6-Prohibited Contracts Form.pdf
PDF 117 KB Posted
- Attached to
- Caustic Soda State and local contract opportunity
- Solicitation number
- WU-06-26
- Issued by
- Tyler County, Texas
About this file
This is a Prohibited Contracts Verification Form issued by the City of San Angelo, Texas Purchasing Division for use in connection with a caustic soda procurement for the Water Production Plant. The form requires declarants to verify their identity, position, and company affiliation while confirming compliance with multiple state and federal contract prohibitions. Bidders must attest that their contracting company does not and will not maintain contracts with entities known to have relationships with foreign terrorist organizations as listed by the Texas Comptroller, does not boycott Israel, does not boycott energy companies per Senate Bill 13, and does not discriminate against firearm and ammunition industries per Senate Bill 19. The form requires execution under penalty of perjury with signature, date, county, and state information documented.
The City of San Angelo Water Production Plant is procuring caustic soda (sodium hydroxide diaphragm) for potable water treatment, with annual requirements of approximately 450 dry tons at 50% solution concentration. All contractors submitting bids must complete and return this certification form as a condition of contract eligibility. Bidders are required to notify the City of San Angelo immediately if any circumstances relevant to these representations change during the contract term. Failure to comply with these prohibitions or provide accurate declarations may result in contract disqualification or termination.
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Text version
CITY OF SAN ANGELO, TEXAS
PURCHASING DIVISION
72 West College Avenue, San Angelo, Texas 76903
325.657.4219 • sapurch@cosatx.us
Verification Related to Prohibited Contracts
CITY OF SAN ANGELO, TEXAS
My name is “Declarant”;
FIRST MIDDLE LAST
My date of birth is ; and, BIRTHDAY
My address is , .
STREET CITY STATE
, and .
ZIP CODE COUNTRY
My position with , contracting company, is .
CONTRACTING COMPANY OFFICE HELD
(1) The foregoing named contracting Company does not now and will not during the term of this contract, have contracts with or provide supplies or services to, an entity or company known to have contracts with or to provide supplies or services to a foreign terroristic organization or with an entity or company identified as providing such on a list prepared and maintained by the Texas Comptroller pursuant to Subchapter “F”, Sections 2252.151 et. seq., Chapter 2252 “Contracts with Governmental Entity” of the Texas Government Code; neither is contracting Company identified as an entity providing such supplies or services on said list.
(2) The foregoing named contracting Company does not boycott Israel; and will not boycott Israel during the term of the contract with the City of San Angelo.
(3) Entities that Boycott Energy Companies. In accordance with Senate Bill 13, Acts 2021, 87th Leg., R.S., pursuant to Section 2274.002 of the Texas Government Code (relating to prohibition on contracts with companies boycotting certain energy companies), the foregoing named contracting Company represents and warrants that it does not, and will not for the duration of the Contract, boycott energy companies.
(4) Entities that Discriminate Against Firearm and Ammunition Industries. In accordance with Senate Bill 19, Acts 2021, 87th Leg., R.S., pursuant to Section 2274.002 of the Texas Government Code (relating to prohibition on contracts with companies that discriminate against firearm and ammunition industries), The foregoing named contracting Company verifies that it 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.
(5) If circumstances relevant to this provision change during the course of the Contract the City of San Angelo shall be promptly notified.
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of , on the
COUNTY OFFICE HELD
day of , 20
DAY MONTH YEAR
Declarant Signature mailto:sapurch@cosatx.us
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