ESBD_File_349115_IFB 2024-B09 Winters Mill Parkway Roadway Improvements, Lighting and Pavement Markings - Project Manual.pdf

HAYS COUNTY

PROJECT CONSTRUCTION MANUAL

FOR

WINTERS MILL PARKWAY ROADWAY IMPROVEMENTS,

LIGHTING & PAVEMENT MARKINGS

Federal-Aid Project Number: STP 2024(361)HESG

TxDOT CSJ: 0914-33-092

Bid No. IFB 2024-B09 Bid Date: February 22, 20244

Bid Time: 10:00 AM CST

Hays County, Texas Purchasing Office

712 South Stagecoach Trail, Suite 101212 San Marcos, TX 78666

January 31, 2024

Table of Contents

Contents Section

IFB Submittal Checklist Invitation to Bid Bid Instructions/Bid Requirements Forms

Bid Form Vendor/Bidder's Affirmation Bid Form: Schedule of Rates & Prices Conflict of Interest Questionnaire Certificate of Interested Parties Code of Ethics for Hays County HUB Practices House Bill 89 Verification Senate Bill 252 Certification Debarment and Licensing Certification Vendor References Related Parties Disclosure Form Appendix II To Part 200

Standard Form of Contract

Wage Rates

Performance Bond

Payment Bond

Certificate of Insurance

General Conditions Special Conditions General Notes

Technical Specifications

Plan Drawings ..................................................................................................................... Bond Separately

Appendices Appendix A – Quality Assurance Program for Construction Projects Appendix B – Guide Schedule of Sampling and Testing Appendix C – AASHTO Accredited Laboratories Appendix D – Contract- Federal Affirmation Attachments

FHWA 1273 Certification

State of TX Child Support Form

SECTION 1

IFB SUBMITTAL CHECKLIST

IFB Submittal Checklist

This checklist is provided for convenience and identifies documents that must be submitted with the bid/proposal in order to be considered responsive. Any bids/proposals received without these requisite documents will be deemed nonresponsive and will not be considered for contract award.

The following forms MUST be returned for the bid/proposal to be considered responsive:

____ 1. Completed Bid Form

____ 2. Completed Schedule of Rates and Prices

____ 3. Vendor References Completed

____ 4. Bid Bond for 5% of total bid amount

Required Forms by Hays County:

____ 1. Conflict of Interest Questionnaire Completed and Signed

____ 2. Certificate of Interested Parties – Form 1295 filed online with the Texas Ethics Commission and Signed

____ 3. Code of Ethics for Hays County Signed

____ 4. Hays County Practices Related to Historically Underutilized Businesses Signed

____ 5. Hays County House Bill 89 Verification Signed and Notarized

____ 6. Hays County Purchasing Department Senate Bill 252 Certification Signed

____ 7. Vendor/Bidder’s Affirmation Completed and Signed

____ 8. Related Party Disclosure Form Completed and Signed

____ 9. Debarment & Licensing Certification Signed and Notarized

____ 10. Appendix II to Part 200 - Contract Provisions for Non-Federal Entity Contracts Under Federal Awards

____ 11. FHWA-1273 Certification

____ 12..State of Texas Child Support Business Ownership Form Form

____ 13.. System for Award Management (www.SAM.gov) Entity Registration Page

____ 14. Any addenda applicable to this solicitation

Hays County will accept bids, by the stated due date by one of the following methods:

____ 1. Electronic Submission of Bid Packet through BidNet Direct and one (1) hard copy delivered in a sealed envelope with the Solicitation Number and Vendor’s name on the outermost envelope addressed to: Hays County Purchasing, 712 S Stagecoach Trail, Suite 1012, San Marcos, TX 78666 (within 24 hours of bid due date.e

OR

____ 2. One (1) original bid packet and one (1) digital copy on a thumb drive in a sealed envelope with the Solicitation Number and Vendor’s Name on the outermost envelope, addressed to:

Hays County Purchasing, 712 S Stagecoach Trail, Suite 1012, San Marcos, TX 78666

SECTION 2

INVITATION FOR BIDS

PUBLIC NOTICE HAYS

COUNTY INVITATION FOR

BIDS

Hays County will be accepting sealed Bids for:

IFB 2024-B03 Winters Mill Parkway Roadway Improvements, Lighting & Pavement Markings

Sealed Bids will be received by Hays County, through either hard copy at the Purchasing Office, Hays County Government Center, 712 South Stagecoach Trail, Suite 1012, San Marcos, TX 78666 or electronically through www.bidnetdirect.com/hayscounty (the BidNet Direct website) until 10:00 AM local time on February 22, 2024, at which time and place the bids will be publicly opened and read. Bids received after the time and date set for submission will be returned unopened.

DETAIL SUMMARY

1. Issuing Office:

2. Responses to Solicitation:

3. Deadline for Responses:

4. Pre-Bid Meeting:

5. Bonding Requirements:

6. Retainage

7. Initial Contract Term:

8. Optional Contract Terms:

9. Designated Contact:

Hays Purchasing Office 712 S. Stagecoach Trail, Suite 1012 San Marcos, TX 78666

Sealed bids marked with Solicitation Number and Respondent Name on the outermost envelope: One (1) original and one (1) digital copy on a thumb drive

OR

Electronic bid packets can be submitted through BidNet Direct and one (1) hard copy is required to be received within 24 hours of bid due date.

