ESBD_428063_1749839394325_3_665A1_Attachments A-E_Plastic Resin.pdf

06-2022

Solicitation No.

ATTACHMENT A

EXECUTION OF RESPONSE

Federal Employer ID#:

Company Name:

(Must Match EIN)

By submitting its Response, Respondent represents and certifies each of the following numbered statements, except to the extent that its Response specifically identifies one or more of the statements and describes each and every fact and circumstance which prevents it from making the representation and certification. Furthermore, the Respondent promises to promptly notify the Comptroller if any of these representations or certifications is no longer true.

1. Acknowledgements

A. The Respondent acknowledges the Response will remain in effect for 120 days after the due date and time as provided in the Schedule of Events in Part A.

B. The Respondent acknowledges its obligation to specifically identify information it contends to be confidential or proprietary, and where respondent designates substantial portions of or the entire Response as confidential or proprietary, the Response is subject to being determined to be non-responsive to the solicitation.

C. The Respondent grants a royalty-free, non-revocable limited perpetual license to reproduce any copyrighted portions of the Response and subsequent documents to comply with Legislative Budget Board reporting requirements, Public Information Act disclosures, or any other reporting requirements mandated by law.

D. The Respondent does hereby acknowledge that it can meet all requirements as stated and also acknowledges the receipt, review and acceptance of the Solicitation identified in its Response. Any exceptions to the statement of work, requirements, specifications, terms and conditions have been explicitly set forth in the Respondent’s Response.

2. Conflicts of Interest

By signing the Execution of Response, Respondent affirms that the execution of an agreement between Respondent and the State will not create a conflict of interest or cause an appearance of a conflict of interest. In its Response, Respondent shall disclose any existing or potential conflicts of interest or possible issues that might create appearances of impropriety relative to Respondent’s (and its proposed subcontractors’) submission of a Response and possible selection as Contractor or its performance of the Contract.

If the circumstances certified by Respondent change or additional information is obtained subsequent to submission of Responses, by submitting a Response Respondent agrees that it is under a continuing duty to supplement its Response under this provision, and Respondent shall submit updated information as soon as reasonably possible upon learning of any change to Respondent’s affirmation.

3. Address in Texas

The Respondent certifies that if a Texas address is shown as the address of the Respondent on this Response, the Respondent qualifies as a Texas Bidder as defined in Section 2155.444(c) of the Texas Government Code.

4. Anti-Fraud Policy of CPA

Respondent represents and warrants that it has read and understood and will comply with Comptroller’s Anti-Fraud Policy as such Policy currently reads and as it is amended throughout the term of the Contract.

The policy can be found at https://www.comptroller.texas.gov/about/policies/ethics.php

5. Antitrust

The Respondent represents and warrants that in accordance with section 2155.005 of the Texas Government Code, neither Respondent nor the firm, corporation, partnership, or institution represented by Respondent, or anyone acting for such a firm, corporation or institution has (1) violated any provision of the Texas Free Enterprise and Antitrust Act, Tex. Bus. & Comm. Code Chapter 15; (2) violated any federal antitrust laws; and (3) directly or indirectly communicated the contents of this Response to any competitor or any other company, corporation, firm, partnership or individual engaged in the same line of business as the Respondent.

6. Buy Texas Affirmation

In accordance with Section 2155.4441 of the Texas Government Code, Respondent agrees that during the performance of a Contract for services it shall purchase products and materials produced in Texas when they are available at a price and time comparable to products and materials produced outside this state.

7. Equal Employment Opportunity

Respondent represents and warrants its compliance with all applicable duly enacted state and federal laws governing equal employment opportunities.

