ESBD_428085_1749852829802_01 Exhibit A - TxDMV Respondent's Affirmations & Solicitation Acceptance (Version 1.10).pdf

TxDMV Solicitation No.

TxDMV Respondent’s Preferences, Affirmations, and Solicitation Acceptance Version 1.10 Page 1 of 12 Published and Effective: November 26, 2024

Responsible Division: Office of General Counsel

Exhibit A

Respondent’s Preferences, Affirmations, and Solicitation Acceptance

In this document, when referring to the following preferences, affirmations, and solicitation acceptance (whether framed as certifications, representations, warranties, or in other terms), the term “Respondent” shall mean any or any combination of the following as may be applicable to this Solicitation: Bidder, Respondent, Applicant, Vendor, Contractor, or Grantee. Also, the following terms have the associated meanings:

a. “Solicitation” shall include all of the following: Invitation for Bids, Request for

Proposals, Request for Offers, Request for Qualifications, Request for Applications, or

Pricing Requests.

b. “Solicitation Response” shall mean any bid, proposal, offer, application, or responsive documentation submitted in response to this Solicitation.

c. “Affirmation” or “Affirmations” shall mean this Respondent’s Preferences, Affirmations, and Solicitation Acceptance document.

d. “TxDMV” shall mean Texas Department of Motor Vehicles, Motor Vehicle Crime

Prevention Authority (“MVCPA”), or both, that will be the party to any contract that may result from this Solicitation and the officers, employees, authorized representative, and designees of those governmental entities.

The headings used below are for convenience and reference only and shall not affect the interpretation or construction of this document.

1. Respondent’s Preference(s)

To claim a preference under Title 34 of the Texas Administrative Code §§ 20.306 or 20.307, or

Chapter 2155, Subchapter H, of the Texas Government Code, the Respondent must mark the appropriate box(es) below and provide sufficient documentation to demonstrate that the

Respondent qualifies for the preference. If the appropriate box is not marked, a preference will not be granted, unless the Respondent requests the preference in other documents included in the

Response which demonstrates that the Respondent qualifies for the preference. The Respondent represents and warrants that it qualifies for all preferences claimed below: (check all applicable boxes, if any)

Goods produced or offered by a Texas Bidder that are owned by a Texas resident service-disabled veteran

Goods produced in Texas or offered by a Texas Bidder that are not owned by a Texas resident service-disabled veteran

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 Bidder 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 intellectual 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

Paper containing recycled fibers

Recycled or reused computer equipment of other manufacturers

Foods of higher nutritional value

Commercial production company or advertising agency located in Texas

Travel agents residing in Texas

2. Respondent’s Affirmations and Solicitation Acceptance

These Affirmations apply to all Respondents regardless of their business form (e.g., individual, sole proprietorship, partnership, limited liability company, corporation, nonprofit organization, or governmental entity).

The Respondent must provide information, as applicable, and affirms, without exception, as follows:

2.1. Addenda and Amendments to Solicitation. Respondent acknowledges receipt of all addenda and amendments to this Solicitation posted to the Texas Electronic State Business

Daily website, if any.

2.2. Antitrust. The undersigned affirms under penalty of perjury of the laws of the State of

Texas that (a) in connection with the Solicitation Response, neither I nor any representative of the Respondent has violated any provision of the Texas Free Enterprise and Antitrust

Act, Chapter 15 of the Texas Business and Commerce Code; (b) in connection with the

Solicitation Response, neither I nor any representative of the Respondent has violated any federal antitrust law; and (c) neither I nor any representative of the Respondent has directly or indirectly communicated any of the contents of the Solicitation Response to a competitor of the Respondent or any other company, corporation, firm, partnership or individual engaged in the same line of business as the Respondent.

2.3. Binding Offer. Respondent represents and warrants that its prices include all costs of

Respondent to provide the requested goods, products, and/or services that meet all specifications of this Solicitation, and that the Solicitation Response and prices will remain firm and binding for acceptance for a minimum of 120 days from the date the Solicitation

Response due.

