RFP 25-0012 Attachments Processing Beef_Fillable.pdf

SECTION V – ATTACHMENTS

ATTACHMENT A

Solicitation No: RFP 25-0012

PROPOSER CERTIFICATION

Legal Name of Proposer (Firm):

Physical Address:

Mailing Address:

The Proposer certifies and agrees:

1. The prices in this Proposal have been arrived at independently, without, for the purpose of restricting competition, any consultation, communication, or agreement with any other Proposer relating to: the intention to submit a Proposal, or the methods or factors used to calculate the prices Proposed.

2. The Proposer has read and understands all terms and conditions of this Solicitation.

3. The Proposer agrees to provide insurance as required in the sample Contract Terms and Conditions (see

Attachments).

4. The Proposer has, or has available, the equipment, personnel, materials, equipment, facilities, and equipment as well as the technical and financial ability necessary to complete and execute all Work in a sound and suitable manner for the use specified and intended.

5. The Proposer agrees to execute the formal Contract within ten (10) days from date of Notice of Intent to Award.

6. The Proposer acknowledges that the person that signs this Certification is fully authorized to sign on behalf of the Proposer listed and to fully bind the Proposer to all conditions and provisions thereof.

7. The Proposer certifies that Proposer has complied or will comply with all requirements of local, state, and national laws, and that no legal requirement has been or will be violated in making or accepting this Proposal.

8. The Proposer, pursuant to ORS 279A.120 (1), (check one) is ____ / is not ____ a resident Proposer.

If not, indicate State of residency________________________.

9. The Proposer certifies that it has not discriminated and will not discriminate, in violation of ORS 279A.110, against any disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disabled veteran owns or an emerging small business that is certified under ORS

200.055 in obtaining any required subcontract.

10. The Proposer agrees to comply with Oregon tax laws in accordance with ORS 305.385.

11. The Proposer acknowledges receipt of the following addenda: (list by number and date appearing on addenda.)

Addendum Number Date Addendum Number Date

12. The Proposer (check one) ____ will / ____ will not extend the terms, conditions and prices to any Participating Agency that intends on establishing a Contract awarded to the Proposer resulting from this Solicitation.

Respectfully submitted this __________day of ________________________, 20_____.

Signature: ___________________________________ Printed Name: ___________________________________

Title: _______________________________________ Email Address: ____________________________________

Phone: _____________________________________ Fax: _____________________________________________

Rev 10-15-25

ATTACHMENT B

Solicitation No: RFP 25-0012

INDEPENDENT CONTRACTOR CERTIFICATION

Proposer: ________________________________________________

Employer Identification Number: _____________________________

If Proposer signs Part A, the remainder of this Certification Statement does not need to be completed.

Part A. Proposer is a Corporation:

The Proposer/Firm is a corporation authorized to do business in the State of Oregon.

Proposer Signature: _________________________________________________Date: _____________________

Part B. Proposer is an Independent Contractor:

I, under penalties of perjury, certify that I am an independent contractor as defined in ORS 670.600 and that the following statements are true and correct:

1. I have filed Federal and State income tax returns in the name of my business or a business Schedule C as part of the personal income tax return, for the previous year, or expect to file federal and state income tax returns, for labor or services performed as an independent contractor in the previous year.

2. I will furnish the tools or equipment necessary for the contracted labor or services.

3. I have the authority to hire and fire employees who perform the labor or services.

4. I represent to the public that the labor or services are to be provided by my independently established business as four (4) or more of the following circumstances exist.

(Please check all that apply):

_____ A. The labor or services are primarily carried out at a location that is separate from my residence or is primarily carried out in a specific portion of my residence, which is set aside as the location of the business.

_____ B. Commercial advertising or business cards are purchased for the business, or I have a trade association membership with ________________________________________.

_____ C. Telephone listing is used for the business that is separate from the personal residence listing.

_____ D. Labor or services are performed only pursuant to written contracts.

_____ E. Labor or services are performed for two or more different persons or agencies within a period of one year.

_____ F. I assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omissions insurance or liability insurance relating to the labor or services to be provided.

