ESBD_473695_1764948414483_26-4090-02 RFQ - ENGINEERING SERVICES - CIPP.pdf

RFQ Documents for

PROFESSIONAL ENGINEERING SERVICES:

TRANSPORTATION PLANNING & CAPITAL

IMPROVEMENT PLAN AND PROGRAM

(CIPP) DEVELOPMENT

Burnet County, Texas

RFQ # 26-4090-02

DEADLINE FOR QUESTIONS: DECEMBER 15,

2025 12:00 PM

DUE DATE/TIME: DECEMBER 30, 2025 10:30 AM

RFQ 26-4090-02 PROFESSIONAL ENGINEERING SERVICES CIPP

REQUEST FOR QUALIFICATIONS (RFQ) FOR PROFESSIONAL

ENGINEERING SERVICES

RFQ NO. 26-4090-02: TRANSPORTATION PLANNING & CAPITAL IMPROVEMENT

PLAN AND PROGRAM (CIPP) DEVELOPMENT

ISSUANCE DATE: December 05, 2025

SUBMISSION DEADLINE: December 30, 2025, at 10:30 AM (CST)

SUBMISSION LOCATION: Burnet County Auditor’s Office 133 E. Jackson, Burnet, TX 78611

WAYS TO SUBMIT: bids@burnetcountytexas.org or dropped off/mailed to Burnet County Auditor’s Office 133 E. Jackson, Burnet, TX 78611

POINT OF CONTACT: Megan Schumann

Purchasing Agent Email: mschumann@burnetcountytexas.org Phone: (512) 756-5412

INTRODUCTION

Burnet County ("County") is soliciting Statements of Qualifications (SOQs) from qualified professional engineering firms ("Respondents") to provide comprehensive professional engineering services. These services are related to the coordination of county-wide transportation planning efforts and the development of a Transportation Infrastructure Capital Improvement Plan and Program (CIPP).

This solicitation is being conducted in accordance with Texas Local Government Code, Chapter 2254, Subchapter A (Professional Services Procurement Act).

Selection will be based on demonstrated competence, experience, knowledge, and qualifications. Fees and pricing information shall not be submitted with the SOQ.

All communications regarding this RFQ must be directed to the Point of Contact listed above.

1.0 DEFINITIONS

• County: Burnet County, Texas, and its authorized representatives.

• CIPP: Capital Improvement Plan and Program.

• Respondent/Firm: The individual, partnership, corporation, or joint venture submitting a Statement of Qualifications.

• SOQ: Statement of Qualifications submitted in response to this RFQ.

• Commissioners Court: The governing body of Burnet County.

2.0 SCOPE OF WORK

The County seeks a qualified firm to act as the primary consultant for long-range transportation planning. The successful Respondent will assist the County in identifying transportation needs, prioritizing projects, coordinating with regional partners (e.g., mailto:bids@burnetcountytexas.org

TxDOT, CAMPO, and local municipalities) provide reports to summarize activities, make recommendations and identify funding streams.

The Scope of Work includes, but is not limited to, the following tasks:

A. Transportation Planning & Coordination

1. Data Analysis: Review existing traffic counts, safety data, population growth projections, and land use plans to identify current and future congestion points.

2. Inter-agency Coordination: Represent Burnet County’s interests in technical meetings with the Texas Department of Transportation (TxDOT), Capital Area Metropolitan Planning Organization (CAMPO), and municipalities located in and adjacent to Burnet County to ensure connectivity and alignment with regional plans.

3. Thoroughfare Plan Updates: Review and recommend updates to the County’s Master Thoroughfare Plan to reflect changing development patterns.

B. Public Involvement

1. Facilitate public meetings and stakeholder workshops to gather input on transportation needs, identify risks and draft the CIPP.

2.

C. Capital Improvement Plan and Program (CIPP) Development

1. Project Identification: Identify specific roadway, bridge, and drainage infrastructure projects required to meet safety and capacity needs over 5-year, 10-year, and 20-year horizons.

2. Cost Estimation: Develop preliminary engineering cost estimates for identified projects, including right-of-way acquisition, utility relocation, design, and construction.

3. Prioritization Matrix: Create a data-driven methodology for ranking projects based on safety, mobility, economic development impact, and readiness.

4. Implementation Schedule: Develop a phased implementation schedule for the

CIPP.

D. Written report

1. Provide Draft Report summarizing activities and information used with recommendations and funding sources;

2. After receiving commissioners, stakeholder and public comments finalize the plan for adoption in the Burnet County commissioners court..

E. Funding Strategy & Support

1. Grant Identification: Identify potential state and federal funding opportunities (e.g., TxDOT calls for projects, federal infrastructure grants).

2. Bond Program Support: If requested, assist the County in preparing technical data and visual aids for potential bond elections.

3.0 STATEMENT OF QUALIFICATION (SOQ) REQUIREMENTS

Respondents must submit a concise SOQ that clearly demonstrates their ability to perform the Scope of Work. The SOQ should be organized as follows:

A. Transmittal Letter

• Signed by an officer authorized to bind the firm.

• Include a statement confirming the firm’s understanding of the project and willingness to sign the County’s standard professional services agreement.

