ESBD_File_352803_RFP 945-Gases, Welding, Steel.pdf

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RFP 945 Lab Gases, Welding Gases, Core Welding Items, Flat Bar, Pipe & Plate Supplies
Solicitation number
RFP945
Issued by
Harris County, Texas

About this file

This document is a Request for Proposal (RFP) issued by Lone Star College (LSC) in Texas for lab gases, welding gases, core welding items, flat bar, pipe, and plate supplies. LSC is seeking a pool of suppliers to provide these products for its science lab, health science, and welding programs. The RFP has a non-exclusive award, with no guarantee of volume. Respondents must complete pricing worksheet Exhibit A and understand that all prices are due by the proposal deadline of March 19, 2024. The RFP has a pre-proposal WebEx conference on March 18, 2024, and a proposal submission deadline of March 28, 2024. LSC plans to evaluate proposals and recommend a selection to its Board of Trustees on June 6, 2024. The awarded contract will be for an initial 3-year term with two optional 1-year renewals, not to exceed 5 years total.

The RFP outlines the evaluation criteria, which includes purchase price, reputation, quality, meeting College needs, past relationship, HUB compliance, long-term cost, and the location of the respondent's parent company. Respondents are encouraged to utilize certified HUB, minority, women, and veteran-owned businesses, with set goals and penalties for non-compliance. LSC reserves the right to refuse any rate increases deemed unreasonable.

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REQUEST FOR PROPOSAL

RFP # 945

Lab Gases, Welding Gases, Core Welding Items

Flat Bar, Pipe & Plate Supplies

Bids due: Tuesday, March 19, 2024, at 5:00PM

Issued By:

Lone Star College 5000 Research Forest Drive

The Woodlands, Texas 77381

RFP # 945 Lab Gases, Welding Gases, Core Welding Items, Flat Bar, Pipe & Plate Supplies

TABLE OF CONTENTS

RFP # 945

Lab Gases

Welding Gases, Core Welding Items

Flat Bar, Pipe & Plate Supplies

• BACKGROUND INFORMATION

• LSC SERVICE AREA

• CALENDAR OF EVENTS

• WEBEX INFORMATION

• CONTRACT TERMS

• SCOPE OF WORK

• EVALUATION CRITERIA PROCESS

• CERTIFIED HISTORICALLY UNDERUTILIZED BUSINESS (HUB) AND M/WBE

• PROVISIONS FOR RECOMMENDATION

• INTERPRETATION OR CORRECTION

• SUBMITTAL FORMAT

• IMPORTANT iSTAR VENDOR PORTAL NOTES

BACKGROUND INFORMATION

Lone Star College enrolls over 80,000 credit students each semester providing high-quality, low-cost academic transfer and career training education. LSC is also training tomorrow’s workforce today and redefining the community college experience to support student success.

LSC consists of 23 locations, including eight colleges, seven centers, and eight Workforce Centers of Excellence, all located in the greater Houston area.

Fully accredited, Lone Star College offers industry-specific certifications, associates and workforce bachelor’s degrees and it’s 7,300 employees are committed to supporting students both in and outside the classroom.

Lone Star College serves an area of more than 2,700 square miles with a total population of 2.7 million residents, provides an annual economic impact of nearly $3 billion and is a major and growing contributor to the local economy.

Mario K. Castillo, J.D., serves as chancellor of LSC, the largest institution of higher education in the Houston area. LSC has been named a 2023 Great Colleges to Work For® institution by the Chronicle of Higher Education and recognized by Fortune Magazine and Great Place To Work® as one of this year’s Best Workplaces in Texas™.

Visit LoneStar.edu to learn more.

http://www.lonestar.edu/

CALENDAR OF EVENTS

Listed below are the dates and times by which stated actions need to be completed. If LSC determines, in its sole discretion, that it is necessary to change any of the dates and times, LSC will issue a written Addendum to this RFP. All listed times are Central Standard Time.

DATE / TIME ACTION

Tuesday, March 05, 2024 1st Legal advertising & release of RFP

Tuesday, March 12, 2024 2nd Legal advertising

Monday, March 18, 2024 @ 2:00 PM Web-Ex Pre-proposal Conference (non-mandatory) *This is a demo of the iStar bid submission process.

Tuesday, March 19, 2024 @ 5:00PM

Last day and time for Respondents to submit email communications and inquiries. Inquiries need to be addressed to: Dina.Sauser@lonestar.edu

Friday, March 22, 2024 @ 5:00 PM Addenda, if any, responding to written communications/inquiries will be emailed to Respondents.