2.4. Buy Texas (Service Contracts). Respondent agrees to comply with Section 2155.4441 of the Texas Government Code, requiring the purchase of products and materials produced in the State of Texas in performing service contracts that may result from this Solicitation.

2.5. Child Support Obligation. “Under Section 231.006, Family Code, the [Respondent] certifies that the individual or business entity named in this contract, bid, 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.” Furthermore, any Respondent subject to Section 231.006 of the Texas Family

Code must include in the Solicitation Response the names and the last four digits of the social security numbers (“SSNs”) of each person with at least 25% ownership of the business entity submitting the Solicitation Response. The Respondent must provide the following information: (if additional space is needed attach a separate page or pages to this document)

Name: SSN: XXX-XX-

Name: SSN: XXX-XX-

Name: SSN: XXX-XX-

Name: SSN: XXX-XX-

FEDERAL PRIVACY ACT NOTICE: This notice is given pursuant to the Federal

Privacy Act of 1974 (5 U.S.C. § 552a), as amended. Disclosure of your Social Security

Number (SSN) is required under Section 231.006(c) and Section 231.302(c)(2) of the

Texas Family Code. The Social Security number will be used to identify persons that may owe child support and will be kept confidential to the fullest extent allowed under Section

231.302(e) of the Texas Family Code.

The Respondent further acknowledges and agrees that if the Respondent is subject to

Section 231.006 of the Texas Family Code, the Respondent upon request by TxDMV shall promptly submit the complete SSNs for each person identified above via separate, secure transmission prior to evaluation of the Solicitation responses.

IF RESPONDENT CHOOSES TO SUBMIT COMPLETE SSNs WITH ITS

SOLICITATION RESPONSE VIA EMAIL, THE SOLICITATION RESPONSE

MUST BE ENCRYPTED. Failure by Respondent to encrypt an email containing complete SSNs as required may result in disqualification of the Respondent’s Solicitation

Response.

2.6. Cloud Computing State Risk and Authorization Management Program (TX-RAMP).

In accordance with Section 2054.0593(d)-(f) of the Texas Government Code, relating to cloud computing Texas state risk and authorization management program, Respondent represents and warrants that it complies with the requirements of the state risk and authorization management program and Respondent agrees that throughout the term of any contract that may result from this Solicitation it shall maintain its certifications and comply with the program requirements in the performance of any contract that may result from this Solicitation. Respondent acknowledges that any contract that may result from this Solicitation may be terminated by TxDMV without recourse and payment withheld if this representation is shown to be inaccurate or becomes inaccurate.

2.7. Complete and Accurate Information. Respondent represents and warrants that all statements and information provided to TxDMV are current, complete, and accurate. This includes all statements and information in the Respondent’s Solicitation Response.

2.8. Computer Equipment Recycling Program. If Respondent is submitting a Solicitation

Response for the purchase or lease of computer equipment, then Respondent certifies that it is in compliance with Subchapter Y, Chapter 361 of the Texas Health and Safety Code related to the Computer Equipment Recycling Program and the Texas Commission on

Environmental Quality rules in Title 30 of the Texas Administrative Code Chapter 328.

2.9. Confidential or Proprietary Information. Respondent acknowledges its sole obligation to specifically identify information it contends to be confidential or proprietary and, if

Respondent designated substantial portions of its Solicitation Response or its entire

Solicitation Response as confidential or proprietary, the Solicitation Response is subject to being disqualified by TxDMV is its sole and absolute discretion.

2.10. Contracting Information Requirements ($1 Million or Greater in Public Funds).

Respondent represents and warrants that it will comply with the requirements of Section

552.372(a) of the Texas Government Code. Except as provided by Section 552.374(c) of the Texas Government Code, the requirements of Subchapter J, Chapter 552 of the

Government Code, may apply to any contract that may result from this Solicitation and the Respondent agrees that any contract that may result from this Solicitation can be terminated if the Respondent knowingly or intentionally fails to comply with a requirement of that subchapter.

2.11. COVID-19 Vaccine Passports. 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 any Texas state-funded contract that may result from this Solicitation.

