Appendix B - Signature Page - Transmission to IRIS Services RFP.docx
DOCX document 41 KB Posted
- Attached to
- Request for Proposals for Transmission to Information Returns Intake System (IRIS) Services
- Solicitation number
- 26-15697-001
- Issued by
- Texas
About this file
This is a signature page and attestation form for the Employees Retirement System of Texas (ERS) Request for Proposals (RFP) No. 26-15697-001 for Transmission to Information Returns Intake System (IRIS) Services. The document serves as the official signature page through which an authorized representative of a bidding company certifies compliance with all solicitation requirements, project specifications, and regulatory obligations. The signatory must confirm that they have read and fully understand the RFP, that their company's proposal is complete and accurate, and that their company commits to providing all goods and services as specified in the solicitation.
The attestation form requires the authorized representative to make representations regarding antitrust compliance, financial stability, conflicts of interest, lobbying activities, confidentiality obligations, and prohibited communications with ERS board members, advisory committee members, and state officials. The signatory must affirm that neither they nor their company have violated Texas Free Enterprise and Antitrust Act provisions or federal antitrust laws, have not disclosed solicitation contents to competitors, and will immediately disclose any actual or perceived conflicts of interest that arise before contract award. The document also requires confirmation that no amendments to the solicitation were posted and that the company agrees to provide documentation upon request during the RFP process and throughout any applicable record retention period.
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APPENDIX B
SIGNATURE PAGE
APPENDIX B
SIGNATURE PAGE
Statement of Authorized Representative Regarding Solicitation and Proposal
| 1) | My name is _______________________________. |
| 2) | I am the _________________________ (title) of ________________________________ (legal entity name of contract owner) (“my Company”). |
| 3) | I do solemnly swear/affirm that I am duly authorized to make the following statements on behalf of my Company in response to the Employees Retirement System of Texas’ RFP No. 26-15697-001 titled Transmission to Information Returns Intake Services, including all attachments thereto (“ERS’ Solicitation” or “RFP”). |
| 4) | I further warrant and represent that as signatory I have the full right and power and am legally authorized to execute the Contract resulting from this solicitation and act on behalf of myself and/or my Company. Commitments shall be unqualified, not limited, and fully commit myself and my Company to provide the goods and services required under this solicitation. |
Antitrust Statement
| 5) | In connection with ERS’ Solicitation, I affirm under penalty of perjury of the laws of the State of Texas that neither I nor any representative of my Company have violated any provision of the Texas Free Enterprise and Antitrust Act, Texas Business and Commerce Code Chapter 15. |
| 6) | In connection with ERS’ Solicitation, neither I nor any representative of my Company have violated any federal antitrust law. |
| 7) | Neither I nor any representative of my Company have directly or indirectly communicated any of the contents of ERS’ Solicitation to a competitor of my Company or any other company, corporation, firm, partnership or individual engaged in the same line of business as my Company. |
Attestation Regarding RFP, Proposal and Financial Stability
| 8) | I have completely read and understand ERS’ Solicitation. Each section of ERS’ Solicitation includes statements of fact regarding how ERS expects the services to be administered and ERS’ requirements. I acknowledge that ERS will presume that my Company agrees with and will comply with each ERS requirement unless my Company specified its deviations therefrom in its response (“Proposal”) and ERS accepted such deviations in writing in accordance with ERS’ Solicitation instructions. |
| 9) | I have reviewed the information contained within my Company’s Proposal to ERS’ Solicitation. The information presented in my Company’s Proposal is complete, true, accurate, and in full compliance with ERS’ Solicitation, except as specifically indicated in my Company’s Proposal. |
| 10) | My Company is in good financial standing, has not been disqualified by the State of Texas to conduct business or perform services of any kind, is not in any form of bankruptcy, and is current in the payment of all taxes and fees. |
| 11) | I acknowledge, understand and agree that my Company’s responses to the questions and all other provisions of the RFP are material and will be relied on by ERS in connection with ERS’ scoring and contract award recommendation. |
| 12) | My Company represents and warrants to the truth and accuracy of all statements, warranties and representations contained in the Proposal and other documents submitted by my Company. |
Attestation Regarding Lobbying Activity (if applicable)
13) To the extent my Company is required to register and/or employs at least one (1) individual who is required to register as a lobbyist in the State of Texas under Chapter 305 of the Tex. Gov’t Code, I attest that my Company’s proposed provision of services to ERS is entirely separated from all lobbying activities such that no individual who is required to register as a lobbyist in the State of Texas will play any role with respect to such services or receive any direct or indirect compensation in connection with the provision of such services.
Acknowledgement of Receipt of Amendment
14) I acknowledge that no amendment to ERS’ Solicitation was posted.
Attestation Regarding Confidential and/or Proprietary Information
| 15) | My Company will comply with all instructions related to the provision of public, confidential, or proprietary information. |
| 16) | My Company agrees to fully cooperate with ERS to provide any or all documentation related to ERS’ Solicitation upon request by ERS and within the deadline specified by ERS, whether during the RFP process or any applicable record retention period set forth in the Contractual Provisions attached to the Solicitation, regardless if my Company is selected for contract award. |
Attestation Regarding Conflicts of Interest Contractual Provisions
| 17) | For the purpose of the following attestation, “Prohibited Communications” shall be defined as including any communications to any member of the ERS Board of Trustees, Group Benefits Advisory Committee, or Investment Advisory Committee, any officer or employee of ERS, or any member, officer, or staff employee of any office of the executive or legislative branches of the State of Texas (including advising, consulting or communicating with any of these persons) regarding (i) my Company’s proposal to this RFP; (ii) the subject matter of my Company’s proposal to this RFP or any other contract or program administered by ERS; (iii) anything that in any manner affects ERS’ administration of any existing or prospective contract; or (iv) any attempt to facilitate and/or influence the obtaining of any contract, rights, payment, or direct or indirect benefit in relation to the subject matter of my Company’s proposal to this RFP. I hereby attest that I have read and understand the Prohibited Communications provisions contained herein and that (check one): |
| |_| | My Company has not engaged nor will it engage in any actions that are or could be perceived to be a conflict of interest, appearance of impropriety or Prohibited Communication. |
| |_| | My Company has engaged in the following actions that are or could be perceived to be a conflict of interest, appearance of impropriety or Prohibited Communication: |
My Company has also taken the following actions or proposes to take the following actions to cure, avoid, or mitigate such issues or potential issues (Use additional pages, as necessary, to fully respond):
18) I further attest that, if any time after the submittal of my Company’s Proposal to ERS’ Solicitation but before award of the work under such Proposal, my Company discovers or is made aware of an actual or perceived conflict of interest, appearance of impropriety or Prohibited Communication that pre-existed the submittal of Company’s Proposal or arose thereafter, I will immediately disclose such interest, appearance or communication in writing to ERS.
Electronic Signature Attestation (if applicable)
19) I acknowledge, understand and agree that my electronic signature below constitutes an “electronic signature” as such term is defined in Chapter 322 of the Texas Business and Commerce Code.
| By: | ________________________________ | |
| Signature of Authorized Representative | ||
| Printed Name: | ________________________________ | |
| Title: | ________________________________ | |
| Date: | ________________________________ |
Appendix B – Signature Page Page 3 of 3 Transmission to Information Returns Intake System (IRIS) Services RFP
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