ESBD_572193_1793201042669_2 Exhibit A - TxDMV Respondent's Affirmations and Solicitation Acceptance (v2.2).pdf
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- Attached to
- Gym Equipment Services
- Solicitation number
- 608-27-80594
- Issued by
- Travis County, Austin City, Texas
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Exhibit A - TxDMV Respondent's Affirmations and Solicitation Acceptance
This document is a standardized affirmations and solicitation acceptance form issued by the Texas Department of Motor Vehicles (TxDMV) for use in state procurement solicitations. The form requires all respondents to acknowledge receipt of solicitation documents, including any addenda or amendments, and to affirm compliance with numerous state and federal statutory requirements. Respondents must complete and submit this form with their solicitation response or face disqualification. The form applies to all types of procurement solicitations issued by TxDMV, including Invitations for Bids, Requests for Proposals, Requests for Offers, Requests for Qualifications, and Requests for Applications, without specified response deadlines, award dates, or contract terms in the form itself, as those details would be contained in the specific solicitation documents.
The form establishes affirmations covering compliance with Texas antitrust law, federal antitrust provisions, artificial intelligence disclosure requirements, binding price commitments for a minimum of 120 days from the solicitation response due date, Texas Buy Texas procurement requirements for service contracts, child support obligation certifications, cloud computing security standards under TX-RAMP, cybersecurity training requirements, data management and security controls, E-Verify employment eligibility verification, and prohibitions on contracts with entities that boycott energy companies, boycott Israel, discriminate against firearm entities, engage in human trafficking, employ former TxDMV executive heads within specified timeframes, or maintain COVID-19 vaccination requirements for customers. Additionally, respondents must certify they are not debarred or suspended from federal contracting, not listed as terrorist-affiliated entities, not majority-owned by citizens or governmental entities of designated countries, and not engaged in surveillance, intimidation, or coercion of state officials or employees. The form requires respondents to identify any claimed preference eligibility under Texas Government Code provisions and to disclose complete information regarding business ownership, prior state employment if consulting services are involved, pending legal or governmental actions, felony convictions, and any conflicts of interest. No specific set-asides, pricing requirements, or funding amounts are established within this affirmations document itself.
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TxDMV Respondent’s Preferences, Affirmations, and Solicitation Acceptance (Version 2.2) Page 1 of 12 Published and Effective: September 28, 2026
Responsible Division: Office of General Counsel
Exhibit A
Respondent’s Preferences, Affirmations, and Solicitation Acceptance
Important: Respondent must carefully read and understand all certifications, representations, warranties, acknowledgements, and other terms in this document before signing. Failure to sign and submit this document with the Solicitation Response will result in disqualification of the Response.
In this document, the term “Respondent” refers to the individual, business, or entity submitting a
Solicitation Response, including, as applicable, a bidder, proposer, respondent, offeror, applicant, vendor, contractor, grantee, or any other term used to identify a submitting party under the Solicitation. Also, the following terms have the associated meanings as set forth below:
A. “Solicitation” means the Invitation for Bids, Request for Proposals, Request for Offers, Request for Qualifications, Request for Applications, Request for Pricing, or Price Request issued under a government procurement notice and to which the Respondent is submitting a
Solicitation Response.
B. “Solicitation Response” means any bid, proposal, offer, statement of qualifications, application, quote, pricing submission, or other responsive documentation submitted by the
Respondent in response to the Solicitation.
C. “Affirmation” or “Affirmations” means this document, together with all certifications, representations, attestations, warranties, and any other terms set forth herein.
D. “TxDMV” means the Texas Department of Motor Vehicles, Motor Vehicle Crime Prevention
Authority (“MVCPA”), or both, that will be the party to any contract that may result from the
Solicitation, and the officers, employees, authorized representatives, and designees of those governmental entities.
The headings and captions in this document are for convenience and for reference only and do not affect the interpretation or construction of the preferences, affirmations, or other terms of this document.