In issuing office or submitted to BidNet Direct no later than:

February 22, 2024; 10:00 a.m. Central Time (CT)

Recommended February 7, 2024; 10:00 a.m. Central Time (CT) Hays County Transportation Department 2171 Yarrington Road, San Marcos, TX 78666

Bid Bond: 5% of total bid amount due at bid submittal Performance and Payment Bonds: 100% of Contract Price within 10 days of award

The owner will withhold 5% retainage of the Contractor. The Contractor may withhold retainage on subcontractors in accordance with state and federal regulations.

16 standard workweek days

None

Hays County Purchasing Email: purchasing@co.hays.tx.us

10. Questions & Answers:

11. Addenda

12. Contact with County Staff:

13. Websites:

Questions regarding this solicitation must be made in writing and submitted to the designated contact above no later than February 14, 2024; 5:00 p.m. CT. Telephone inquiries will not be accepted.

Questions may be submitted by email to the purchasing address above. Answers to questions will be provided in the form of an addendum after the question deadline has passed. All addenda will be posted on CivicPlus, BidNet Direct and ESBD websites.

Any interpretations, corrections or changes to this IFB and specifications will be made by addenda. Sole issuing authority of addenda shall be vested in the Hays County Purchasing Office. It is the Respondent’s responsibility to acknowledge receipt of all addenda with bid submission.

Upon issuance of this solicitation, employees and representatives of Hays County, other than the Purchasing Office staff identified as the Designated Contact above, will not discuss the contents of this solicitation with any Respondent or its representatives. Failure of a Respondent or any of its representatives to observe this restriction may result in disqualification of any related offer. This restriction does not preclude discussions between affected parties for the purpose of conducting business unrelated to this procurement.

Plans, Specifications, and Bidding documents for pre-qualified bidders and interested non-bidders may be secured from the following websites:

www.bidnetdirect.com/hayscounty, http://www.txsmartbuy.com/sp, https://www.sanmarcostx.gov/Bids.aspx

Anticipated Schedule of Events

January 31, 2024 Issuance of IFB February 7, 2024 Pre-Bid Meeting in-person (10:00 AM, CT) February 14, 20244 Deadline for Submission of Questions (5:00 PM, CT) February 22, 20244 Deadline for Submission of Bids (10:00 AM, CT) Late bids will not be accepted March 2024 Anticipated Contract Award Date

SECTION 3

BID INSTRUCTIONS / REQUIREMENTS

BID INSTRUCTIONS/REQUIREMENTS

A. Scope of Work The proposed project will add safety illumination and raised profile reflective pavement markings. The attachments to this IFB provide specific detail regarding this project and should be thoroughly reviewed prior to bid submittal:

Attachment A: IFB 2024-B09 Construction Plans

B. Qualifications Prospective bidder shall meet the following requirements:

1. Be qualified via “Confidential Questionnaire” by the Texas Department of Transportation (TxDOT) for bidding on State projects or within the 90-day grace period for the preparation of a new qualification statement, or have submitted the Confidential Questionnaire and have it on file with TxDOT at least 14 days before the date proposals are to be opened;

2. not on the TxDOT list of currently debarred/sanctioned contractors; and

3. Provide suitable evidence of prior experience for similar work and be able to provide written documentation of successfully complete similar contracts.

4. Contractor must confirm prequalification for all subcontractors and materials suppliers of greater than

$10,000.

REFERENCES: Hays County requires respondent to supply with the statement of qualifications, a list of at least three (3) references where like services have been supplied by their company. Include name of company, address, telephone number and name of representative.

RESPONSIBILTY: A prospective respondent must affirmatively demonstrate respondent’s responsibility. A prospective respondent must meet the following requirements:

Have adequate financial resources, or the above ability to obtain such resources as required Have a satisfactory record of performance Be otherwise qualified and eligible to receive an award

SYSTEM FOR AWARD MANAGEMENT: Respondent and its Principals may not be debarred or suspended nor otherwise have an exclusion record created in the System for Award Management (SAM.gov). Include verification that the company as well as the company's principals are not listed (are not debarred) through the System for Award Management (www.SAM.gov). Enclose a printout of the Entity Registration page that shows your firm is in active status and is not expired.

TIME OF PERFORMANCE: It is imperative that the prospective respondent respond to County requests in a timely manner and comply with required or proposed delivery schedules. Please describe how you intend to respond to and track County requests.

COMPLIANCE WITH LAWS: The successful bidder shall comply with all applicable federal, state and local laws and regulations pertaining to the practice of the profession and the execution of the duties under the bid.

INSURANCE: The successful bidder will be required to furnish proof of insurance for Workers’

Compensation, Auto Liability and General Liability before any work may begin.

It is the practice of Hays County to encourage local participation and to promote and encourage contracting and subcontracting opportunities for locally owned businesses and labor in all contracts.

