ESBD_547568_1786129241339_Exhibit A Response Certification Form.docx

Department of Information Resources Request for Offer: COOP2026SOL-00008 Cabling Services and Related Products Exhibit A Response Certification Form This form must be filled out in its entirety and signed by an officer or agent empowered to contractually bind the Respondent.

1. Respondent Information Please ensure the Legal Entity Name and Address exactly match the name and address associated with the DUNS Number provided or contact Dun and Bradstreet with corrections prior to responding to this RFO.

Respondent Entity Information

Legal Entity Name:

Assumed Name, if applicable (DBA or “doing business as”):

Legal Entity Address:

Parent Company Name (if applicable):

Texas Comptroller of Public Accounts (CPA) Identification Number:

DUNS Number:

Federal Employer Identification Number (FEIN):

Principal Place of Business

Address:

City/State/Zip Code:

Facility Responsible for fulfilling Services

Address: City/State/Zip Code:

2. Contact Information Respondents are encouraged to provide multiple contact persons in order to ensure critical information is received and acted upon timely. Updates to contact information should be provided throughout the duration of the procurement process. DIR is not responsible for a Respondent’s failure to timely respond due to outdated contact information.

Contact Person(s) Regarding Respondent’s RFO

Name:

Title:

Address:

City, State, Zip:

Phone Number:

Fax:

Email:

Contact Person Regarding Negotiations (if different from above)

Name:

Title:

Address:

City, State, Zip:

Phone Number:

Fax:

Email:

Officer/Agent Empowered to Contractually Bind Respondent (if different from above)

Name:

Title:

Address:

City, State, Zip:

Phone Number:

Fax:

Email:

3. Exceptions A. Respondent may request exceptions through the RFO Exhibit A1 Exceptions Table, pursuant to the format and instructions outlined Section 3.7.3.5 of the RFO. Failure to abide by those instructions may result in DIR rejecting all exceptions submitted by the Respondent.

B. If there are no exceptions, Respondent shall explicitly state in the Exhibit A1 Exceptions Table that the Respondent takes no exception to any part of the RFO.

4. Respondent and Subcontractor Conflict of Interest Disclosure List below, for both Respondent and all subcontractors, all current or former employees or proposed personnel with a conflict of interests as follows:

A. Any current or former employees who will spend twenty percent (20%) or more of their time on a contract resulting from this RFO and are current or former employees of the State of Texas within the past five (5) years; and B. Any proposed personnel assigned to work directly on any contract to arise from this RFO twenty percent (20%) or more of their time who are related within two (2) degrees of consanguinity of any current or former employees of the State of Texas. Disclosure of former state employees may be limited to the last five (5) years.

Respondent Personnel

Subcontractor Personnel

5. Contracting with the Executive Head of a State Agency Respondent certifies that they are in compliance with Texas Government Code, Title 6, Subtitle B, Section 669.003, relating to contracting with the executive head of a state agency. If Section 669.003 applies, Respondent will complete the following information in order for the Response to be evaluated:

Former Executive Information #1

Name of Former Executive:

Name of State Agency:

Date of Separation from State Agency:

Position with Respondent:

Dates of Employment with Respondent:

Former Executive Information #2

Name of Former Executive:

Name of State Agency:

Date of Separation from State Agency:

Position with Respondent:

Dates of Employment with Respondent:

6. Proof of Financial Stability All Respondents must be and remain current in payment of all taxes, including Sales and Franchise Taxes. In general, the Comptroller of Public Accounts must identify the Respondent to be “in good standing” and a Respondent with which the state is authorized to do business.

Respondents must maintain evidence of financially stable company with a Duns and Bradstreet SER Score of 8 or less before a contract can be awarded.

7. Statement of Compliance A. Checklist for the RFO

1. The following checklist is provided for the convenience of Respondents in their Response preparation process. It is not intended to represent an exhaustive list of the mandatory requirements for this RFO. Respondents must ensure that all mandatory requirements for this RFO are met, even if they are not included in this checklist.

2. A completed checklist shall not be binding on DIR’s administrative review for compliance with the mandatory Response contents specified in this RFO. As step one of the evaluation process, DIR will review all Responses to ensure compliance with the mandatory Response contents as specified in Section 3.7.4 of the RFO and reject any Response that does not comply.

3. All Responses must be received by DIR on or before the date and time specified in Section 3.3 of this RFO. No late Responses will be reviewed.