1. Respondent’s Preference(s)
To claim a preference under Title 34 of the Texas Administrative Code, Part 1, Chapter 20, Subchapter
D, Division 2, Sections 20.306 or 20.307, or Chapter 2155, Subchapter H, of the Texas Government Code, the Respondent must mark the appropriate box(es) below and provide sufficient documentation to demonstrate the Respondent qualifies for the preference. If the appropriate box is not marked, a preference will not be granted. The Respondent represents and warrants that it qualifies for all preferences claimed below: (check all applicable boxes, if any)
Goods produced or offered by a Texas Bidder that are owned by a Texas resident service-disabled veteran
Goods produced in Texas or offered by a Texas Bidder that are not owned by a Texas resident service-disabled veteran
Agricultural products grown in Texas
Agricultural products offered by a Texas Bidder
Services offered by a Texas Bidder that is owned by a Texas resident service-disabled veteran
Services offered by a Texas Bidder that is not owned by a Texas resident service-disabled veteran
Texas vegetation native to the region
USA produced supplies, materials, or equipment
Products of persons with intellectual or physical disabilities
Products made of recycled, remanufactured, or environmentally sensitive materials including recycled steel
Energy Efficient Products
Rubberized asphalt paving material
Recycled motor oil and lubricants
Products produced at facilities located on formerly contaminated property
Products and services from economically depressed or blighted areas
Vendors that meet or exceed air quality standards
Paper containing recycled fibers
Recycled or reused computer equipment of other manufacturers
Foods of higher nutritional value
Commercial production company or advertising agency located in Texas
Travel agents residing in Texas
2. Respondent’s Affirmations and Solicitation Acceptance
These Affirmations apply to all Respondents regardless of their business form (e.g., individual, sole proprietorship, partnership, limited liability company, corporation, nonprofit organization, or governmental entity).
The Respondent must provide information, as applicable, and affirms, without exception, as follows:
2.1. Addenda and Amendments to Solicitation. Respondent acknowledges receipt of all addenda and amendments to the Solicitation, if any, either submitted by TxDMV to Respondent, or posted to the Texas Electronic State Business Daily website.
2.2. Antitrust. The undersigned affirms under penalty of perjury of the laws of the State of Texas that
(a) in connection with the Solicitation Response, neither I nor any representative of the
Respondent has violated any provision of the Texas Free Enterprise and Antitrust Act, Chapter 15 of the Texas Business and Commerce Code; (b) in connection with the Solicitation Response, neither I nor any representative of the Respondent has violated any federal antitrust law; and (c) neither I nor any representative of the Respondent has directly or indirectly communicated any of the contents of the Solicitation Response to a competitor of the Respondent or any other company, corporation, firm, partnership or individual engaged in the same line of business as the
Respondent.
2.3. Artificial Intelligence Disclosure. Respondent certifies that its Solicitation Response fully and accurately discloses all artificial intelligence (“AI”) systems (as defined by Tex. Gov’t Code §
2054.003) and functions it proposes to use in performing, supporting, or providing any goods, products, or services, or any portion thereof, requested under the Solicitation. The Respondent further acknowledges and agrees that the use of AI systems or functions are strictly prohibited in any performance under any contract that may result from the Solicitation without the prior written consent of TxDMV. Respondent certifies that, as part of its Solicitation Response, it:
is not proposing to use any AI systems or functions in performance under any contract that may result from the Solicitation; or is proposing to use AI systems or functions in performance under any contract that may result from the Solicitation and has disclosed all such proposed AI systems or functions using the
TxDMV Artificial Intelligence Disclosure Form included with its Solicitation Response.
The Respondent acknowledges that TxDMV may, at its sole and absolute discretion, terminate any contract that may result from the Solicitation for cause and may withhold payment(s) otherwise due under the Contract if this certification is found to be inaccurate or later becomes inaccurate; and the Respondent waives any recourse against TxDMV arising from such termination or withholding.
2.4. Binding Offer. Respondent represents and warrants that its price(s), including all costs to provide the requested goods, products, and/or services, in accordance with the specifications of the
Solicitation, and its Solicitation Response, will remain firm and binding for a minimum of 120 days from the Solicitation Response due date.
2.5. Buy Texas (Service Contracts). Respondent agrees to comply with Section 2155.4441 of the
Texas Government Code, requiring the purchase of products and materials produced in the State of Texas in performing service contracts that may result from the Solicitation.