The County of Hays does not discriminate on the basis of race, color, national origin, sex, religion, age and disability in employment or the provision of services.

C. Warranty of Performance The successful respondent expressly warrants that all services specified in the IFB will be performed with care and diligence and in accordance with all specifications of the IFB. The successful bidder agrees to correct any deficiencies in performance of services upon notification by the County and without additional expense to the County.

CONTINUING NON-PERFORMANCE of the bidder, in terms of specifications, shall be basis for the termination of the contract by the County. The County shall not pay for merchandise/services that are unsatisfactory. Failure to perform any provision will constitute a default of contract, in which case, corrective action shall take place within ten (10) days from the date of written notice citing the nature of breach.

Failure to take corrective action or to provide a satisfactory written reply excusing such failure within the prescribed ten (10) days will authorize the County to terminate this agreement by written notice.

COMPLIANCE WITH LAWS: The successful Respondents shall comply with all applicable federal, state and local laws and regulations pertaining to the practice of the profession and the execution of the duties under the solicitation. Any contract executed as a result of this IFB shall be governed by the laws of the State of Texas.

LIQUIDATED DAMAGES FOR DELAYS: If the work is not substantially complete within the contract time, the Contractor shall pay to the County as fixed, agreed, and liquidated damages (it being impossible to determine the actual damages occasioned by the delay) the amount of $750 (seven hundred fifty dollars) for each calendar day of delay, until the work is completed. The Contractor and Contractor’s sureties shall be liable to the County for the amount thereof.

EXCUSABLE DELAYS: The right of the Contractor to proceed shall not be terminated nor shall the Contractor be charged with liquidated damages for any delays in the completion of the work due to:

1. Any acts of the Government, including controls or restrictions upon or requisitioning of materials, equipment, tools, or labor by reason of war, national defense, or any other national emergency;

2. Any acts of the County;

3. Causes not reasonably foreseeable by the parties to this Contract at the time of execution which are beyond the control and without the fault or negligence of the Contractor, including, but not restricted to, acts of God, terrorism, war, acts of another Contractor in the performance of some other contract with the County, fires, floods, epidemics, quarantine, restrictions, strikes, freight embargoes, and weather of unusual severity such as hurricanes, tornadoes, cyclones and other extreme weather conditions;

Provided, however, that the Contractor promptly notifies the City/County within ten (10) days in writing of the cause of the delay. Upon receipt of such notification, the City/County shall ascertain the facts and the cause and extent of delay. If, upon the basis of the facts and the terms of this contract, the delay is properly excusable, the

County shall extend the time for completing the work for a period of time commensurate with the period of excusable delay.

SECTION 4

BID FORM

VENDOR/BIDDER’S AFFIRMATION

BID FORM: SCHEDULE OF RATES AND PRICES

CONFLICT OF INTEREST QUESTIONNAIRE

CERTIFICATION OF INTERESTED PARTIES

CODE OF ETHICS FOR HAYS COUNTY

HAYS COUNTY PRACTICES RELATED TO HISTORICALLY UNDERUTILIZED BUSINESSES

HOUSE BILL 89 VERIFICATION

SENATE BILL 252 CERTIFICATION

DEBARMENT AND LICENSING CERTIFICATION

VENDOR REFERENCES

RELATED PARTY DISCLOSURE FORM

APPENDIX II TO PART 200 - CONTRACT PROVISIONS FOR NON-FEDERAL ENTITIY

CONTRACTS UNDER FEDERAL AWARD

FHWA 1273 CERTIFICATION

STATE OF TEXAS CHILD SUPPORT BUSINESS OWNERSHIP FORM

4-2

BID FORM

PROJECT IDENTIFICATION

Project No. IFB 2024-B09 Winters Mill Parkway Roadway Improvements, Lighting & Pavement Markings

THIS BID IS SUBMITTED TO:

Electronically: BidNet Direct: www.bidnetdirect.com//hayscounty

Manually:

Hays County Purchasing Department Attn: Stephanie Hunt 712 South Stagecoach Trail, Suite 1012 San Marcos, Texas 78666

The undersigned BIDDER proposes and agrees, if this Bid is accepted, to enter into an agreement with COUNTY in the form included in the Contract Documents to perform and furnish all Work as specified or indicated in the Contract Documents for the Bid Price and within the Bid Times indicated in this Bid and in accordance with the other terms and conditions of the Contract Documents.

All Bids will be considered non-responsive if the following forms are not signed and submitted with the Bid

BIDDER accepts all of the terms and conditions of the Notice to Bidders and Instructions to Bidders, including without limitation those dealing with the disposition of Bid security. This Bid will remain subject to acceptance for 60 days after the day of Bid opening. BIDDER will sign and deliver the required number of counterparts of the Agreement with the Bonds and other documents required by the Bidding Requirements within 10 working days after the date of COUNTY’s Notice of Award.

This Bid is genuine and not made in the interest of or on behalf of any undisclosed person, firm, or corporation and is not submitted in conformity with any agreement or rules of any group, association, organization, or corporation;

BIDDER has not directly or indirectly induced or solicited any other Bidder to submit a false or sham Bid; BIDDER has not solicited or induced any person, firm, or corporation to refrain from bidding; and BIDDER has not sought by collusion to obtain for itself any advantage over any other Bidder or over COUNTY.