The Respondent agrees that no person will, on the ground of race, color, religion, sex, national origin, age, disability, political affiliation, or religious belief, be excluded from the participation in, be denied the benefits of, be subjected to discrimination under, or be denied employment in the administration of, or in connection with, any program or activity funded in whole or in part with funds available under this Contract. Respondent will comply with Executive Order 11246, “Equal Employment Opportunity," as amended by Executive Order 11375, “Amending Executive Order 11246 relating to Equal Employment Opportunity,” and as supplemented by regulations at 41 C.F.R. Part 60, “Office of Federal Contract Compliance Programs, Equal Employment Opportunity Department of Labor.”

8. Child Support Obligation Certification

Under Section 231.006 of the Family Code, the Respondent certifies that the individual or business entity named in this contract, Response or application is not ineligible to receive the specified grant, loan or payment and acknowledges that this Contract may be terminated and payment may be withheld if this certification is inaccurate.

Pursuant to Sections 231.006(c) and 231.302(c)(2) of the Texas Family code, responses must include names and the LAST 4 DIGITS of the Social Security Numbers of each person with at least 25% ownership of the business entity submitting the response. If any person meets the 25% ownership criteria, failure to provide the required information will result in disqualification of the Response. Respondents meeting the ownership criteria must complete the following:

XXX-XX-

Name Social Security Number

XXX-XX-

Name Social Security Number

XXX-XX-

Name Social Security Number

XXX-XX-

Name Social Security Number

9. Dealings with Public Servants Affirmation

Respondent has not given, offered to give, nor intends to give at any time hereafter any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant in connection with the submitted Response.

10. Financial Participation Prohibited Certification

Pursuant to Section 2155.004(b) of the Texas Government Code, Respondent certifies that neither Respondent nor any person or entity represented by Respondent has received compensation from CPA to participate in the preparation of the specifications or solicitation on which this Response or contract is based. Under Section 2155.004(b) of the Texas Government Code, Respondent certifies that the individual or business entity named in this Response or contract is not ineligible to receive the specified contract and acknowledges that the contract may be terminated, and payment withheld if this certification is inaccurate.

11. Former or Retired CPA Employees

In accordance with Section 2252.901 of the Texas Government Code, Respondent represents and warrants that none of its employees including, but not limited to, those authorized to provide services under the contract, were former employees of the CPA during the twelve (12) month period immediately prior to the date of execution of the contract.

12. Certain Employment for Former State Officer or Employee Restricted

In accordance with Section 572.069 of the Texas Government Code, Respondent certifies that it has not employed and will not employ a former CPA employee or state officer or a former employee or state officer for the state agency referenced in the solicitation, who participated in a procurement or contract negotiation for CPA the state agency referenced in the solicitation or Customer state agency involving Respondent before the second anniversary of the date the contract is signed or the procurement is terminated or withdrawn.

Respondent must disclose any of its personnel who are current or former officers or employees of the CPA or who are related, within the third degree by consanguinity as defined by Section 573.023 of the Texas Government Code or within the second degree by affinity as defined by Section 573.025 of the Texas Government Code, to any current or former officers or employees of the CPA.

Respondents must comply with all applicable Texas and federal laws and regulations relating to the hiring of former state employees (see e.g., Chapters 572 and 573 of the Texas Government Code). Such “revolving door” provisions generally restrict former agency heads from communicating with or appearing before the agency on certain matters for two years after leaving the agency. The revolving door provisions also restrict some former employees from representing clients on matters that the employee participated in during state service or matters that were in the employee’s official responsibility. Respondent, by signing this solicitation, certifies that it has complied with all applicable laws and regulations regarding former state employees.

Respondent must identify each employee who works for more than one staffing company at any facility and ensure that the employee’s cumulative weekly hours worked at all state facilities through any one staffing company does not exceed 40 hours per week.

13. Executive Head of a State Agency Affirmation

Pursuant to Section 669.003 of the Texas Government Code, relating to contracting with an executive head of a state agency, Respondent represents that no person who served as an executive of CPA, in the past four (4) years, was involved with or has any interest in the contract. If Respondent employs or has used the services of a former executive of CPA, then Respondent shall provide the information below to be considered for evaluation.