Thursday, March 28, 2024 @ 5:00 PM Deadline for proposal submission

Week of April 02, 2024 Evaluation of Proposals

Thursday, June 6, 2024 Recommendation of Selected Respondent(s) to the Board of Trustees mailto:Dina.Sauser@lonestar.edu

WEBEX INFORMATION

Monday, March 18, 2024, 2:00 PM Central Standard Time | 1 hr.

Join from the meeting link https://lonestar.webex.com/lonestar/j.php?MTID=mde1fc6d03b52312d22fa19ae314488 d5 Join by meeting number Meeting number (access code): 2632 447 8289 Meeting password: bmCJdmqg856 Tap to join from a mobile device (attendees only) +1-408-792-6300,,26324478289## Call-in toll number (US/Canada) Join by phone 1-408-792-6300 Call-in toll number (US/Canada) Join from a video system or application Dial 26324478289@lonestar.webex.com You can also dial 173.243.2.68 and enter your meeting number.

WebEx agenda:

1. How to register as a supplier,

2. Where to locate the bid documents and

3. How to successfully submit a bid proposal.

The individual responsible for uploading the bid proposal submission is strongly recommended to attend this online meeting.

CONTRACT TERMS

This Request for Proposal (“RFP”) and the information contained are invitations to bid.

This RFP is not a contract nor an offer to contract. No contractual obligations shall arise until a formal agreement between Lone Star College and the successful respondent(s) is executed.

The term of the award with the successful respondent will be for an initial period of three years, with an additional two (2) one-year options, by mutual consent—not to exceed a total contract term of five years.

Per Lone Star College Policy Manual, Section III.D.1.4 and III.D.1.7, all vendors are responsible for verifying an individual’s or organization’s authority before any purchase, contract, or debt is incurred. Persons making unauthorized purchases are fully responsible for such debts. Therefore, vendors are not to render services or provide goods to Lone Star College until a contract is executed.

https://lonestar.webex.com/lonestar/j.php?MTID=mde1fc6d03b52312d22fa19ae314488d5%20 https://lonestar.webex.com/lonestar/j.php?MTID=mde1fc6d03b52312d22fa19ae314488d5%20

SCOPE OF WORK

This proposal intends to develop an ongoing relationship with a pool of suppliers who can provide lab gases, welding gases, core welding items, and flat bar, pipe & plate supplies for programs such as science lab, health science, and welding at Lone Star College.

Respondents will be awarded based on the product offering, cost structure, and best value for the College. The respondents shall understand that the award of this RFP is non-exclusive, and LSC provides no guarantee that the respondent(s) will be awarded.

Respondents shall complete Exhibit A Pricing Worksheet, as applicable, with prices for Lab Gases, Welding Gases, Core Welding Items, and Flat Bar, Pipe & Plate Supplies.

For comparison purposes, all prices for the above listed items shall be as of March 19, 2024 (deadline for proposal).

All purchases may vary according to instructional needs. Quotes will be requested, received, and approved before the College makes any purchase. All quotes shall indicate unit price, including shipping, fuel, and delivery charges. The College reserves the right to obtain quotes based on the best value for the College.

The College will not accept restocking fees or other charges for incorrect deliveries received due to the supplier's error.

The respondents shall protect all finished building surfaces from damage and repair caused by the delivery of any equipment or supplies.

EVALUATION CRITERIA PROCESS

All Requests for Proposals shall be evaluated by members of an evaluation committee based on the criteria listed below. The committee consists of individuals who are well-versed in the subject matter and those who will be the beneficiaries or users of said RFP.

Weighted scoring criteria for the review of the submitted proposals following Texas Education Code §44.031 will be:

1 The purchase price 30%

2 The reputation of the respondent and of the respondent’s goods or services 5%

3 The quality of the respondent’s goods or services 10%

4 The extent to which the goods or services meet the district’s (LSC’s) needs 30%

5 The respondent’s past relationship with the district (LSC) 5%

6 The impact on the ability of the college to comply with laws and rules relating to historically underutilized businesses (HUB) 5%

7 The total long-term cost to the district (LSC) to acquire the vendor’s goods or services 5%

The respondent’s ultimate parent company or majority owner has its principal place of business in Texas or employs at least 500 persons in Texas

5%

9 Any other relevant factor specifically listed in this request for bids or proposals 5%

TOTAL 100%

The information provided under each of the above criteria factors shall be as follows:

1. The purchase price

a. The respondent will include all applicable costs in their RFP response, including, but not limited to, future costs that may apply and that are not resulting from additional services requested by the college

b. The Respondent must agree to hold all annual increases and discounts for the Core Welding Items as applicable. Any changes to this must be submitted and approved in writing by a duly authorized representative of the College.

c. Lone Star College reserves the right to refuse any rate increase it may deem unreasonable. Respondent shall not consider a “no response” as an approval to proceed.

d. Respondents shall complete Exhibit A – Pricing Worksheet.