B. Firm Profile & Qualifications

• General information about the firm (size, years in business, office locations).

• Specific details regarding the firm’s capacity to handle transportation planning in a high-growth rural/suburban environment.

C. Project Team

• Organizational chart.

• Resumes of the Project Manager and Key Personnel proposed for this contract.

• Identification of any sub-consultants and their roles.

D. Relevant Experience

• Describe at least three (3) similar projects completed for Texas counties or municipalities within the last five (5) years.

• Specifically highlight experience with CIPP development

• Describe municipal (or other local governments) and TxDOT coordination in past projects.

E. Project Approach

• Describe the methodology the firm will use to accomplish the Scope of Work.

• Detail how the firm will manage the project schedule and quality control.

F. References

• Provide contact information (name, email, phone) for three (3) public sector clients for whom similar services have been provided.

NOTE: DO NOT INCLUDE ANY COST, FEE, OR PRICING INFORMATION IN THE

SOQ.

4.0 EVALUATION FACTORS AND AWARD

A Selection Committee appointed by the County will evaluate the SOQs based on the following factors (Total: 100 Points):

1. Experience and Qualifications of the Firm (30 points):

o Demonstrated history of successful transportation planning and CIPP development for Texas counties.

2. Qualifications of the Project Team (25 points):

o Experience and technical competence of the Project Manager and Key Personnel.

3. Project Understanding and Approach (25 points):

o Clarity and feasibility of the proposed methodology; understanding of

Burnet County’s specific transportation challenges.

4. Capacity and Availability (15 points):

o Ability to commit resources and meet timelines.

5. References (5 points):

o Feedback from past clients regarding performance and reliability.

5.0 SELECTION PROCESS

1. Review: The Selection Committee will review and score all responsive SOQs.

2. Shortlist (Optional): The County reserves the right to shortlist the top-ranked firms and conduct interviews.

3. Ranking: The Committee will rank the Respondents in order of qualification.

4. Negotiation: IN accordance with Texas Government Code Sec. 2254.003 the

County will attempt to negotiate a fair and reasonable price with the highest-ranked firm.

o If a satisfactory contract cannot be negotiated with the most highly qualified provider, the County will formally end negotiations with that provider and attempt to negotiate with the next most highly qualified provider.

o This process will continue until a contract is entered into or the County rejects all proposals.

5. Approval: The final contract must be approved by the Burnet County Commissioners Court.

Selection will be made in accordance with the Professional Services Procurement Act, Government Code Chapter 2254.

6.0 RESTRICTIONS ON LOBBYING

From the date of this RFQ's issuance until a final contract is awarded by the Commissioners Court, respondents and their agents are prohibited from communicating with any County elected official, employee, or evaluation committee member regarding this specific procurement. All communications, inquiries, and requests for clarification must be directed, in writing, to the official Point of Contact listed herein. Violation of this provision may result in the disqualification of the Firm's SOQ.

7.0 PUBLIC INFORMATION NOTIFICATION

All materials submitted in response to this RFQ shall become the property of Burnet County.

Submissions are subject to the Texas Public Information Act (Texas Government Code, Chapter 552). If a Respondent believes any part of its SOQ contains proprietary or confidential information, it must be clearly marked as such. The County will make a determination on the disclosure of such information in accordance with the Act.

8.0 ADDITIONAL TERMS

• Cost of Preparation: The County will not be liable for any costs incurred by any Firm in the preparation or submission of an SOQ.

• Right to Reject: The County reserves the right to accept or reject any or all SOQs, to waive any informalities or non-conformities in a submission, and to make an award that is in the best interest of Burnet County.

• Insurance: The selected Firm will be required to provide proof of insurance, including, at a minimum, Professional Liability (Errors & Omissions), Commercial General Liability, and Workers' Compensation, in amounts specified by the County's Risk Manager.

Documents are to be submitted as outlined in this RFQ. The remaining documents are for the information of the RESPONDENT and will form the Contract Documents between the successful RESPONDENT and the OWNER.

LEGAL NAME OF CONTRACTING COMPANY

CONTACT NAME TITLE

MAILING ADDRESS E-MAIL ADDRESS

CITY STATE ZIP CODE

PHONE NUMBER FAX NUMBER

SIGNATURE PRINT SIGNATURE

The undersigned acknowledges receipt of the following addenda:

Addendum No. 1 dated _________________ Received ______________________ Addendum No. 2 dated _________________ Received ______________________ Addendum No. 3 dated _________________ Received ______________________

THIS FORM MUST BE SIGNED AND RETURNED WITH YOUR RFQ

CIQ Page 1 of 2

THIS FORM MUST BE SIGNED AND THE ORIGINAL RETURNED WITH RFQ RESPONSE

CIQ Page 2 of 2

BURNET COUNTY

RESPONDENT AFFIRMATION

This sheet must be completed, signed, and returned by RESPONDENT

NOTE: FAILURE TO SIGN AND RETURN THIS FORM WITH THE RFQ DOCUMENT

MAY RESULT IN THE RFQ BEING REJECTED OR THE TERMINATION OF

ANY RESULTING CONTRACT OR PURCHASE ORDER.

