ESBD_446612_1755286886810_SOL_EXH_F.2_INFO&CERTS.pdf

INFORMATION AND CERTIFICATIONS FORM

Department of Public Safety of the State of Texas

Approved 1/22/2025 Page 1 of 10

For the purposes of this form, Vendor means Respondent, Bidder, Applicant, or Contractor as those terms apply throughout the relevant solicitation and contracting process Vendor is participating in or to whom a final contract or purchase order has been awarded. Response means any interested response from the Vendor to DPS for purposes of applying to a solicitation, such as a Proposal, Bid, or Application.

1. Vendor Information

A. Demographics

Company’s Legal Name

Company’s DBA if applicable

Mailing Address

Physical Address

DUNS No.

(Texas) Payee Identification Number

Federal Taxpayer Identification Number

Secretary of State Charter No.

Texas Franchise Tax File No.

Email for Receipt of Purchase Orders

Remittance Address if Direct Deposit is Declined

B. Authorized Representatives and Vendor’s Personnel

Complete all fields for each name as requested on this form. All information is necessary.

i. Vendor’s Authorized Representative

First Name

Middle Initial/Name

Last Name

Title

Email

Phone

ii. Contact for Response Clarifications, Inquiries, and Negotiations

Approved 1/22/2025 Page 2 of 10

Middle Initial/Name

Last Name

Title

iii. Contract/Project Manager

Middle Initial/Name

Last Name

Title

C. Historically Underutilized Business (HUB) Representation

Vendor represents and certifies as part of its response that it ☐is or ☐ is not, a HUB certified by the Comptroller of Public Accounts’ Statewide Procurement Division.

D. Preferences

Check the preferences for which you qualify.

☐ Goods produced or offered by a Texas bidder that is owned by a Texas resident service-disabled veteran

☐ Goods produced in Texas or offered by a Texas bidder that is 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 mental or physical disabilities

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

☐ Energy efficient products

Approved 1/22/2025 Page 3 of 10

☐ 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

2. Required Submissions

A. Child support certification. Under Texas Family Code §231.006(d) (relating to delinquent child support), Respondent acknowledges that it is not ineligible to receive the specified grant, loan, or payment and acknowledges that this Contract will be terminated and payment will be withheld if this certification is found to be inaccurate. Under Tex. Fam. Code § 231.006(c), responses must include names and 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 solicitation. Vendors meeting the criteria must complete the following.

Name Social Security Number

B. Certification for former executives. Under Tex. Gov’t Code § 669.003, the Department may not enter into a contract with a person who employs a current or former Executive head of a state agency until four years have passed since that person was the executive head of the state agency.

By signing the below acknowledgment, Vendor certifies that it is in compliance with Tex. Gov’t

Code § 669.003. If Tex. Gov’t Code § 669.003 applies, Vendor must complete the following.

Name of Former Executive

Name of State Agency

Date of Separation from State Agency

Date of Employment with Vendor

C. Type of Business Organization

Vendor, by checking the applicable box, represents that it operates in Texas as:

☐ A corporation incorporated under the laws of Texas

Approved 1/22/2025 Page 4 of 10

☐ An individual

☐ A partnership

☐ A non-profit organization

☐ A joint venture; or

If Vendor is a foreign entity, it operates as:

☐ An individual;

☐ A partnership;

☐ A non-profit organization;

☐ A joint venture; or

☐ A corporation, registered for business in .

D. Lawsuits (check the applicable paragraph that applies)

i. ☐ Vendor represents and warrants that it is not aware of and has no notice of any court or governmental agency actions, proceedings, or investigations, etc., pending or threatened against Vendor or any related individuals or affiliated entities related to the subject matter of this solicitation or otherwise relevant to DPS’s consideration of the response. Vendor represents and warrants that it is not aware of any court or governmental agency actions, proceedings, or investigations, etc. against Vendor or any of these individuals or entities within the five years immediately preceding the submission of the

Response to this solicitation. In addition, Vendor represents and warrants that it will notify