2.12. Critical Infrastructure. In accordance with Section 2275.0102 of the Texas Government

Code, 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 2275.0103, or (2) headquartered in any of those countries.

2.13. Cybersecurity Training. If Respondent will have access to any Texas state computer system or database under any contract that may result from this Solicitation, Respondent shall complete cybersecurity training and verify completion of the training program to

TxDMV during the term of any contract that may result from this Solicitation and during any renewal period pursuant to and in accordance with Section 2054.5192 of the

Government Code.

2.14. Data Management and Security Controls. In accordance with Section 2054.138 of the

Texas Government Code, Respondent certifies that it will comply with the security controls required under any contract that may result from this Solicitation and will maintain records and make them available to TxDMV as evidence of Respondent’s compliance with the required controls.

2.15. Dealings with Public Servants. In accordance with Section 2155.003 of the Texas

Government Code, Respondent represents and warrants that it 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 Solicitation Response or any contract that may result from this Solicitation.

2.16. Debts and Delinquencies. Respondent agrees that any payments due under any contract that may result from this Solicitation shall be applied towards any debt or delinquency that is owed to the State of Texas.

2.17. Disaster Recovery Plan. Respondent agrees that upon request of TxDMV, Respondent shall provide the descriptions of its business continuity and disaster recovery plans.

2.18. Disclosure of Prior State Employment (Consulting Services). If this Solicitation is for consulting services, A. 2254.033 of the Texas Government Code, a Respondent offering to provide consulting services in response to this Solicitation who has been employed by, or employs an individual who has been employed by, TxDMV or another Texas state agency at any time during the two years preceding the submission of

Respondent’s Solicitation Response must disclose the information below in its

Solicitation Response and hereby certifies that this information is true, correct, and complete: (if additional space is needed attach a separate page or pages to this document)

Name of individual(s): (Respondent or employee(s))

Status: (check one) Respondent Employee(s)

The nature of the previous employment with TxDMV or the other Texas state agency:

The date the employment was terminated and the reason for the termination:

The annual rate of compensation for the employment at the time of its termination:

If more than one individual is identified in above, Respondent must provide responses to each of the questions above for each identified individual. To satisfy this requirement, Respondent must attach a separate page or pages to this document, as necessary, and include the information required set forth above.

Respondent acknowledges, agrees, and certifies that all information provided above or attached in a separate page or pages is true, correct, and complete on this and all attached pages.

B. If no information is provided above in response to this Subsection, Respondent certifies that neither Respondent nor any individual employed by Respondent was employed by TxDMV or any other State of Texas agency at any time during the two years preceding the submission of Respondent's Solicitation Response.

2.19. Entities that Boycott Energy Companies. If Respondent is required to make a verification pursuant to Section 2276.002 of the Texas Government Code, Respondent verifies that Respondent does not boycott energy companies and will not boycott energy companies during the term of any contract that may result from this Solicitation. If

Respondent does not make that verification, Respondent must state below why the verification is not required: (if additional space is needed attach a separate page or pages to this document)

2.20. Entities that Boycott Israel. If Respondent is required to make a certification pursuant to

Section 2271.001 of the Texas Government Code, Respondent certifies that Respondent does not boycott Israel and will not boycott Israel during the term of any contract that may result from this Solicitation. If Respondent does not make that certification, Respondent, Respondent must state below why the certification is not required: (if additional space is needed attach a separate page or pages to this document)

2.21. Entities that Discriminate Against Firearm Entities and Trade Associations. If

Respondent is required to make a verification pursuant to Section 2274.002 of the Texas

Government Code (relating to prohibition on contracts with companies that discriminate against firearm and ammunition industries), 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 any contract that may result from this Solicitation against a firearm entity or firearm trade association. If

Respondent does not make that verification, Respondent must state below why the verification is not required: (if additional space is needed attach a separate page or pages to this document)

2.22. E-Verify Program. Respondent certifies that it utilizes and will continue to utilize the

U.S. Department of Homeland Security’s E-Verify system to determine the eligibility of:

1. all persons employed by Contractor to perform duties within Texas; and

2. all persons, including subcontractors, assigned by Contractor to perform work pursuant to any contract that may result from this Solicitation within the United States of America.

