Exhibit P, DFPS Certifications and Affirmations Form 4543.pdf
PDF 704 KB Posted
- Attached to
- Child Protective Post Adoption Services
- Solicitation number
- HHS0016376
- Issued by
- Texas
About this file
This document is the Texas Department of Family and Protective Services (DFPS) Vendor Certifications and Affirmations Form 4543, which outlines mandatory certifications and affirmations that all contractors must acknowledge and comply with throughout the contract term. The form addresses 18 distinct areas of compliance, including abortion provider transaction prohibitions, antitrust affirmation, Buy Texas requirements for service contracts, child support obligation verification, public information act compliance, COVID-19 vaccine documentation, restrictions on dealings with public servants, Israel boycott prohibitions, federal excluded parties verification, state agency executive head restrictions, firearm industry non-discrimination, foreign adversary ownership prohibitions, foreign terrorist organization restrictions, franchise tax status verification, human trafficking prohibitions, lobbying restrictions, prior disaster relief contract violations, and suspension and debarment status. The contractor and all associated principals, officers, directors, shareholders, partners, owners, agents, employees, and subcontractors must maintain compliance with these certifications, and any changes in status must be promptly disclosed to DFPS. The form requires signature by an authorized representative with legal authority to bind the contractor.
The document functions as a prerequisite compliance instrument for the Child Protective Post Adoption Services contract opportunity, establishing that contractors must verify their eligibility and adherence to multiple state and federal regulatory requirements before contract execution. The contractor's failure to maintain accurate certifications or subsequent discovery of inaccuracy may result in contract termination and payment withholding. Contractors are required to include suspension and debarment provisions in their subcontracts if federal funding is involved. This certification form applies universally to all DFPS contracts and represents a binding commitment by the contractor to maintain compliance with Texas and federal law throughout the contract period.
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N502 FORM 4543
August 2025
TEXAS DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES
VENDOR CERTIFICATIONS AND AFFIRMATIONS PAGE 1
TEXAS DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES
VENDOR CERTIFICATIONS AND AFFIRMATIONS
By entering into this Contract, Contractor, without exception affirms, certifies, understands, and agrees to adhere to the following Certifications and Affirmations throughout the life of the Contract.
Additionally, Contractor represents and warrants that these Certifications and Affirmations apply to Contractor and all of Contractor's principals, officers, directors, shareholders, partners, owners, agents, employees, subcontractors, independent contractors, and any other representatives who may provide services and/or goods under, or who have a financial or any other interest in this Contract.
If the Contractor, at any time during the Contract Term, no longer can certify and/or affirm any of the Certifications and Affirmations for itself or persons/entities identified below, the Contractor will promptly disclose such to
DFPS.
As instructed by DFPS, Contractor agrees to comply with any requirements and provide the documents that are necessary to maintain compliance with the following Certifications and Affirmations.
A. Abortion Provider and Affiliate Transactions Prohibited. Contractor certifies that this Contract is not a taxpayer resource transaction prohibited by Texas Government Code §2273.003 made by DFPS to the Contractor and Contractor’s Receipt of appropriated funds under this Contract are not prohibited by Article IX, Section 6.24 of the General Appropriations Act.
B. Antitrust Affirmation. Contractor has not violated state or federal antitrust laws and has not communicated its bid for this Contract directly or indirectly to any competitor or any other person engaged in such line of business.
Contractor hereby assigns to DFPS any claims for overcharges associated with this Contract under 15 U.S.C. §1, et seq., and Texas Business and Commerce Code §15.01, et seq.
C. Buy Texas Affirmation. If this Contract is for services, the Contractor will comply with Texas Government Code §2155.4441 for the purchase of products and materials produced in the State of Texas. However, this Section is not applicable to Contracts or Agreements with federal funding that further prohibits the use of geographic preferences.
D. Child Support Affirmation Obligation. Under Texas Family Code §231.006 (relating to delinquent child support), Contractor acknowledges that it is not ineligible to receive the specified Grant, loan, or payment and acknowledges that this Contract will be terminated, and payment will be withheld if this certification is found to be inaccurate.
E. Contracting Information Responsibilities. The requirements of Texas Government Code 552, Subchapter J may apply to this Contract, and the Contractor agrees that this Contract can be terminated if the Contractor knowingly or intentionally fails to
RFP No. HHS0016376 Exhibit P
TEXAS DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES
VENDOR CERTIFICATIONS AND AFFIRMATIONS PAGE 2
comply with a requirement of this Subchapter.