Proposer Signature: _____________________________________________Date: _____________________

Revised 10-15-25

ATTACHMENT C

Solicitation No: RFP 25-0012

AFFIDAVIT OF NON-COLLUSION / COMPLIANCE WITH TAX LAWS

(Proposer)

I state that:

(1) The correct taxpayer identification numbers are: A. Federal Employer ID Number (EIN):

____________________ B. Employer’s Oregon ID Number: __________________

(2) Proposer is not subject to backup withholding because (i) Proposer is exempt from backup withholding, (ii)

Proposer has not been notified by the IRS that Proposer is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified Proposer that Proposer is no longer subject to backup withholding;

(3) The price(s) and amount of this Proposal must be arrived at independently and without consultation, communication or agreement with any other Supplier, Proposer or potential Proposer, except as disclosed on the attached appendix.

(4) That neither the price(s) nor the amount of this Proposal, and neither the approximate price(s) nor approximate amount of this Proposal, will be disclosed to any other firm or person who is a Proposer or potential Proposer, and they will not be disclosed before Contract award.

(5) No attempt has been made or will be made to induce any firm or person to refrain from proposing on this Solicitation, or to submit any noncompetitive Proposal or other complementary Proposal.

(6) The Proposal of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive Proposal.

(7) _________________________________________ (name of firm), its affiliates, subsidiaries, officers, directors and employees are not currently under investigation by any governmental agency and have not in the last four years been convicted of or found liable for any act prohibited by State or Federal law in any jurisdiction, involving conspiracy or collusion with respect to proposing on any public contract, except as described in the attached appendix.

I state that _______________________________________________(name of firm) understands and acknowledges that the above representations are material and important and will be relied on by the Beaverton School District in awarding the contract(s) for which this Proposal is submitted.

I further state that any misstatement in this affidavit shall be treated as fraudulent concealment from the Beaverton School District of the true facts relating to the submission of Proposals for this contract.

I am authorized to act on behalf of Proposer, and have authority and knowledge regarding Proposer's payment of taxes. To the best of my knowledge, the Proposer is not in violation of any Oregon tax laws, including, without limitation, those listed in ORS 305.380(4), the elderly rental assistance program under ORS 310.630 to 310.706;

and any local taxes administered by the Oregon Department of Revenue under ORS 305.620.

(Affiant’s Signature)

STATE _______________________________________ County of _________________________________

Signed and sworn to(or affirmed) before me on ______________________ by _______________________

(date) (Affiant’s name)

Notary: ____________________________________ My Commission Expires: _________________________

Revised 10-15-25

ATTACHMENT D

Solicitation No: RFP 25-0012

NON-CONFLICT OF INTEREST CERTIFICATION

Issuing Agency: Beaverton School District

I, hereby certify I have read the statement defining conflict of interest as quoted below; that I understand the statement; that no conflict of interest exists as therein defined, which precludes an impartial Bid/Proposal to be submitted by myself or the entity/company for which the Bid/Proposal is submitted, and that if such a conflict should arise, I will immediately notify the Beaverton School District and disqualify my Bid/Proposal.

"NO OFFICER, EMPLOYEE, OR AGENT OF THE BIDDER/PROPOSER HAS ANY PERSONAL

FINANCIAL INTEREST, DIRECT OR INDIRECT, IN THE OPERATION OF THE BEAVERTON SCHOOL

DISTRICT OR WITH ANY PARTY CONNECTED WITH THE OREGON SCHOOL AND DISTRICT

IMPROVEMENT NETWORK, DIRECTLY OR INDIRECTLY."

Proposer Name (signature)

Proposer Name (printed)

Proposer Title (printed)

Entity/Company Name (printed)

Date

ATTACHMENT E

Solicitation No: RFP 25-0012

PROPOSER RESPONSIBILITY FORM

(PROPOSER’S QUALIFICATIONS AND FINANCIAL INFORMATION)

DECLARATION AND SIGNATURES

The undersigned hereby declares that the he or she is duly authorized to complete and submit this Proposer Responsibility Form and that the statements contained herein are true and correct as of the date set forth below. Incomplete, incorrect or misleading information will be reason for a determination by the District of Proposer non-responsibility.

Date:

By:

(Signature of authorized official)

Name:

(Please type or print)

Title:

(Please type or print)

For:

(Firm’s name) (Please type or print)

Instructions

1. The information provided in this form is part of the District inquiry concerning proposer responsibility. Please print clearly or type.