1. The undersigned agrees this RFQ becomes the property of Burnet County after the official opening.

The undersigned affirms he has familiarized himself with the local conditions under which the work is to be performed; satisfied himself of the conditions of delivery, handling and storage of equipment and all other matters which may be incidental to the work, before submitting a RFQ.

The undersigned agrees, if this RFQ is accepted, to furnish any and all items/services upon which prices are offered, at the price(s) and upon the terms and conditions contained in the Specifications. The period for acceptance of this RFQ Proposal will be sixty (60) calendar days unless a different period is noted by the RESPONDENT.

2. RESPONDENT affirms that they are duly authorized to execute this Contract, that this company, corporation, firm, partnership or individual has not prepared this RFQ in collusion with any other RESPONDENT, and that the contents of this RFQ as to prices, terms or conditions of said RFQ have not been communicated by the undersigned nor by any employee or director to any other person engaged in this type of business prior to the official opening of this RFQ.

3. RESPONDENT hereby assigns to purchaser any and all claims for overcharges associated with this Contract which arise under the antitrust laws of the United States, 15 USCA Section 1 et seq., and which arise under the antitrust laws of the State of Texas, Tex. Bus. & Com. Code, Section 15.01, et seq.

4. Pursuant to §262.076 (a) of the Texas Local Government Code, RESPONDENT, hereby affirms that RESPONDENT:

(Please check all that are applicable)

______ Does not own taxable property in Burnet County.

______ Does not owe any ad valorem taxes to Burnet County or is not otherwise indebted to Burnet County.

RESPONDENT Affirmation Page 1 of 2

RESPONDENT AFFIRMATION

The undersigned affirms that they have read and do understand the specifications, addendum, RFQ forms and any attachments contained in this RFQ package. Failure to sign and return this form will result in the rejection of the entire RFQ.

RESPONDENT COMPANY NAME

ADDRESS

CITY STATE ZIP CODE

PHONE EMAIL

RESPONDENT SIGNATURE DATE

RESPONDENT PRINTED NAME TITLE

SIGNATURE OF COMPANY OFFICIAL DATE

AUTHORIZING THE RFQ (If Applicable)

COMPANY OFFICIAL PRINTED NAME TITLE

Corporate Vendors Shall Furnish the Following Information:

WHERE INCORPORATED CHARTER NUMBER

BUSINESS INCLUDED IN A CORPORATE INCOME TAX RETURN? _______YES _______NO

CORPORATION ORGANIZED & EXISTING UNDER THE LAWS OF THE STATE OF________

PARTNERSHIP CONSISTING OF ________________________________________________

INDIVIDUAL TRADING AS ______________________________________________________

PRINCIPLE OFFICES ARE IN THE CITY OF ________________________________________

RESPONDENT Affirmation Page 2 of 2

NON-COLLUSION/ANTI-TRUST AFFIDAVIT

The Company 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. Failure to sign this document or signing it with a false statement shall void the submitted offer or any resulting contracts.

Neither the Company or the firm, corporation, partnership, or institution represented by the Company or anyone acting for such firm, corporation, or institution has violated the antitrust laws of this State, codified in Section 15.01, et seq., Texas Business and Commerce Code, or the Federal antitrust laws, nor communicated directly or indirectly the offer made to any competitor or any other person engaged in such line of business. The Company’s signature herein assigns to the County any and all claims for overcharges associated with his contract for this project, which arise under the Antitrust Laws of the United States, 15 USCA, Section 1, Et. Seq. (1973). By signing this proposal, Company certifies that if a Texas address is shown as its address, Company qualifies as a Texas Resident RESPONDENT as defined in Rule 1 TAC 111.2.

RESPECTFULLY SUBMITTED:

AUTHORIZED SIGNATURE

PRINTED NAME

TITLE

COMPANY NAME

COMPANY’S CORPORATE CHARTER NO.

TAX RECORD AND FAMILY CODE REQUIREMENTS

The Company's signature herein certifies that the firm is not currently delinquent in the payment of any debt owed to the State of Texas; including but not limited to franchise taxes and child support, property tax, and that any payments due the firm under this contract will be applied to that debt.

Texas Family Code Compliance Requirement:

Under Section 231.006, Family Code, the vendor or applicant certifies that the individual or business entity named in this contract, RFQ, 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. The response includes the names and Social Security Numbers of each person with a minimum of twenty-five percent (25%) ownership of the business entity submitting the response.

Firm Owner(s), Partners, Sole Proprietors, or Share Holder(s) of twenty-five percent (25%) interest:

NAME SSN

NAME SSN

NAME SSN

NAME SSN

RESPECTFULLY SUBMITTED:

AUTHORIZED SIGNATURE

PRINTED NAME

TITLE

COMPANY NAME

COMPANY’S CORPORATE CHARTER NO.

VENDOR REFERENCE INFORMATION SHEET

Please list three (3) references, other than Burnet County, who can verify your performance as a vendor. Performance includes but shall not be limited to, sales and/or service, delivery, invoicing, and other items as may be required for Burnet County to determine your firm’s ability to provide the intended goods or services of this RFQ. The County prefers references to be from customers for whom your firm has provided the same items (sales and/or services) as those specified in this RFQ. Inaccurate, obsolete or negative responses from the listed references could result in rejection of your RFQ. County reserves the right to reject RFQs from RESPONDENTs without experience similar to that provided in this RFQ document.