Child Support Obligation. “Under Section 231.006, Family Code, the [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.” Furthermore, any
Respondent subject to Section 231.006 must include in the Solicitation Response the names and the last four digits of the Social Security Numbers (“SSN”) of each person with at least 25% ownership of the business entity submitting the Solicitation Response. The Respondent must provide the following information: (if additional space is needed attach a separate page or pages to this document)
Name: SSN: XXX-XX-
Name: SSN: XXX-XX-
Name: SSN: XXX-XX-
Name: SSN: XXX-XX-
FEDERAL PRIVACY ACT NOTICE: This notice is given pursuant to the Federal Privacy Act of 1974 (5 U.S.C. § 552a), as amended. Disclosure of your SSN is required under Sections
231.006(c) and 231.302(c)(2) of the Texas Family Code. The SSN will be used to identify persons that may owe child support and will be kept confidential to the fullest extent allowed under Section
231.302(e) of the Texas Family Code.
The Respondent further acknowledges and agrees that if Respondent is subject to Section 231.006 of the Texas Family Code, Respondent upon request by TxDMV must promptly submit the complete SSNs for each person identified above via separate, secure transmission prior to evaluation of the Solicitation Response.
If Respondent chooses to submit complete SSNs with its Solicitation Response via email, the
Solicitation Response must be encrypted. The Respondent should contact the TxDMV Sole
Point of Contact identified in the Soliciation prior to sending the email to confirm the Soliciation
Response can be encrypted and received properly. Failure by Respondent to encrypt an email containing complete SSNs as required may result in disqualification of the Respondent’s
Solicitation Response.
2.7. Cloud Computing State Risk and Authorization Management Program (TX-RAMP). In accordance with Section 2063.408 of the Texas Government Code, relating to the cloud computing
Texas state risk and authorization management program, Respondent represents and warrants that it complies with the requirements of the state risk and authorization management program and
2.6
Respondent agrees that throughout the term of any contract that may result from the Solicitation, it must maintain its certifications and comply with the program requirements in the performance of any contract that may result from the Solicitation. The Respondent acknowledges that TxDMV may, at its sole and absolute discretion, terminate any contract that may result from the Solicitation for cause and may withhold payment if this representation or warranty is found to be inaccurate or later becomes inaccurate, and the Respondent waives any recourse against TxDMV arising from such termination or withholding.
2.8. Complete and Accurate Information. Respondent represents and warrants that all statements and information provided to TxDMV are current, complete, and accurate. This includes all statements and information in the Respondent’s Solicitation Response.
2.9. Computer Equipment Recycling Program. If Respondent is submitting a Solicitation Response for the purchase or lease of computer equipment, then Respondent certifies that it is in compliance with Subchapter Y, Chapter 361 of the Texas Health and Safety Code related to the Computer
Equipment Recycling Program and the Texas Commission on Environmental Quality rules in Title
30 of the Texas Administrative Code, Chapter 328.
2.10. Confidential or Proprietary Information. Respondent acknowledges it is solely responsible for specifically identifying any information in its Solicitation Response that the Respondent contends to be confidential or proprietary and, if Respondent designated substantial portions of its
Solicitation Response or its entire Solicitation Response as confidential or proprietary, TxDMV may, at its sole and absolute discretion, disqualify the Solicitation Response.
2.11. Contracting Information Responsibilities ($1 Million or Greater in Public Funds).
Respondent represents and warrants that it will comply with the requirements of Section
552.372(a) of the Texas Government Code. Except as provided by Section 552.374(c) of the Texas
Government Code, the requirements of Subchapter J, Chapter 552 of the Government Code, may apply to any contract that may result from the Solicitation and the Respondent agrees that any contract that may result from the Solicitation can be terminated if the Respondent knowingly or intentionally fails to comply with a requirement of that subchapter.
2.12. COVID-19 Vaccine Passports Prohibition. Respondent certifies that it does not require its customers to provide any documentation certifying the customer’s COVID-19 vaccination or post-transmission recovery on entry to, to gain access to, or to receive service from the Respondent’s business. Respondent acknowledges that such a vaccine or recovery requirement would make
Respondent ineligible for any Texas state-funded contract that may result from this Solicitation.
2.13. Critical Infrastructure. In accordance with Section 2275.0102 of the Texas Government Code, Respondent certifies that neither it nor its parent company, nor any affiliate of Respondent or its parent company, is: (a) majority owned or controlled by citizens or governmental entities of China, Iran, North Korea, Russia, or any other country designated by the Governor under Government
Code Section 2275.0103, or (b) headquartered in any of those countries.
