ESBD_558898_1789481099549_Attachment A - K.docx

ATTACHMENT A

CERTIFICATION OF RESPONDENT

I, the undersigned, submit this quote/bid and have read the specifications, which are a part of this solicitation. My signature also certifies that I am authorized to submit this quote/bid. Sign as a representative for the firm, and carry out services solicited in this solicitation:

ATTACHMENT B

CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS

This certification is required by the Federal Regulations Implementing Executive Order 12549, Debarment and Suspension, 45 CFR Part 93, Government-wide Debarment and Suspension, for the Department of Agriculture (7 CFR Part 3017), Department of Labor (29 CFR Part 98), Department of Education (34 CFR Parts 85, 668, 682), Department of Health and Human Services (45 CFR Part 76).

The undersigned certifies, to the best of his or her knowledge and belief, that both it and its principals:

1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency;

2. Have not within a three-year period preceding this contract 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 statues or commission of embezzlement, theft, forgery, bribery, falsification, or destruction of records, making false statements, or receiving stolen property;

3. Are not presently indicated for or otherwise criminally or civilly charged by a government entity with commission of any of the offense enumerated in Paragraph (2) of this certification; and,

4. Have not within a three-year period preceding this contract had one or more public transactions terminated for cause or default.

Where the prospective recipient of federal assistance funds is unable to certify to any of the statements in this certification, such prospective recipient shall attach an explanation to this certification form.

Name of Organization/Firm

Print Name and Title of Authorized Representative

ATTACHMENT C

CERTIFICATION REGARDING CONFLICT OF INTEREST

By signature of this bid proposal, Respondent covenants and affirms that:

· No manager, employee or paid consultant of the Respondent is a member of the Board, or an employee of Workforce Solutions;

· No manager or paid consultant of the Respondent is married to a member of the Board, the CEO, or an employee of Workforce Solutions;

· No member of the Board, the CEO or an employee of Workforce Solutions is a manager or paid consultant of the respondent;

· No member of the Board, the CEO or an employee of Workforce Solutions owns or controls more than 10 percent in the Respondent;

· No member of the Board, CEO, or employee of Workforce Solutions receives compensation from Respondent for lobbying activities as defined in Chapter 305 of the Texas Government Code;

· Respondent has disclosed within the Bid any interest, fact or circumstance which does or may present a potential conflict of interest;

· Should Respondent fail to abide by the foregoing covenants and affirmations regarding conflict of interest, Respondent shall not be entitled to the recovery of any costs or expenses incurred in relation to any contract with Workforce Solutions and shall immediately refund to Workforce Solutions any fees or expenses that may have been paid under the contract and shall further be liable for any costs incurred or damages sustained by Workforce Solutions relating to that contract.

Name of Organization/Firm

Print Name and Title of Authorized Representative

ATTACHMENT D

WORKFORCE SOLUTIONS DISCLOSURE OF INTERESTS

It is the fiscal policy of Workforce Solutions that all persons or firms seeking to do business with Workforce Solutions have to provide the following information. Every question must be answered. If the question is not applicable, answer with “NA”.

NAME OF ENTITY/INDIVIDUAL: ________________________ __________________

BUSINESS NAME (dba): _________________________________________________

TAXPAYER IDENTIFICATION NUMBER (EIN OR SS#): ________________________

ADDRESS: ____________________________________________________________

CITY: _________________________ STATE: __________________ ZIP: _________

Firm is: (1.) Corporation (2.) Partnership (3.) Sole Owner (4.) Association (5.) Other

DISCLOSURE QUESTIONS

If additional space is necessary, please use the reverse side of this page or attach separate sheet.

1. State the name of each “non-managerial employee” of having an “ownership interest” constituting 10% or more of the ownership in the above name “firm”

Name Job Title

2. State the names of each “managerial employee” of Workforce Solutions having an “ownership interest” constituting 10% or more of the ownership in the above name “firm”

Name Job Title

3. State the names of each “member” of Workforce Solutions or Board Staff having an “ownership interest” constituting 10% or more the ownership in the above name “firm”

Name Job Title

4. State the name of each employee or officer of a “consultant” for Workforce Solutions who worked on any matter related to the subject of this contract and has an “ownership interest” constituting 10% or more of the ownership in the above name “firm”

Name Job Title

5. Other

Name Job Title

Name of Organization/Firm

Print Name and Title of Authorized Representative

26-RFP-01-001

ATTACHMENT E

CERTIFICATION REGARDING DRUG-FREE WORKPLACE

This certification is required by the Federal Regulations Implementing Sections 5151-5160 of the Drug-Free Workplace Act, 41 U.S.C. 701, for the Department of Agriculture (7 CFR Part 3017), Department of Labor (29 CFR Part 98), Department of Education (34 CFR Parts 85, 668 and 682), Department of Health and Human Services (45 CFR Part 76).