2. If you need more space, use plain paper. Submit completed form with Proposal response.

3. Answer all questions. Submission of a form with unanswered questions, incomplete or illegible answers may result in a finding that the Proposer is not a responsible Proposer.

ATTACHMENT E Solicitation

No: RFP 25-0012

RELIABILITY

Has your company ever been declared in breach of any contract for unperformed or defective work? Yes. No.

If “yes”, explain.

Has any employee or agent of your company ever been convicted of a criminal offense arising out of obtaining, attempting to obtain, or performing a public or private contract or subcontract? Yes. No.

If “yes,” explain.

Has any employee or agent of your company been convicted under state or federal law of embezzlement, theft, forgery, bribery, falsification or destruction of records, receiving stolen property or any other offense indicating a lack of business integrity or business honesty? Yes. No.

If “yes,” explain.

Has your company or any employee or agent of your company been convicted under state or federal antitrust laws?

Yes. No.

If “yes,” explain.

Has any Officer or Partner of your organization ever been an Officer or Partner of another Organization that failed to complete a construction contract? Yes. No.

If “yes,” explain.

ATTACHMENT E Solicitation

No: RFP 25-0012

FINANCIAL RESOURCES

Has your firm ever been at any time in the last ten years the debtor in a bankruptcy case? Yes. No.

If “yes,” explain.

Does your firm have any outstanding judgments pending against it? Yes. No.

If “yes,” explain.

In the past ten years, has your firm been a party to litigation, arbitration or mediation where the amount in dispute exceeded $10,000? Yes. No.

If “yes,” explain. (Include court, case number and party names.)

In the past ten years, has your firm been a party to litigation, arbitration or mediation on a matter related to payment to subcontractors or work performance on a contract? Check “yes” even if the matter proceeded to arbitration or mediation without court litigation. Yes. No.

If “yes,” explain. (Include court, case number and party names.)

Have you or any of your affiliates discontinued business operation with outstanding debts? Yes. No.

If “yes,” explain.

ATTACHMENT E

Solicitation No: RFP 25-0012

KEY PERSONNEL

List the principal individuals of your company, their current job title, the total years of experience they have in the industry and their current primary responsibility for your company. Corporations list current officers and those who own 5% or more of the corporation’s stock. Limited liability companies list members who own 5% or more of the company. Partnerships list all partners. Joint ventures list each firm that is a member of the joint venture and the percentage of ownership the firm has in the joint venture.

ITEM Principal Individual

A. Name

B. Position

C. Years in Position

D. Current Primary Responsibility

ITEM Principal Individual

A. Name

B. Position

C. Years in Position

D. Current Primary Responsibility

ITEM Principal Individual

A. Name

B. Position

C. Years in Position

D. Current Primary Responsibility

ITEM Principal Individual

A. Name

B. Position

C. Years in Position

D. Current Primary Responsibility

Person who will be in direct charge of work if your company is awarded this Contract:

ITEM PERSON IN DIRECT CHARGE

A. Name

B. Position

C. Years in Position

D. Largest Project Supervised -$

E. Largest number of employees ever supervised

Nutrition Services Reference Form (provide 3 references)

Date(s) Work Performed ______________________________________

Annual Value of Project(s) $____________________________________

Brief Description of work performed _______________________________________________________

Name of Customer/Client_______________________________________

Address_____________________________________________________

Contact Name_________________________________ Position_______________________

Phone______________________ Email________________________________________

Date(s) Work Performed ______________________________________

Annual Value of Project(s) $____________________________________

Brief Description of work performed _______________________________________________________

Name of Customer/Client_______________________________________

Address_____________________________________________________

Contact Name_________________________________ Position_______________________

Phone______________________ Email________________________________________

Date(s) Work Performed ______________________________________

Annual Value of Project(s) $____________________________________

Brief Description of work performed _______________________________________________________

Name of Customer/Client_______________________________________

Address_____________________________________________________

Contact Name_________________________________ Position_______________________

Phone______________________ Email________________________________________

“USDA and this institution are equal opportunity providers and employers.”