2.14. Cybersecurity Training. If Respondent will have access to any Texas state computer system or database under any contract that may result from the Solicitation, Respondent must complete cybersecurity training and verify completion of the training program to TxDMV during the term of any contract that may result from the Solicitation and during any renewal period pursuant to and in accordance with Section 2063.104 of the Texas Government Code.
2.15. Data Management and Security Controls. In accordance with Section 2054.138 of the Texas
Government Code, Respondent certifies that it will comply with the security controls required under any contract that may result from the Solicitation and will maintain records and make them available to TxDMV as evidence of Respondent’s compliance with the required controls.
2.16. Dealings with Public Servants. In accordance with Section 2155.003 of the Texas Government
Code, Respondent represents and warrants that it 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 Solicitation
Response or any contract that may result from the Solicitation.
2.17. Debts and Delinquencies. Respondent agrees that any payments due under any contract that may result from this Solicitation shall be applied towards any debt or delinquency that is owed to the
State of Texas.
2.18. Disaster Recovery Plan. Respondent agrees that upon request of TxDMV, Respondent must provide the descriptions of its business continuity and disaster recovery plans.
2.19. Disclosure of Prior State Employment (Consulting Services). If the Solicitation is for consulting services, A. In accordance with Section 2254.033 of the Texas Government Code, a Respondent offering to provide consulting services in response to the Solicitation who has been employed by, or employs an individual who has been employed by, TxDMV or another
Texas state agency at any time during the two years preceding the submission of
Respondent’s Solicitation Response must disclose the information below in its
Solicitation Response and hereby certifies that this information is true, correct, and complete: (if additional space is needed attach a separate page or pages to this document)
Name of individual(s): (Respondent or employee(s))
Status: (check one) Respondent Employee(s)
The nature of the previous employment with TxDMV or the other Texas state agency:
The date the employment was terminated and the reason for the termination:
The annual rate of compensation for the employment at the time of its termination:
If more than one individual is identified above, Respondent must provide responses to each of the questions above for each identified individual. To satisfy this requirement, Respondent must attach a separate page or pages to this document, as necessary, and include the information required set forth above. Respondent acknowledges, agrees, and certifies that all information provided above or attached in a separate page or pages is true, correct, and complete on this and all attached pages.
B. If no information is provided above in response to this Subsection, Respondent certifies that neither Respondent nor any individual employed by Respondent was employed by
TxDMV or any other State of Texas agency at any time during the two years preceding the submission of Respondent's Solicitation Response.
2.20. Entities that Boycott Energy Companies. If Respondent is required to make a verification pursuant to Section 2276.002 of the Texas Government Code, Respondent verifies that
Respondent does not boycott energy companies and will not boycott energy companies during the term of any contract that may result from the Solicitation. If Respondent does not make that verification, Respondent must state below why the verification is not required: (if additional space is needed attach a separate page or pages to this document)
2.21. Entities that Boycott Israel. If Respondent is required to make a certification pursuant to Section
2271.001 of the Texas Government Code, Respondent certifies that Respondent does not boycott
Israel and will not boycott Israel during the term of any contract that may result from the
Solicitation. If Respondent does not make that certification, Respondent must state below why the certification is not required: (if additional space is needed, attach a separate page or pages to this document)
2.22. Entities that Discriminate Against Firearm Entities and Trade Associations. If Respondent is required to make a verification pursuant to Section 2274.002 of the Texas Government Code
(relating to prohibition on contracts with companies that discriminate against firearm and ammunition industries), Respondent verifies that it (a) does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association and (b) will not discriminate during the term of any contract that may result from the Solicitation against a firearm entity or firearm trade association. If Respondent does not make that verification, Respondent must state below why the verification is not required: (if additional space is needed, attach a separate page or pages to this document)
2.23. E-Verify Program. Respondent certifies that it utilizes and will continue to utilize the U.S.
Department of Homeland Security’s E-Verify system to determine the eligibility of: (a) all persons employed by Contractor to perform duties within Texas; and (b) all persons, including subcontractors, assigned by Contractor to perform work pursuant to any contract that may result from the Solicitation within the United States of America.
2.24. Excluded Parties. Respondent certifies that it is not listed in the prohibited vendors 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. The Respondent acknowledges that TxDMV may, at its sole and absolute discretion, terminate any contract that may result from the Solicitation for cause and may withhold payment if this certification is found to be inaccurate or later becomes inaccurate, and the Respondent waives any recourse against TxDMV arising from such termination or withholding.