2.23. Excluded Parties. Respondent certifies that it is not listed in the prohibited vendors list authorized by Executive Order 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. Respondent acknowledges that any contract that may result from this Solicitation may be terminated by TxDMV without recourse and payment withheld if this certification is shown to be inaccurate or becomes inaccurate.

2.24. Executive Head of a State Agency. In accordance with Section 669.003 of the Texas

Government Code, Respondent certifies that it does not employ, or has disclosed its employment of, any former executive head of the Agency. If Respondent does employ a person who was the executive head of TxDMV and cannot make that certification, Respondent must provide the following information:

Name of Former TxDMV

Executive:

Date of Separation from TxDMV:

Date of Employment with TxDMV:

2.25. False Representation. Respondent understands, acknowledges, and agrees that any false representation or any failure to comply with a representation, warranty, or certification made by Respondent is subject to all civil and criminal consequences provided at law or in equity including, but not limited to, immediate termination of any contract that may result from this Solicitation.

2.26. False Statements. Respondent represents and warrants that all statements and information prepared and submitted in its Solicitation Response are current, complete, true, and accurate. Submitting a Solicitation Response with a false statement or material misrepresentations made during the performance of a contract is a material breach of contract and may void the submitted Solicitation Response and any contract that may result from this Solicitation.

2.27. Financial Participation Prohibited. “Under Section 2155.004, Government Code, the

[Respondent] certifies that the individual or business entity named in this bid 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.” Section 2155.004 prohibits a Texas state agency from accepting a bid from or awarding a contract to an individual or business entity that includes proposed financial participation by a person who received compensation from the agency to participate in preparing the specifications or request for proposals on which the bid or contract is based.

2.28. 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. Section 2252.152 prohibits a Texas state agency from entering into a contract with a business entity that is identified on a list prepared and maintained by the Texas Comptroller of Public Accounts and the Texas

Pension Review Board. Additionally, pursuant to Texas Executive Order No. GA-43, Respondent represents and warrants that all goods or products that may be provided under this

Contract were not produced in or exported from the Gaza Strip, and from any organization or state actor with ties to Hamas. Respondent acknowledges that any contract that may result from this Solicitation may be terminated by TxDMV without recourse and payment withheld if either of these representations are shown to be inaccurate or becomes inaccurate.

2.29. Former Agency Employees (Certain Contracts). If this Solicitation is for an employment contract, a professional services contract under Chapter 2254 of the Texas

Government Code, or a consulting services contract under Chapter 2254 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 any contract that may result from this Solicitation, were former employees of TxDMV during the twelve

(12) month period immediately prior to the date of execution of any contract that may result from this Solicitation.

2.30. Hardening State Government from the Chinese Communist Party. In accordance with

Texas Executive Order No. GA-48, Respondent certifies by submitting a Solicitation

Response that it, and, if applicable, any of its holding companies or subsidiaries, is not: (1) listed in Section 889 of the 2019 National Defense Authorization Act (“NDAA”); (2) listed in Section 1260H of the 2021 NDAA; (3) owned by the government of a country on the

U.S. Department of Commerce's foreign adversaries list under 15 C.F.R. § 791.4; or (4) controlled by any governing or regulatory body located in a country on the U.S.

Department of Commerce’s foreign adversaries list under 15 C.F.R. § 791.4. Respondent acknowledges that any contract that may result from this Solicitation may be terminated by TxDMV without recourse and payment withheld if this certification is shown to be inaccurate or becomes inaccurate.

2.31. Human Trafficking Prohibition. “Under Section 2155.0061, Government Code, the

[Respondent] certifies that the individual or business entity named in this bid 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.” Section 2155.0061 prohibits a Texas state agency from accepting a bid from or awarding a contract to an individual or business entity that includes proposed financial participation by a person http://www.statutes.legis.state.tx.us/GetStatute.aspx?Code=GV&Value=2155.0061 who, during the five-year period preceding the date of the bid or award, has been convicted of any offense related to the direct support or promotion of human trafficking.