Section V - ATTACHMENTS

ATTACHMENT F

RFP 25-0012

ATTACHMENT G Solicitation

No: RFP 25-0012

SEE ATTACHMENT G - Price Schedule

MS Excel Spreadsheet (Is attached as a separate document)

Buy American Statement of Understanding and Responsibility

The undersigned Proposer to Beaverton School District Solicitation # ______________ understands the requirements of 7 CFR §210.21(d) Procurements (210.21(d), the Buy American Provision) and the guidance offered in USDA Memo SP 38-2017 Compliance with and Enforcement of the Buy American

Provision in the National School Lunch Program.

Furthermore, it is the intention of the Proposer to offer food products that comply with the Buy

American Provision and the guidance in USDA Memo SP 38-2017 where ever possible and where it is not possible, to notify the District.

The Proposer also understands it is solely the decision of the District to use or not use a product not meeting the Buy American Provision or the guidance in USDA Memo SP 38-2017.

Name Title

Signature Date

Enitity/Company Name

SECTION V - ATTACHMENTS

ATTACHMENT H

Solicitation No. RFP 25-0012

NOTE: This certificate must be completed for all new and renewal contract years when the contract exceeds $100,000.

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY

EXCLUSION -- LOWER TIER COVERED TRANSACTIONS

This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, Title 7 CFR Part 3017, Section 3017.510, Participants' responsibilities. The regulations were published as Part IV of the January 30, 1989, Federal Register (pages 4722-4733). Copies of the regulations may be obtained by contacting the Department of Agriculture agency with which this transaction originated.

(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS BELOW)

(1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

(2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.

Organization Name PR/Award Number or Project Name

Names(s) and Title(s) of Authorized Representative(s)

Signature(s) Date

SECTION V - ATTACHMENTS

ATTACHMENT I

Suspension and Debarment Certification

Suspension and Debarment Instructions for Certification

1. By signing and submitting this form, the prospective lower tier participant is providing the certification set out on the reverse side in accordance with these instructions.

2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

3. The prospective lower tier participant shall provide immediate written notice to the person to whom this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant,"

"person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations.

5. The prospective lower tier participant agrees by submitting this form that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.

6. The prospective lower tier participant further agrees by submitting this form that it will include this clause titled "Certification

Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List.

8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant are not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.

ATTACHMENT J

Solicitation No.: RFP 25-0012

Certification Regarding Lobbying - Disclosure of Lobbying Activities (Complete the form that is applicable.)

NOTE: This certificate must be completed for all new and renewal contract years when the contract exceeds $100,000.

Applicable to Grants, Subgrants, Cooperative Agreements, and Contracts Exceeding $100,000 in Federal Funds.

Submission of this certification is a prerequisite for making or entering into this transaction and is imposed by section 1352, Title 31, U.S. Code. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of a Federal contract, the making of a Federal grant, the making of a Federal loan, the entering into a cooperative agreement, and the extension, continuation, renewal, amendment, or modification of a Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all covered subawards exceeding $100,000 in Federal funds at all appropriate tiers and that all subrecipients shall certify and disclose accordingly.

Name/Address of Organization

Name/Title of Submitting Official

Signature/Date

DISCLOSURE OF LOBBYING ACTIVITIES

Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

1. Type of Federal Action: _____ 2. Status of Federal Action: _____ 3. Report Type: _____

a. contract a. bid/offer/application a. initial filing

b. grant b. initial award b. material change

c. cooperative agreement c. post award For Material Change Only:

d. loan Year _____

e. loan guarantee Quarter ____

f. loan insurance Date of Last Report ____

4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

____ Prime ____ Subawardee Tier, if known: ____

Congressional District, if known: Congressional District, if known:

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable: __________________

8. Federal Action Number, if known: 9. Award Amount, if known:

10a. Name and Address of Lobbying Entity: 10b. Individuals Performing Services: (include address if different from 10a.) (last (if individual, last name, first name, middle) name, first name, middle)

11. Amount of Payment (check all that apply): 12. Type of payment (check all that apply):

$ ____ a. retainer

____ b. one-time fee ____ Actual ____ Planned ____ c. commission

____ d. contingent fee ____ e. deferred ____ f. other; specify: ____________________________________________

13. Form of Payment (check all that apply): 14. Continuation Sheet(s) SF-LLL-A Attached:

____ a. cash Yes ____ (Number ________) ____ b. in-kind; specify: No ____ Nature: _____________________ Actual: _____________________

15. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or member(s) contracted for Payment indicated in Item 11:

Attach Continuation Sheet(s) SF-LLL-A (if necessary)

16. Information requested through this form is authorized by Title 31

U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Federal Use Only Authorized for Local Reproduction Standard Form - LLL

Signature: _______________________________________________________

Print Name: _____________________________________________________

Title: ____________________________________________________________

Telephone: __________________________ Date: ______________________

This disclosure form shall be completed by the reporting entity, whether sub awardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action.