2.25. Executive Head of a State Agency. In accordance with Section 669.003 of the Texas Government
Code, the Respondent certifies that it does not employ, or has disclosed its employment of, any former executive head of the Agency. If Respondent does employ a person who was the executive head of TxDMV and cannot make that certification, Respondent must provide the following information:
Name of Former TxDMV
Executive:
Date of Separation from TxDMV:
Date of Employment with TxDMV:
2.26. False Representation. Respondent understands, acknowledges, and agrees that any false representation or any failure to comply with a representation, warranty, or certification made by
Respondent is subject to all civil and criminal consequences provided at law or in equity including, but not limited to, immediate termination of any contract that may result from the Solicitation.
2.27. False Statements. Respondent represents and warrants that all statements and information prepared and submitted in its Solicitation Response are current, complete, true, and accurate.
Submitting a Solicitation Response with a false statement or material misrepresentations made during the performance of a contract is a material breach of contract and may void the submitted
Solicitation Response and any contract that may result from the Solicitation.
2.28. Financial Participation Prohibited. “Under Section 2155.004, Government Code, the
[Respondent] certifies 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.” Section 2155.004 prohibits a Texas state agency from accepting a bid from or awarding a contract to an individual or business entity that includes proposed financial participation by a person who received compensation from the agency to participate in preparing the specifications or request for proposals on which the bid or contract is based.
2.29. Foreign Terrorist Organizations. Respondent represents and warrants that it is not engaged in business with Iran, Sudan, or a foreign terrorist organization, as prohibited by Section 2252.152 of the Texas Government Code. Section 2252.152 prohibits a Texas state agency from entering into a contract with a business entity that is identified on a list prepared and maintained by the
Texas Comptroller of Public Accounts and the Texas Pension Review Board. Additionally, pursuant to Texas Executive Order No. GA-43, Respondent represents and warrants that all goods or products that may be provided under any contract that may result from the Solicitation were not produced in or exported from the Gaza Strip, and from any organization or state actor with ties to Hamas. The Respondent acknowledges that TxDMV may, at its sole and absolute discretion, terminate any contract that may result from the Solicitation for cause and may withhold payment if either of these representations are found to be inaccurate or later becomes inaccurate, and the Respondent waives any recourse against TxDMV arising from such termination or withholding.
2.30. Former Agency Employees (Certain Contracts). If the Solicitation is for an employment contract, a professional services contract under Chapter 2254 of the Texas Government Code, or a consulting services contract under Chapter 2254 of the Texas Government Code, Respondent represents and warrants that none of its employees including, but not limited to, those authorized to provide services under any contract that may result from the Solicitation, were former employees of TxDMV during the 12 month period immediately prior to the date of execution of any contract that may result from the Solicitation.
2.31. Hardening of State Government. In accordance with Texas Executive Order No. GA-48, Respondent certifies by submitting a Solicitation Response that it, and, if applicable, any of its holding companies or subsidiaries, is not: (a) listed in Section 889 of the 2019 National Defense
Authorization Act (“NDAA”); (b) listed in Section 1260H of the 2021 NDAA; (c) owned by the government of a country on the U.S. Department of Commerce's foreign adversaries list under 15
C.F.R. § 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. § 791.4. The Respondent acknowledges that TxDMV may, at its sole and absolute discretion, terminate any contract that may result from the Solicitation for cause and may withhold payment if this certification is found to be inaccurate or later becomes inaccurate, and the Respondent waives any recourse against
TxDMV arising from such termination or withholding.
2.32. Human Trafficking Prohibition. “Under Section 2155.0061, Government Code, the
[Respondent] certifies 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.” Section 2155.0061 prohibits a Texas state agency from accepting a bid from or awarding a contract to an individual or business entity that includes proposed financial participation by a person who, during the five-year period preceding the date of the bid or award, has been convicted of any offense related to the direct support or promotion of human trafficking.