Name of former Executive:

Name of State Agency:

Date of separation from State Agency:

Date of employment with Respondent

14. COVID-19 Vaccine Passport Prohibition

Respondent certifies that it does not require its customers to provide any documentation certifying the customer's COVID-19 vaccination or post-transmission recovery on entry to, to gain access to, or to receive service from the Respondent’s business. Respondent acknowledges that such a vaccine or recovery requirement would make Respondent ineligible for a state-funded contract.

15. Environmental Protection

Respondent certifies its compliance with all applicable standards, orders, or regulations issued pursuant to the mandates of the Clean Air Act (42 U.S.C. § 7401 et seq.) and the Federal Water Pollution Control Act, as amended, (33 U.S.C. § 1251 et seq.).

16. Energy Company Boycotts

If Respondent is required to make a verification pursuant to Section 2274.002 of the Texas Government Code, Respondent verifies that Respondent does not boycott energy companies and will not boycott energy companies during the term of the Contract. If Respondent does not make that verification, Respondent must so indicate in its Response and state why the verification is not required.

17. Immigration

The Contractor represents and warrants that it will comply with the requirements of the Immigration and Nationality Act (8 U.S.C.§ 1101 et seq.) and all subsequent immigration laws and amendments.

18. Foreign Terrorist Organizations

Respondent represents and warrants that it is not engaged in business with Iran, Sudan, or a foreign terrorist organization, as prohibited by Section 2252.152 of the Texas Government Code and certifies that it is not ineligible to receive the contract.

19. Boycott Israel

If Respondent is required to make a certification pursuant to Section 2270.002 of the Texas Government Code, Respondent certifies that Respondent does not boycott Israel and will not boycott Israel during the term of the Contract. If Respondent does not make that certification, Respondent must indicate that in its Response and state why the certification is not required.

20. Critical Infrastructure Affirmation

Pursuant to Government Code Section 2274.0102, Respondent certifies that neither it nor its parent company, nor any affiliate of Respondent or its parent company, is: (1) majority owned or controlled by citizens or governmental entities of China, Iran, North Korea, Russia, or any other country designated by the Governor under Government Code Section 2274.0103, or (2) headquartered in any of those countries.

21. Legal and Regulatory Actions

Respondent represents and warrants that it is not aware of and has not received notice of any court or governmental CPA actions, proceedings or investigations, etc., pending or threatened against Respondent or any of the individuals or entities included in the Response within the five (5) calendar years immediately preceding the submission of the Response that would or could impair Respondent’s performance under the contract, relate to the solicited or similar goods or services, or otherwise be relevant to CPA’s consideration of the Response.

If Respondent is unable to make the preceding representation and warranty, then Respondent instead represents and warrants that it has included as a detailed attachment in its Response a complete disclosure of any such court or governmental CPA actions, proceedings or investigations, etc. that would or could impair Respondent’s performance under the contract, relate to the solicited or similar goods or services, or otherwise be relevant to CPA’s consideration of the Response.

In addition, Respondent represents and warrants that it shall notify CPA in writing within five (5) business days of any changes to the representations or warranties in this clause and understands that failure to so timely update CPA shall constitute breach of contract and may result in immediate termination of the contract.

22. No Felony Criminal Convictions

Respondent represents that neither Respondent nor any of its employees, agents, or representatives, including any subcontractors and employees, agents, or representative of such subcontractors, has been convicted of a felony criminal offense or that if such a conviction has occurred Respondent has fully advised CPA of the facts and circumstances surrounding the convictions.

If awarded the contract, Contractor has a continuing duty to amend, supplement, or correct this representation and warranty not later than ten days after discovering additional information relating to felony criminal convictions of Contractor or any of its employees. Contractor will not allow any employee convicted of a felony criminal offense to perform tasks related to the contract without such disclosure and express permission from CPA.

23. Prohibition on Certain Responses and Contracts

Under Sections 2155.006 and 2261.053 of the Texas Government Code, the Respondent certifies that the individual or business entity named in this Response or contract is not ineligible to receive the specified contract and acknowledges that this contract may be terminated and payment withheld if this certification is inaccurate.