1. _____________________________________________________________________

GOVERNMENT ENTITY/COMPANY NAME

ADDRESS PHONE

CONTACT PERSON TITLE

EMAIL ADDRESS (PRIMARY) EMAIL ADDRESS (SECONDARY)

SCOPE OF WORK

CONTRACT PERIOD

2. _____________________________________________________________________

GOVERNMENT ENTITY/COMPANY NAME

ADDRESS PHONE

CONTACT PERSON TITLE

EMAIL ADDRESS (PRIMARY) EMAIL ADDRESS (SECONDARY)

SCOPE OF WORK

3. _____________________________________________________________________

GOVERNMENT ENTITY/COMPANY NAME

ADDRESS PHONE

CONTACT PERSON TITLE

EMAIL ADDRESS (PRIMARY) EMAIL ADDRESS (SECONDARY)

SCOPE OF WORK

This Form must be SIGNED and the Original Returned with RFQ response

CERTFICATE OF ELIGIBILITY

By submitting a RFQ or proposal I response to this solicitation, the RESPONDENT/proposer certifies that at the time of submission, he/she is not on the Federal Government’s list of suspended, ineligible, or debarred contractors.

In the event of placement on the list between the time of RFQ/proposal submission and time of award, the RESPONDENT/ proposer will notify the Burnet County Purchasing Agent. Failure to do may result in terminating this contract for default.

AUTHORIZED SIGNATURE DATE

PRINT NAME

VENDOR COMPLIANCE WITH RECIPROCITY ON NON-RESIDENT

RESPONDENTS

Government Code 2252.002 provides that, in order to be awarded a contract as low RESPONDENT, a non-resident RESPONDENT must submit projects for construction, improvements, supplies or services in Texas at an amount lower than the lowest Texas resident RESPONDENT by the same amount that a Texas resident RESPONDENT would be required to under RFQ a non-resident RESPONDENT in order to obtain a comparable contract in the state in which the non-resident’s principal place of business is located. A non-resident RESPONDENT is a contractor whose corporate offices or principal place of business is outside of the state of Texas. This requirement does not apply to a contract involving Federal funds. The appropriate blanks in Section A must be filled out by all out-of-state or non-resident RESPONDENTs in order for your RFQ to meet specifications. The failure of out-of-state or non-resident contractors to do so will automatically disqualify that RESPONDENT. Resident RESPONDENTs must check the blank in Section B.

A. Non-resident vendors in ________________________(give state), our principal place of business, are required to be __________ percent lower than resident RESPONDENTs by state law. A copy of the statute is attached.

Non-resident vendors in ______________________(give state), our principal place of business, are not required to under RFQ resident RESPONDENTs.

B. Our principal place of business or corporate offices are in the State of Texas: ________.

RESPONDENT:

COMPANY NAME

CITY STATE ZIP CODE

PRINTED NAME

AUTHORIZED SIGNATURE

TITLE

HISTORICALLY UNDERUTILIZED BUSINESSES (HUB) POLICY

I. POLICY STATEMENT

The Burnet County Commissioners Court, being the policy development and budgetary control unit of county government, will strive to ensure that all businesses, regardless of size, economic, social or ethnic status have an equal opportunity to participate in the County’s procurement processes. The County is committed to promote full and equal business opportunity for all businesses to supply the goods and services needed to support the mission and operations of county government, and seeks to encourage the use of certified historically underutilized businesses (HUBs) through the use of race, ethnic and gender neutral means. It is the policy of Burnet County to involve certified HUBs to the greatest extent feasible in the County’s procurement of goods, equipment, services and construction projects while maintaining competition and quality of work standards. The County affirms the good faith efforts of firms who recognize and practice similar business standards.

II. DEFINITIONS

Historically Underutilized Businesses (HUBs), also known as a disadvantaged business enterprise (DBE), are generally business enterprises at least 51% of which is owned, and the management and daily business operations are controlled by one or more persons who is/are socially and economically disadvantaged because of his or her identification as a member of certain groups, including women, Black Americans, Mexican Americans and other Americans of Hispanic origin, Asian Americans and American Indians.

Certified HUBs includes business enterprises that meet the definition of a HUB and who meet the certification requirements of certification agencies recognized by Burnet County.

Businesses include firms, corporations, sole proprietorships, vendors, supplier’s contractors, subcontractors, professionals and other similar references when referring to a business that provides goods and/or services regardless of the commodity category.

Statutory RFQ limit refers to the Texas Local Government Code provisions that require competive proposals for many items/services valued at greater than $100,000.

III. POLICY GUIDELINES

A. Burnet County, its contractors, their subcontractors and suppliers, as well as all vendors of goods, equipment and services shall not discriminate on the basis of race, color, creed, gender, age, religion, national origin, citizenship, mental or physical disability, veteran’s status or political affiliation in the award and/or performance of contracts. All entities doing business or anticipating doing business with County shall support, encourage and implement affirmative steps toward a common goal of establishing equal opportunity for all citizens and businesses of the County.

B. Burnet County will use and recognize the State of Texas Historically Underutilized Business certification process in conjunction with the implementation of this policy.