2. The reputation of the respondent and the respondent’s goods or services

a. Provide previous experience and references with similar goods and services for similar scopes of work (maximum of three (3) pages for submittal).

3. The quality of the respondent’s goods or services

a. Provide the quality control plan your company will follow to ensure the College will receive the best quality of service requested under this RFP

4. The extent to which the goods or services meet the college’s needs

a. Provide the company name, address, telephone number, and the proposed account executive.

b. Provide detailed product specifications for any equivalents offered

5. The respondent’s past relationship with the college

a. Previous contract award and respondent’s track record.

b. This is an opportunity to evaluate how the respondent has performed on a previous contract award with LSC. New firms with no history with the College will receive three (3) points. No respondent response is needed here.

6. The impact on the ability of the college to comply with laws and rules relating to historically underutilized businesses (HUB) Certified HUB, Minority and/or Veteran and Women-Owned Businesses Participation:

a. If applicable, provide a copy of Certified HUB, Minority and/or Veteran and Women-Owned Businesses certification.

b. If applicable, indicate the percentage of Certified HUB, Minority and/or Veteran and Women-Owned Businesses participation you wish to achieve.

c. Provide procedures to achieve the established plan.

d. Provide an example of tools your Firm uses to report to Owners on the actual use of Certified HUB, Minority and/or Veteran and Women-Owned Businesses.

7. The total long-term cost to the college to acquire the respondent’s goods or services

a. Provide any other components that may add cost to the bid price.

8. The respondent’s ultimate parent company or majority owner has its principal place of business in Texas or employs at least 500 persons in Texas

a. Does your parent company or majority owner have its principal place of business in Texas?

b. Does your parent company or majority owner employ at least 500 persons in

Texas?

9. Any other relevant factor specifically listed in this request for bids or proposals

a. Provide any recommendations or enhanced services your company can provide relevant to the RFP.

b. This bid factor will evaluate the comprehensiveness of your company’s response to the proposal, including all attachments and required information provided to assess your company’s capacity, experience, staffing, and quality control measures.

c. Bidder’s discretion. Respondent should indicate whether it would be willing to accept payment from Buyer via credit card with JPMorgan Chase Bank. Such payment would result in a quicker turnaround time of the respondent’s invoice once approved, eliminating the possibility of lost checks, mail delays, etc. If the successful respondent has indicated that they will accept such payment, further information will be available at the time of the award.

CERTIFIED HISTORICALLY UNDERUTILIZED BUSINESS (HUB) and MINORITY, WOMEN, AND VETERAN BUSINESS ENTERPRISE (M/WVBE)

Lone Star College (LSC) promotes and encourages contracting and subcontracting opportunities for Certified HUB and Minority, Women, and Veteran Business Enterprises (M/WVBE) in all proposals/contracts. Respondents are encouraged to include Certified HUB and Minority, Women, and Veteran Business Enterprises whenever feasible, which may consist of subcontracts for products and services. For non-HUB and non-M/WVBE firms, Respondents selected for an on-site interview will be asked to present a HUB/MWBE subcontractor plan as part of its presentation.

Noncompliance with Commitment Participation Utilization Goal:

A Respondent will propose a participation commitment utilization percentage (or goal), which will be tracked by a progress assessment report based on data provided monthly.

The monthly submittal of the Progress Assessment Report is mandatory; failure to meet the utilization goal will subject the Respondent to penalties based on the amount of the goal not achieved. Attached will be the mandated LSC Prime Contractor Progress Assessment Report form.

Utilization Goal and Penalty:

If a Respondent utilization goal is not met, there will be a penalty assessed on the amount not achieved using the following sliding scale.

Utilization Goal

Penalty Applied to

Amount not Achieved

0-20% 5% 21-40% 4% 41-60% 3% 61-80% 2.75% 81-100% 2.50%

A Respondent must recommend and receive approved written consent from the LSC Supplier Diversity Department for any substitutions of Certified HUB and Minority, Women, and Veteran Business Enterprises related to maintaining the participation commitment or goal. A Respondent who intentionally and/or knowingly misrepresents facts may be suspended from participating in work for not less than one (1) year.

