ESBD_448715_1755883280683_HARDCOPYFORDISTTOPOST.pdf

Revised 05.13.25

GARLAND INDEPENDENT SCHOOL DISTRICT

PURCHASING DEPARTMENT

501 S. Jupiter Garland, Texas 75042

REQUEST FOR PROPOSAL

Property Insurance

PROPOSAL #363-26

PLEASE SUBMIT PROPOSAL NO LATER THAN 10:30A.M. LOCAL TIME SEPTEMBER 30, 2025.

Mark the sealed return envelope in the lower left hand corner with PROPOSAL#, time, and due date, as noted above. (Should the district close for unforeseen reasons (force majeure) on the date the solicitation is due, the above referenced date should be changed to 10:30A.M. the first date the district is open to conduct business)

You are invited to submit a Proposal to provide Property Insurance to the Garland Independent School District (GISD) from December 3, 2025 (or date of award) with optional annual renewal through December 2, 2031 .

This Proposal includes Instructions to Proposer, Terms and Conditions, Proposer Qualifications, Proposer Certification and Declaration of Compliance, Insurance Agent/Company Errors & Omissions Insurance Information, Felony Conviction Notification, Conflict of Interest Questionnaire, Specifications, Garland ISD Property Insurance Proposer Questionnaire. These provisions shall be considered as part of any resulting legal and binding contract/purchase order as if thereto attached or therein repeated.

Total Pages: 16 (without Phase 2 attachments C-F)

THIS RFP WILL NOT BE OPENED OR READ PUBLICLY

DELIVERY DATE IS _____Business Days ARO (After Receipt of Order)

Company Name

Address

City State Zip

Authorized Representative Name Title

Signature

Printed Name Email Address

Telephone # Fax #

Mark A. Booker Executive Director of Purchasing

Revised 05.13.25

RFP # 363-26

The Garland Independent School District, Garland, Texas is currently seeking proposals from qualified and interested insurers to provide insurance for property to include boiler and machinery, inland marine, and electronic data processing. We are also seeking proposals for crime insurance under this RFP. (RFP #363-26).

If you are interested in participating, complete and email the Proposer Questionnaire to receive Attachments C through F by the due date in phase 1, September 3, 2025, 12:00PM. You will be emailed the attachments after receipt of the Proposer Questionnaire. If you wish to submit a full proposal, complete all documents and return to the Purchasing Department at 501 S Jupiter Road, Garland, Texas 75042 no later than September 30, 2025, by 10:30 a.m. Proposals may include “NOT TO EXCEED” amounts but must include specific coverage limits and deductibles and an identification of all carriers in the proposal. PLEASE NOTE: You must allow enough time to be checked in at the receptionist desk and submit the proposal to be date/time stamped in at the desk in Purchasing.

Please keep the following dates in mind as they are inflexible:

August 22, 2025 – RFP #363-26 invitation is published and advertised.

September 3, 2025, 12:00p.m. – Last day to submit questions and phase 1 documents.

Phase 1: Garland ISD Property Insurance Proposer Questionnaire required to receive additional documents for final submission should be send to bids@garlandisd.net with copy to Cramire@garlandisd.net

September 5, 2025 4:00p.m. –All addenda will be issued, as amendments to the RFP (s). It is the supplier’s responsibility to check the district’s website (http://www.garlandisd.net/connect/do-business/current-opportunities ) and all electronic notifications for addendums prior to submitting responses.

Phase 2: All additional documents will be sent to suppliers that responded to Phase 1.

Please continue to monitor our website for any updates past the addendum date.

September 30, 2025, 10:30 a.m. – Proposals due to the Purchasing Department, Garland ISD, 501 S. Jupiter Rd., Garland, Texas 75042.

November Board Meeting – Notification of proposal acceptance and bind coverage.

December 3, 2025 - Coverage begins.

Any questions regarding this request for proposal and the insurance specifications should be directed in writing to bids@garlandisd.net with copy to Senior Buyer, Cecilia Ramirez in the Purchasing Department, at Cramire@garlandisd.net.

Fact Sheet

RFP # 363-26

Garland Independent School District (Garland ISD). Garland ISD has a student population of approximately 51,000 students. This year we will have an estimated 7,300 employees, of which approximately 4,800 are professional employees.