DPS in writing within five business days of any changes to the representations or warranties in Subsection i and understands that failure to so timely update DPS will constitute breach of contract and may result in immediate termination of the awarded contract.

ii. ☐ Vendor is unable to make the representation and warranty in Subsection i above and instead represents and warranties that it has included as a detailed attachment within its response, which expressly references this Subsection ii, a complete disclosure of any such court or governmental agency actions, proceedings or investigations, etc., and specifically addresses whether any of such past, pending, or threatened actions, proceedings or investigations, etc., would or could (1) impair Vendor’s performance under the awarded contract; (2) relate to the solicited or similar goods or services or the awarded contract; or

(3) be otherwise relevant to DPS’s consideration of the response. In addition, Vendor represents and warrants that it will notify DPS within five business days of any changes to the representations and warranties in this Subsection ii or attachments in response to

Subsection ii and understands that failure to so timely update DPS will

Approved 1/22/2025 Page 5 of 10 constitute breach of contract and may result in immediate termination of the awarded contract.

E. Ethics and Conflict of Interest

Under Tex. Gov’t Code § 572.051, any individual who interacts with public purchasers in any capacity is required to adhere to the established guidelines. Tex. Gov’t Code § 572.051 outlines the ethical standards required of state officers and employees who interact with public purchasers in the conduct of state business.

Specifically, a DPS employee may not have an interest in, or in any manner be connected with a contract or offer for a purchase of goods or services by an agency of the state; or in any manner, including by rebate or gift, accept or receive from a person to whom a contract may be awarded, directly or indirectly, anything of value or a promise, obligation or contract for future reward or compensation. Entities who are interested in seeking business opportunities with the state must be mindful of these restrictions when interacting with public purchasers of

DPS or purchasers of other state agencies. Vendor must also comply with the Conflict of

Interest provisions and disclosure requirements as listed in the Texas Procurement and

Contract Management Guide.

Vendor represents that it has disclosed to DPS all existing or potential conflicts of interest relative to performance of the Contract or that performance will not constitute an actual or potential conflict of interest or reasonably create an appearance of impropriety.

Vendor must disclose any actual or potential conflict of interest below.

3. Vendor Acknowledgments, Certifications, Assurances, Warranties, and Affirmations

Vendor acknowledges it can meet all requirements as stated and also acknowledges the receipt, review, and acceptance of the Solicitation. Any exceptions to the specifications or statement of work

(SOW), terms, requirements, or conditions must be explicitly permitted to be excepted in the

Approved 1/22/2025 Page 6 of 10 solicitation and Vendor must explicitly identify them within Vendor’s response in the required format.

Failure to sign and submit this form with the response may disqualify Vendor.

By signing the solicitation and submitting a response to DPS, Vendor certifies its compliance and understanding with the following statements.

By signature and submission, Vendor represents and warrants that the individual signing the documents made part of the submitted Response is authorized to sign such documents on behalf of

Vendor and to bind Vendor under any contract which may be awarded from the submission of its response.

By signature and submission, Vendor represents and warrants that all statements and information prepared and submitted in response to this solicitation are true, current, complete, and accurate.

If the circumstances certified by Vendor change or additional information is obtained subsequent to submission of the response, Vendor agrees that it is under a continuing duty to supplement its response under this provision. Vendor must submit updated information as soon as reasonably possible upon learning of any change to its affirmation.

A. Acknowledges that all of its representations and warranties contained in any part of its response and the awarded contract are material and have been relied upon by DPS in selecting

Vendor for contract award. Vendor warrants and represents that all of its statements and representations made to DPS prior to contract award, and those made during the negotiation of the contract are material, true and correct. Vendor certifies that it will promptly notify DPS if any representations, certifications, or warranties provided in the awarded contract are no longer true and correct.

B. Certifies it will include without limitation all disclosures, affirmations, guarantees, certifications, statements, and warranties of Vendor in submitting its response to this

Solicitation and will become certifications of the Contractor if Vendor is selected for contract award.