PROVISIONS FOR RECOMMENDATION

LSC reserves the right to:

1. Reject any and/or all Proposals.

2. Revise the RFP and/or issue addenda to the RFP if necessary. An addenda will be provided to all those who received the RFP notice.

3. Accept any Proposals or a portion thereof that, in the opinion of LSC, are the most advantageous to LSC.

4. Cancel this RFP in partial or total; to make a partial or no award if it determines that such action is in the college's best interest.

5. Request additional references when deemed necessary.

6. Conduct a post-award meeting with the successful Respondent as deemed necessary.

7. Request additional information or clarifications from the Respondent(s), if needed.

8. Award this RFP to the respondent or respondents providing the best value for goods or services.

9. Pricing will be held firm 180 days after the bid closes.

INTERPRETATION OR CORRECTION

LSC is not liable for interpretations, misinterpretations, or other errors or omissions the respondent makes in responding to this RFP. Any required addendum to the RFP will be made in writing by the LSC purchasing department. Any person, firm, or corporation submitting a proposal is deemed to have read, understood, and agreed to all terms, conditions, and requirements outlined in the RFP. The respondent agrees to conform to the terms of the RFP, details of which will be outlined in a signed agreement between LSC and the respondent.

From the date of issuance of the RFP until a contract is fully executed, the respondent must not discuss the proposals or any part thereof with any employee, agent, or representative of LSC except as expressly requested by LSC in writing. Violating this restriction will result in rejecting the respondent’s proposal.

All inquiries, requests for clarification, or additional information must be submitted in writing to the commodity manager. In the written request, the respondent must identify him/herself and provide the page number, section, and paragraph in question. All written inquiries must be received by LSC no later than the scheduled date shown in the Calendar of Events outlined in this document.

All LSC responses will be provided to all prospective respondents. All addenda issued by LSC shall become a part of the RFP, and respondents shall acknowledge receipt of each addendum by the corresponding number and date in its response.

Inquiries concerning this RFP should be addressed to LSC as follows:

Dina Sauser, Commodity Manager E-mail: dina.sauser@lonestar.edu Phone: (832) 813-6532

SUBMITTAL FORMAT

Responses to this RFP shall be submitted online through the iStar Vendor Portal in the order outlined in the Table of Contents. No paper or email submissions will be accepted.

Register to submit a bid proposal or view online documents at http://wwwappsdstc.lonestar.edu/istar/supplier.htm.

For assistance with the online registration process, contact MC-Vendors@lonestar.edu

IMPORTANT iSTAR VENDOR PORTAL NOTES:

The respondents are responsible for successfully submitting bid proposals before the bid close date and time specified in the Calendar of Events. Once your proposal has been submitted successfully in the iStar Vendor Portal, the email address that is associated with the registration will receive an automated confirmation email.

If you believe that you have successfully submitted your bid proposal and did not receive a confirmation email and you have confirmed that it did not go to your SPAM, then contact the Commodity Manager.

Please upload as one PDF attachment on line 1 in iStar the following required information in your proposal in the order of the Table of Contents.

Please name your PDF file as such: RFP945 _YourCompanyName.pdf

Please return the following documents below this page in your bid submittal.

mailto:dina.sauser@lonestar.edu http://wwwappsdstc.lonestar.edu/istar/supplier.htm mailto:MC-Vendors@lonestar.edu

(1) TABLE OF CONTENTS CHECKLIST

Your Company Name:

☐ 1. Table of Contents Checklist

☐ 2. Pricing Worksheet

☐ 3. Primary Contact

☐ 4. Company Profile

☐ 5. References

☐ 6. Exclusions and/or Substitutions to Proposal

☐ 7. Certified HUB, Minority and/or Veteran and Women-Owned Business

☐ 8. LSC-HSP PAR SDD 2017 7.10.17

☐ 9. Felony Conviction/Debarment Notice Clean Air & Water Act Notice

☐ 10. Federal Provisions Questionnaire

☐ 11. Conflict of Interest Questionnaire: Provide a SIGNED copy of the CIQ (State Required Form, provided in the iStar Vendor Portal)

☐ 12. Certificate of Insurance

☐ 13. Addenda, if any

(2) PRICING WORKSHEET

Complete EXHIBIT A – Pricing Worksheet

(3) PRIMARY CONTACT

dba (if applicable):

Address:

Phone Number:

Primary Contact for Bid Clarification for this RFP (please print):