2.32. Legal and Regulatory Actions. Respondent represents and warrants that it is not aware of and has received no notice of any court or governmental agency actions, proceedings or investigations, or other action pending or threatened against Respondent or any of the individuals or entities included in Subsection 2.35 of this Affirmations and Solicitation

Acceptance within the five calendar years immediately preceding the submission of the

Solicitation Response that would or could impair Respondent’s performance under any contract that may result from this Solicitation, relate to the contracted or similar goods, products, or services, or otherwise be relevant to TxDMV’s consideration of the

Solicitation Response. If Respondent is unable to make the preceding representation and warranty, then Respondent must provide below a complete disclosure of any such court or governmental agency actions, proceedings or investigations, or other action that would or could impair Respondent’s performance under any contract that may result from this

Solicitation, relate to the contracted or similar goods, products, or services, or otherwise be relevant to TxDMV’s consideration of the Solicitation Response: (if additional space is needed attach a separate page or pages to this document)

2.33. No Conflicts of Interest. Respondent represents and warrants that the provision of goods, products, and services or other performance under any contract that may result from this

Solicitation will not constitute an actual or potential conflict of interest or reasonably create an appearance of impropriety in accordance with Sections 2252.908, 2254.032, and

2261.252(b) of the Texas Government Code.

2.34. 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, have been convicted of a felony criminal offense, or that if such a conviction has occurred, Respondent must fully advise TxDMV of the facts below and the circumstances surrounding the convictions: (if additional space is needed attach a separate page or pages to this document)

2.35. Parties to the Affirmations and Acceptance. Respondent represents and warrants that all certifications, representations, warranties, and other provisions in these Affirmations apply to Respondent and all of Respondent’s principals, officers, directors, shareholders, partners, owners, agents, employees, subcontractors, independent contractors, and any other representatives who may provide services under, who have a financial interest in, or otherwise are interested in this Solicitation or any contract that may result from this

Solicitation.

2.36. Prior Disaster Relief Contract Violation. “Under Section 2155.006 [and Section

2261.053], Government Code, the [Respondent] certifies that the individual or business entity named in this bid 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 prohibits a Texas state agency from accepting a bid from or awarding a contract to an individual or business entity that includes proposed financial participation by a person who, during the five-year period preceding the date of the bid or award, has been convicted of violating a federal law in connection with a contract awarded by the federal government for relief, recovery, or reconstruction efforts as a result of Hurricane Rita, Hurricane Katrina, or any other disaster occurring after September 24, 2005, or assessed a penalty in a federal civil or administrative enforcement action in connection with a contract awarded by the federal government for relief, recovery, or reconstruction efforts as a result of Hurricane Rita, Hurricane Katrina, or any other disaster occurring after September 24, 2005.

2.37. Public Information Act Copy. Respondent understands, acknowledges, and agrees, that its Solicitation Response and any contract that may result from this Solicitation are subject to disclosure under the Texas Public Information Act (“PIA”), Texas Government Code

Chapter 552, and may be disclosed to the public upon request or through posting on

TxDMV website (as required by Tex. Gov’t Code § 2261.253), the Legislative Budget

Board’s (“LBB”) website (as required by Tex. Gov’t Code § 322.020), or as otherwise required by law. Respondent certifies that it:

asserts that information provided in its Solicitation Response may be excepted from disclosure under the PIA, and Respondent, therefore, has also submitted a “Public

Information Act Copy” as required under this Solicitation; or asserts that there is no information provided in its Solicitation Response that is excepted from disclosure under the PIA, and Respondent, therefore, has not submitted a “Public

Information Act Copy.”

Respondent further acknowledges and agrees, that if a box is not checked above within this Subsection, its Solicitation Response including, but not limited to, all associated documents and information therein and any contract that may result from this Solicitation are deemed to contain no information that would be excepted from disclosure under the

PIA.

