ESBD_548443_1786483235514_2027 RFQ 212-27-0003 Attachment A Execution of Request for Qualifications.pdf

RFQ # 212-26-0003

Attachment A

Execution of Request for Qualifications

NOTE: THIS ATTACHMENT MUST BE SIGNED AND RETURNED WITH THE

RESPONSE. RESPONSES THAT DO NOT INCLUDE THIS EXECUTION OF

RESPONSE WILL BE DISQUALIFIED. THE RESPONSE SHALL BE VOID IF

FALSE STATEMENTS ARE CONTAINED IN THE EXECUTION OF REQUEST FOR

QUALIFICATIONS.

By signature hereon, Respondent certifies that:

All statements and information prepared and submitted in the response to this RFQ are current, complete, and accurate, and that pricing is guaranteed for 90 days beyond the date of signature.

Neither Respondent nor any individual or business entity named in this Response has 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.

Neither Respondent nor the firm, corporation, partnership, or institution represented by Respondent or anyone acting for such firm, corporation, or institution has (1) violated the antitrust laws of the State of Texas under Texas Business & Commerce Code, Chapter 15, or the federal antitrust laws; or (2) communicated the contents of this Response either directly or indirectly to any competitor or any other person engaged in the same line of business during the procurement process for this REQ.

When a Texas business address is shown hereon that address is, in fact, the legal business address of Respondent and Respondent qualifies as a Texas Resident Respondent under Texas Government Code Section 2155.444(c).

Under Government Code Section 2155.004, Respondent certifies that neither Respondent nor any person or entity represented by Respondent has received compensation from the Office of Court Administration to participate in the preparation of this REQ. Respondent certifies that it is eligible to enter into a contract resulting from this REQ and understands and acknowledges that any contract resulting from this REQ may be terminated and payment withheld if this certification is inaccurate.

Under Family Code Section 231.006, relating to child support obligations, Respondent and any other individual or business entity named in this solicitation are eligible to receive the specified payment and acknowledge that this contract may be terminated and payment withheld if this certification is inaccurate.

The names of persons or entities holding at least a twenty-five percent (25%) ownership interest in the business entity submitting the Response are included below the signature block of this Execution of Request for Qualifications. Respondent understands that if Respondent is awarded a contract under this REQ, Respondent will be required to provide the social security numbers of the listed persons or entities.

In accordance with Government Code Section 2252.901, Respondent certifies that no principal of Respondent was an employee of the Office of Court Administration within the past year and that no employee of Respondent who was an employee of the Office of Court Administration within the past year will perform services if Respondent is awarded this contract.

Under Government Code Section 669.003, relating to contracting with an executive head of a state agency, Respondent certifies that it does not employ any person who in the past four years served as an executive head of the Office of Court Administration or any other state agency. If Respondent employs or has used the services of a former executive head of the Office of Court Administration or other state agency, then Respondent shall provide the following information: Name of former executive, name of state agency, date of separation from state agency, position with Respondent, and date of employment with Respondent.

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.

Respondent certifies that the individual or business entity named in this Response is not listed in the prohibited vendors list authorized by Executive Order No. 13224, “Blocking Property and Prohibiting Transactions with Persons Who Commit, Threaten to Commit, or Support Terrorism,” published by the United States Department of the Treasury, Office of Foreign Assets Control.

Respondent represents and warrants that the individual or business entity named in this Response is not engaged in business with Iran, Sudan, or a foreign terrorist organization, as prohibited by Government Code Section 2252.152.

Under Government Code Sections 2155.006 and 2261.053, related to prior disaster relief contract violations, Respondent certifies that the individual or business entity named in this Response is not ineligible to enter into a contract resulting from this REQ and acknowledges that any contract resulting from this REQ may be terminated and payment withheld if this certification is inaccurate.

Pursuant to Government Code Section 2262.003, the state auditor may conduct an audit or investigation of the vendor or any other entity or person receiving funds from the state directly under this contract or indirectly through a subcontract under this contract. The acceptance of funds by the Respondent or any other entity or person directly under a contract resulting from the REQ or indirectly through a subcontract under the resulting contract acts as acceptance of the authority of the state auditor, under the direction of the legislative audit committee, to conduct an audit or investigation in connection with those funds. Under the direction of the legislative audit committee, the Respondent or other entity that is the subject of an audit or investigation by the state auditor must provide the state auditor with access to any information the state auditor considers relevant to the investigation or audit. Respondent will ensure that this clause concerning the authority to audit funds received indirectly by subcontractors through the vendor and the requirement to cooperate is included in any subcontract it awards.

Respondent certifies that it understands this RFQ and has full knowledge of the scope, nature, quality, and quantity of the work to be performed, the detailed requirements of the services to be provided, and the conditions under which the services are to be performed.

Respondent represents and warrants that the individual signing this Execution of Request for Qualifications is authorized to sign this document on behalf of Respondent and to bind Respondent under any contract resulting from this Response. By signing this document, Respondent acknowledges that all information contained in the document is true and correct and that Respondent agrees to comply with all Terms and Conditions listed in Section 4 of the REQ. Failure to sign will disqualify this Response.

RESPONDENT (COMPANY):

SIGNATURE (INK):

NAME (TYPED/PRINTED):

TITLE:

DATE:

STREET:

CITY/STATE/ZIP:

TELEPHONE AND FACSIMILE NUMBERS:

TEXAS IDENTIFICATION NUMBER (TIN):

OWNERSHIP INFORMATION: (Name(s) of person(s) or entities holding at least a twenty-five percent (25%) ownership interest in the business entity submitting this Response.)