If the space on the form is inadequate, use of SF-LLL-A Continuation Sheet for additional information. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks "Subawardee", then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the Federal agency making the award or loan commitment. Include at Sponsorst one organizational level belo w agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) Number, Invitation for Bid (IFB) Number; grant announcement number; the contract, grant or loan award number; the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001."

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action.

10. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI).

11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity (item 10).

Indicate whether the payment has been made (actual) or will be made (planned). Check all that apply. If this is a material change re port, enter the cumulative amount of payment made or planned to be made.

12. Check type of payment. Check all that apply.

13. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. Check all that apply. If other, specify nature.

14. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached. If yes, list number of sheets attached.

15. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted.

The certifying official shall sign and date the form, print his/her name, title, and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comment s regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget. Paperwork Reduction Project (0348-00046), Washington, DC 20503.

1) Equal Employment Opportunity. If the Contract is for more than $10,000, compliance with Executive Order 11246 of September 24, 1965, entitled “Equal Employment Opportunity,” as amended by Executive Order 11375 of October 13, 1967, and as supplemented in Department of Labor regulations (41 CFR chapter 60). A religious organization's exemption from the Federal prohibition on employment discrimination on the basis of religion, in section 702(a) of the Civil Rights Act of 1964, 42 U.S.C. 2000e-1, is not forfeited.

2) Copeland Anti-Kickback Act. Compliance with the Copeland “Anti-Kickback” Act (18 U.S.C. 874) as supplemented in Department of Labor regulations (29 CFR part 3).

3) Davis-Bacon Act. Compliance with the Davis-Bacon Act (40 U.S.C. 276a to 276a-7) as supplemented by Department of Labor regulations (29 CFR part 5).

4) Contract Work Hours and Safety Standards Act. Compliance with sections 103 and 107 of the Contract Work Hours and Safety Standards Act (40 U.S.C. 327-330) as supplemented by Department of Labor regulations (29 CFR part 5).

5) Clean Air Act and Clean Water Act. If the Contract is for more than $100,000, compliance with all applicable standards, orders, or requirements issued under section 306 of the Clean Air Act (42 U.S.C. 1857(h)), section 508 of the Clean Water Act (33 U.S.C. 1368), Executive Order 11738, and Environmental Protection DAS regulations (40 CFR part 15).

6) Energy Policy and Conservation Act. Compliance with mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163, 89 Stat. 871).

7) Disclosure of Lobbying Activities. Pursuant to Byrd Anti-Lobbying Amendment 31 USC 1352, the contractor must disclose lobbying activities in connection with school nutrition programs. If there are material changes after the initial filing, updated reports must be submitted on a quarterly basis. 2 CFR 200.326, 2 CFR 200.450 and 2 CFR 200 Appendix II (Only applies to contracts over $100,000)

8) Certification Regarding Lobbying. Pursuant to 31 USC 1352, the contractor must submit a certification regarding lobbying which conforms in substance with the language provided in 2 CFR 200.450. No appropriated funds may be expended by the recipient of a Federal contract, grant, loan, or cooperative agreement to pay any person for influencing or attempting to influence an officer of employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with any of the following covered Federal actions. (Only applies to contracts over $100,000).

9) Certification of Independent Price Determination. The vendor admits that all prices in their Offer have been arrived at independently, without consultation, communication or agreement, for the purpose of restricting competition, as

SECTION V - ATTACHMENTS

ATTACHMENT K

Solicitation No. RFP 25-0012

Certification Regarding Federal Matters

School districts seeking to procure goods and services using funds under a federal grant or contract, specific federal laws, regulations, and requirements may apply in addition to those under state law. This includes, but is not limited to, the procurement standards of the Uniform Administrative Requirements, Cost Principles and Audit Requirements for

Federal Awards, 2 CFR 200 (sometimes referred to as the “Uniform Guidance”). All Contractors submitting proposals must complete this certification form regarding Contractor’s willingness and ability to comply with certain requirements which may be applicable to specific District purchases using federal grant funds.