The County may recognize other agencies’ certification processes recognized by the State of Texas. Burnet County reserves the right to review the certification status of any vendor applying to do business with the County. The review will be accomplished to determine the validity and authenticity of the vendor’s certification as a HUB.

C. The Commissioners Court may establish HUB target goals. Through a systematic approach of soliciting quotes, RFQs and proposals from certified HUBs and in compliance with applicable state and federal law this policy will strive to meet those goals.

1. Target goals should consider:

a. The availability of HUB firms within the specific category of goods or services to be procured; and

b. The diversity of the County’s population.

2. The goals should be reviewed and amended periodically.

3. The program may apply to all County procurements including construction and professional services.

4. Particular attention will be given to HUB participation on purchases in excess of the statutory RFQ limit.

5. Commissioners Court will use good faith efforts to meet the goals of this policy.

D. Burnet County will actively seek and encourage HUBs to participate in all facets of the procurement process by:

1. Utilizing the State of Texas Historically Underutilized Business vendor database.

2. Advertising RFQs on the County’s website and in the local newspaper.

3. Providing RFQ notice to minority Chambers of Commerce within Burnet County, if applicable.

E. As prescribed by law, the purchase of one or more items costing in excess of the statutory RFQ limit must comply with the competitive RFQ process. Where possible, those RFQs will be structured to include and encourage the participation of HUB firms in the procurement process.

F. A HUB Policy statement shall be included in all specifications. The County will consider the RESPONDENT’s responsiveness to the HUB Policy in the evaluation of RFQs and proposals. Failure to demonstrate a good faith effort to comply with the County’s HUB policy may result in a RFQ or proposal being considered non-responsive to specifications.

G. The Purchasing Department will actively search the State Comptroller’s HUB vendor list in the quotation process for purchases under the statutory RFQ limit.

H. Nothing in this policy shall be construed to require the County to award a contract other than to the lowest responsive RESPONDENT as required by law. This policy is narrowly tailored in accordance with applicable law.

IV. ADMINISTRATIVE GUIDELINES

A. The Purchasing Office shall serve as the County’s HUB Office with responsibility for the implementation, monitoring and general operations of the HUB policy. The Purchasing Director shall serve as the County HUB Officer.

1. The HUB Officer will establish procedures to implement this policy across the full spectrum of the procurement process. The County HUB Office will periodically review with department head and elected officials regarding procurement opportunities.

2. Managing the policy and training buyers and other County personnel in order to meet County goals will be the responsibility of the HUB Office.

3. The HUB Office will cooperate with other local government entities to increase HUB participation throughout the county and region. The HUB Office is encouraged to participate in educational and other outreach programs to assist HUB firms.

4. Any complaints and/or recommendations regarding the implementation of this policy will be received and reviewed by the HUB Officer. Further, the HUB Office will audit for compliance to the HUB Policy on eligible projects after award, during the performance of the contract and after completion, while also making any recommendations to Commissioner's Court regarding any irregularities or misrepresentations of facts as they relate to compliance with the policy. The HUB Office will review documentation submitted by HUB firms in compliance with this policy.

FOR DISADVANTAGED BUSINESS ENTERPRISES ONLY

Disadvantaged Business Enterprises (DBE) are encouraged to participate in Burnet County’s RFQ process. The Purchasing Office will provide additional clarification of specifications, assistance with RFQ Proposal Forms, and further explanation of responding/submittal procedures to those DBEs who request it.

Representatives from DBE companies should identify themselves as such and submit a copy of the Certification.

The County recognizes the certifications of the Texas Comptroller of Public Accounts Historically Underutilized Business Program. All companies seeking information concerning DBE certification are urged to contact The Texas Comptroller of Public Accounts at 800-531-5441, extension 3- 6958 or 512-463-6958.

If your company is already certified, attach a copy of your certification to this form and return with

RFQ.

REPRESENTATIVE TITLE

ADDRESS

CITY STATE ZIP CODE

PHONE FAX

EMAIL ADDRESS (PRIMARY) EMAIL ADDRESS (SECONDARY)

Indicate all that apply:

______ Minority-Owned Business Enterprise

______ Women-Owned Business Enterprise

______ Disadvantaged Business Enterprise

CERTIFICATE OF INTERESTED PARTIES FORM 1295

Complete Nos. 1 - 4 and 6 if there are interested parties.

Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.

OFFICE USE ONLY

1 Name of business entity filing form, and the city, state and country of the business entity's place of business.

2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed.

3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract.

Name of Interested Party

City, State, Country (place of business)

Nature of Interest (check applicable)

Controlling Intermediary

5 Check only if there is NO Interested Party.

6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.

Signature of authorized agent of contracting business entity

AFFIX NOTARY STAMP / SEAL ABOVE

Sworn to and subscribed before me, by the said , this the day of , 20 , to certify which, witness my hand and seal of office.

Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath

Must file this form online at www.ethics.state.tx.us/File

Please include a printed copy of this notarized form with bid response.

http://www.ethics.state.tx.us/File

HOUSE BILL 89 VERIFICATION

NOTE: FAILURE TO SIGN AND RETURN THIS FORM WITH RFQ RESPONSE MAY RESULT IN YOUR RFQ BEING REJECTED

This verification must be completed, signed, and returned by RESPONDENT unless the business is a sole proprietorship or has less than 10 full time employees. Please sign and date below if you are exempt from this requirement.

