ESBD_567617_1791926574522_EXHIBIT C REQUIRED FORMS & CERTIFICATIONS.pdf

BIDDER/PROPOSER INFORMATION AND OFFER STATEMENT

By signing below, the bidder/proposer certifies that the information provided in this submission is accurate and complete to the best of their knowledge. The bidder/proposer acknowledges and agrees to comply with all terms, conditions, and specifications outlined in this solicitation. This submission is made in accordance with the applicable laws, regulations, and procurement policies. The bidder/proposer further certifies that the individual signing this document is authorized to bind the bidder/proposer to the terms of this solicitation.

*Bidder/Proposer is REQUIRED to sign this page and return with the bid or proposal. An unsigned bid or proposal will be deemed non-responsive.

Proposer Information Bidder/Proposer’s

Legal Name:

Business Name (if different from above):

Business Address:

City, State, Zip Code:

Tax ID Number

(TIN OR EIN):

DUNS Number (if applicable):

SAM.gov UEID # (if applicable):

Contact Information

Contact Person Name:

Phone Number:

Email Address:

Authorized Representative Information

Name of Authorized Representative:

Title/Position:

Phone Number:

Email Address:

Certification and Signature By signing below, the undersigned certifies that the bidder/proposer has reviewed and understands all terms and conditions of the solicitation and has the legal authority to submit this bid or proposal on behalf of the organization. The undersigned acknowledges that the bid or proposal is binding and that any misrepresentation may result in disqualification.

Authorized Signature: __________________________________________________________

Date: _________________________________________________________________________

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS

By signing and submitting this certification, the undersigned certifies to the best of its knowledge and belief that the contractor (or its principals):

• Is not currently debarred, suspended, proposed for debarment, or declared ineligible for award of contracts by any state or federal agency;

• Has not been convicted of or had a civil judgment rendered against it for the commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a state or federal contract or grant;

• Is not currently indicted or otherwise criminally or civilly charged by a government entity (federal, state, or local) with the commission of any of the offenses listed in FAR 9.4;

• Has not, within a three-year period preceding this certification, been convicted or had a civil judgment rendered against it for violation of federal or state laws involving fraud, bribery, or a false claim or statement;

• Is not currently, nor has been, subject to any proceedings relating to debarment, suspension, or exclusion under 2 CFR 180 (OMB guidelines) or FAR Subpart 9.4.

1. Certification Regarding Federal Criminal Offenses and Civil Fraud Violations

a) If the Contractor is an individual, and it has been convicted or had a civil judgment rendered against it for any of the violations listed above, or is under indictment for such violations, the contractor must notify the contracting officer immediately.

b) If the Contractor is a corporation, partnership, or other legal entity, and any principal of the organization (officers, directors, or partners) has been convicted of or has a civil judgment rendered against them for the same violations listed above, the contractor must immediately notify the contracting officer.

2. Subcontractors and Exclusions

a) The Contractor will ensure that it verifies, before awarding any subcontract in excess of $25,000, that any proposed subcontractor is not listed on the List of Excluded Parties in the System for Award Management (SAM).

b) The Contractor will require its subcontractors to comply with the same debarment and suspension certification requirements and to notify the contractor if they are debarred, suspended, or excluded from state or federal contracting.

3. Exception to Certification

a) If the Contractor cannot make the certifications above, the contractor must provide an explanation, detailing the circumstances of any exclusions or pending actions regarding debarment, suspension, or proposed debarment.

b) The Contractor must attach any relevant supporting documents to the explanation if necessary.

The Contractor, ________________________________________________________________, certifies that the information provided above is true and correct to the best of its knowledge and belief. The undersigned acknowledges that providing false information on this certification may result in the contractor being subject to penalties, including debarment or suspension from federal contracting.

Signature of Authorized Official

Name and Title of Authorized Official

Date

CERTIFICATION REGARDING LOBBYING

Certification for Contracts, Grants, Loans, and Cooperative Agreements

Contractors must sign and submit the following certification to the recipient or subrecipient with each bid or offer exceeding $100,000.

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

A. 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 an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any federal contract, the making 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 any federal contract, grant, loan, or cooperative agreement.

B. 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, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

C. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

D. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The Contractor, ________________________________________________________, certifies or affirms the truthfulness and accuracy of each statement of its certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31 U.S.C. Chap. 38, Administrative Remedies for False Claims and Statements, apply to this certification and disclosure, if any.

CERTIFICATION REGARDING BOYCOTT OF ISRAEL

TEXAS GOVERNMENT CODE CHAPTER 2271

Pursuant to Texas Government Code Chapter 2271, the undersigned certifies that the company named below:

1. Does not boycott Israel; and

2. Will not boycott Israel during the term of this contract.

For purposes of this certification, “boycott Israel” has the meaning assigned by Section 2271.001 of the Texas Government Code.

Company Name

ENERGY COMPANY BOYCOTT CERTIFICATION

TEXAS GOVERNMENT CODE CHAPTER 2274

Pursuant to Texas Government Code Chapter 2274, the undersigned certifies that the company named below:

1. Does not boycott energy companies; and

2. Will not boycott energy companies during the term of this contract.

CERTIFICATION REGARDING BUSINESS WITH CERTAIN FOREIGN TERRORIST ORGANIZATIONS

TEXAS GOVERNMENT CODE CHAPTER 2252

The undersigned certifies that the company named below does not engage in business with Iran, Sudan, or a foreign terrorist organization as defined in Texas Government Code Chapter 2252, and is not listed on the Texas Comptroller’s list of companies known to have contracts with or provide supplies or services to a foreign terrorist organization.

NON-COLLUSION CERTIFICATION

The undersigned certifies that this proposal is submitted independently and without collusion with any other person or entity for the purpose of restricting competition.

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