ATTACHMENT C PROPOSER INFORMATION AND CERTIFICATION SHEET~1.docx

OregonBuys Bid: S-58100-00017199 RFP for Federal ESEA Implementation Support and Oversight Attachment C

Proposer INFORMATION AND CERTIFICATION SHEET Legal Name of Proposer:

Address:

City, State, Zip:

State of Incorporation:

Entity Type:

Contact Name:

Telephone:

Email:

Oregon Business Registry Number (if required):

Any individual signing below hereby certifies they are an authorized representative of Proposer and that:

The Proposer has a minimum of three (3) years of experience working with one or more of the following: State Education Agencies (SEAs), Education Service Districts (ESDs), School Districts (SDs), or Schools.

The Proposer has a minimum of three (3) years of experience working in one or more of the following: Elementary and Secondary Education Act (ESEA) federal programs, or School improvement initiatives. Such experience may be through direct employment with SEAs, ESDs, SDs, or schools, or through contracted work for those organizations.

The Proposer has knowledge of applicable federal rules and regulations, including but not limited to the Education Department General Administrative Regulations (EDGAR) and the Uniform Grant Guidance (UGG).

The Proposer has demonstrated professional written and verbal communication with SEAs, ESDs, SDs, or schools at both leadership and staff levels.

The Proposer has experience in the use of software programs, including but not limited to: Microsoft Office products (e.g., Outlook, Word, Excel), Google products (e.g., Gmail, Docs, Sheets), and Video conferencing platforms (e.g., Teams, Zoom).

Proposer must check which Domain(s) included in Proposal.

☐ Domain One: Monitoring Support (Programmatic and Fiscal) ☐ Domain Two: Technical Assistance and Professional Learning for Continuous Improvement ☐ Domain Three: Allocation Review and Support ☐ Domain Four: Specialized and Emerging Needs (Flexible Task Orders; Available After Award) Any individual signing below hereby certifies they are an authorized representative of Proposer and that:

Proposer understands and accepts the requirements of this INTERMEDIATE PROCUREMENT. By submitting a Proposal, Proposer agrees to be bound by the Price Agreement terms and conditions in Attachment A and as modified by any Amendment, except for those terms and conditions that Agency has reserved for negotiation, as identified in the INTERMEDIATE PROCUREMENT.

Proposer acknowledges receipt of any and all Amendments to this INTERMEDIATE PROCUREMENT.

Proposal is a Firm Proposal for 180 days following the Opening.

If awarded a Price Agreement, Proposer agrees to perform the scope of work and meet the performance standards set forth in the final negotiated scope of work of the Price Agreement.

I have knowledge regarding Proposer’s payment of taxes and by signing below. I hereby certify that, to the best of my knowledge, Proposer is not in violation of any tax laws of the state or a political subdivision of the state, including, without limitation, ORS 305.620 and ORS chapters 316, 317 and 318.

Proposer does not discriminate in its employment practices with regard to race, creed, age, religious affiliation, gender, disability, sexual orientation, national origin. When awarding subcontracts, Proposer does not discriminate against any business certified under ORS 200.055 as a disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disabled veteran owned or an emerging small business. If applicable, Proposer has, or will have prior to contract execution, a written policy and practice, that meets the requirements described in ORS 279A.112 (formerly HB 3060), of preventing sexual harassment, sexual assault and discrimination against employees who are members of a protected class. Agency may not enter into a contract with an anticipated contract price of $150,000 or more with a Proposer that does not certify it has such a policy and practice. See https://www.oregon.gov/DAS/Procurement/Pages/hb3060.aspx for additional information and sample policy template.

Proposer complies with ORS 652.220 and does not unlawfully discriminate against any of Proposer’s employees in the payment of wages or other compensation for work of comparable character on the basis of an employee’s membership in a protected class. “Protected class” means a group of persons distinguished by race, color, religion, sex, sexual orientation, national origin, marital status, veteran status, disability or age.

Contractor’s continuing compliance constitutes a material element of this Price Agreement and a failure to comply constitutes a breach that entitles Agency to terminate this Price Agreement for cause.

Contractor may not prohibit any of Contractor’s employees from discussing the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person. Contractor may not retaliate against an employee who discusses the employee’s rate of wage, salary, benefits, or other compensation with another employee or another person.

Proposer is not engaged in the provision of broadband Internet access service, or if at any time Proposer is engaged in or may engage in the provision of broadband Internet access service Proposer is in compliance with Oregon Laws 2018, Chapter 88 (HB 4155) and applicable Public Utility Commission rules, and will remain in compliance throughout the term of the Contract.

Proposer and Proposer’s employees, agents, and subcontractors are not included on:

the “Specially Designated Nationals and Blocked Persons” list maintained by the Office of Foreign Assets Control of the United States Department of the Treasury found at: https://www.treasury.gov/ofac/downloads/sdnlist.pdf., or the government wide exclusions lists in the System for Award Management found at: https://www.sam.gov/portal/ Proposer certifies that, to the best of its knowledge, there exists no actual or potential conflict between the business or economic interests of Proposer, its employees, or its agents, on the one hand, and the business or economic interests of the State, on the other hand, arising out of, or relating in any way to, the subject matter of the INTERMEDIATE PROCUREMENT. If any changes occur with respect to Proposer’s status regarding conflict of interest, Proposer shall promptly notify the State in writing.

Proposer certifies that all contents of the Proposal (including any other forms or documentation, if required under this INTERMEDIATE PROCUREMENT) and this Proposal Certification Sheet are truthful and accurate and have been prepared independently from all other Proposer s, and without collusion, fraud, or other dishonesty.

Proposer understands that any statement or representation it makes, in response to this INTERMEDIATE PROCUREMENT, if determined to be false or fraudulent, a misrepresentation, or inaccurate because of the omission of material information could result in a "claim" {as defined by the Oregon False Claims Act, ORS 180.750(1)}, made under Price Agreement being a "false claim" {ORS 180.750(2)} subject to the Oregon False Claims Act, ORS 180.750 to 180.785, and to any liabilities or penalties associated with the making of a false claim under that Act.

Proposer acknowledges these certifications are in addition to any certifications required in the Price Agreement and Statement of Work in Attachment A at the time of Price Agreement execution.

Authorized Signature

Date

(Printed Name and Title)