1. I certify my business is a sole proprietorship or has less than 10 full-time employees.

DATE SIGNATURE OF COMPANY REPRESENTATIVE

If #1 is not applicable to your company, please move to #2 below.

2. I, ___________________________________(Name), the undersigned representative of (Company Name and Address)__________________________________________________ (hereafter referred to as Company) being an adult over the age of eighteen (18) years of age, after being duly sworn by the undersigned notary, do hereby depose and verify under oath that the company named-above, under the provisions of Subtitle F, Title 10, Government Code Chapter 2270:

1. Does not boycott Israel currently; and

2. Will not boycott Israel during the term of the contract the above-named

Company, business or individual with Burnet County, Texas.

Pursuant to Section 2270.001, Texas Government Code:

1. “Boycott Israel” means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes; and

2. “Company” means a for-profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit.

DATE SIGNATURE OF COMPANY REPRESENTATIVE

On this, the _____ day of ___________________, 20____, personally appeared ________________________________________, the above-named person, who after by me being duly sworn, did swear and confirm that the above is true and correct.

NOTARY SEAL _____________________________

NOTARY SIGNATURE

FELONY CONVICTION NOTIFICATION

Any person and/or business entity that enters into a contract with the Burnet County must give advance notice if any employee 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.

The notice must also describe the role that the employee, owner, or operator will perform in executing the contract.

Burnet County may require substitution of employees in the performance of the contract. Burnet County may terminate a contract with a person or business entity if the County determines that the person or business entity failed to give notice as required by this clause, misrepresented the conduct resulting in the conviction, or failed to substitute personnel at the County’s request.

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.

Signature of Authorized Company Official Date

Authorized Company Official’s Name and Title (Printed)

Firm Name

A. My firm is not owned or operated by anyone who has been convicted of a felony nor does it have any employees who have been convicted of a felony:

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

Person 1 Person 2

C. Provide a general description of the conduct resulting in the conviction of a felony.

Signature of Authorized Company Official Date

D. Describe the role that the person(s) convicted of a felony will play in the performance of the contract.

GC 2252.152 CERTIFICATION FORM

CONTRACTS WITH COMPANIES ENGAGED IN BUSINESS WITH IRAN,

SUDAN, OR FOREIGN TERRORIST ORGANIZATIONS PROHIBITED -

CERTIFICATION

I, _______________________________________________, the undersigned representative of

(Company or business name) being an adult over the age of eighteen (18) years of age, pursuant to Texas Government Code, Chapter 2252, Section 2252.152 and Section 2252.153, certify that the company named above is not listed on the website of the Comptroller of the State of Texas concerning the listing of companies that are identified under Section 806.051, Section

807.051 or Section 2253.153. I further certify that should the above-named company enter into a contract that is on said listing of companies on the website of the Comptroller of the State of Texas which do business with Iran, Sudan or any Foreign Terrorist Organization, I will immediately notify the Burnet County Purchasing Office.

SIGNATURE OF COMPANY REPRESENTATIVE

NAME OF COMPANY REPRESENTATIVE (PRINT)

TITLE

DATE

NON-COLLUSION/ANTI-TRUST AFFIDAVIT

The Company 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. Failure to sign this document or signing it with a false statement shall void the submitted offer or any resulting contracts.

Neither the Company or the firm, corporation, partnership, or institution represented by the Company or anyone acting for such firm, corporation, or institution has violated the antitrust laws of this State, codified in Section 15.01, et seq., Texas Business and Commerce Code, or the Federal antitrust laws, nor communicated directly or indirectly the offer made to any competitor or any other person engaged in such line of business. The Company’s signature herein assigns to the County any and all claims for overcharges associated with his contract for this project, which arise under the Antitrust Laws of the United States, 15 USCA, Section 1, Et. Seq. (1973). By signing this proposal, Company certifies that if a Texas address is shown as its address, Company qualifies as a Texas Resident RESPONDENT as defined in Section 2252.001, Texas Government Code.

SIGNATURE OF COMPANY REPRESENTATIVE

NAME OF COMPANY REPRESENTATIVE (PRINT)

TITLE

COMPANY’S CORPORATE CHARTER NO.

GC 2274 CERTIFICATION FORM

FIREARM ENTITIES AND TRADE ASSOCIATIONS

DISCRIMINATION CERTIFICATION

I, ___________________________________ the undersigned representative of

(Company or business name) being an adult over the age of eighteen (18) years of age, pursuant to Texas Government Code, Chapter 2274 verify that this company or business (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 indicate in its Response and state why the verification is not required.

APPLICABILITY: This clause applies only to a contract that:

(1) is between a governmental entity and a company with at least 10 full-time employees; and

(2) has a value of at least $100,000 that is paid wholly or partly from public funds of the governmental entity.

SIGNATURE OF COMPANY REPRESENTATIVE

NAME OF COMPANY REPRESENTATIVE (PRINT)

TITLE

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND

OTHER RESPONSIBILITY MATTERS

Offeror certifies to the best of its knowledge and belief that it and its principals:

1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal, State, or local department or agency.