F. COVID-19 Vaccine Documentation. Contractor represents and warrants that it is in compliance with Section §161.0085(c) of the Texas Health and Safety Code and is eligible, pursuant to this Section, to receive a grant or enter into a contract with DFPS payable with state funds.
G. Dealing with Public Servants. Contractor has not given or offered to give and does not intend 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 this Contract.
H. Entities that Boycott Israel. If the Contractor is a “Company” under Texas Government Code §808.001, at the time of executing this Contract, the Contractor is certifying that it does not boycott Israel and will not boycott Israel during the term of this Contract.
I. Excluded Parties. Contractor is not listed on the federal government's terrorism watch list described in Executive Order 13224. Entities ineligible for federal procurement or award are listed at https://sam.gov/search/?index. This Contract will be terminated, and payment withheld if this certification is inaccurate. This provision will be included in its entirety in Contractor’s subcontracts.
J. Executive Head of a State Agency Affirmation. Under Texas Government Code §669.003 (relating to contracting with the executive head of a state agency), Contractor acknowledges that it is not the executive head of DFPS, was not at any time during the past four years the executive head of DFPS and does not employ a current or former executive head of
DFPS.
K. Firearm and Ammunition Industries Discrimination Prohibition. For contracts entered into on or after September 1, 2021, if the Contractor is a Company under Texas Government Code §2274.002, at the time of executing this Contract, the Contractor certifies that it is exempt under that section, or it does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association and will not discriminate during the term of the Contract against a firearm entity or firearm trade association.
L. Foreign Adversary Ownership Prohibited. Contractor certifies, represents, and warrants that for the term of this Contract, Contractor is not and, if applicable, any of its holding companies or subsidiaries, is not:
1. Listed in Section 889 of the 2019 National Defense Authorization Act
(NDAA);
2. Listed in Section 1260H of the 2021 NDAA;
3. 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
4. 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.
M. Foreign Terrorists Organizations. Under Texas Government Code https://sam.gov/search/?index
VENDOR CERTIFICATIONS AND AFFIRMATIONS PAGE 3
§2252.152, the Contractor warrants that it is not engaged in business with Iran, Sudan, or a foreign terrorist organization.
N. Franchise Tax Status. Contractor acknowledges that it is not currently delinquent in the payment of any franchise taxes owed to the State of Texas under Texas Tax Code Chapter 171.
O. Human Trafficking Prohibition. Under Texas Government Code §2155.0061, Contractor certifies that it is not ineligible to receive this contract and acknowledges that this contract may be terminated, and payment withheld if it is found that during the five-year period preceding the date of this Contract, the Contractor was convicted of any offense related to the direct support or promotion of human trafficking.
P. Lobbying Prohibition. Payments to Contractor and Contractor's receipt of appropriated or other funds under this Contract are not prohibited by Texas Government Code §§556.005, 556.0055, or
556.008 (relating to use of appropriated money or state funds to employ or pay lobbyists, lobbying expenses, or influence legislation).
Q. Prior Disaster Relief Contract Violation. Under Texas Government Code §§2155.004 (regarding the prohibition of certain financial participation by persons) and 2155.006 and 2261.053 (both relating to ability to receive this Contract, and convictions or penalties regarding Hurricane Rita, Hurricane Katrina or other disasters), Contractor acknowledges that it is not ineligible to receive this Contract, and that this Contract will be terminated and payment withheld if this certification is found to be inaccurate.
R. Suspension and Debarment. Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency under the regulations implementing Executive Order 12549 and Executive Order 12689, 2 CFR Part 376 Debarment and Suspension, and any relevant regulations promulgated by the department or agency funding this project. Contractor agrees that this provision will be included in its entirety in Contractor’s Subcontracts if payment in whole or in part is from federal funds. Furthermore, Contractor acknowledges that it has not been subjected to suspension, debarment, or similar ineligibility determined by any state or local governmental entity.
VENDOR CERTIFICATIONS AND AFFIRMATIONS PAGE 4
By signing below, the following individual represents that he/she has the requisite legal authority to bind the Contractor, and further certifies, affirms, represents, and warrants that the Contractor adheres to the above Certifications and Affirmations at time of execution and throughout the Contract Term.
CONTRACTOR
X
NAME:
TITLE:
DATE: Click or tap to enter a date.
| TEXAS DEPARTMENT OF FAMILY AND PROTECTIVE SERVICES VENDOR CERTIFICATIONS AND AFFIRMATIONS |
| CONTRACTOR |
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