2.33. Legal and Regulatory Actions. Respondent represents and warrants that it is not aware of and has received no notice of any court or governmental agency actions, proceedings or investigations, or other action pending or threatened against Respondent or any of the individuals or entities included in Subsection 2.36 of this Affirmations and Solicitation Acceptance within the five calendar years immediately preceding the submission of the Solicitation Response that would or could impair Respondent’s performance under any contract that may result from the Solicitation, relate to the contracted or similar goods, products, or services, or otherwise be relevant to
TxDMV’s consideration of the Solicitation Response. If Respondent is unable to make the preceding representation and warranty, then Respondent must provide below a complete disclosure of any such court or governmental agency actions, proceedings or investigations, or other action that would or could impair Respondent’s performance under any contract that may result from the Solicitation, relate to the contracted or similar goods, products, or services, or otherwise be relevant to TxDMV’s consideration of the Solicitation Response: (if additional space is needed attach a separate page or pages to this document)
2.34. No Conflicts of Interest. Respondent represents and warrants that the provision of goods, products, and services or other performance under any contract that may result from the
Solicitation will not constitute an actual or potential conflict of interest or reasonably create an appearance of impropriety in accordance with Sections 2252.908, 2254.032, and 2261.252(b) of the Texas Government Code.
2.35. No Felony Criminal Convictions. Respondent represents that neither Respondent nor any of its employees, agents, or representatives, including any subcontractors and employees, agents, or representatives of such subcontractors, have been convicted of a felony criminal offense, or that if such a conviction has occurred, Respondent must fully advise TxDMV of the facts below and the circumstances surrounding the convictions: (if additional space is needed attach a separate page or pages to this document)
2.36. Parties to the Affirmations and Acceptance. Respondent represents and warrants that all certifications, representations, warranties, and other provisions in these Affirmations apply to
Respondent and all of Respondent’s principals, officers, directors, shareholders, partners, owners, agents, employees, subcontractors, independent contractors, and any other representatives who may provide services under, who have a financial interest in, or otherwise are interested in the
Solicitation or any contract that may result from the Solicitation.
2.37. Prior Disaster Relief Contract Violation. “Under Section 2155.006 [and Section 2261.053], Government Code, the [Respondent] certifies 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.” Sections
2155.006 and 2261.053 prohibits a Texas state agency from accepting a bid from or awarding a contract to an individual or business entity that includes proposed financial participation by a person who, during the five-year period preceding the date of the bid or award, has been convicted of violating a federal law in connection with a contract awarded by the federal government for relief, recovery, or reconstruction efforts as a result of Hurricane Rita, Hurricane Katrina, or any other disaster occurring after September 24, 2005, or assessed a penalty in a federal civil or administrative enforcement action in connection with a contract awarded by the federal government for relief, recovery, or reconstruction efforts as a result of Hurricane Rita, Hurricane
Katrina, or any other disaster occurring after September 24, 2005.
2.38. Public Information Act Copy. Respondent understands, acknowledges, and agrees that its
Solicitation Response and any contract that may result from the Solicitation are subject to disclosure under the Texas Public Information Act (“Public Information Act”), Chapter 552 of the Texas Government Code, and may be disclosed to the public upon request or through posting on the TxDMV website (as required by Tex. Gov’t Code § 2261.253 and 2157.0685), the
Legislative Budget Board’s (“LBB”) website (as required by Tex. Gov’t Code § 322.020), or as otherwise required by law. Respondent certifies that, as part of its Solicitation Response, it either:
asserts that there is no information provided in its Solicitation Response that is excepted from disclosure under the Public Information Act, and Respondent, therefore, has not submitted a
“Public Information Act Copy;” or asserts that information provided in its Solicitation Response may be excepted from disclosure under the Public Information Act, and Respondent, therefore, has submitted both an “Original
Response - Confidential Information Asserted” and “Public Information Act Copy” in accordance with the instructions as outlined in the Solicitation
Respondent further acknowledges and agrees, that if neither box above is checked, its entire
Solicitation Response, including, without limitation, all associated documents and information therein and any contract that may result from the Solicitation, will be treated as containing no information excepted from disclosure under the Public Information Act and therefore may be released in its entirety in any manner including, but not limited to, in accordance with the Public
Information Act, or posted on Texas state governmental websites.
2.39. RELEASE FROM LIABILITY. RESPONDENT GENERALLY RELEASES FROM LIABILITY AND WAIVES
ALL CLAIMS AGAINST ANY PARTY PROVIDING INFORMATION ABOUT THE RESPONDENT AT THE
REQUEST OF TXDMV.
2.40. Signature Authority. By submitting the Solicitation Response, Respondent represents and warrants that the individual submitting and signing this document, and the documents made part of its Solicitation Response, is either the Respondent (if individual) or an authorized representative of the Respondent, duly delegated with authority to negotiate on behalf of and legally bind the
Respondent in all contractual matters related to the Solicitation, and bind the Respondent to perform under any contract that may result from the Solicitation.