The school district currently has 43 elementary schools, 12 middle schools, 4 other Education Centers, and 7 high schools. Combined with our support facilities, Garland ISD has 81 operating locations in three cities, Garland, Rowlett, and Sachse. Property and contents is valued at approximately $2.2 billion, see attached schedules in Attachment B for details.

Every school is on a five-year renovation plan. Garland ISD has a federally mandated choice of school program which allows a family to choose the school their child will attend. Because of this program Garland ISD does a lot of renovation to keep all of their school facilities in the best condition. This work makes all of the schools attractive to encourage families to stay with their neighborhood school. This work also keeps the schools in compliance with current fire and life safety standards. All schools have security, fire, and smoke monitored (24/7) by a central in- house station and use an in-house security patrol with direct connections to the local fire departments.

Garland ISD began its risk management program in November 1992. Each year this program has expanded where now each employee group and physical location is touched by the program. We have experienced very low frequency of property damage and have held the number of vehicle accidents relatively constant. The district and its various departments have won awards from the Texas Safety Association, Texas Association of School Business Officials, and Texas PRIMA in the area of loss reduction and innovative risk control.

The Garland ISD continues to take aggressive action in loss control and safety. The Garland ISD is very concerned and committed to making the District a safe place to work and attend classes, while keeping the costs of risk down and by protecting its physical assets.

Table of Contents

RFP # 363-26

If you are interested in participating, complete and email the Garland ISD Property Insurance Proposer Questionnaire to receive Attachments C through F by the due date in phase 1.

Review and complete the following attachments AND return with your response: Attachment C through F will be sent only to proposers who responded with attachment B by the deadline

PHASE 1- These documents are included

Garland ISD Request for Proposal Instructions & Conditions

Section 1 – Instructions to Proposers Section 2 – Terms and Conditions Section 3 – Proposer Qualifications Section 4 – Evaluation Criteria

Attachment A- Section 5 – 6

Section 5 – Proposer Certification and Declaration of Compliance Section 6 – Insurance Agent/Company Errors & Omissions

Insurance Information Attachment B Section 7

Section 7 – Property Insurance Proposer Questionnaire Required Forms

Section 8 – Felony Conviction Notification- Section 9 – Conflict of Interest Questionnaire FORM CIQ, 2 pages

PHASE 2- These documents are not included, but must be addressed and submitted as part of this RFP.

Attachment C - Garland ISD Property Value Information Schedules

a. Property

b. Fire Sprinkler

c. Band-Middle School

d. Band-High School

e. Portables

f. Fleet List

Attachment D - Current Policy Information

a. Crime Loss Runs 3 years

b. GISD Property Loss run 2021-2025

c. Financial Report-FY24

d. AIG Lexington - Primary

e. Hanover Crime Policy

Attachment E - Location Employee Counts

Attachment F- Premium History Property Crime

GARLAND ISD

INSTRUCTIONS & CONDITIONS

SECTION 1 – INSTRUCTIONS TO PROPOSERS

Sealed proposals shall be received in the office of the Garland ISD Purchasing Department, 501 S.

Jupiter, Garland, Texas 75042, prior to September 30, 2025, 10:30 am. Proposals submitted via the U. S. Postal Service are to be mailed to Garland ISD Purchasing Department, P. O. Box 469026, Garland, Texas 75046-9026. Delivery of the Proposal envelope to other departments within the GISD is not considered as delivery to the Purchasing Department. Proposals submitted after the specified date and time will be rejected.

NOTE: Submissions must be sealed and not exceed 14”x10”x5” to use the Purchasing Drop Box

Delivery of submission to other Departments within the District is not considered as delivery to the Purchasing Department. The submission must be date/time stamped by Purchasing before the deadline.

1. Proposals received at the GISD Purchasing Department after the time and date specified above will not be considered and will be filed unopened. The Garland ISD shall not be held liable for late proposals.

2. PLEASE PROVIDE ONE (1) ORIGINAL, ONE (1) COPY AND ONE (1) FLASH DRIVE WITH ALL

DOCUMENTS INCLUDED OF PROPOSAL RESPONSE! ENSURE THE ORIGINAL AND COPY

ARE CLEARLY LABELED. – Property Insurance, RFP # 363-26” with name of proposer.

