Combined Required Bid Documents and Tarrif Notice FY26 (2) (1).pdf

Adopted 06/29/2007

FORM CIQ

OFFICE USE ONLYThis questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session.

This questionnaire is being filed in accordance with Chapter 176, Local Government Code by a person who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the person 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 person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code.

A person commits an offense if the person knowingly violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor.

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor or other person doing business 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 the originally filed questionnaire becomes incomplete or inaccurate.)

Name of person who has a business relationship with local governmental entity.1

Date Received

Name of local government officer with whom filer has employment or business relationship.

Name of Officer

This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.

A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the filer of the questionnaire?

Yes No

B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in this section AND the taxable income is not received from the local governmental entity?

Yes No

C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership of 10 percent or more?

Yes No

D. Describe each employment or business relationship with the local government officer named in this section.

Signature of person doing business with the governmental entity Date

TRINITY RIVER AUTHORITY OF TEXAS

HUB STATUS

is certified as a HUB.

FIRM'S NAME

A person commits a criminal offense if the person intentionally applies as an historically underutilized business for an award of a purchasing contract or public works contract and the person knowingly does not meet the definition of an historically underutilized business in the Texas Government Code.

Please state how your firm qualifies:

A copy of the certification from is attached.

AUTHORIZED AGENT'S SIGNATURE DATE

Subscribed and sworn to before me by the above named on this the day of , 19 .

Notary Public in and for County, for the State of .

TRINITY RIVER AUTHORITY OF TEXAS

RESIDENT BIDDER CERTIFICATION

Pursuant to Texas Government Code Chapter 2252, Subchapter A (Nonresident Bidders), the Trinity River Authority requires a residence certification in connection with bids. The Government Code defines a “resident bidder” as “a person [or company] whose principal 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.” TEX. GOV’T CODE § 2252.001(4). It likewise defines a “nonresident bidder” as “a person [or company] who is not a resident.” TEX. GOV’T CODE § 2252.001(3). Please complete the appropriate portion of the following certification.

� I certify that ______________________________________ is a Resident Bidder of Texas as defined in [Company Name] the Texas Government Code.

FIRM’S AUTHORIZED AGENT TITLE

AUTHORIZED AGENT’S SIGNATURE DATE

� I certify that ______________________________________ is a Nonresident Bidder as defined in [Company Name] the Texas Government Code and our principal place of business is ______________________________.

[City and State]

FIRM’S AUTHORIZED AGENT TITLE

AUTHORIZED AGENT’S SIGNATURE DATE

VERIFICATION REQUIRED BY TEXAS GOV’T CODE CHAPTERS 2252, 2274 & 2271

By signing below, the signatory hereby verifies that the firm it represents:

(1) Does not boycott energy companies and is authorized to agree in such contracts not to boycott energy companies during the term of such contracts. “Boycott energy company” has the meaning provided in Section 809.001 of the Texas Government Code;

(2) Does not have a practice, policy, guidance or directive that discriminates against a firearm entity or firearm trade association and is authorized to agree in such contracts not to discriminate against a firearm entity or firearm trade association during the term of such contracts. “Discriminate against a firearm entity or firearm trade association” has the meaning provided in Section

2274.001(3) of the Texas Government Code. “Firearm entity” and “firearm trade association” have the meanings provided in Section 2274.001(6) and (7) of the Texas Government Code;

(3) Does not boycott Israel and is authorized to agree in such contracts not to boycott Israel during the term of such contracts. “Boycott Israel” has the meaning provided in Section 808.001 of the Texas

Government Code; and

(4) Unless affirmatively declared by the United States government to be excluded from its federal sanctions’ regime relating to Sudan or Iran or any federal sanctions regime relating to a foreign terrorist organization, is not identified on a list prepared and maintained by the Texas Comptroller of Public Accounts under Section 2252.153 or Section 2270.0201 of the Texas Government Code.

Signature

Name & Title

Date

Firm Name

NOTARIZATION

BEFORE ME, the undersigned notary public on this day personally appeared ________________________, on behalf of ________________________________ (Company), who, being duly sworn, stated under oath that they read the foregoing verification and said statements contained therein are true and correct.

SWORN TO AND SUBSCRIBED before me on the _______ day of _________, 20__.

NOTARY PUBLIC IN AND

FOR THE STATE OF _______________

State law requires any firm entering into an agreement or contract with the Authority to complete the foregoing verification. TEX. GOV’T CODE § 2270.002.

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INSTRUCTIONS TO BIDDERS

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TRINITY RIVER AUTHORITY

NOTICE TO VENDORS: PAYMENT OF TARIFF CHARGES

The imposition of a tariff by the government does not automatically result in a charge to the consumer, unless it can be proven that the tariff charge is directly incurred on the good supplied. According to our policy, tariffs must be verifiable:

“The General Manager may authorize payment to contractors for verifiable tariff claims and directly-affected contractor costs for legally-required performance and payment bonds and contractually-required insurance cost increases. However, no contractor overhead charges claimed to be affected by tariffs are compensable. For a contractor to be reimbursed for tariff costs, it must submit to the Authority documentation specifically detailing the specific tariff costs imposed.”

To demonstrate that the tariff charge was directly incurred on the commodity being supplied, please submit, along with your quote/invoice, the supporting documentation. If we do not receive the supporting document to justify the tariff charge, the invoice will be paid less the tariff amount.

NOTICE TO VENDORS - TARRIF PAYMENT