8-Vendor Certification Form.pdf

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MANOR ISD

Vendor Certification Form

By submitting this offer, the Vendor certifies that he/she is a responsible authorized officer of the company and certifies the accuracy of the following statements:

DEBARMENT AND SUSPENSION

a. By signing this bid/proposal, vendor makes the assurance that vendor has not been debarred or suspended from conducting business with the US Government according to Executive Order 12549 entitled “Debarment and Suspension.” Non-Federal entities are prohibited from contracting with or making sub-awards under covered transactions to parties that are suspended or debarred or whose principals are suspended or debarred. 'Covered transactions' include those procurement contracts for goods and services awarded under a nonprocurement transaction (e.g., grant or cooperative agreement) that are expected to equal or exceed $25,000 or meet certain other specified criteria. 2 CFR section 180.220 of the Government-wide Non-Procurement Debarment and Suspension Guidance contains those additional limited circumstances. All non-procurement transactions (i.e., sub-awards to sub-recipients), irrespective of award amount, are considered covered transactions.

□ Acknowledged

FELONY CONVICTION NOTIFICATION

b. Texas Education Code, Section 44.034, Notification of Criminal History of Contractor, 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 an 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 for services performed before the termination of the contract.”

Check one:

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

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

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

Name of Felon(s): ________________________________________________________________________ Details of Conviction(s): ___________________________________________________________________

□ Acknowledged

NON-COLLUSION STATEMENT AND ANTI-LOBBYING CERTIFICATION

c. "Non-Collusion Statement" and “Anti-Lobbying Certification”: "The undersigned affirms that they are duly authorized to execute this Certification, Offer, and/or Contract and that this company, corporation, firm, partnership, etc., or individual has not prepared this bid in collusion (An agreement between two or more persons to deceive the school district or defraud the school district of its rights) with any other bidder, school board member, or school district employee, and that the contents of this bid as to prices, quality of product, terms and/or conditions, etc., have not been communicated by the undersigned nor by any other employee, agent and/or representative of the company, corporation, firm, partnership, etc., or individual to any other person engaged in this type of business prior to the official opening of this bid for the intent or purpose of collusion." In accordance with Title 31, USC Section 1352, no attempt has been or will be made by this company’s officers, employees, or agents to lobby, directly or indirectly, with the Manor Independent School District Board of Trustees between bid/ proposal submission date and award by the Board.

□ Acknowledged

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CONFLICT OF INTEREST

d. “Conflict of Interest”:

(1) Neither an officer, agent, employee, or stockholder (if vendor is a privately held corporation) of the vendor, nor the vendor (if the vendor is a sole proprietorship) is a MISD employee or related by consanguinity (second degree) or marriage (first degree) to a MISD employee.

(2) Neither an officer, agent, employee, affiliate, subsidiary, nor stockholder (if vendor is a privately held corporation) of the vendor, nor the vendor itself has a conflict of interest in the performance of its contract with MISD. Note: as used here, “conflict of interest” means a vendor (including its affiliates and subsidiaries) has an interest (financial or otherwise) that is inconsistent with its contractual obligations to MISD, or the vendor’s officer’s, agent’s, employee’s, or stockholder’s personal interests are contrary or inconsistent with the vendor’s contractual obligations to MISD.

(3) Vendor has timely submitted the required conflict of interest questionnaire (CIQ) in compliance with Chapter 176 of the Local Gov’t Code and MISD mandates.

Note: Texas law requires vendors to file a CIQ adopted by the Texas Ethics Commission not later than the seventh (7TH ) business day after the date that the vendor: (i) begins discussions or negotiations to enter into a contract with MISD; (ii) submits to MISD an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with MISD; or (iii) the date the person becomes aware of an employment or other business relationship with a MISD officer, or a family member of the officer, or that the person has given one or more gifts to an MISD officer of the District, or a family member of the officer. A vendor is further mandated by MISD to file a CIQ thirty (30) days before the vendor’s contract term expires and a renewal is considered by MISD. Failure to timely file the CIQ may disqualify the vendor from being awarded a contract or having its contract renewed. See MISD Board Policy CHE (LEGAL) and the Texas Ethics Commission for additional information on the filing of a CIQ.