3. Each proposal must be submitted in printed format with a complete duplicate of all documents on a flash drive to include the (1) Proposal Spreadsheet Questionnaire with proposer’s answers and comments (including the quotation), (2) Proposer's Certification, and (3) Proposer's Questionnaire, all of which must be located at the front of the printed proposal. Any proposal, which does not strictly adhere to the requirements enumerated in this document and the Proposal Spreadsheet Questionnaire may not be considered. The certification forms are included in this document, “Insurance Specifications, Terms & Conditions”. This document, as well as other documents, contain the underwriting information.

4. Suppliers finding errors, requests for additional information, omissions, questions, or corrections shall contact the Purchasing Department by submitting an email to bids@garlandisd.net and a copy to cramire@garlandisd.net no later than September 3, 2025 at 12:00p.m.

5. Garland ISD Property Insurance Proposer Questionnaire is essential for accurate comparison.

Terms such as “see attached” or “refer to policy” will regard the question as not answered. Avoid the use of N/A or N/C. Since they have different meanings: not applicable, not available, not acceptable, no charge or not covered.

SECTION 2 - TERMS AND CONDITIONS

1. GENERAL TERMS

1.1 The procedures used by the District will be in accordance with the "Request for Proposal" procedures as set forth in the Texas Education Code 44.031. Throughout these specifications, when the term RFP, bidder or vendor is used, it refers to a request for proposal.

1.2 All contracts shall be for a minimum of one year beginning December 3, 2025 with rates and costs guaranteed for at least 12 months. Nothing in these Specifications shall prohibit the District from negotiating longer terms or from automatically renewing coverage for additional years if service is satisfactory and both parties agree upon renewal terms. Rate or rate cap guarantees are welcome. The District shall have the opportunity to cancel contracts at each policy anniversary with no penalties for unearned premium with 30 days notice. At the end of the contract period, policies may be renewable by mutual consent of the District Administration and the awardee.

Renewal pricing and currently valued loss reports must be provided.

1.3 The District requests a loss limit of at least $300 million with multiple deductible options for wind/hail including flat deductibles and a $100,000 deductible for other perils plus various sub deductibles for property. Engineering services for property along with boiler and machinery should be included. Layered responses are understandably accepted. The crime policy should have a limit of $1 million with deductibles of $5,000 - $25,000.

1.4 Except as stated above, all proposals must be an exact duplication of the existing plans unless otherwise specifically indicated on the Proposal Spreadsheets. Any plan of insurance, additional information, different method of handling coverage, increased protection, etc., not in the specifications shall be welcomed, but must be submitted separately as an alternate proposal unless specifically requested on the Proposal Spreadsheet Questionnaire.

1.5 Proposals are being accepted for property including boiler and machinery, inland marine, and electronic data processing, and separately for crime insurance.

1.6 If awarded the contract, providers must be able to supply:

Monthly or quarterly loss reports Periodic reports showing status and prognosis of losses greater than $10,000 Annual premium and loss exhibits On-site consultation at least once each calendar quarter

1.7 Each proposal must include sample copies of:

Loss reports Annual billing to the District Claim forms & procedures

1.8 Copies of all policy and contract forms must be included with your proposal.

1.9 The basis of premium payment including down payment, number of installments, installment amounts, and finance charges must be outlined.

1.10 The District will evaluate the proposals, attempting to place all coverages with one insurance agency, but reserves the right to separate policies and agencies. Any proposals that will have different premiums for separate or "packaged" proposals may indicate both premiums in a separate column of the Proposal Spreadsheet Questionnaire, which is a Microsoft Excel document.

2. WAIVING INFORMALITIES

The Garland Independent School District reserves the right to accept or reject all or any part of any proposal, waive minor proposal formalities / technicalities and award the proposal deemed to be most advantageous to the District.

3. CANCELLATION FOR CONVENIENCE

The Garland Independent School District reserves the right to cancel any contract (purchase order) resulting from this Request for Proposal at any time, for any reason (or for no reason) with a thirty (30) day written notice to the contractor(s). Contractor may cancel any resulting contract, at any time for any reason, or for no reason with one-hundred and twenty (120) day written notice. Any notice required or permitted to be delivered to the contractor(s) shall be deemed to be delivered when mailed by registered or certified mail, return receipt requested, postage prepaid, and addressed to the bidder’s address appearing on the face of the Request for Proposal (or as subsequently revised or changed). Any compensation due the contractor(s) will be limited to items received and/or services performed and accepted by the District.