BIDDER will complete the work in accordance with the Contract Documents and the accompanying Schedule of Rates and Prices, and will pay not less than the Prevailing Wage Rates for Hays County, Texas. The work will be completed within 16 standard workweek days from the date for commencing work as set forth in the "Notice to Proceed" to be issued by the COUNTY.

Communications concerning this Bid shall be addressed to the address of BIDDER indicated below:

5-2

Terms used in this Bid which are defined in the General Provisions or Instructions will have the meanings indicated in the General Provisions or Instructions.

SUBMITTED ON , 20 .

State Contractor License Number

IF BIDDER is:

An Individual

By (SEAL)

(Individual’s Name)

(Signature) doing business as Business address:

Phone Number: Fax Number:

Email:

4-6

A Partnership

By (SEAL)

(Firm Name)

(General Partner)

(Signature)

Business address:

Phone Number: Fax Number:

Email:

A Corporation

By (SEAL)

(Corporate Name)

(State of Incorporation)

By (SEAL)

(Name of Person Authorized to Sign)

(Signature)

(Corporate Seal)

Attest:

(Secretary)

Business Address

4-7

Phone Number: Fax Number:

Email:

Date of Qualification to Do Business is

A Joint Venture

By (SEAL)

(Name)

(Address)

(Signature)

By

(Name)

(Address)

(Signature)

Phone & Fax Numbers, Email & mailing addresses for receipt of official communications:

(Each joint venturer must sign. The manner for signing for each individual, partnership, and corporation that is a party to the joint venture should be in the manner above.)

4-5

Vendor/Bidder’s Affirmation

1. Vendor/Bidder affirms that they are duly authorized to execute this Contract, that this company, corporation, firm, partnership or individual has not prepared this bid in collusion with any other bidder, and that the contents of this bid as to price, terms or conditions of said bid have not been communicated by the undersigned nor by any employee or agent to any other person engages in this type of business prior to the official opening of this bid.

2. Vendor/Bidder hereby assigns to Purchaser any and all claims for overcharges associated with this Contract which arise under the antitrust laws of the United States, 15 USCA Section 1 et seq., and which arise under the antitrust laws of the State of Texas, Tex. Bus. & Com. Code, Section 15.01, et seq.

3. Pursuant to 262.0276 (a) of the Texas Local Government Code, Vendor/Bidder, hereby affirms that Vendor/Bidder:

Does not own taxable property in Hays County, or;

Does not owe any ad valorem taxes to Hays County or is not otherwise indebted to Hays County

Name of Contracting Company

If taxable property is owned in Hays County, list property ID numbers:

Signature of Company Official Authorizing Bid/Offer

Printed Name Title

Email Address Phone

Full compensation for compliance with each and every provision of the Request for Bids, the Bid, the Specifications, and the Contract will be considered as included in the unit prices for the work set forth below, and no separate payment will be made for compliance with each and every provision of the Request for Bids, the Bid, the Specifications, and the Contract, unless separate payment is expressly provided for therein.

1Refer to the Technical Specifications section for a description of the specific reference number. Page 1 of 7

BID FORM

SCHEDULE OF RATES AND PRICES

HAYS COUNTY, TEXAS

PROJECT: IFB 2024-B09 Winters Mill Parkway Roadway Improvements, Lighting & Pavement Markings

BID TECH

ITEM SPEC1

DESCRIPTION

WITH UNIT PRICES IN WORDS

BID UNIT

QUANTITY MEASURE

UNIT COST AMOUNT BID

1 416 6029

DRILL SHAFT (RDWY ILL POLE)(30 IN)

48 LF $ -

at Dollars and Cents per

2 432 6001

RIPRAP (CONC)(4")

2.10 CY $ -

at Dollars and Cents per

3 500 6001

MOBILIZATION

1 LS $ -

Dollars and Cents per

4 502 6001

BARRICADES, SIGNS AND TRAFFIC HANDLING

2 MO $ -

at Dollars and Cents per

5 610 6162

IN RD IL (TY SA) 30T-8 (250W EQ) LED

6 EA $ -

at Dollars and Cents per

6 618 6023

CONDT (PVC) (SCH 40) (2")

1005 LF $ -

at Dollars and Cents per

7 618 6024

CONDT (PVC) (SCH 40) (2") (BORE)

35 LF $ -

at Dollars and Cents per

8 620 6007

ELEC CONDR (NO.8) BARE

1080 LF $ -

at Dollars and Cents per

Full compensation for compliance with each and every provision of the Request for Bids, the Bid, the Specifications, and the Contract will be considered as included in the unit prices for the work set forth below, and no separate payment will be made for compliance with each and every provision of the Request for Bids, the Bid, the Specifications, and the Contract, unless separate payment is expressly provided for therein.