Certification

Proposer certifies that Proposer shall comply, and require all sub-vendors to comply, with all federal laws, regulations, and executive orders applicable to a Contract. These may include but not be limited to:

to any matter relating to such prices with any other Offeror or with any competitor certification regarding non-collusion.

10) Resource Conservation and Recovery Act. Compliance with mandatory standards and policies that relate to resource conservation and recovery pursuant to the Resource Conservation and Recovery Act (codified at 42 USC

6901 et. seq.). Section 6002 of that Act (codified at 42 USC 6962) requires that preference be given in procurement programs to the purchase of specific products containing recycled materials identified in guidelines developed by the Environmental Protection DAS. Current guidelines are set forth in 40 CFR Part 247. 7 CFR § 250.31 Procurement requirements (Food Distribution).

11) Audits of States, Local Governments and Non-profit Organizations. Compliance with applicable audit requirements and responsibilities set forth in the Office of Management and Budget Circular A-133 entitled “Audits of States, Local Governments and Non-Profit Organizations.” Sub recipients shall also comply with applicable Code of Federal Regulations (CFR) sections and OMB Circulars governing expenditure of federal funds.

12) Pro-Children Act of 1994 Compliance with the Pro-Children Act of 1994 (codified at 20 USC section 6081 et. seq.). 42

13) Debarment and Suspension. Vendor certifies and shall not permit any person or entity to be a sub-vendor if the person or entity is listed on the non-procurement portion of the General Service Administration’s “List of Parties Excluded from Federal Procurement or Non-procurement Programs” in accordance with Executive Orders No. 12549 and No. 12689, “Debarment and Suspension”. (See 2 CFR Part 180.) This list contains the names of parties debarred, suspended, or otherwise excluded by agencies, and Vendors declared ineligible under statutory authority other than Executive Order No. 12549. Sub-vendors with awards that exceed the simplified acquisition threshold shall provide the required certification regarding their exclusion status and that of their principals prior to award.

14) National School Lunch Program. Vendor must comply with the requirements of the National School Lunch Program, 7 CFR §210; title IX of the Education Amendments of 1972; section 504 of the Rehabilitation Act of 1973; the Age Discrimination Act of 1975; Department of Agriculture regulations on nondiscrimination (7 CFR Parts 15, 15a, and 15b); and FNS Instruction 113-1., 7 CFR 250.31.

I, the official named below, certify that I am duly authorized to legally bind Proposer to this Certification Regarding Federal Matters:

Proposer Name (Printed)

By (Authorized Signature of Person with Authority to Obligate the Proposer), and Date

Printed Name Title of Person Signing

NAME OF VENDOR

THE VENDOR AGREES AS FOLLOWS:

A. To comply with all the applicable standards, orders or regulation issued pursuant to the Clean Air Act, as amended , 42 U.S.C 7401-7671q and the Federal Water Pollution Control Act, as amended, 33 U.S.C.1251- 1387 respectively, relating to inspection, monitoring, entry, reports and information as well as other requirements specified in Section 114 and Section 308 of the Air Act and the Water Act, respectively, and all regulations and guidelines issued thereunder before the award of this contract.

B. That no portion of the work required by this prime contract will be performed in a facility listed on the Environmental Protection Agency list of violating facilities on the date when this contract was awarded unless and until the EPA eliminates the name of such facility or facilities from such listing.

C. To use his/her best efforts to comply with Clean Air standards and Clean Water standards at the facilities in which the contract is being performed.

D. To insert the substance of the provisions of this clause in any nonexempt subcontract, including this paragraph.

THE TERMS IN THIS CLAUSE HAVE THE FOLLOWING MEANINGS:

A. The term "Air Act" means the Clean Air Act, as amended (42 U.S.C 7401-7671q, as amended by Public Law 91-604).

B. The term "Water Act" means Federal Water Pollution Control Act, as amended (33 U.S.C. 1251-1387, as amended by Public Law 92-500).