Primary Contact’s Phone Number (if different from the above phone number):

Primary Contact’s email address required (please print):

Primary Contact’s Title:

(4) COMPANY PROFILE

Phone Number:

Web Page (if available):

Years of experience providing services equivalent to those requested in this proposal:

Number of employees:

Date company established under name stated in this proposal:

Company Principals:

Name: Title:

(5) REFERENCES

Reference # 1:

Is this reference one of your most current and relevant contracts similar in size and scope to this LSC RFP? ☐YES ☐NO

Company Name:

Contact Name:

Phone:

Email:

Brief description of services:

Term of Contract:

Comments:

Reference # 2:

Reference # 3:

(6) EXCLUSIONS AND/OR SUBSTITUTIONS TO PROPOSAL

☐ We DO have exclusions and/or substitutions included for this Event (see details listed below)

☐ We DO NOT have any exclusions and/or substitutions included for this Event

Details: (Please list all exclusions and/or substitutions or attach a separate sheet)

(7) CERTIFIED HUB, MINORITY AND/OR VETERAN

AND WOMEN-OWNED BUSINESS

1. Complete Section I to indicate what kind of certifications you have as a HUB. (If you are not a HUB, continue to Section II.)

2. Complete Section II if your company is not planning to utilize HUB or minority sub-contractor(s) and explain why. (Do not fill out Sections III and IV, and then continue to Sections V and VI.)

3. Complete Section III if your company plans to utilize HUB or minority sub-contractor(s). List the subcontractors and attach the certification with each subcontractor separately.

4. Complete Section IV to describe your sub-contracting plan.

5. Complete Section V to provide information about your supplier diversity practices.

6. Complete Section VI to do your self-assessment.

Section I: Certifications for HUB Please check the appropriate group and attach your Certification(s) behind this form in your proposal submittal. Upon receiving valid certification, HUBs will obtain 5 points on the HUB evaluation.

☐ City of Austin ☐ Southwest Minority Supplier Development Council

☐ City of Houston ☐ State of Texas HUB ☐ Dallas/Fort Worth Minority Supplier Development Council

☐ Texas Department of Transportation

☐ El Paso Hispanic Chamber of Commerce

☐ Women’s Business Council Southwest

☐ Golden Triangle Minority Business Council

☐ Women’s Business Enterprise Alliance

☐ Houston Minority Supplier Development Council

☐ U.S. Department of Veteran Affairs

☐ South Central Texas Regional Certification Agency

☐ National Minority Supplier Development Council

☐ Women’s Business Enterprise National Council

Please state the business utilization goal you wish to achieve with your workforce. % of our business utilization goal is with our workforce.

Section II: Not Presenting a Subcontracting Plan

Section III – Sub-contracting Plan If you will utilize HUB or minority businesses, fill out the percentage of utilization goal and the list of subcontractors.

% of our business utilization goal with other Certified HUB or minority businesses.

Sub-Contractors

In the table below, write the company name, the service they will provide, the contact information, and the estimated utilization goal.

Insert certification(s) for each Company after this page (Verify all certifications are valid and not expired). If additional space is required, please attach the information in the below format behind this form in your proposal.

Company Name

Services Address Company Contact

Phone # Subcontracting

Total estimated utilization goal for proposal:

Please provide an explanation of why you will not be presenting a sub-contracting plan.

Section IV: Description of the Sub-contracting Plan

Please provide information about the subcontracting plan. Presenting a solid and coherent sub-contracting plan will allow you to get 2.75 points on the HUB evaluation.

a) Describe the principal types of supplies and services to be subcontracted.

b) Describe your efforts to make sure that minority businesses have an equitable opportunity to compete for subcontracts and how you identify potential subcontractors.

c) Are you committed to submitting monthly reports so that Lone Star College can determine the extent of compliance with the subcontracting plan?

☐ YES ☐ NO

Section V: Diversity Practices

Please provide information about the diversity practices implemented in your business.

Presenting strong supplier diversity initiatives will allow you to get 2 points on the HUB evaluation.

a) Describe the initiatives performed by the company in supplier diversity and outreach efforts to contact business development organizations, trade associations, conferences, and trade fairs to locate HUB or minority businesses.

b) Share data regarding expenditures made to certified minority businesses or HUBs and has established goals based upon subcontracting activities in the past. (Write N/A if this information is not available).

c) Do you have a mentor-protégé program?