4. CANCELLATION FOR CAUSE

District shall have all remedies available at law or in equity. Where the Supplier is in default in delivery or otherwise or has breached any terms or conditions of this contract. Garland ISD may terminate this contract in whole or in part without any adjustment, and in addition to any other remedy provided by law, may procure items or services, similar to those as to which this contract is terminated, and Supplier shall be liable to Garland ISD for any costs or such similar items or services in excess of the price or prices specified herein, provided, however, that Supplier shall continue the performance of this contract to the extent not terminated by the Garland ISD.

5. OPEN RECORDS

Garland Independent School District is a public entity subject to the provisions of the Texas Public Information Act (Tex. Govt. Code Ch. 552). Responses to this invitation may be subject to release as public information unless the response or specific parts of the response are exempted from public disclosure under such Act. Proposers should consult with their legal counsel regarding disclosure issues and take the appropriate precautions to safeguard trade secrets or any other proprietary information before responding to this invitation.

6. CONFIDENTIALITY

Should the proposer access personal, identifiable information in reference to any claimant, inadvertently or intentionally, proposer shall establish and maintain the confidentiality of records and information contained therein. Proposer gives full assurance that no information obtained from the district shall be used by or disclosed by its employees except as required to perform duties under the contract. The proposer must stamp in bold red letters the term "CONFIDENTIAL" or “PROPRIETARY” on every page of any part of a proposal that the proposer claims is confidential or proprietary. All proposals and parts of proposals that are not marked as confidential or proprietary will be considered public information after the contract is awarded. The District assumes no liability or responsibility for release of any information not properly marked.

7. In the event that the District receives a request for disclosure of material marked “confidential” or “proprietary”, the District may request an opinion from the Texas Attorney General concerning whether such material must be disclosed. Submission of material marked “confidential” or “proprietary constitutes agreement by the proposer to reimburse the District for all costs incurred by the District in connection with such an Attorney General request, including attorney fees.

Copyrighted proposals are unacceptable and may be disqualified as non-responsive.

8. ADDENDA

All addenda will be issued, as amendments to the RFP(s). It is the supplier’s responsibility to check the district’s website In addition any addenda, if issued, will be posted on the District’s website (www.garlandisd.net/departments/purchasing/currentbids.asp) and Phase 2 additional documents will be sent to suppliers that responded to Phase 1 via email. by September 5, 2025, at 4:00 pm.

(refer to specification) It is the vendor’s responsibility to check this website for addenda postings prior to submitting responses.

9. FOREIGN TERRORIST ORGANIZATION LIST

Pursuant to Texas Government Code Chapter 2252, Company certifies that it is not a company identified on the on a list prepared and maintained pursuant to Texas Government Code § 806.051, 807.051, or 2252.153 (“Foreign Terrorist Organization List”). In the event that Company is added to a Foreign Terrorist Organization List at any time during this Agreement, Company shall promptly provide notice to School. Garland ISD may terminate this Agreement immediately upon receipt and verification of information, by any means, that Company has been added to a Foreign Terrorist Organization List.

10. BOYCOTT ISRAEL

Pursuant to Texas Government Code Chapter 2270, Company certifies that it does not boycott (as defined in Texas Government Code Chapter 808) Israel and will not boycott Israel during the term of this Agreement with the Garland ISD.

11. FIREARM INDUSTRY

Pursuant to Texas Government Code Chapter 2274.002 (SB 19), a governmental entity may not enter into a contract with a company for the purchase of goods or services unless the contract contains a written verification from the company that it: does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and will not discriminate during the term of the contract against a firearm entity or firearm trade association. This provision is only applicable to a company with at least 10 full-time employees and a contract value of $100,000 or greater. Executing this agreement is considered written verification that your company is in compliance with the law.

12. CHIOCE OF LAW/VENUE

This Request for Proposal and any resulting award(s) shall be interpreted within the laws of the State of Texas and the Uniform Commercial Code (UCC). In case of discrepancies between the laws of the state of Texas and the UCC, the laws of Texas will prevail. Venue for any legal action filed relative to this Request for Proposal or any resulting purchase orders shall be in Dallas County, Texas.