2.41. Surveillance, Intimidation, and Related Acts. Respondent certifies that neither it nor any of its employees, agents, representatives, or subcontractors, or their respective employees, agents, or representatives have engaged, and if awarded a contract resulting from the Solicitation will not engage, directly or indirectly through a third party, in surveillance targeting or engage in an act of intimidation, coercion, extortion, undue influence, or other similar conduct intended to influence, silence, or retaliate against: (a) a member of the state legislature or person employed to support the state legislature in any capacity; (b) a family member of a person described by (a); (c) a state agency employee; or (d) an individual making a complaint or raising concerns regarding state agency operations or contracting. Additionally, Respondent further certifies that neither it nor any of its employees, agents, representatives, or subcontractors, or their respective employees, agents, or representatives have used, and if awarded a contract resulting from the Solicitation will not use, directly or indirectly through a third party, private or confidential information to manipulate or influence any Texas state contract, decision, or proceeding.
Respondent acknowledges that, pursuant to Section 2261.306 of the Texas Government Code, any violation of the prohibited activities described in Section 2261.302, may result in immediate termination of any contract that may result from the Solicitation, administrative penalties up to $2 million, and debarment from responding to or accepting Texas state contracts. The Respondent further acknowledges and understands these enforcement actions may be applied not only to the
Respondent, but also to its employees, agents, representatives, subcontractors, and their respective employees, agents, representatives, as well as to any other individual or entity acting on behalf of or associated with the Respondent, as outlined in Section 2261.306(c).
2.42. Suspension and Debarment. Respondent certifies that neither it nor its principals are debarred, suspended, proposed for debarment, declared ineligible, or otherwise excluded from participation in any contract that may result from the Solicitation by any federal or Texas state agency.
2.43. Television Equipment Recycling Program. If the Respondent is submitting a Solicitation
Response for the purchase or lease of covered television equipment, then Respondent certifies that it is in compliance with Chapter 361, Subchapter Z of the Texas Health and Safety Code related to the Television Equipment Recycling Program.
2.44. Terms and Conditions. Respondent accepts the Solicitation’s terms and conditions unless specifically noted by exceptions advanced in the form and manner directed in the Solicitation and submitted with the Solicitation Response. No exceptions, terms, or conditions will be considered if not advanced in the form and manner outlined in the Solicitation. Respondent acknowledges and agrees that any exceptions to the Solicitation as well as terms and conditions advanced by
Respondent that differ in any manner from TxDMV’s Contract Uniform Terms and Conditions with Affirmations attached to the Solicitation and these Affirmations, are rejected unless expressly accepted in writing by a document drafted, signed, and provided by TxDMV.
2.45. Texas Bidder. Respondent certifies that if a Texas address is shown as the address of Respondent on the Solicitation Response, Respondent qualifies as a Texas Bidder as defined in Section
2155.444(c) of the Texas Government Code.
2.46. TxDMV Right to Use. Respondent acknowledges and agrees that TxDMV has the right to use, produce, and distribute copies of and to disclose to TxDMV employees, agents, and contractors and other governmental entities all or part of Respondent’s Solicitation Response as TxDMV deems necessary to complete the procurement process or comply with federal or Texas laws.
3. Respondent’s Business Information
The Respondent must complete and provide the information requested below; failure to do so may delay processing or disqualify the Solicitation Response, and TxDMV reserves the right to make this determination in its sole and absolute discretion: (if any of the following line-items are not applicable, insert n/a)
Respondent’s Legal Name:
Respondent’s Assumed Name (d/b/a):
(Respondent’s must include copies of its Assumed Name Certificate(s) filed with the Texas Secretary of State and/or each
Texas County where the Assumed Name Certificate(s) has been filed, if any, as part of its Solicitation Response)
Physical Address:
City: State: Zip Code:
Mailing Address (if different):
City: State: Zip Code:
Telephone Number:
Website:
E-Mail Address:
Federal Employer Identification Number:
Texas Identification Number System (“TINS”) Number:
Texas Franchise Tax Number:
Texas Secretary of State Filing Number:
Sam.gov Unique Entity Identifier (“UEI”) Number:
4. Respondent’s Certification and Execution of Response
By submitting its Solicitation Response and signing below, Respondent certifies that Respondent, through its authorized representative, has thoroughly reviewed and understands the Solicitation and all documents attached to or incorporated by reference therein. Respondent further affirms that it possesses the ability to perform, support, or provide the goods, products, or services requested under the Solicitation in accordance with the specifications and terms set forth therein. The undersigned further affirms that all
Affirmations contained in this document are true and correct.