Sections 2155.006 and 2261.053 of the Texas Government Code, prohibit state agencies from accepting a Response or awarding a contract that includes proposed financial participation by a person who, in the past five years, has been convicted of violating a federal law or assessed a penalty in connection with a contract involving relief for Hurricane Rita, Hurricane Katrina, or any other disaster, as defined by Section 418.004 of the Texas Government Code, occurring after September 24, 2005.

24. Firearm Entities and Trade Associations Discrimination

If Respondent is required to make a verification pursuant to Section 2274.002 of the Texas Government Code, Respondent verifies that it (1) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association and (2) will not discriminate during the term of the contract against a firearm entity or firearm trade association. If Respondent does not make that verification, Respondent must so indicate in its Response and state why the verification is not required.

25. Human Trafficking Prohibition

Under Section 2155.0061 of the Texas Government Code, the Respondent certifies that the individual or business entity named in this Response or Contract is not ineligible to receive the specified Contract and acknowledges that this Contract may be terminated and payment withheld if this certification is inaccurate.

26. Abortion Funding Limitation

Respondent represents and warrants that this Contract is not a taxpayer resource transaction prohibited by Section 2273.003 of the Texas Government Code and that payments made by CPA to Respondent and Respondent’s receipt of appropriated funds under the contract are not prohibited by Article IX, Section

6.24 of the General Appropriations Act.

27. Professional Sports Teams - National Anthem Verification

If the Respondent is a professional sports team as defined by Section 2004.002 of the Texas Occupations Code, Respondent will play the United States national anthem at the beginning of each team sporting event held at the Respondent’s home venue or other venue controlled by Respondent for the event. Failure to comply with this obligation constitutes a default of this contract, and immediately subjects Respondent to the penalties for default, such as repayment of money received or ineligibility for additional money. In addition, Respondent may be debarred from contracting with the State. CPA or the Attorney General may strictly enforce this provision.

28. Prohibition on Lobbying

Respondent represents and warrants that the Customer’s payments to Respondent and Respondent's receipt of appropriated or other funds under the contract are not prohibited by Sections 556.005 or 556.0055 of the Texas Government Code.

29. Deceptive Trade and Unfair Business Practices

Respondent represents and warrants that it has not been the subject of allegations of Deceptive Trade Practice violations under Chapter 17 of the Texas Business and Commerce Code or allegations of any unfair business practice in any administrative hearing or court suit. Respondent represents and warrants that it has not been found to be liable for such practices in such proceedings. Respondent certifies that it has no officers who have served as officers of other entities who have been the subject of allegations of Deceptive Trade Practice violations or allegations of any unfair business practices in an administrative hearing or court suit, and further certifies that such officers have not been found to be liable for any such practices in such proceedings.

30. Franchise Tax Certification

Respondent certifies that it is exempt or not delinquent in the payment of any franchise taxes owed the State of Texas under Chapter 171, Texas Tax Code.

If Respondent is a qualifying business entity type per CPA guidelines and is not set up in the Texas Franchise Tax system, Respondent must do so prior to contracting with the State of Texas.

31. Debts and Delinquencies Affirmation

Respondent agrees that any payments due under the Contract shall be applied towards any debt or delinquency that is owed the State of Texas including, but not limited to, delinquent taxes, delinquent student loan payments, delinquent child support and any payments or other amounts Respondent is otherwise owed under the contract may be applied toward any debt Respondent owes until the debt is paid in full. These provisions are effective at any time Respondent owes any such debt or delinquency.