SECTION 3 – PROPOSER QUALIFICATIONS

1. Companies submitting proposals must be licensed in Texas and have an organization of permanence with adequate personnel and experience. Qualifications should be shown on the Proposer Questionnaire, which should be included in the proposal.

2. All Agents and Companies must have the capability of corresponding and exchanging files with the

Garland ISD via e-mail. Garland ISD uses both Microsoft WORD and Excel programs.

3. Proposers must have an Errors and Omissions policy with a minimum limit of $5,000,000 per occurrence. A certificate of insurance must be included with the proposal.

4. Providers must furnish contact information and/or (800) phone numbers for claims assistance after normal business hours.

5. Agents and/or insurance companies must be able to provide Loss Prevention and Engineering Services, if requested by the District. Any additional cost must be identified in the Proposal. Loss Prevention Service Providers must hold Texas Department of Insurance Loss Control Representative Designations.

6. All insurance companies proposing coverage or service must be licensed by the State of Texas. Insurance companies, must be subject of the Texas Insurance Guaranty Fund, unless coverage is not available through a licensed company. All insurance companies must have an A. M. Best Rating of at least A-VIII (as published in the most recent edition of the Rating Guide). Pools must be financially stable and show proof that they can pay their claims.

7. Garland ISD is an affirmative action, equal employment opportunity educational institution

SECTION 4 – EVALUATION CRITERIA

Parameters: Max Points:

The purchase price

The reputation of the vendor and of the vendor's goods or services;

Best Rating-5 points Financial Statement-5 points References- 5 Points

The quality of the vendor's goods or services Compliance with RFP Instructions, Completion of Questionnaire, Coverages, Limits- 20 points all required

The extent to which the goods or services meet the district's needs;

Ability to provide Appraisal Services, Loss Modeling Reports, Flood Determinations, Reports, Claim Services, and Loss Prevention Service-15 points all are required.

The vendor's past relationship with the district

The impact on the ability of the district to comply with the laws and rules relating to historically under-utilized businesses

The total long-term cost to the district to acquire the vendor's goods and services;

Rate guarantees- 2.5 points Rate stability history-2.5 points

Any other relevant factor specially listed in the request for RFP or proposal;

Client Management Team and Strength and Cost Effectiveness of Provider network-2 points

For a contract for goods and services, other than goods and services related to telecommunications and information services, building construction and maintenance, or instructional materials, whether the vendor or the vendor's ultimate parent company or majority owner:

a. has its principal place of business in this state; or employs at least 500 persons in this state; and (Form E)

Total

ATTACHMENT A

SECTION 5 - PROPOSER CERTIFICATION

AND DECLARATION OF COMPLIANCE

1. The undersigned, as Proposing Agent/Insurance Company, does hereby declare that they have read the specifications for the Garland Independent School District insurance programs, and with full knowledge of the requirements, does hereby agree to furnish all services and afford all provisions of coverage in full accordance with the specifications and requirements.

2. The undersigned insurance agency/company warrants that any benefit that would be paid by the existing policies will be paid by the proposed policies. Further, the insurance agency/company indemnifies the District for any liability because of failure to provide insurance, which is at least equal to that coverage being replaced.

3. By signing this Request For Proposal, the undersigned proposer affirms that its company, corporation, firm, partnership or individual has not prepared this proposal in collusion with any other bidder and that the contents of this proposal as to prices, terms, or conditions have not been communicated by the undersigned or by any employee or agent to any other person or firm engaged in this type of business prior to the official opening of this proposal.

4. The signatory for this Request For Proposal hereby certifies (by signing this document) that the individual and/or firm on whose behalf this proposal is submitted is not listed on the Federal Government’s “List of Parties Excluded from Federal Procurement and Non-procurement Programs” published by the U. S. General Services Administration (GSA) effective as of the date of opening of this proposal.

5. By submitting a response to this request, vendor represents that it is in compliance with the requirements of Chapter 176 of the Texas Local Government Code, Disclosure of Certain Relationships with Local Government Officers; Providing Public Access to Certain Information. A list of local government officers may be obtained at: https://www.garlandisd.net/content/conflict-disclosure . A copy of this form is part of this Terms & Conditions document. Failure to comply with this provision may result in the RFP being considered non-responsive.