The undersigned subcontractor certifies it will provide a drug-free workplace by:

· Publishing a policy statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the workplace and specifying the consequences of any such action by an employee;

· Establishing an ongoing drug-free awareness program to inform employees of the dangers of drug abuse in the workplace, the subcontractor’s policy of maintaining a drug-free workplace, the availability of counseling, rehabilitation and employee assistance programs, and the penalties that may be imposed on employees for drug violations in the workplace;

· Providing each employee with a copy of the subcontractor’s policy statement;

· Notifying the employees in the subcontractor’s policy statement that as a condition of employment under this subcontract, employees shall abide by the terms of the policy statement and notifying the subcontractor in writing within five days after any conviction for a violation by the employee of a criminal drug abuse statue in the workplace;

· Notifying Workforce Solutions within ten (10) days of the subcontractor’s receipt of a notice of a conviction of any employee; and,

· Taking appropriate personnel action against an employee convicted of violating a criminal drug statue or requires such employee to participate in a drug abuse assistance or rehabilitation program.

Name of Organization/Firm

ATTACHMENT F

CERTIFICATION REGARDING LOBBYING

This certification is required by the Federal Regulations Implementing Section 1352 of the Program Fraud and Civil Remedies Act, Title 31 U.S. Code for the Department of Agriculture (7 CFR Part 3018), Department of Labor (29 CFR Part 93), Department of Education (34 CFR Part 82), Department of Health and Human Services (45 CFR Part 93).

The undersigned certifies to the best of his/her knowledge and belief, that:

1. No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned to any person for influencing or attempting to influence an officer or employee of Congress, or an employee or a Member of Congress in connection with the awarding of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of a federal contract, grant, loan, or cooperative agreement.

2. If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this federal contract, grant, loan, and or cooperative agreement, the undersigned shall complete and submit Standard Form – LLL, “Disclosure Form to Report Lobbying”, in accordance with the instructions.

3. The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

Name of Organization/Firm

ATTACHMENT G

CERTIFICATION REGARDING

TEXAS CORPORATE FRANCHISE TAX

Pursuant to Article 2.45, Texas Business Corporation Act, state agencies may not contract with for-profit corporations that are delinquent in making state franchise tax payments. The following certification that the entity entering into this subcontract is current in its franchise taxes or is not subject to the payment of franchise taxes to the State of Texas must be signed by the individual authorized to sign the subcontract for the subcontracting entity.

The undersigned authorized representative of the entity subcontracting herein certifies that the following indicated statement is true and correct and that the undersigned understands making a false statement is a material breach of subcontract and is grounds for subcontract cancellation.

Indicate the certification that applies to your subcontracting entity:

Name of Business: _____________________________________________________

Type of Business (if not corporation): Sole Proprietor

· Partnership

· Other I.R.S Tax Number: _____________________________________________________

Name of Organization/Firm

ATTACHMENT H

STATE ASSESSMENT CERTIFICATION

The authorized representative of the corporation contracting herein by executing this contract certifies that the following indicated statement is true and correct and that the undersigned understands making a false statement is a material breach of contract and is grounds for contract cancellation.

The corporation certifies that:

_____ It is current in Unemployment Insurance taxes, Payday and Child Labor law monetary obligations, and Proprietary School fees and assessments payable to the State of Texas.

_____ It has no outstanding Unemployment Insurance overpayment balance payable to the State of Texas.

Name of Organization/Firm

ATTACHMENT I

EQUAL OPPORTUNITY AND NONDISCRIMIANTION

(Respondent Name) promotes employment opportunity through a progressive program designed to provide equal opportunity without regard to race, color, sex, religion, national origin, age, disability, or political affiliation or belief. Additionally, discrimination is prohibited against any beneficiary of programs funded under the Workforce Innovation Opportunity Act, on the basis of the beneficiary’s citizenship/status as a lawfully admitted immigrant authorized to work in the United States, or his/her participation in any Workforce Innovation Opportunity Act financially assisted program or activity. (Respondent Name) conforms to all applicable federal and state laws, rules, guidelines, regulations, and provides equal employment opportunity in all employment and employee relations.