C. If a Texas address is shown as the address of Vendor, Vendor qualifies as a Texas Resident

Bidder as defined in Tex. Gov’t Code § 2155.444(c).

D. Acknowledges its obligation to specifically identify information it contends to be confidential or proprietary, and where Vendor 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.

E. 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

Approved 1/22/2025 Page 7 of 10 reporting requirements, Texas Public Information Act disclosures, or any other reporting requirements mandated by law or statute. Vendor’s response and subsequent documents are subject to the Texas Public Information Act.

F. Certifies that it is exempt or not delinquent in the payment of any franchise taxes owed the

State of Texas under Tex. Tax Code Chapter 171.

G. Certifies it is not in default, nor is there any event in existence which, with notice or the passage of time or both, would constitute a default by Vendor under any indenture, mortgage, deed of trust, lease, loan agreement, license, security agreement, contract, governmental license or permit or other agreement or instrument to which it is a party or by which any of its properties are bound and which default would materially and adversely affect Vendor’s ability to perform its obligations.

H. Vendor affirms that no person will, on the grounds 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 any awarded contract. Vendor must 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.”

I. Certifies that Vendor and its principals are eligible to participate in this transaction and have not been subjected to suspension, debarment, or similar ineligibility determined by any federal, state, or local governmental entity and Vendor is in compliance with the State of Texas statutes and rules relating to procurement and that Vendor is not listed on the federal government’s terrorism watch list as described in Executive Order 13224 or debarred on the

Texas Debarred Vendor List. Entities ineligible for federal procurement are listed at http://www.sam.gov.

J. Affirms 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.).

K. Complies with the provisions of the Lobbying Disclosure Act, 2 U.S.C. § 1601 et seq. By submitting a response, Vendor certifies that it will not and has not used federally appropriated funds to pay any person or organization for influencing or attempting to influence any officer or employee of any federal agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any federal contract, grant, or any other award covered by 31 U.S.C. § 1352. It also certifies that Vendor will disclose any http://www.sam.gov/

Approved 1/22/2025 Page 8 of 10 lobbying with non-federal funds that takes place in connection with obtaining any federal award by completing and submitting Standard Form LLL.

L. Certifies that it has not given and does not intend to give at any time, any economic opportunity, future employment, gift, loan, gratuity, special discount, trip, favor, payment, inducement, or service to a public servant or DPS officer, employee, or agent in connection with this transaction. Violation of this requirement may result in the termination of the contract at the discretion of DPS.

M. Under Tex. Gov’t Code § 2155.004, Vendor certifies that the individual or business entity named in its response is not ineligible to receive the Contract and acknowledges that the contract may be terminated and payment withheld if this certification is inaccurate. Tex. Gov’t

Code § 2155.004 prohibits a person or entity from receiving a state contract if that person or entity received compensation for participating in preparing the solicitation or specifications for the Contract.

N. Under Tex. Gov’t Code § 2155.006, Vendor certifies that the individual or business entity named in its response is not ineligible to receive the contract and acknowledges that the contract may be terminated and payment withheld if this certification is inaccurate.

O. Represents and warrants that it has not been the subject of allegations of Deceptive Trade

Practices violations under Tex. Bus. & Com. Code Chapter 17 or allegations of any unfair business practice in any administrative hearing or court suit and that Vendor has not been found to be liable for such practices in such proceedings. Vendor certifies that it has no officers who have served as officers of other entities who have been the subject of allegations of

Deceptive Trade Practices violations or allegations of any unfair business practices in an administrative hearing or court suit, and that such officers have not been found to be liable for such practices in such proceedings.

P. Represents and warrants that Vendor and Vendor’s employees have not been convicted of a felony criminal offense, or that, if such a conviction has occurred, Vendor has fully advised DPS as to the facts and circumstances surrounding the conviction.

Q. Certifies its compliance with Tex. Health & Safety Code Ch. 361, Subchapter Y and Texas

Commission on Environmental Quality rules in 30 Tex. Admin. Code Ch. 328, if Vendor is submitting a response for the purchase or lease of computer equipment.

