, and none of its covered employees has a disqualifying criminal history

2) Contractor, its covered employees and its subcontractors will comply with any and all reasonable requests from Klein ISD in facilitating criminal history reviews that are mandated by state and federal law, including but not limited to the provision of a list of covered employees prior to the provision of services, provision of updated lists upon changes to personnel providing services to Klein ISD, and notification within two days of the end of service of any covered employee

3) Contractor acknowledges that covered employees will not provide services until completion of the required reviews of criminal history information

I also certify to the District on behalf of Contractor that Contractor has obtained certifications from its subcontractors of compliance with Texas Education Code chapter 22.

Noncompliance or misrepresentation regarding this certification may be grounds for contract termination.

Contractor Business Name (dba Name) Authorized Contractor Representative (Print Name)

Signature Title

Date

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY

AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS

Per Title 34, Code of Federal Regulations, 80.35, “Grantees and subgrantees must not make any award or permit any award (subgrant or contract) at any tier to any party which is debarred or suspended or is otherwise excluded from or ineligible for participation in Federal assistance programs under Executive Order 12549, “Debarment and Suspension.”

(Before completing certification, read the instructions below.) Please check one choice below:

The prospective lower tier participant certifies, by submission of this proposal, 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.

When the prospective lower tier participant is unable to certify any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.

Organization Name

Name and Title of Authorized Representative

Instructions For Suspension/Debarment Certification Statement

1. By signing and dating the certification statement, the bidder certifies that neither it nor any of its principals

(e.g., key employees) has been proposed for debarment, debarred or suspended by a federal agency on the date signed.

2. The prospective bidder shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective bidder learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

3. Federal and State penalties exist for vendors and districts that knowingly enter into contracts with suspended/debarred persons.

DEVIATION FORM

All deviations to the Specifications must be noted on this sheet. In the absence of any entry on this Deviation Form, the Vendor assures the Buyer of their full compliance with the Specifications and Conditions. The form may be duplicated as needed.

THIS DEVIATION FORM MUST BE SIGNED BY EACH VENDOR WHETHER

THERE ARE DEVIATIONS LISTED OR NOT AND SUBMITTED WITH THIS

PROPOSAL.

ITEM NO. PAGE NO.

NO DEVIATION If alternate proposed does not deviate from the item specified, check the box.

Company Name Authorized Signature Date

FELONY CONVICTION NOTIFICATION

I, the undersigned 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 select ONE choice below:

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

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

My firm is owned or operated by the following individuals who have been convicted of a felony.

Name of individual (s):

Details of conviction (s):

Please COMPLETE the information below:

Vendor Name:

(Please Print)

Company Name:

(Please Print)

Signature: Date:

Rev 04/24

State of Texas Legislative Senate Bill No. 1, Section 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 the district 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 the district determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction.

The district 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.

Klein 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.

Klein 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 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/filinginfo/1295/

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. 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 within seven business days after receiving notice from KISD.

Klein ISD HB 89 and SB 252 Certification Addendum

This addendum (“Addendum”) is hereby incorporated to and made a part of the underlying agreement (the “Contract”) between Klein ISD and the vendor, consultant, contractor, or independent contractor (“Contractor”) referenced herein.

The Texas 85th Legislature passed two bills during its regular session that will impact all government contracts for goods and services, regardless of dollar amount, including contracts for professional, consulting, and construction services. This Addendum requires review and signature from any Contractor entering into a contract with Klein ISD to ensure the Contractor complies with the requirements stipulated herein.

HB 89 – Certification Regarding Boycotting of Israel

Texas House Bill 89 (HB 89) prohibits governmental entities from entering a contract for goods and services that do not contain the Contractor's written verification that the Contractor does not, and during the term of the contract will not, boycott Israel.