EEO Laws, Rules, Guidelines, Regulations (Respondent Name) provides equal opportunities consistent with applicable federal and state laws, rules, guidelines, regulations, and executive orders (29 CFR 38.25). Such regulations include:

· Title VI of the Civil Rights Act of 1964, as amended, which prohibits discrimination under any program or activity receiving federal financial assistance.

· Title VII of the Civil Rights Act of 1964, as amended, and its implementing regulations at 29 CFR Part 38 which prohibit discrimination based on race, color, religion, sex, or national origin in any term, condition or privilege of employment.

· Section 504 of the Rehabilitation Act of 1973, as amended, which prohibits discrimination against qualified individuals because of disability.

· Age Discrimination in Employment Act of 1967, as amended, which prohibits discrimination against individuals 40 years of age and older.

· Americans with Disabilities Act of 1990, which prohibits discrimination against qualified individuals with disabilities.

· Age Discrimination Act of 1975, as amended, which prohibits discrimination based on age in programs receiving federal financial assistance.

· Texas Commission on Human Rights Act, as amended, which prohibits discrimination in employment based on race, color, handicap, religion, sex, national origin, or age (40-70).

· Equal Pay Act of 1963, as amended, which requires equal pay for men and women performing equal work.

· Pregnancy Discrimination Act of 1978, which prohibits discrimination against pregnant women.

· Title IX of the Education Amendments Act of 1972 which prohibits discrimination on the basis of sex under any education program or activity receiving Federal financial assistance

· Section 188 of the Workforce Innovation and Opportunity Act (WIOA), which prohibits discrimination against all individuals in the United States on the basis of race, color, religion, sex (including pregnancy, childbirth, and related medical condition, transgender status, and gender identity), national origin (including limited English proficiency), age, disability, or political affiliation or belief or against beneficiaries on the basis of either citizenship status or participation in any WIOA Title I-financially assisted program or activity.

(Respondent Name) is committed to promoting equal employment opportunity through a progressive program designed to provide equal opportunity without regard to race, color, sex, religion, national origin, age, disability, or political affiliation or belief. (Respondent Name) takes positive steps to eliminate any systematic discrimination from personnel practices. (Respondent Name) recruits, hires, trains, and promotes into all job levels the most qualified persons without regard to race, color, religion, sex, national origin, age, or disability status.

Staff at all levels is responsible for active program support and personal leadership in establishing, maintaining, and carrying out an effective equal employment opportunity program.

Name of Organization/Firm

ATTACHMENT J

LISTING OF PRIOR CONTRACTS FOR SIMILAR SERVICES

On the following table, list the major contracts or services your organization has provided in the past three (3) years. Note: The table shown below may be reproduced, as needed, to provide the requested information.

Name of Organization

Contract Begin/End Dates

Contact Name/Phone Number/Email

Contract Amount

Detail of Services Provided

ATTACHMENT K - RESPONSE SUBMITTAL

LEGAL SERVICES

A Proposal Submitted in Response to

Workforce Solutions

Request for Proposals #26-RFP-01-001

Submitted By:

(Full Legal Name of Respondent)

On:

(Date of Proposal Submission)

SUBMISSION REQUIREMENTS

Respondents shall submit a qualification package that includes the following information:

8.1 Attorney Qualifications, Knowledge, Experience – 35 Points

· Organization description, Size, Structure, and Area of Practice.

· Discuss experience of the individual attorney(s) likely to be assigned to the representation. Include education, position in firm, years, and types of experience, and continuing professional education.

8.2 Legal Experience – 35 Points

· Discuss specific legal experience, advising nonprofit organizations and or advising clients conducting similar programs and government‐funded services.

· Identify the individual(s) in your firm who would be assigned to this project.

8.3 References – 15 Points

· Names and contact information of at least three clients in the public sector;

· Description of the work performed for each of the clients.

8.4 Cost / Price – 15 Points

Provide the cost for the proposed legal services. Include the following costs:

1. Standard Legal Services Costs

2. Other Services Costs