Please complete the Conflict of Interest Questionnaire along with all other required documents to accompany bid/proposal submittal if applicable.

https://www.ethics.state.tx.us/data/forms/conflict/CIQ.pdf

□ Acknowledged

INSURANCE AND BONDS

e. Submission of a certificate of insurance and or bond (if applicable) by the undersigned (or an agent/broker on behalf of the undersigned) represents that the coverages and perils covered by the insurance or bond meet or exceed the requirements of the solicitation document and/or subsequent contract. Manor ISD may make reasonable reliance on the submitted certificate of insurance or bond. The certificate of insurance or bond must accurately reflect the policy coverages and will become a part of the contract documents and incorporated by reference, but the contract terms/conditions and statement of work take precedence over any and all contents of the certificate of insurance or bond including, but not limited to, disclaimers, qualifications, etc. Failure to provide insurance/bond in accordance with contract may be cause for termination for default and other remedies allowed by law and/or equity. Vendor must notify Manor ISD, in writing, by certified mail or personal delivery, within ten

(10) business days after the vendor knew or should have known of any changes that materially affects the insurance or bond coverage.

(11) Acknowledged

CRIMINAL BACKGROUND CHECKS/SEARCHES

f. Bidder/Proposer represents that criminal background checks/searches have been conducted (or will be conducted prior to start of Work if required) in accordance with Texas Education Code Chapter 22.

□ Acknowledged

CERTIFICATE OF INTERESTED PARTIES – FORM 1295

g. Manor Independent School District (MISD) 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 MISD from https://www.ethics.state.tx.us/data/forms/conflict/CIQ.pdf

Page | 5 executing a Board or Superintendent approved contract with a business entity unless the business entity submits a Disclosure of Interested Parties (Form 1295) to MISD. A person or business entity entering into a contract and/or agreement with MISD is required by the New Government Code Statute §2252.908, to complete Form 1295 “Certificate of Interested Parties”.

Prior to the execution of the contract and after the Notice of Award, a 1295 Form must be filled out by the Awarded Vendor electronically with the Texas Ethics Commission’s online filing application,www.ethics.state.tx.us, printed out, signed, and submitted via email to the Purchasing Coordinator on record.

□ Acknowledged

Is your company a publicly traded business entity, including a wholly owned subsidiary of the business entity?

Yes _____ No _____

CERTIFICATION OF COMPLIANCE WITH TEXAS FAMILY CODE PROVISION

h. As per Section 14.52 of the Texas Family Code, added by S.B. 84, Acts, 73rd Legislature, R.S. (1993), all bidders must complete and submit with the bid the following affidavit:

I, the undersigned vendor, do hereby acknowledge that NO sole proprietor, partner, majority shareholder of a corporation, or an owner of 10% or more of another business entity is 30 days or more delinquent in paying child support under a court order or a written repayment agreement. I understand that under this provision, a sole proprietorship, partnership, corporation or other entity in which a sole proprietor, partner, majority shareholder or a corporation, or an owner of 10% or more of another entity is 30 days or more delinquent in paying child support under a court order or a written repayment agreement is NOT eligible to bid or receive a state contract.

□ Acknowledged

CERTIFICATION OF COMPLIANCE WITH HOUSE BILL 89

i. Vendor certifies that compliance with all applicable provisions of the House Bill 89. Purchases made in accordance under the provisions of Subtitle F, Title 10, Government Code Chapter 2270 must comply with the following:

1. Does not boycott Israel currently; and

2. Will not boycott Israel during the term of the contract the above-named Company, business or individual with Manor Independent School District.

□ Acknowledged

CERTIFICATION OF COMPLIANCE WITH SENATE BILL 252

j. “Senate Bill 252 (SB 252)” updates state contracting law to prohibit governmental entities from contracting with companies engaged in business with Iran, or designated foreign terrorist organizations.