SB 252 - Verification Regarding Terrorist Organizations

Texas Senate Bill 252 (SB 252) prohibits governmental entities from contracting with parties on the Texas State Comptroller's list of companies known to have contracts with, or provide supplies or services to, an organization designated as a Foreign Terrorist Organization by the U.S. Secretary of State. As a result of the new law, governmental entities are required to verify that vendors are not on the Comptroller's list (the "List") of companies with ties to foreign terrorists. The T e x a s Comptroller's Office provides and maintains such List and anticipates the List going live on September 1, 2017. The List is accessible through the Texas Comptroller's website (https://comptroller.texas.gov/purchasing/); click on Publications and Forms (under Procurement Resources), and then click on Divestment Statute Lists (under Reports).

Contractor Certifications

The Contractor entering into a Contract with Klein ISD for the provision of goods or services, whether such Contract is in the form of either a written agreement executed between both parties or a duly authorized Klein ISD purchase order, hereby certifies and verifies that neither Contractor, nor any affiliate, subsidiary, or parent company of Contractor, if any (the "Contractor Companies"), boycott Israel, and Contractor agrees that Contractor and Contractor Companies will not boycott Israel during the term of this Contract. For purposes of this Contract, the term "boycott" shall mean and include terminating business activities or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory.

Contractor further certifies that it is not a company identified on the Texas Comptroller's List of companies known to have contracts with, or provide supplies or services to, a foreign organization designated as a Foreign Terrorist Organization by the U.S. Secretary of State.

The certifications referenced above are hereby made by the Contractor as of the date specified below.

Company Name (Please Print): Date:

Authorized Agent Name: Signature:

KLEIN INDEPENDENT SCHOOL DISTRICT

AFFIDAVIT OF NON-COLLUSION

By submission of this bid/proposal/quote, the undersigned certifies that:

A: This bid/proposal/quote has been independently arrived at without collusion with any bidder/proposer or competitor;

B: This bid/proposal/quote has not been knowingly disclosed and will not be knowingly disclosed, to any other bidder/proposer competitor or potential competitor, prior to the opening of bids/proposals/quotes for this project;

C: No attempt has been or will be made to induce any other person, partnership or corporation to submit or not submit a bid/proposal/quote;

D: The undersigned certifies that he/she is fully informed regarding the accuracy of the statements contained in this certification, and that the penalties herein are applicable to the bidder/proposer as well as to any person signing in his behalf.

Company Name:

Address:

City/State/Zip:

Phone Number:

Authorized Signature:

Print Name/Title:

Instructions for Completion of SF--LLL, Disclosure of Lobbying Activities

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal Action.

2. Identify the status of the covered Federal Action.

3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal Action.

4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known.

Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants, and contract awards under grants.

5. If the organization filing the report in item 4 checks “Subawardee,” then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the Federal Agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application proposal control number assigned by the Federal agency). Include prefixes, e.g., “RFP- DE-90-00l.”

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services and include full address if different from 10 (a). Enter Last Name, First Name, and Middle Initial (MI).

11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made.

12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment.

13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.

14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employees(s), or Member(s) of Congress that were contacted.

15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.

16. The certifying official shall sign and date the form, print his/her name, title, and telephone number.

Texas Department of Agriculture — January 2012 Procurement 17.31

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction

Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 Approved by OMB

(See next page for public burden disclosure) 0348 0046

1. Type of Federal Action:

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. Status of Federal Action:

a. bid/offer/application

b. initial award

c. post award

3. Report Type:

a. initial filing

b. material change For material change only:

year_______ quarter____ Date of last report_______

4. Name and Address of Reporting Entity:

Prime Subawardee

Tier______, if Known:

Congressional District, if known:

5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

Congressional District, if known:

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable: __________________

8. Federal Action Number, if known: 9. Award Amount, if known:

10. a. Name and Address of Lobbying Entity

(if individual, last name, first name, MI):

b. Individuals Performing Services

(including address if different from No. 10a) (last name, first name, MI):

(Attach Continuation Sheet(s) SF LLL A, if necessary)

11. Amount of Payment (check all that apply):

$__________________ Actual Planned

13. Type of Payment (check all that apply):

a. retainer

b. one time fee

c. commission

d. contingent fee

e. deferred

f. Other; specify: ______________________

12. Form of Payment (check all that apply):

a. cash

b. in kind; specify: nature __________ value __________

14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11:

(Attach Continuation Sheet(s) SF LLL A, if necessary)

15. Continuation Sheet(s) SF LLL A attached: Yes No

16. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi annually and will be available for public inspection.

Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Signature: _____________________________________________

Print Name: ___________________________________________

Title: _________________________________________________

Telephone No.: _________________ Date: ________________

Federal Use Only: Authorized for Local Reproduction Standard Form – LLL (Rev. 7 97)

Texas Department of Agriculture — January 2012

CONFIDENTIALITY DECLARATION FORM

AGREEMENT IS GOVERNED BY TEXAS GOVERNMENT CODE, CHAPTER 552

As a governmental body, KISD is subject to the Texas Public Information Act found in Chapter 552, Texas Government Code. Proposals and other information submitted to KISD in connection with this procurement solicitation or the Agreement may be subject to release as public information. If a Vendor believes that part(s) of its proposal or any other information submitted by Vendor to KISD in connection with this procurement solicitation or the Agreement contain confidential, proprietary, and/or trade secret information or otherwise may be excepted from disclosure under Texas law, the Vendor must clearly and conspicuously mark the applicable information as “CONFIDENTIAL.”

Marking information as “CONFIDENTIAL” does not guarantee that the information will be withheld from disclosure. If KISD receives a request for public information involving information that Vendor has clearly and conspicuously marked as “CONFIDENTIAL,” KISD will respond pursuant to Chapter 552, Texas Government Code, which may or may not require that KISD provide notice of the request to Vendor. Vendor understands and agrees that it is solely responsible for submitting to the Attorney General of Texas each reason why the requested information should be withheld and a letter, memorandum, or brief in support of that reason. KISD assumes no obligation or responsibility relating to the disclosure or nondisclosure of information submitted by Vendors, and Vendor hereby waives any claim against and releases from liability KISD, its respective officers, employees, agents, and attorneys with respect to disclosure of information provided under or in connection with this procurement solicitation or the Agreement or otherwise created, assembled, maintained, or held by Vendor or KISD and determined by KISD, the Attorney General of Texas, or a court of law to be subject to disclosure under the Texas Public Information Act. Further, even if Vendor marks information as “CONFIDENTIAL,” Vendor expressly agrees that KISD may disclose Vendor’s proposal, including, but not limited to, pricing information, to other governmental entities.

Please check ONLY ONE of the following options:

Declaration of Confidentiality – Vendor HAS clearly and conspicuously marked information contained in its proposal and/or other information submitted by Vendor to KISD in connection with this procurement solicitation or the Agreement as “CONFIDENTIAL.” Vendor declares that the information marked by Vendor as “CONFIDENTIAL” contains confidential, proprietary, and/or trade secret information and is excepted from disclosure under Chapter 552, Texas Government Code.

of Confidentiality – Vendor HAS NOT marked any information contained in its proposal and/or other information submitted by Vendor to KISD in connection with this procurement solicitation or the Agreement as “CONFIDENTIAL.”

Vendor certifies that it has not submitted any confidential, proprietary, and/or trade secret information to KISD and that its proposal and all other information—including any pricing information—submitted by Vendor to KISD in connection with this procurement solicitation or the Agreement is subject to disclosure under Chapter 552, Texas Government Code.

Vendor hereby expressly waives any claim of confidentiality with respect to its proposal and/or any other information— including any pricing information—submitted by Vendor to KISD in connection with this procurement solicitation or the Agreement.

Vendor Name

Printed Name of Authorized Officer/Representative of Vendor Title