R. Certifies its compliance with Tex. Health & Safety Code Ch. 361 related to the Television

Equipment Recycling Program, if Vendor is submitting a response for the purchase or lease of covered television equipment.

S. Certifies, in accordance with Tex. Gov’t Code § 2254.033, relating to consulting services, that it does not employ an individual who has been employed by DPS or another agency at any time during the two years preceding the submission of the response, or in the alternative, Vendor has disclosed in its response the following: (1) the nature of the previous employment with

Approved 1/22/2025 Page 9 of 10

DPS or the other agency; (2) the date the employment was terminated; and (3) the annual rate of compensation for the employment at the time of its termination.

T. Represents, if solicitation and Contract is for a professional or consulting service under Tex.

Gov’t Code Ch. 2254, that none of its employees, including those authorized to provide services under the Contract, were former employees of DPS during the 12 months immediately preceding Contract execution.

U. Certifies, under Tex. Gov’t Code § 2155.0061 that it is not ineligible to receive the specified contract and acknowledges that this contract may be terminated and payment withheld if this certification is inaccurate.

V. Certifies that it will comply with Tex. Gov’t Code § 2054.5192, which requires cybersecurity training. Any Contractor who has access to a state computer system or database must complete a cybersecurity training program certified by DIR and selected by DPS during the initial term of the contract and during any optional renewal period. Contractor must verify completion of the program by sending proof of training to the Contract Monitor upon request.

W. Acknowledges that Tex. Gov’t Code Chapter 552, Subchapter J may apply to this solicitation or contract and agrees that DPS may terminate the contract if Contractor or Vendor knowingly or intentionally fails to comply with a requirement of that subchapter.

X. If defined as a company under Tex. Gov’t Code § 806.001, certifies that it is not (1) engaged in business with Iran, Sudan, or a foreign terrorist organization as prohibited by Tex. Gov’t Code

§ 2252.152, or (2) identified on a list prepared and maintained by the comptroller under Tex.

Gov’t Code §§ 806.051, 807.051, or 2252.153.

Y. If defined as an applicable company, certifies that it does not boycott Israel and will not boycott

Israel during the term of any contract resulting from this solicitation. If Vendor cannot make that certification or is not required to do so by law, Vendor must indicate that in its Response and state why the certification is not required.

Z. Certifies, under Tex. Gov’t Code § 572.069, that it has not employed and will not employ a former DPS employee or state officer who participated in a procurement or contract negotiation for DPS involving Vendor before the second anniversary of the date the contract is signed or the procurement is terminated or withdrawn. This certification only applies to former state officers or employees whose state service or employment ceased on or after September

1, 2015.

AA. Certifies that it is not ineligible to receive the Contract under Tex. Health & Safety Code §

161.0085.

BB. Certifies that it, its parent company, any affiliate, or affiliate of its parent are not (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 Tex. Gov’t Code § 2274.0103, or (2) headquartered in any of those countries.

Approved 1/22/2025 Page 10 of 10

CC. If required to do so under Tex. Gov’t Code § 2274.002, verifies that it does not boycott energy companies and will not boycott energy companies during the term of the Contract. If Vendor cannot make that verification, Vendor must indicate that it in its response and state why the verification is not required.

DD. If required to do so under Tex. Gov’t Code § 2274.002, 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 Contract term against a firearm entity or firearm trade association. If Vendor cannot make that verification, Vendor must indicate that it in its response and state why the verification is not required.

EE. Vendor certifies that all subcontractors used in performance of this contract are held accountable for all security and contractual requirements, including compliance with all obligations of the Historically Underutilized Businesses (HUB) Sub-Contracting Plan (HSP), including submission and amendments to the HSP and Progress Assessment Reports (PARs).

FF. Vendor certifies that it, and if applicable, any of its holding companies or subsidiaries, is not (1) listed in § 889 of the 2019 National Defense Authorization Act (NDAA), or (2) listed in § 1260H of the 2021 NDAA, or (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.