Undersigned agrees to provide annual loss runs valued no earlier than December 3, 2025 for each year with outstanding or newly closed losses.

Undersigned agrees to provide District with not to exceed renewal rates by October 15, 2025 of each year. Agency/Company:

Signature of Authorized Agent:

Typed Name: Title:

ATTACHMENT A

SECTION 6 - INSURANCE AGENT/COMPANY

ERRORS & OMISSIONS INSURANCE INFORMATION

1. Errors & Omissions Insurance Company:

Dates: Limits: Deductible:

2. Theft of District Funds Crime Insurance Company:

Dates: Limits: Deductible:

3. We are not submitting a proposal at this time, but request to remain on the vendor list for future RFPs. Check here if “yes”.

*Please add additional documents if necessary

INTENTIONALLY LEFT BLANK

ATTACHMENT B

SECTION 7 -

PROPERTY INSURANCE PROPOSER QUESTIONNAIRE

Agent/Company Office Head Address City, State, Zip Phone Fax 800 #

E-mail address: Web Site:

Identify whether agency, direct writer:

Date Founded/Opened Total Number of Local Employees Number of Texas School Clients Number of Clients with greater than 5,000 employees

In-House Services – Contact Employee In-House Services – Contact Employee

Service Rep - Other -

Claims - Other -

Loss Control - Other -

Account Executive Backup Executive

Name Direct Office Phone E-Mail Address Home Phone Cell Phone Assistant Assistant Direct Phone Number School Clients Number Commercial Clients Years with Firm Years in Insurance Designations Previous Experience

References Contact Phone

Required Forms

SECTION 8 – FELONY CONVICTION NOTIFICATION

I, the undersigned agent for the firm named below, certify that the information concerning notification of felony convictions has been reviewed by me and the following information furnished is true to the best of my knowledge.

Vendor’s Name:

Authorized Company Official’s Name (Printed)

A. My firm is a publicly held corporation; therefore, this reporting requirement is not applicable.

Signature of Company Official

B. My Firm is not owned or operated by anyone who has been convicted of a felony:

C. My firm is owned or operated by the following individual(s) who has/have been convicted of a felony:

Name(s) of Felon(s):

Details of Conviction(s):

Section 44.034, Texas Education Code, Notification of Criminal History, Subsection (a), states “a person or business entity that enters into a contract with a school district must give advance notice to the District if the person or an owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony.” Subsection (b) states “a school District may terminate a contract with a person or business entity if the District determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The District must compensate the person or business entity for services performed before the termination of the contract.” This Notice Is Not Required of a Publicly–Held Corporation

SECTION 9- CONFLICT OF INTEREST QUESTIONNAIRE (CIQ) 1 OF 2

Addjcdcdc

CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ

For vendor or other person doing business with local governmental entity

This questionnaire is being filed in accordance with Chapter 176 of the Local Government Code by a person doing business with the governmental entity.

By law this questionnaire must be filed with the records administrator of the local government 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 violates Section 176.006, Local Government Code An offense under this section is a Class C

OFFICE USE ONLY

Date Received

Name of person doing business with local government 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 September 1 of the year for which an activity described in Section 176.006(a), Local Government Code, is pending and not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.)

Describe each affiliation or business relationship with an employee or contractor of the local governmental entity who makes recommendations to a local government officer of the local governmental entity with respect to expenditure of money.

Describe each affiliation or business relationship with a person who is a local government officer and who appoints or employs a local government officer of the local governmental entity that is the subject of this questionnaire.

Amended 01/13/06

SECTION 9- CONFLICT OF INTEREST

QUESTIONNAIRE (CIQ) 2 OF 2

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor or other person doing business with local governmental entity

FORM CIQ

Name of local government officer with whom filer has affiliation or business relationship. (Complete this section only if the answer to A, B or C is YES.)

This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has affiliation or business relationship. 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 from the filer of the questionnaire?

Yes No

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

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

D. Describe each affiliation or business relationship.

Describe any other affiliation or business relationship that might cause a conflict of interest.

Signature of person doing business with the governmental entity

Date