C. The term "Clean Air Standards" means any enforceable rules, regulations, guidelines, standards, limitations, orders, controls, prohibitions, or other requirements which are contained in, issued under, or otherwise adopted pursuant to the Clean Air Act or Executive Order 11738, an applicable implementation plan as described in section 42 U.S.C.7410(d) of the Clean Air Act (42 U.S.C. 7410), an approved implementation procedure or plan under Section 42 U.S.C 7405-7411, or approved implementation procedure under (42 U.S.C. 7412).

D. The term "Clean Water Standards" means any enforceable limitation, control, condition, prohibition, standard, or other requirement which is promulgated pursuant to the Federal Water Pollution Control Act or contained in a permit issued to a discharger by the Environmental Protection Agency or by a State under an approved program, as authorized by the Water Act (33 U.S.C. 1342) or by local government to ensure compliance with pretreatment regulations as required by the Water Act (33 U.S.C. 1317).

SECTION V - ATTACHMENTS

ATTACHMENT L

Solicitation No. RFP 25-0012

Clean Air and Water Certificate

NOTE: This certificate must be completed for all new and renewal contract years when the contract exceeds $150,000.

Applicable if the contract exceeds $150,000, or the Vending Officer has determined that the orders under an indefinite quantity contract in any one year will exceed $150,000, or a facility to be used has been the subject of a conviction under the Clean Air Act (42 U.S.C. 7401-7671q.) or the Federal Water Pollution Control Act (33 U.S.C.

1251-1387) and is listed by EPA, or the contract is not otherwise exempt. The Vendor shall execute this Certificate.

E. The term "Compliance" means compliance with clean air or water standards. Compliance shall also mean compliance with a schedules, plans, and orders approved by a court of competent jurisdiction, the Environmental Protection Agency or an Air or Water Pollution Control Agency in accordance with the requirements of the Clean Air Act or Federal Water Pollution Control Act and regulations issued pursuant thereto.

F. The term "facility" means any building, plant, installation, structure, mine, vessel, or other floating craft, location or sites of operations, owned, sponsored, or supervised by the Vendor.

SIGNATURE/TITLE OF THE VENDOR AUTHORIZED REPRESENTATIVE DATE

SECTION V - ATTACHMENTS

ATTACHMENT M

Solicitation No. RFP 25-0012

Oregon Certification of Business Inclusion and Diversity Plan

“Certified Firm” means a small business certified under ORS 200.055 by the Oregon Certification Office for

Business Inclusion and Diversity (COBID) as a minority-owned business, woman-owned business, service-disabled veteran-owned business, or emerging small business.

Certified Firm Participation

As noted in Governor Kitzhaber’s Executive Order 12-03, “Minority-owned and Woman-owned businesses continue to be a dynamic and fast-growing sector of the Oregon economy. Oregon is committed to creating an environment that supports the ingenuity and industriousness of Oregon’s Minority Business Enterprise [MBE] and

Woman Business Enterprise [WBE]. Emerging Small Business [ESB] firms are also an important sector of the state’s economy.” In 2015, HB 3303 revised ORS 200.055 to also include a certification for “. . . business[es] that a service-disabled veteran owns”.

According to ORS 200.090, Contracting agencies must aggressively pursue a policy to provide opportunities to

Certified Firms. As such, Certified Firms must have an equal opportunity to participate in the performance of contracts financed with state funds. By submitting its offer, Proposer certifies that it has taken, and if there are further opportunities, will take reasonable steps to ensure that Certified Firms are provided an equal opportunity to compete for and participate in the performance of any subcontracts resulting from this procurement. Proposer has not discriminated and will not discriminate against a sub-vendor in the awarding of a subcontract because the sub-vendor is a Certified Firm.

Proposer further certifies and agrees that it has not discriminated and will not discriminate in its employment practices with regard to ethnicity, creed, age, religious affiliation, gender, disability, sexual orientation, or national origin.

Following proposal due date and prior to Contract Award, the Proposer with the apparent highest scoring Proposal must provide, within five days of Notice of Intent to Award, a Certified Firm Outreach Plan using the form on the following page. The information submitted in response to this clause will not be considered in any scored evaluation.

Oregon Certification of Business Inclusion and Diversity Plan (continued)

1. Is Proposer an Oregon Certified Firm? Yes No

If yes, indicate all certification type(s): DBE MBE WBE SDV ESB

Oregon State Certification Number:

2. Does Proposer foresee any subcontracting opportunities for this procurement? Yes No

If no, do not complete the rest of this form.