32. Suspension and Debarment

A. State of Texas Debarment Respondent certifies that it and its principals are not suspended or debarred from doing business with the state or federal government as listed on the State of Texas Debarred Vendor List maintained by the Texas Comptroller of Public Accounts which can be accessed at:

https://comptroller.texas.gov/purchasing/programs/vendor-performance-tracking/debarred-vendors.php

B. Excluded Parties – Federal - Certification Respondent certifies that it and its principals are eligible to participate in this solicitation and have not been subjected to suspension, debarment or excluded from federal contracts for any reason by any federal, state or local government entity and the Respondent is in compliance with the state of Texas statutes and rules relating to procurement and that the Respondent does not have a designated exclusion on SAM which can be accessed at: https://www.sam.gov/

Respondent certifies that it is not listed in the prohibited vendors list authorized by Executive Order No. 13224, “Blocking Property and Prohibiting Transactions with Persons Who Commit, Threaten to Commit, or Support Terrorism,” published by the United States Department of the Treasury, Office of Foreign Assets Control.

33. Terminated Contracts

Respondent certifies that it has not had a contract terminated or been denied the renewal of any contract for non-compliance with policies or regulations of any state or federally funded program within the past five years nor is it currently prohibited from contracting with a governmental agency. If the Respondent does have such a terminated contract, Respondent must identify each and provide an explanation for the termination.

34. False Statements Affirmation

Respondent represents and warrants that all statements and information prepared and submitted in this document are current, complete, true, and accurate. Submitting a Response with a false statement or material representations made during the performance of a contact is a material breach of contract and may void the submitted Response and any resulting contract.

Respondent will promptly notify CPA in the event that any representations and warranties provided in this Contract are no longer true and correct. Respondent acknowledges that all of its representations and warranties contained in any part of its Response and this Contract are material and have been relied upon by the CPA in selecting the Respondent for the award of the Contract. Further, the Respondent warrants and represents that all of its statements and representations made to the CPA prior to being awarded the Contract are material, true and correct.

35. Public Information Act

The Respondent acknowledges that its Response and subsequent documents submitted are subject to the Texas Public Information Act, Chapter 552 of the Texas Government Code.

36. Signature Authority

By submitting the Response, Respondent represents and warrants that the individual submitting this document and the documents made part of this Response is authorized to sign such documents on behalf of the Respondent and to bind the Respondent under any contract that may result from the submission of the Response.

Respondent represents and certifies each of the above numbered statements, except to the extent that its Response specifically identifies one or more of the statements and describes each and every fact and circumstance which prevent it from making the representation and certification. Furthermore, Respondent promises to promptly notify the Comptroller if any of these representations or certifications are no longer true. Failure to complete, sign and submit this form will disqualify the Response.

Signature - Authorized Respondent/Company Representative:_____________________________

Printed Name: ________________________________

Date: _________________

Signature Required

ATTACHMENT B – RESPONDENT INFORMATION

Complete and Return with Response

Company Name (Must Match Attachment A) Principal

Place of Business Address (Headquarters) Physical

Address (if different from above)

DUNS Number

Texas Franchise Tax File Number

E-Mail for Receipt of Purchase Orders

E-Mail for Receipt of Invoices

Complete all fields for each name as requested. All information is necessary to conduct mandated checks prior to award.

AUTHORIZED RESPONDENT/COMPANY REPRESENTATIVE

Name – First Middle Initial/Name Last Title

Phone E-mail

REPRESENTATIVE FOR RECIEPT OF INVOICES

Name – First Middle Initial/Name Last Title

Phone E-mail

CONTRACT MANAGER or CUSTOMER SERVICE

Name – First Middle Initial/Name Last Title

Phone E-mail

ALTERNATE CONTRACT MANAGER or CUSTOMER SERVICE

Name – First Middle Initial/Name Last Title

Phone E-mail

Payment terms for the State of Texas are typically 30 days.

Provide the additional expedited payment discount extended if paid within the time period indicated below.

No. of Days % No. of Days % No. of Days %

ATTACHMENT C - PREFERENCES

Reference State of Texas Procurement and Contract Management Guide Pages 80 and 81

Reciprocal Preference Law (check any that apply):

Goods offered in this Response will be manufactured for the sole purpose of fulfilling this Contract.