1Refer to the Technical Specifications section for a description of the specific reference number. Page 2 of 7

BID FORM

SCHEDULE OF RATES AND PRICES

HAYS COUNTY, TEXAS

PROJECT IFB 2024-B09 Winters Mill Parkway Roadway Improvements, Lighting & Pavement Markings

BID TECH

ITEM SPEC1

DESCRIPTION

WITH UNIT PRICES IN WORDS

BID UNIT

QUANTITY MEASURE UNIT COST AMOUNT BID

9 620 6008

ELEC CONDR (NO.8) INSULATED

2160 LF $ -

at Dollars and Cents per

10 624 6002

GROUND BOX TY A (122311)W/APR ON

2 EA $ -

at Dollars and Cents per

11 628 6045

ELC SRV TY A 240/480 060(NS)SS(E)SP(O)

2 EA $ -

Dollars and Cents per

12 666 6035

REFL PAV MRK TY I (W)8"(SLD)(090MIL)

280 LF $ -

at Dollars and Cents per

13 666 6047

REFL PAV MRK TY I (W)24"(SLD)(090MIL)

41 LF $ -

at Dollars and Cents per

14 666 6053

REFL PAV MRK TY I (W) (ARROW) (090MIL)

3 EA

at Dollars and Cents per

15 666 6077

REFL PAV MRK TY II (W) (WORD)

2 EA $ -

at Dollars and Cents per

16 666 6174

REFL PAV MRK TY II (W) 6” (SLD)

21,900 LF $ -

at Dollars and Cents per

Full compensation for compliance with each and every provision of the Request for Bids, the Bid, the Specifications, and the Contract will be considered as included in the unit prices for the work set forth below, and no separate payment will be made for compliance with each and every provision of the Request for Bids, the Bid, the Specifications, and the Contract, unless separate payment is expressly provided for therein.

1Refer to the Technical Specifications section for a description of the specific reference number. Page 3 of 7

BID TECH

ITEM SPEC1

DESCRIPTION

WITH UNIT PRICES IN WORDS

BID UNIT

QUANTITY MEASURE UNIT COST AMOUNT BID

17 666 6178

REFL PAV MRK TY II (W) 8” (SLD)

280 LF $ -

at Dollars and Cents per

18 666 6182

REFL PAV MRK TY II (W) 24” (SLD)

41 LF $ -

at Dollars and Cents per

19 666 6184

REFL PAV MRK TY II (W) (ARROW)

3 EA $ -

Dollars and Cents per

20 666 6192

REFL PAV MRK TY II (W) (WORD)

2 EA $ -

at Dollars and Cents per

21 666 6208

REF PAV MRK TY II (Y) 6" (BRK)

1,900 LF $ -

at Dollars and Cents per

22 666 6210

REF PAV MRK TY II (Y) 6" (SLD)

10,880 LF $ -

at Dollars and Cents per

23 666 6285

REF PROF PAV MRK TY I (Y)6"(BRK)(090MIL)

21,900 LF $ -

at Dollars and Cents per

24 666 6289

REF PROF PAV MRK TY I (Y)6"(SLD)(090MIL)

10,880 LF

at Dollars and Cents per

BID FORM

SCHEDULE OF RATES AND PRICES

HAYS COUNTY, TEXAS

PROJECT IFB 2024-B09 Winters Mill Parkway Roadway Improvements, Lighting & Pavement Markings

Full compensation for compliance with each and every provision of the Request for Bids, the Bid, the Specifications, and the Contract will be considered as included in the unit prices for the work set forth below, and no separate payment will be made for compliance with each and every provision of the Request for Bids, the Bid, the Specifications, and the Contract, unless separate payment is expressly provided for therein.

1Refer to the Technical Specifications section for a description of the specific reference number. Page 4 of 7

25 666 6291

REF PROF PAV MRK TY I (Y)6”(BRK)(090MIL)

1,900 LF $ -

at Dollars and Cents per

26 672 6007

REFL PAV MRKR TY I-C

at Dollars and Cents per

14 EA $ -

27 672 6009

REFL PAV MRKR TY II-A-A

at Dollars and Cents per

233 EA $ -

28 6056 6002

PREFORMED CENTERLINE RUMBLE STRIP

3380 LF $ -

at Dollars and Cents per

29 6185 6002

TMA (STATIONARY)

5 DAY $ -

at Dollars and Cents per

30 6185 6005

TMA (MOBILE OPERATION)

5 DAY $ -

at Dollars and Center per

TOTAL AMOUNT OF BID

Dollars and Cents

BID

ITEM

TECH

SPEC1

DESCRIPTION

WITH UNIT PRICES IN WORDS

BID

QUANTITY

UNIT

MEASURE

UNIT COST AMOUNT BID

BID FORM

SCHEDULE OF RATES AND PRICES

Full compensation for compliance with each and every provision of the Request for Bids, the Bid, the Specifications, and the Contract will be considered as included in the unit prices for the work set forth below, and no separate payment will be made for compliance with each and every provision of the Request for Bids, the Bid, the Specifications, and the Contract, unless separate payment is expressly provided for therein.

1Refer to the Technical Specifications section for a description of the specific reference number. Page 5 of 7

NOTE: THE COURT MAY EITHER REJECT ALL BIDS OR AWARD A CONTRACT TO THE LOWEST AND/OR BEST BID.