YES _____ NO _____

d) If the “c” is yes, please describe how your program works.

e) If you have a link with more information about your supplier diversity strategies on your website, please share the link here:

Section VI: Self-Assessment

Write an “X” according to your evaluation of the criteria listed. Presenting the self-assessment coherent with the information provided in the other sections will allow you to get 0.25 points on the HUB evaluation.

Description Strong Moderate Minimum None

The methods to calculate and develop a subcontracting goal are…

The system for identifying potential subcontractors for several projects is…

The efforts to make sure that minority businesses have an equitable opportunity to compete for subcontracts are…

The system for controlling the compliance of the subcontracting plan is…

The initiatives performed by the company in supplier diversity and outreach efforts to contact business development organizations, trade associations, conferences, and trade fairs to locate minority or HUB businesses are…

The system to obtain data regarding expenditures made to certified minority businesses or HUBs is…

The mentor-protégé program is…

The program to promote the use of minority businesses is…

Date: Printed Name:

Title: Signature:

(8) LSC-HSP PAR FORM

Do not complete or fill in this form at this time; include a copy of this form in your proposal after the Certified HUB section. Including this form will be your acknowledgment and agreement your firm will utilize this progress assessment form after the awarding of this project.

(9) FELONY CONVICTION / DEBARMENT NOTICE

CLEAN AIR & WATER ACT NOTICE

Texas Education Code Section 44.034, Notification of Criminal History, Subsection (a) states, “A person or business entity that enters into a contract with a school district must give advance notice to the district if the person or an owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony.”

Subsection (b) states, “A school district may terminate a contract with a person or business entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for services performed before the termination of the contract.” This notice is not required of a publicly held corporation. (Please CHECK APPROPRIATE BOX below and COMPLETE ALL SIGNATURE BLOCKS.)

Company’s Name:

Authorized Company Official’s Name (printed):

☐ My firm is a publicly held corporation; therefore, this reporting requirement is not applicable ☐ My firm is not owned nor operated by anyone who has been convicted of a felony ☐ My firm is owned or operated by the following individual(s) who has/have been convicted of a felony:

Name of Felon(s):

Details of Conviction(s):

Signature of Company Official:

I certify that my company has not been debarred, suspended, or otherwise made ineligible for participation in Federal Assistance programs under Executive Order 12549, “Debarment and Suspension,” as described in the Federal Register and Rules and Regulations.

I, the vendor, comply with all applicable standards, orders, or regulations issued according to the Clean Air Act of 1970, as amended (42 U.S.C. 7606), Section 508 of the Clean Water Act, as amended (33 U.S.C. 1368), Executive Order 11738 and Environmental Protection Agency Regulation, 40 CFR Part 31 and as required under OMB Circular A-102, the grantor agency and to the United States Environment Protection Agency Assistant Administrator for the Enforcement.

(10) FEDERAL PROVISIONS QUESTIONNAIRE

(This form must be completed in its entirety and attached to your completed proposal)

Representative’s Name:

Title:

FEDERAL PROVISIONS

The following provisions are required and apply when Lone Star College expends federal funds for any contract resulting from this procurement process. Please acknowledge that you have read the provisions and will comply accordingly. (See terms and conditions for definition) ☐ Yes ☐ No Equal Employment Opportunity

☐ Yes ☐ No Copeland “Anti-Kickback” Act (18 U.S.C. 874 and 40 U.S.C.

276c)

☐ Yes ☐ No Contract Work Hours and Safety Standards Act (40 U.S.C. 3701- 3708)

☐ Yes ☐ No Rights to Inventions Made Under a Contract or Agreement (37

CFR PT 401)

☐ Yes ☐ No Davis-Bacon Act as amended (40 U.S.C. 3141-3148)

☐ Yes ☐ No Clean Air Act (42 U.S.C. 7401-7671 q.)

☐ Yes ☐ No Debarment and Suspension (Executive Orders 12549 and 12689)

☐ Yes ☐ No Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)

☐ Yes ☐ No Buy American Act (41 U.S.C. 10a-10d)

☐ Yes ☐ No Sherman Antitrust Act (15 U.S.C. 1-7)

Signature: Date:

(11) CONFLICT OF INTEREST QUESTIONNAIRE

Insert your conflict of interest questionnaire (CIQ) here.

(12) CERTIFICATE OF INSURANCE

Insert a copy of your certificate of insurance (COI) here.

(13) ADDENDA

Insert copies of all addenda here to acknowledge that you have received and read each one.

END OF DOCUMENT

TABLE OF CONTENTS
(1) TABLE OF CONTENTS CHECKLIST

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