If so, in which state or states will these goods be manufactured? Attach additional sheets if necessary.

Check the preferences for which you qualify:

Agricultural products grown in Texas

Agricultural products offered by a Texas Bidder

Services offered by a Texas Bidder that is owned by a Texas resident service-disabled veteran

Services offered by a Texas Respondent that is not owned by a Texas resident service disabled veteran

Texas vegetation native to the region

USA produced supplies, materials or equipment

Products of persons with mental or physical disabilities

Products made of recycled, remanufactured, or environmentally sensitive materials including recycled steel

Energy efficient products

Rubberized asphalt paving material

Recycled motor oil and lubricants

Products produced at facilities located on formerly contaminated property

Products and services from economically depressed or blighted areas

Vendors that meet or exceed air quality standards

Recycled or reused computer equipment of other manufacturers

Foods of higher nutritional value

Commercial production company or advertising agency located in Texas https://comptroller.texas.gov/purchasing/publications/procurement-contract.php

ATTACHMENT D

INSURANCE STATEMENT OF INTENT

Respondent certifies that if awarded it intends to obtain and maintain for the term of the Contract and any renewal periods or extensions, the minimum insurance coverages specified in the above referenced solicitation documents, and is in compliance with all Contract insurance requirements. Respondent will, within five business days of receiving a request from CPA, submit current certificates of insurance to CPA.

When requested, proof of insurance shall be sent to the CPA primary point of contact listed in Part A of the solicitation. Failure to submit acceptable proof of insurance will result in non-award. Contractor shall maintain the required insurance throughout the Contract.

Signature - Authorized Respondent/Company Representative:

Signature Required

Printed Name:

Date:

Attachment D Insurance Statement of Intent Rev. 9/24

ATTACHMENT E

SELF INSURED RETENTION CERTIFICATION

AND REQUEST FOR APPROVAL

______________________ (“Respondent”) has submitted a response to the solicitation identified above (the “Solicitation”). Respondent has provided one or more certificates of insurance showing that it has the required types and amounts of insurance. However, Respondent’s insurance includes a self-insured retention (the “SIR”) in an amount that requires pre-approval by the Texas Comptroller of Public Accounts (“CPA”). Respondent hereby requests CPA’s approval of the following SIR:

The amount of the SIR is: .

The SIR applies to the following insurance coverages: .

As a condition of approval, Respondent agrees as follows:

• Respondent affirms that it has the authority to make this certification.

• Respondent affirms that it has the resources to properly administer and respond to claims that may arise as a result of this contract.

• In addition to the insurance provisions in the Solicitation, Respondent shall ensure that its certificates of insurance state that any SIR may be satisfied by any additional insured party, and name CPA and any customer that places an order through a contract that Respondent is awarded by CPA as additional insured parties.

• Respondent shall administer any claims to which the SIR applies in good faith and in accordance with standards of conduct that govern insurers in the State of Texas.

• CPA may revoke its approval of the SIR at any time, for any reason. Respondent will either submit insurance coverage that complies with the Solicitation without an SIR, or it will notify CPA of its intent to forego coverage. Failure to provide compliant insurance may be a breach of contract.

• If the SIR is approved, that approval will apply for this Solicitation only. Respondent must obtain approval for each solicitation response or contract it has with CPA. CPA will retain complete discretion to approve or deny SIR requests and will not be bound by its past decisions.

For the Respondent, I declare under penalty of perjury that the foregoing is true and correct.

A false statement on this document could be a crime under Texas Penal Code Section 37.02 or 37.03.

Name:_______________________________________

Address:____________________________________________________

Executed in ______________ County, State of ___________, on the ____day of ___________, 20____.

Signature

Title

II. SPD’s Decision

For CPA, I [ ] approve [ ] do not approve the self-insured retention described above.

Director, Statewide Procurement Division

Date

Attachment E SIR Certification Form Rev. 8/24