Acknowledgment of Addenda

Addendum No. 1:

Addendum No. 2:

Addendum No. 3:

BID FORM

SCHEDULE OF RATES AND PRICES

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor doing business with local governmental entity

FORM CIQ

OFFICE USE ONLY

Date Received

This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.

This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).

By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.

A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor.

1 Name of vendor who has a business relationship with local governmental entity.

Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)

3 Name of local government officer about whom the information is being disclosed.

Name of Officer

4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.

Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary.

A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor?

Yes No

B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity?

Yes No

5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an

Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).

Signature of vendor doing business with the governmental entity Date ownership interest of one percent or more.

www.ethics.state.tx.usForm provided by Texas Ethics Commission Revised 1/1/2021 www.ethics.state.tx.us

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor doing business with local governmental entity

A complete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.

Local Government Code § 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on:

(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity;

(B) a transaction conducted at a price and subject to terms available to the public; or

(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency.

Local Government Code § 176.003(a)(2)(A) and (B):

(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:

(2) the vendor:

(A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that

(i) a contract between the local governmental entity and vendor has been executed;

or

(ii) the local governmental entity is considering entering into a contract with the vendor;

(B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that:

(i) a contract between the local governmental entity and vendor has been executed; or

(ii) the local governmental entity is considering entering into a contract with the vendor.

Local Government Code § 176.006(a) and (a-1)

(a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and:

(1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A);

(2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or

(3) has a family relationship with a local government officer of that local governmental entity.

(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of:

(1) the date that the vendor:

(A) begins discussions or negotiations to enter into a contract with the local governmental entity; or

(B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or

(2) the date the vendor becomes aware:

(A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a);

(B) that the vendor has given one or more gifts described by Subsection (a); or

(C) of a family relationship with a local government officer.

Form provided by Texas Ethics Commission Revised 1/1/2021

Certificate of Interested Parties

In 2015, the Texas Legislature adopted House Bill 1295, which added 2252.908 to the Texas Government Code and applies to all contracts entered into on or after January 1, 2016. Section 2252.908 (b)(1)(2) applies only to a contract of a governmental entity or state agency that requires an action or vote by the governing body of the entity or agency before the contract may be signed or that has a value of at least $1 million. In addition, pursuant to Section 2252.908 (d), a governmental entity or state agency may not enter into a contract described by Subsection (b) with a business entity unless the business entity, in accordance with this section and rules adopted under this section, submits a disclosure of interested parties to the governmental entity or state agency at the time the business entity submits the signed contract to the governmental entity or state agency.

With regard to Hays County purchases, a vendor that is awarded a contract or purchase approved by Hays County Commissioner’s Court is required to electronically complete a Form 1295 through the Texas Ethics Commission website (https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm) and submit a signed and notarized copy of the form to the County. A contract, including County issued purchase order (if applicable), will not be enforceable or legally binding until the County receives and acknowledges receipt of the properly completed Form 1295 from the awarded vendor.

CODE OF ETHICS FOR HAYS COUNTY

Public employment is a public trust. It is the policy of Hays County to promote and balance the objective of protecting government integrity and the objective of facilitating the recruitment and retention of personnel needed by Hays County. Such a policy implemented by prescribing essential standards of ethical conduct without creating unnecessary obstacles to entering public services.

Public servants must discharge their duties impartially so as to assure fair competitive access to governmental procurement by responsible contractors. Moreover, they should conduct themselves in such a manner as to foster public confidence in the integrity of the Hays County procurement organization.

To achieve the purpose of this article, it is essential that those doing business with Hays County also observe the ethical standards prescribed here.

It shall be a breach of ethics to attempt to influence any public employee, elected official or department head to breach the standards of ethical conduct set forth in this code.

It shall be a breach of ethics for any employee of Hays County or a vendor doing business with the county to participate directly or indirectly in a procurement when the employee or vendor knows that:

The employee or any member of the employee’s immediate family, or household has a substantial financial interest pertaining to the procurement. This means ownership of 10% or more of the company involved and/or ownership of stock or other interest or such valued at $2500.00 or more.

A business or organization in which the employee, or any member of the employee’s immediate family, has a financial interest pertaining to the procurement.

Gratuities: It shall be a breach of ethics to offer, give or agree to give any employee of Hays County or for any employee to solicit, demand, accept or agree to accept from a vendor, a gratuity of consequence or any offer of employment in connection with any decision approval, disapproval, recommendation, preparation or any part of a program requirement or purchase request influencing the content of any specification or procurement standard, rendering of advice, investigation, auditing, or in any other advisory capacity in any proceeding or controversy, any particular matter pertaining to any program requirement or a contract or subcontract, or to any solicitation or proposal therefore pending before this government.

Kickbacks: It shall be a breach of ethics for any payment, gratuity or offer of employment to be made by or on behalf of a subcontractor under a contract to the prime contractor or higher tier subcontractor for any contract for Hays County as an inducement for the award of a contract or order.

Contract Clause: The prohibition against gratuities and kickbacks prescribed above shall be conspicuously set forth in every contract and solicitation therefore.

