IFB_2200_JRN1038_ATT_6_v1.docx

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Attached to
Powder Activated Carbon
Solicitation number
IFB 2200 JRN1038
Issued by
Texas

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This is an Employer Certification form for the City of Austin's Wage Theft Ordinance Responsibility Criteria, related to IFB 2200 JRN1038 for Powder Activated Carbon to be used in the treatment of potable water in Texas. The solicitation was posted on February 2, 2026. Any employer submitting an offer to the City of Austin for contract award must complete this certification form prior to contract execution.

All employers awarded a contract with the City of Austin are required to complete the City of Austin Wage Theft Training within 30 days of contract award. The certification requires the employer to affirm under penalty of perjury that the firm has not been adjudicated for wage theft related incidents as defined in Austin City Code Chapter 4, Sections 4-22-1 (G) and (H) within the five years prior to the solicitation posting date. Additionally, the firm must agree to abide by the items outlined in Austin City Code Sections 4-22-5 (B) and 4-22-6 (A). The form requires the signature of an authorized representative, including the firm's legal name, the signatory's printed name and title, location, and date of certification. Questions regarding the wage theft certification may be directed to wagetheft@austintexas.gov.

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Text version

EMPLOYER CERTIFICATION

WAGE THEFT ORDINANCE – RESPONSIBILITY CRITERIA

CITY OF AUSTIN

Any Employer that submits an offer to the City seeking award of a city contract prior to awarding a contract are required to certify that they have not been adjudicated for certain offenses related to wage theft. See City of Austin Ordinance No. 20221201-031. “Wage theft” and “adjudicated” are to be understood per the definitions set forth in Austin City Code Chapter 4, § 4-22-1 (G) and (H).

Solicitation or Agreement Title: IFB 2200 JRN1038

Solicitation Posting Date or Agreement Start Date: February 2, 2026

All Employers are required to complete the City of Austin Wage Theft Training within 30 days of being awarded a contract with the City.

Contact the Wage Compliance Team to register for a class.

I hereby certify, under penalty of perjury under the laws of the State of Texas, that the below certification is true and correct and that I am authorized to make the following certification on behalf of the firm listed herein.

CERTIFICATION:

This firm has NOT been adjudicated for wage theft related incidents as defined in Austin City Code Chapter 4, § 4-22-1 (G) & (H) within five (5) years prior to the above-stated date. Furthermore, this firm agrees to abide by the items outlined in Section 4-22-5 (B) and Section 4-22-6 (A) of the Austin City Code.

Firm Name:

Name of Employer - Print Full Legal Entity Name of Firm

Signed:

Signature of Authorized Person

Print Name of Person Making Certification for Firm

Title:
Place:

Title of Person Making Certificate

Print City and State Where Signed

Date:

SUBMITTAL – Employer Certification Wage Theft Ordinance – Responsibility Criteria

EMPLOYER CERTIFICATION – WAGE THEFT PROGRAM

If you have questions or need more information, contact us at wagetheft@austintexas.gov.

Revised 09.14.23 image1.png

File details come from the government source that posted it. Updated .