3. The Proposer shall provide a narrative description of its experience in obtaining a certified firm’s participation as a sub-vendor, consultant, or supplier on previous projects, and discuss any innovative or particularly successful measures that the Proposer has undertaken. The Proposer shall include a list of Certified Firms with which it has had a contractual relationship during the past 24 months immediately preceding the date this solicitation document was issued. If none, mark the following checkbox: No prior experience obtaining participation from Certified Firms.

4. The Proposer shall provide examples where participation was achieved by Certified Firms, along with information regarding the subcontracting participation levels of Certified Firms for up to three projects/contracts that the Proposer is either currently performing or has completed within the past 24 months immediately preceding the date this solicitation document was issued.

Participation by Certified Firms should be described as the percentage of the dollar value of subcontracts and material or supply contracts awarded as compared with the total dollar value of subcontracts and material or supply contracts let for each identified project or contract. The Proposer shall describe any technical assistance or mentoring the Proposer provided to Certified Firms subcontracting on each project. If none, mark the following checkbox: No prior experience obtaining participation from Certified Firms.

Project 1 Name Award Date _/ / Completion Date _/ _/ Contract Award Amount $

Certified Firms goal percentage, if applicable

Certified Firms subcontract award amount $ _% Certified Firms achievement percentage %

Certified Firms spend achieved $

Describe any technical assistance or mentoring provided to Certified Firms subcontracting on this project.

Project 2 Name Award Date _/ / Completion Date _/ / Contract Award Amount $

Certified firms goal percentage, if applicable

Certified firms subcontract award amount $ % Certified firms achievement percentage %

Certified firms spend achieved $

Describe any technical assistance or mentoring provided to Certified Firms subcontracting on this project.

Oregon Certification of Business Inclusion and Diversity Plan (continued)

Project 3 Name Award Date _/ / Completion Date _/ / Contract Award Amount $

Certified firms goal percentage, if applicable

Certified firms subcontract award amount $ % Certified firms achievement percentage %

Certified firms spend achieved $

Describe any technical assistance or mentoring provided to firms subcontracting on this project.

5. If the total cost of the awarded contract is expected to be greater than $100,000, the Proposer shall describe the outreach and subcontracting plan it will use, if awarded the contract, to provide Oregon Certified Firms an equal opportunity to perform any subcontracts under the contract. The plan must be realistic and based on Proposer’s successful past experience. If Proposer has no previous outreach experience, the Proposer shall describe the outreach plan it intends to use if awarded the contract.

The Proposer must include the following in its plan:

i. A description of the steps that the Proposer will take to solicit participation by Certified Firms;

ii. A description of the mentoring, technical, or other business development assistance the Proposer will provide to sub-vendors needing or requesting such services.

If awarded the contract, the Proposer must accept, as contract performance obligations, the outreach and subcontracting plan described in this section. If Certified Firms are unavailable for type of work to be performed, please indicate in this section.

Company Name: ______________________________________________________________

Authorized Signature:___________________________________________________________

Name of Authorized Representative:________________________________________________

Title:_________________________________________________________________________

ATTACHMENT N

Solicitation No. RFP 25-0012

Recall Contact Information

Proposer Name:________________________________________________ Date:___________

Primary Contact:

Name:_____________________________

Title:______________________________

Email:_____________________________

Office Phone:_______________________

Cell Phone:_________________________

Back Up Contact:

Name:_____________________________

Title:______________________________

Email:_____________________________

Office Phone:_______________________

Cell Phone:_________________________

Recall Contact Information Completed by:

Name: _____________________________________

Title: ___________________________ Telephone Number: _____________ Fax Number: _____________

E-Mail:_________________________________

Signature: ________________________________________

Revised 10-22-25

SECTION V-ATTACHMENTS

ATTACHMENT O

Solicitation No. 25-0012

Provider Information Sheet

Proposer: ______________________________________________________________

Please provide the following contact information for the individuals who will be responsible for administering the contract if awarded to the proposer:

1. Primary Contact: ____________________________

Title: _____________________________ Telephone Number: ___________________

E-mail: ______________________________

2. Problems and Emergencies provide 2 representatives:

Name: _____________________________________

Title: ___________________________ Telephone Number: _______________

E-Mail:…