2.38. Release from Liability. RESPONDENT GENERALLY RELEASES FROM

LIABILITY AND WAIVES ALL CLAIMS AGAINST ANY PARTY PROVIDING

INFORMATION ABOUT THE RESPONDENT AT THE REQUEST OF TxDMV.

2.39. Signature Authority. By submitting the Solicitation Response, Respondent represents and warrants that the individual submitting this document and the documents made part of the Solicitation 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 http://www.statutes.legis.state.tx.us/GetStatute.aspx?Code=GV&Value=2155.006 submission of the Solicitation Response.

2.40. Suspension and Debarment. Respondent certifies that neither it nor its principals are debarred, suspended, proposed for debarment, declared ineligible, or otherwise excluded from participation in any contract that may result from this Solicitation by any federal or

Texas state agency.

2.41. Television Equipment Recycling Program. If Respondent is submitting a Solicitation

Response for the purchase or lease of covered television equipment, then Respondent certifies that it is compliance with Subchapter Z, Chapter 361 of the Texas Health and

Safety Code related to the Television Equipment Recycling Program.

2.42. Terms and Conditions. Respondent accepts this Solicitation’s terms and conditions unless specifically noted by exceptions advanced in the form and manner directed in this

Solicitation and submitted with the Solicitation Response. No exceptions, terms, or conditions will be considered if not advanced in the form and manner directed in this

Solicitation. Respondent acknowledges and agrees that any exceptions to this Solicitation as well as terms and conditions advanced by Respondent that differ in any manner from

TxDMV’s Terms and Conditions attached to this Solicitation and these Affirmations, are rejected unless expressly accepted in writing by a document drafted, signed, and provided by TxDMV.

2.43. Texas Bidder. Respondent certifies that if a Texas address is shown as the address of

Respondent on the Solicitation Response, Respondent qualifies as a Texas Bidder as defined in Section 2155.444(c) of the Texas Government Code.

2.44. TxDMV Right to Use. Respondent acknowledges and agrees that TxDMV has the right to use, produce, and distribute copies of and to disclose to TxDMV employees, agents, and contractors and other governmental entities all or part of Respondent’s Solicitation

Response as TxDMV deems necessary to complete the procurement process or comply with federal or Texas laws.

3. Respondent’s Execution of Response

The Respondent’s authorized representative must complete and sign the following: (if any of the following line-items are not applicable insert n/a)

Respondent’s Legal Name:

Respondent’s Assumed Name (d/b/a):

(Respondent’s must include copies of Assumed Name Certificate(s) filed with the Texas Secretary of State and/or each Texas

County where Assumed Name Certificate(s) has been filed, if any, as part of its Solicitation Response)

Respondent’s Physical Address:

City: State: Zip Code:

Respondent’s Mailing Address (if different):

City: State: Zip Code:

Respondent’s Telephone Number:

Respondent’s Website:

Respondent’s E-Mail Address:

Federal Employer Identification Number:

Texas Identification Number System (“TINS”) Number:

Texas Franchise Tax Number:

Texas Secretary of State Filing Number:

Sam.gov Unique Entity Identifier (“UEI”) Number:

By submitting its Solicitation Response and signing below, the Respondent is certifying compliance with the duties, obligations, and requirements of this Solicitation, TxDMV’s

Terms and Conditions attached to this Solicitation, and all other Exhibits referenced in the

List of Solicitation Exhibits. The Respondent’s authorized representative signing on the

Respondent’s behalf must have delegated authority to negotiate and bind the Respondent on all contractual matters related to this Solicitation, the Affirmations, and binds the

Respondent to perform any contract that may result from this Solicitation, if awarded. The

Respondent is advised that submitting its Solicitation Response with a false statement is a material breach of contract and will void the Respondent’s submitted Solicitation Response and any contract resulting from this Solicitation, if any.

Signature of Authorized Representative Date

Name of Authorized Representative (Print) Title of Authorized Representative

FAILURE TO SIGN AND RETURN THIS DOCUMENT WILL

DISQUALIFY THE RESPONDENT’S SOLICITATION RESPONSE