The undersigned acknowledges and understands that any false, misleading, or materially incomplete statement, representation, certification, or other information contained in the Solicitation Response, may render the Response non-responsive. If TxDMV determines before award that the Solicitation Response contains any such information, TxDMV will reject and disqualify the Response from further consideration under the Solicitation. If TxDMV determines, after award of any resulting contract under the Solicitation, that the Solicitation Response contained any such information, the false, misleading, materially incomplete statement, representation, certification, or other information will constitute a material breach of the resulting contract, and TxDMV may terminate the resulting contract for cause, pursue any other remedy available under the contract or applicable law, report the matter through the applicable statewide vendor-performance process, and refer suspected fraud, misrepresentation, or other unlawful conduct to appropriate authorities, as permitted by applicable law.
Signature of Authorized Representative
Name of Authorized Representative (Print)
Title of Authorized Representative
Date
| Goods produced or offered by a Texas Bidder that are owned by a Texas resident service: Off |
| Goods produced in Texas or offered by a Texas Bidder that are not owned by a Texas resident: Off |
| Agricultural products grown in Texas: Off |
| Agricultural products offered by a Texas Bidder: Off |
| Services offered by a Texas Bidder that is owned by a Texas resident servicedisabled veteran: Off |
| Services offered by a Texas Bidder that is not owned by a Texas resident servicedisabled: Off |
| Texas vegetation native to the region: Off |
| USA produced supplies materials or equipment: Off |
| Products of persons with intellectual or physical disabilities: Off |
| Products made of recycled remanufactured or environmentally sensitive materials including: Off |
| Energy Efficient Products: Off |
| Rubberized asphalt paving material: Off |
| Recycled motor oil and lubricants: Off |
| Products produced at facilities located on formerly contaminated property: Off |
| Products and services from economically depressed or blighted areas: Off |
| Vendors that meet or exceed air quality standards: Off |
| Paper containing recycled fibers: Off |
| Recycled or reused computer equipment of other manufacturers: Off |
| Foods of higher nutritional value: Off |
| Commercial production company or advertising agency located in Texas: Off |
| Travel agents residing in Texas: Off |
| is not proposing to use any AI systems or functions in performance under any contract that: Off |
| is proposing to use AI systems or functions in performance under any contract that may result: Off |
| Name: |
| XXXXX: |
| Name_2: |
| XXXXX_2: |
| Name_3: |
| XXXXX_3: |
| Name_4: |
| XXXXX_4: |
| Name of individuals Respondent or employeesRow1: |
| undefined: Off |
| undefined_2: Off |
| The nature of the previous employment with TxDMV or the other Texas state agencyRow1: |
| The date the employment was terminated and the reason for the terminationRow1: |
| The annual rate of compensation for the employment at the time of its terminationRow1: |
| Name of Former TxDMV Executive: |
| Date of Separation from TxDMV: |
| Date of Employment with TxDMV: |
| is needed attach a separate page or pages to this document_2: |
| page or pages to this document: |
| asserts that there is no information provided in its Solicitation Response that is excepted from: Off |
| asserts that information provided in its Solicitation Response may be excepted from disclosure: Off |
| Respondents Legal Name: |
| Respondents Assumed Name dba: |
| Physical Address: |
| City: |
| State: |
| Zip Code: |
| Mailing Address if different: |
| City_2: |
| State_2: |
| Zip Code_2: |
| Telephone Number: |
| Website: |
| EMail Address: |
| Federal Employer Identification Number: |
| Texas Identification Number System TINS Number: |
| Texas Franchise Tax Number: |
| Samgov Unique Entity Identifier UEI Number: |
| 4 Respondents Certification and Execution of Response: |
| Name of Authorized Representative Print: |
| Title of Authorized Representative: |
| Date: |
| Entities that Boycott Energy Companies: |
| Entities that Boycott Israel: |
| Entities that Discriminate Against Firearm Entities and Trade Associations: |
File details come from the government source that posted it. Updated .