□ Acknowledged

CERTIFICATION REGARDING BOYCOTTING CERTAIN ENERGY COMPANIES

k. If (a) company is not a sole proprietorship; (b) company has ten (10) or more full-time employees; and (c) this contract has a value of $100,000 or more that is to be paid wholly or partly from public funds, the following certification shall apply; otherwise, this certification is not required. Pursuant to Tex. Gov’t Code Ch. 2274 of SB 13 (87th session), the company hereby certifies and verifies that the company, or any wholly owned subsidiary, majority-owned subsidiary, parent company, or affiliate of these entities or business associations, if any, does not boycott energy companies and will not boycott energy companies during the term of the contract. For purposes of this contract, the term “company” shall mean an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, that exists to make a profit. The term “boycott energy company” shall mean “without an ordinary business purpose, refusing to deal with, terminating business activities with, or otherwise taking any action 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 https://prd.tecprd.ethicsefile.com/TECCertInt/pages/login/certLogin.jsf

Page | 6 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).” See Tex. Gov’t Code § 809.001(1).

□ Acknowledged

CERTIFICATION PROHIBITING DISCRIMINATION AGAINST FIREARM AND AMMUNITION INDUSTRIES

l. If (a) company is not a sole proprietorship; (b) company has at least ten (10) full-time employees; (c) this contract has a value of at least $100,000 that is paid wholly or partly from public funds; (d) the contract is not excepted under Tex. Gov’t Code §

2274.003 of SB 19 (87th leg.); and (e) governmental entity has determined that company is not a sole-source provider or governmental entity has not received any bids from a company that is able to provide this written verification, the following certification shall apply; otherwise, this certification is not required. Pursuant to Tex. Gov’t Code Ch. 2274 of SB 19 (87th session), the company hereby certifies and verifies that the company, or 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 these entities or associations, that exists to make a profit, does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association and will not discriminate during the term of this contract against a firearm entity or firearm trade association. For purposes of this contract, “discriminate against a firearm entity or firearm trade association” shall mean, with respect to the entity or association, to: “(1) 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; (2) 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 (3) terminate an existing business relationship with the entity or association based solely on its status as a firearm entity or firearm trade association. See Tex. Gov’t Code § 2274.001(3) of SB 19. “Discrimination against a firearm entity or firearm trade association” does not include: “(1) 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 (2) 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 to comply with federal, state, or local law, policy, or regulations or a directive by a regulatory agency, or 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.” See Tex. Gov’t Code § 2274.001(3) of SB 19.

□ Acknowledged

CERTIFICATION REGARDING CERTAIN FOREIGN-OWNED COMPANIES IN CONNECTION WITH CRITICAL INFRASTRUCTURE

m. Client name is prohibited from entering into a contract or other agreement relating to critical infrastructure that would grant to the company direct or remote access to or control of critical infrastructure in this state, excluding access specifically allowed by the client name for product warranty and support purposes. Company, certifies that neither it nor its parent company nor any affiliate of company or its parent company, is (1) owned by or the majority of stock or other ownership interest of the company is held or controlled by individuals who are citizens of China, Iran, North Korea, Russia, or a designated country; (2) a company or other entity, including governmental entity, that is owned or controlled by citizens of or is directly controlled by the government of China, Iran, North Korea, Russia, or a designated country; or (3) headquartered in China, Iran, North Korea, Russia, or a designated country. For purposes of this contract, “critical infrastructure” means “a communication infrastructure system, cybersecurity system, electric grid, hazardous waste treatment system, or water treatment facility.” See Tex. Gov’t Code § 2274.0101(2) of SB 1226 (87th leg.). The company verifies and certifies that company will not grant direct or remote access to or control of critical infrastructure, except for product warranty and support purposes, to prohibited individuals, companies, or entities, including governmental entities, owned, controlled, or headquartered in China, Iran, North Korea, Russia, or a designated country, as determined by the Governor.

□ Acknowledged

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Vendor agrees to comply with all federal, state, and local laws, rules, regulations and ordinances, as applicable. It is further acknowledged that vendor certifies compliance with all provisions, laws, acts, regulations, etc. as specifically noted above.

Vendor’s Name/Company Name: ________________________________________________________

Address, City, State, and Zip Code: ______________________________________________________

Phone Number: _____________________________ Fax Number: ____________________________

Printed Name and Title of Authorized Representative: _______________________________________

Email Address: ______________________________________________________________________

Signature of Authorized Representative: __________________________________________________

Date: ___________________________ Federal Tax ID #_____________________________________