2. Have not within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction: violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph 2 of this certification; and

4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or local) terminated for cause or default.

I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award.

COMPANY NAME

SIGNATURE OF COMPANY REPRESENTATIVE

NAME OF COMPANY REPRESENTATIVE (PRINT)

TITLE

_________ I am unable to certify the above statements. My explanation is attached.

RESERVATION OF RIGHTS

The County is issuing this RFQ in accordance with applicable laws that allow an agreement with a private entity that displays demonstrated competence and qualifications to perform the requested task.

The County reserves the right to terminate this process and to cancel or modify this solicitation process at any time. In no event will the County or any of its respective agents, representatives, consultants, directors, officers, or employees be liable for, or otherwise obligated to reimburse, the costs incurred in preparation of this RFQ, or any other related costs. The prospective firms shall be fully responsible for all costs incurred in the preparation and/or presentation of the RFQ submittals. The RFQ submittals will become the property of the County.

All submissions shall be subject to the Texas Public Information Act unless the respondent clearly and prominently identifies a particular submittal item as proprietary and said item unequivocally qualifies for this exception under the Act as determined by the Attorney General.

In connection with the RFQ, the County reserves all rights (which rights may be exercised by the County in its sole discretion) available to it under applicable laws, including without limitation, and with or without cause and with or without notice, the right to:

1. Cancel this RFQ, in whole or in part, at any time before the execution of contract by the County, without incurring any cost, obligations or liabilities.

2. Issue addenda, supplements, and modifications to this RFQ.

3. Revise and modify, at any time before the RFQ submittal due date, the factors and/or weights of factors the County will consider in evaluating RFQ submittals and to otherwise revise or expand its evaluation methodology as set forth herein.

4. Extend the RFQ submittal due date.

5. Investigate the qualifications of any firm under consideration and require confirmation of information furnished by a firm.

6. Require additional information from a firm concerning contents of its RFQ submittal and/or require additional evidence of qualifications.

7. Waive or permit corrections to data submitted with any response to this RFQ until such time as the County declares, in writing, that a particular stage or phase of its review of the responses has been completed or closed.

8. Reject at any time, any or all submittals, responses and RFQ submittals received.

9. Terminate, at any time, evaluations of responses received.

10. Appoint an evaluation committee to review RFQ submittals or responses, make recommendations and seek the assistance of outside experts and consultants in RFQ submittal evaluation.

11. Hold interviews and conduct discussions and correspondence with one or more of the firms responding to this RFQ to seek an improved understanding and evaluation of the responses to this RFQ.

12. Seek or obtain data from any source that has the potential to improve the understanding and evaluation of the responses to this RFQ.

13. Disclose information contained in a RFQ submittal to the public as required under the Texas Public Information Act.

14. Authorize firms to substitute key personnel until the County declares, in writing, that a particular stage or phase of its review has been completed and closed.

15. Waive deficiencies in a RFQ submittal, accept and review a non-conforming RFQ submittal or seek clarifications or supplements to a RFQ submittal.

16. Disqualify any firm that changes its RFQ submittal without the County’s authorization.

17. Exercise any other right reserved or afforded to the County under this RFQ. The County reserves the right to modify the process, in its sole discretion, to address applicable law and/or the best interest of the County.

The County shall not, under any circumstances, be bound by or be liable for any obligations with respect to any services until such time (if at all) a contract has been awarded and all approvals obtained in form and substance satisfactory to the County have been executed and authorized by the County, and then only to the extent of such agreements.

SIGNATURE OF COMPANY REPRESENTATIVE

NAME OF COMPANY REPRESENTATIVE (PRINT)

TITLE

DATE

MAILING ADDRESS

CITY STATE ZIP CODE

SIGNATURE FORM

The undersigned, on behalf of and as the authorized representative of RESPONDENT, agrees this RFQ becomes the property of Burnet County after the official opening.

The undersigned affirms that the RESPONDENT has familiarized himself with the local conditions under which the work is to be performed; satisfied himself of the conditions of delivery, handling and storage of equipment and all other matters that may be incidental to the work, before submitting a RFQ.

The undersigned agrees, on behalf of RESPONDENT, that if the RFQ is accepted, RESPONDENT will furnish all materials and services upon which price(s) are offered, at the price(s) and upon the terms and conditions contained in the specifications. The period for acceptance of this RFQ will be sixty (60) calendar days.

The undersigned affirms that they are duly authorized to execute this contract, that this RFQ has not been prepared in collusion with any other RESPONDENT, nor any employee of Burnet County, and that the contents of this RFQ have not been communicated to any other RESPONDENT or to any employee of Burnet County prior to the official opening of this RFQ.

Vendor hereby assigns to Burnet County all claims for overcharges associated with this contract which arise under the antitrust laws of the United States, 15 USCA Section 1 et seq., and which arise under the antitrust laws of the State of Texas, Tex. Bus. & Com. Code, Section 15.01, et seq.

The undersigned affirms that they have read and do understand the specifications and any attachments contained in this solicitation. Failure to sign and return this form will result in the rejection of the entire RFQ.