8. Respondent Certifications By submission of its Response and signature of the Execution of Response below by Respondent’s authorized officer or agent, Respondent hereby certifies and represents to DIR the following:

A. Respondent has read and understood the RFO and all attachments, exhibits, and addenda thereto, and has complied with all duties, obligations, and requirements thereof;

B. All statements and information included in its Response are current, complete, and accurate, and Respondent shall affirmatively notify DIR of any changes to all such statements and information;

C. The individual signing the Execution of Response below is an authorized officer or agent of Respondent, and is duly authorized to sign this document, to submit the Response, and to contractually bind Respondent to a contract resulting from submission of the Response;

D. Respondent is capable of providing the products and services as described in its Response to the RFO;

E. Respondent is offering true and correct pricing and discounts for the products and services;

F. Respondent agrees, if awarded a contract, to abide by the terms and conditions of the resulting contract;

G. As of the date of signature below, Respondent is not listed in the prohibited Respondents list authorized by Executive Order #13224, "Blocking Property and Prohibiting Transactions with Persons Who Commit, Threaten to Commit, or Support Terrorism”, published by the United States Department of the Treasury, Office of Foreign Assets Control;

H. Respondent and its principals are not suspended or debarred from doing business with the federal government as listed in the System for Award Management (SAM) maintained by the General Services Administration;

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

J. Respondent certifies that, to the extent applicable to this scope of this RFO, Respondent is in compliance with Health and Safety Code, Chapter 361, Subchapter Y, related to the Computer Equipment Recycling Program, and the related rules found at 30 TAC Chapter 328;

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

L. Respondent, pursuant to Texas Government Code, Section 2155.004(a), has not received compensation for participation in the preparation of specifications for this solicitation;

M. Respondent has not, nor has anyone acting for Respondent, violated the antitrust laws of the United States or the State of Texas, nor communicated directly or indirectly to any competitor or any other person engaged in such line of business for the purpose of obtaining an unfair price advantage;

N. Under Section 231.006, Family Code, Respondent certifies that the individual or business entity named in this contract, bid, or application is not ineligible to receive the specified grant, loan, or payment and acknowledges that this contract may be terminated and payment may be withheld if this certification is inaccurate. Respondent certifies that upon notification of contract award, the names and social security numbers of each person with at least 25% ownership of the business entity shall be provided;

O. Respondent agrees that any payments due under this Contract will be applied towards any debt, including but not limited to delinquent taxes and child support that is owed to the State of Texas;

P. Respondent agrees to comply with Texas Government Code, Section 2155.4441, requiring the purchase of products and materials produced in the State of Texas in performing service contracts;

Q. Respondent certifies for itself and its subcontractors that it has identified all current or former, within the last five (5) years, employees of the State of Texas assigned to work on the contract twenty percent (20%) or more of their time and has disclosed them to DIR and has disclosed or does not employ any relative of a current or former state employee within two (2) degrees of consanguinity, and, if these facts change during the course of the contract, Respondent certifies it shall disclose for itself and on behalf of subcontractors the name and other pertinent information about the employment of current and former employees and their relatives within two degrees of consanguinity;

R. Respondent represents and warrants that the provision of goods and services or other performance under the contract will not constitute an actual or potential conflict of interest and certifies that it will not reasonably create the appearance of impropriety;

S. Respondent certifies that if a Texas address is shown as the Principal Place of Business in Exhibit A, Response Certification Form, Respondent qualifies as a Texas Resident Bidder as defined in Texas Administrative Code, Title 34, Part I, Chapter 20;

T. Respondent understands and agrees that Respondent may be required to comply with additional terms and conditions or certifications that an individual Customer may require due to state and federal law (e.g., privacy and security requirements);

U. Respondent agrees that these representations will be incorporated into any subsequent agreement(s) between Respondent and Customer that result from this RFO;

V. Respondent represents and warrants as required by Texas Government Code Section 2271.002, by executing a contract resulting from this RFO, that Respondent does not, and will not during the term of the contract, boycott Israel. Respondent further certifies that no subcontractor of the Respondent boycotts Israel or will boycott Israel during the term of the contract. Respondent agrees to take all necessary steps to ensure this certification remains true during the term of the contract;

W. Respondent certifies, under Texas Government Code, Section 2155.0061, that the individual or business entity named in this bid or contract is not ineligible to receive the specified contract and acknowledges that this contract may be terminated, and payment withheld if this certification is inaccurate; and X. Respondent certifies that neither it, nor its holding companies or subsidiaries, is: (a) listed in Section 889 of the 2019 National Defense Authorization Act; (b) listed in Section 1260H of the 2021 National Defense Authorization Act; or (c) owned by the government of a country on the U.S. Department of Commerce’s foreign adversaries list under 15 C.F.R Section 791.4; or (d) 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 Section 791.4.

<SIGNATURE PAGE FOLLOWS>

Execution of Response Failure to sign and return this document as instructed will result in disqualification of this Response.

Signature of Officer or Agent

Name of Officer or Agent (please print) Title of Officer or Agent Date

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Exhibit A Response Certification Form Page 1 of 2 Version 1.4 Rev. 11/12/25