Any effort to influence any employee, elected official, or department head to violate the standards of the code is grounds to void the contract. Please certify, by your signature below, that you understand the ethics policy of Hays County and in no way will attempt to violate the code.

SIGNATURE:

PRINT NAME & TITLE:

COMPANY NAME:

Hays County Practices Related to Historically Underutilized Businesses

1. STATEMENT OF PRACTICES

Hays County will strive to ensure that all businesses, regardless of size, economic, social or ethnic status have an equal opportunity to participate in the County’s procurement processes. The County is committed to promote full and equal business opportunity for all businesses to supply the goods and services needed to support the mission and operations of county government, and seeks to encourage the use of certified historically underutilized businesses (HUB’s) through the use of race, ethnic and gender neutral means. It is the practice of Hays County to involve certified HUBs to the greatest extent feasible in the County’s procurement of goods, equipment, services and construction projects while maintaining competition and quality of work standards. The County affirms the good faith efforts who recognize and practice similar business standards.

2. DEFINITIONS

Historically underutilized businesses (HUBs), also known as a disadvantaged business enterprise (DBE), are generally business enterprises at least 51% of which is owned and the management and daily business operations are controlled by one or more persons who is/are socially and economically disadvantaged because of his/her identification as a member of certain groups, including women, Black Americans, Mexican Americans, and other Americans if Hispanic origin, Asian Americans and American Indians.

Businesses include firms, corporations, sole proprietorships, vendors, suppliers, contractors, subcontractors, professionals and other similar references when referring to a business that provides goods and/or services regardless of the commodity category.

Certified HUB’s include business enterprises that meet the definition of a HUB and who meet the certification requirements of certification agencies recognized by Hays County, as expressed below.

Statutory bid limit refers to the Texas Local Government Code provision that requires competitive bidding for many items valued at greater than $50,000.

3. GUIDELINES

a. Hays County, its contractors, their subcontractors and suppliers, as well as all vendors of goods, equipment and services, shall not discriminate on the basis of race, color, creed, gender, age, religion, national origin, citizenship, mental or physical disability, veteran’s status or political affiliation in the award and/or performance of contracts. All entities doing business or anticipating doing business with the County shall support, encourage and implement affirmative steps toward a common goal of establishing equal opportunity for all citizens and businesses of the County.

b. Vendors and/or contractors desiring to participate in the HUB program must successfully complete the certification process with the State of Texas or Texas Unified Certification Program.

The vendor or contractor is also required to hold a current valid certification (title) from either of these entities.

c. Vendors and/or contractors must be registered with the State Comptroller’s web-based HUB directory and with the Comptroller’s Centralized Master Bidder’s List (CMBL). Hays

County will solicit bids from certified HUB’s for state purchasing and public works contracts.

4. Hays County will actively seek and encourage HUBs to participate in all facets of the procurement process by:

a. Continuing to increase and monitor a database of certified HUB vendors, professionals and contractors. The database will be expanded to include products, areas of expertise and capabilities of each HUB firm.

b. Continuing to seek new communication links with HUB vendors, professionals and contractors to involve them in the procurement process.

c. Continuing to advertise bids on the County’s website and in the newspapers including newspapers that target socially and economically disadvantaged communities.

5. As prescribed by law, the purchase of one or more items costing in excess of the statutory bid limit must comply with the competitive bid process. Where possible, those bids will be structured to include and encourage the participation of HUB firms in the procurement process by:

a. Division of proposed requisitions into reasonable lots in keeping with industry standards and competitive bid requirements.

b. Where feasible, assessment of bond and insurance requirements and the designing of such requirements to reasonably permit more than one business to perform the work.

c. Specifications of reasonable, realistic delivery schedules consistent with the County’s actual requirements.

d. Specifications, terms and conditions reflecting the County’s actual requirements are clearly stated, and do not impose unreasonable or unnecessary contract requirements.

6. A HUB practice statement shall be included in all specifications. The County will consider the bidder’s responsiveness to the HUB Practices in the evaluation of bids and proposals. Failure to demonstrate a good faith effort to comply with the County’s HUB practices may result in a bid or proposal being considered non-responsive to specifications.

7. Nothing in this practice statement shall be construed to require the County to award a contract other than to the lowest responsive bidder as required by law. This practice is narrowly tailored in accordance with applicable law.

Please sign for acknowledgement of the Hays County HUB Practices:

Signature Date

Hays County House Bill 89 Verification

I, _____________________________________ (Person name), the undersigned representative of

________________________________(Company or Business name, hereafter referred to as Company) being an adult over the age of eighteen (18) years of age, after being duly sworn by the undersigned notary, do hereby depose and verify under oath that the company named above, under the provisions of Subtitle F, Title 10, Government Code Chapter 2270:

1. Does not boycott Israel currently; and

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

Pursuant to Section 2270.001, Texas Government Code:

1. “Boycott Israel” means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes; and

2. “Company” means a for-profit sole proprietorship, organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or any limited liability company, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate of those entities or business associations that exist to make a profit.