SIGNATURE OF COMPANY REPRESENTATIVE

NAME OF COMPANY REPRESENTATIVE (PRINT)

TITLE

STATEMENT OF NO RFQ

If the RESPONDENT is not responding on the goods and/or services as stated in this RFQ, please complete, and return this form to: Burnet County, Purchasing Office, 133 E. Jackson, Burnet, TX 78611.

CITY STATE ZIP CODE

SIGNATURE TITLE

DATE

EMAIL

The above has declined to submit a RFQ response for the following reason(s) [please check all that apply]:

_____ Specifications too “restrictive,” i.e., goods offered by our company do not meet stated specifications.

_____ Specifications unclear (please explain below).

_____ We do not offer this commodity and/or service or an equivalent.

_____ Insufficient time to respond to the ITB.

_____ Our schedule would not permit us to perform.

_____ Cannot meet insurance requirements.

Remarks:

STATE OF TEXAS Bond No.______________________________

COUNTY OF BURNET Project No. 26-4090-02

Project Name: PROFESSIONAL ENGINEERING SERVICES CIPP

Know All Men By These Presents: That _____________________________________________________________ of the City of _______________________________, County of _____________________________________, and State of Texas, as Principal, and _____________________________________ ______, a solvent company authorized under laws of the State of Texas to act as surety on bonds for principals, are held and firmly bound unto __County of Burnet__ (OWNER), in the penal sum of _________________________ U.S. Dollars ($ ______________________________ U.S.) for payment whereof, well and truly to be made, said Principal and Surety bind themselves and their heirs, administrators, executors, successors and assigns, jointly and severally, by these presents:

Conditions of this Bond are such that, whereas, Principal has entered into a certain written contract with OWNER, dated the ____________ day of ____________________, ________, which Agreement is hereby referred to and made a part hereof as fully and to the same extent as if copied at length herein.

Now, therefore, the condition of this obligation is such, that if said Principal shall faithfully perform said Agreement and shall in all respects duly and faithfully observe and perform all and singular covenants, conditions and agreements in and by said contract agreed and covenanted by Principal to be observed and performed, and according to true intent and meaning of said Agreement hereto annexed, then this obligation shall be void; otherwise to remain in full force and effect. If OWNER notifies Principal and Surety the OWNER is considering declaring Principal in default, Surety agrees to meet with OWNER and Principal no later than fifteen days after receipt of such notice to discuss methods of performing the Work of the Contract.

Provided, however, that this bond is executed pursuant to provisions of Chapter 2253, Texas Government Code as amended and all liabilities on this bond shall be determined in accordance with provisions of said Article to same extent as if it were copied at length herein.

Surety, for value received, stipulates and agrees that no change in Contract Time or Contract Amount shall in anywise affect its obligation on this bond, and it does hereby waive notice of any such change in Contract Time or Contract Amount.

In witness whereof, said Principal and Surety have signed and sealed this instrument this _____________________ day of _________________________ , ________.

Principal Surety

By_____________________________________ By _______________________________________

Title____________________________________ Title _______________________________________

Address_________________________________ Address ___________________________________

Telephone _______________ Fax_______________

E-Mail Address ______________________________

Name and address of Resident Agent of Surety:

Note: Bond shall be issued by a solvent Surety company authorized to do business in Texas, and shall meet any other requirements established by law or by OWNER pursuant to applicable law. A copy of surety agent’s “Power of Attorney” must be attached hereto.

STATE OF TEXAS Bond No. ___________________________________

COUNTY OF BURNET Project No. 26-4090-02

Project Name: PROFESSIONAL ENGINEERING SERVICES CIPP

Know All Men By These Presents: That ___________________________________________________________ of the City of _________________________________, County of ___________________________________ and State of ________Texas____________________, as principal, and _____________________________________ a solvent corporation authorized under laws of the State of Texas to act as surety on bonds for principals, are held and firmly bound unto ________________County of Burnet________________________(Owner), and all Subcontractors, workers, laborers, mechanics and suppliers as their interests may appear, all of whom shall have right to sue upon this bond in the penal sum of _______________________ U.S. Dollars ($____________________________________________U.S.), for payment whereof, well and truly to be made, said Principal and Surety bind themselves and their heirs, administrators, executors, successors and assigns, jointly and severally, by these presents:

Conditions of this Bond are such that, whereas, Principal has entered into a certain written contract with Owner; dated the ______________ day of _________________________, ________ to which Agreement is hereby referred to and made a part hereof as fully and to the same extent as if copied in length herein.

Now, therefore, condition of this obligation is such, that if the said Principal shall well and truly pay all Subcontractors, workers, laborers, mechanics, and suppliers, all monies to them owing by said Principals for subcontracts, work, labor, equipment, supplies and materials done and furnished for the construction of improvement of said Agreement, then this obligation shall be and become null and void; otherwise to remain in full force and effect.

Provided, however, that this bond is executed pursuant to provisions of Chapter 2253, Texas Government Code as amended and all liabilities on bond shall be determined in accordance with provisions of said Article to same extent as if it were copied at length herein.

Surety, for value received, stipulates and agrees that no change in Contract Time or Contract Amount shall in anywise affect its…