Signature of Company Representative Date

On this _____ day of ____________________, 20____, personally appeared ________________________________, the above-named person, who after by me being duly sworn, did swear and confirm that the above is true and correct.

NOTARY SEAL ____________________________________

Notary Public in and for the State of Texas

(if other than Texas, Write state in here ______________________)

Date

Hays County Purchasing Department Senate Bill 252 Certification

Pursuant to Texas Government Code, Chapter 2252, Section 2252.152 and Section 2252.153, certify that the company named below is not listed on the website of the Comptroller of the State of Texas concerning the listing of companies that are identified under Section 806.051, Section 807.051 or Section 2253.153. I further certify that should the above-named company enter into a contract that is on said listing of companies on the website of the Comptroller of the State of Texas which do business with Iran, Sudan or any Foreign Terrorist Organization, I will immediately notify the Hays County Purchasing Department.

Company Name

Print Name of Company Representative

Signature of Company Representative

Date

CERTIFICATION CHECK PERFORMED BY HAYS COUNTY PURCHASING:

On this day; the Purchasing Representative for Hays County in San Marcos, Texas, pursuant to Texas Government Code, Chapter 2252, Section 2252.152 and Section 2252.153, certify that I did review the website of the Comptroller of the State of Texas concerning the listing of companies that is identified under Section 806.051, Section 807.051 or Section 2253.253 and I have ascertained that the above-named company is not contained on said listing of companies which do business with Iran, Sudan or any Foreign Terrorist Organization.

Print Name of Hays County Purchasing Representative

Signature of Hays County Purchasing Representative

Date

IFB/RFP/RFQ Number

DEBARMENT AND LICENSING CERTIFICATION

STATE OF (___________________) §

COUNTY OF HAYS §

I, the undersigned, being duly sworn or under penalty of perjury under the laws of the United States and the State of Texas, certifies that Firm named herein below and its principals:

a. Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any federal department or agency;

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

c. Are not presently indicted for or otherwise criminally or civilly charged by a federal, state or local governmental entity with commission of any of the offenses enumerated in paragraph (1)(b) of this certification;

d. Have not within a three-year period preceding this application/proposal had one or more public (federal, state or local) transactions terminated for cause or default;

e. Are registered and licensed in the State of Texas to perform the professional services which are necessary for the project; and

f. Have not been disciplined or issued a formal reprimand by any State agency for professional accreditation within the past three years.

Name of Firm

Signature of Certifying Official Title of Certifying Official

Printed Name of Certifying Official Date

Where the Firm is unable to certify to any of the statements in this certification, such Firm shall attach an explanation to this certification.

SUBSCRIBED and sworn to before me the undersigned authority by _____________________________________on this the day of _______, 20___, on behalf of said Firm.

Notary Public in and for the State of Texas (If other than Texas, Write state in here ______________________

My commission expires: ________________

Vendor References

List three (3) references of current customers who can verify the quality of service your company provides. The County prefers customers of similar size and scope of work to this proposal/bid. This form must be returned with your bid/proposal.

Company Name:

Address:

Contact Person and Title:

Phone Number:

Email: ____________________________________________________________________________________________________

Scope & Duration of Contract:

Email: ____________________________________________________________________________________________________

Email: ____________________________________________________________________________________________________

REFERENCE ONE

REFERENCE TWO

REFERENCE THREE

Related Party Disclosure Form

Hays County strives to provide financial transparency to its taxpayers. Completion of this form will allow for added transparency into the procurement process by disclosing Vendor relationships with current or former Hays County employees. The existence of a relationship may not present a legal or ethical conflict for a Vendor. However, disclosure will allow for consideration of potential conflicts and/or ways to eliminate conflicts.

A Vendor who Employs any of the following is required to disclose the relationship on this form:

Current Hays County employee (including elected or appointed official)(Complete Section A) Former Hays County employee who has been separated from Hays County for no less than four (4) years

(including elected or appointed official) (Complete Section B) Person related within the 2nd degree of consanguinity or affinity to either of the above(1) (Complete Section C)

If no known relationships exist, complete Section D.

This form is required to be completed in full and submitted with the proposal package. A submitted proposal package that does not include this completed form will be considered non-responsive and will not be eligible for an award.

Attach additional pages if necessary.

Section A: Current Hays County Employee

Employee Name Title

Section B: Former Hays County Employee

Employee Name Title Date of Separation from County

Section C: Person Related to Current or Former Hays County Employee

Employee or Former Employee Name Title

Name of Related Person Title Relationship

Section D: No Known Relationships

If no relationships in accordance with the above exist or are known to exist, provide a written explanation below:

I, the undersigned, hereby certify that the information provided is true and complete to the best of my knowledge.

Name of Vendor

Signature of Certifying Official Title of Certifying Official

Printed Name of Certifying Official Date

(1)A degree of relationship is determined under Texas Government Code Chapter 573. (as outlined below)

Relationship of Consanguinity

Person

1st Degree 2nd Degree 3rd Degree* 4th Degree* child or parent grandchild, sister, brother or grand-parent great-grandchild, niece, nephew, aunt,* uncle* or great-grandparent…