RFQ#23-146 "Frozen Treats"

864 Broad Street – 4th Floor Augusta, Georgia 30901 – 1215

(706) 826-1000 Fax: (706) 826-4612

Charlie B. Walker Jr. KENNETH BRADSHAW, Ed.D. BOBBY A. SMITH, CPA President Superintendent of Schools Chief Financial Officer

QUOTE COVER SHEET

FROZEN TREATS 2023-2025 RFQ #23-146

Date:

Vendor Name:

Address:

Phone:

Fax:

Email:

Addendum(s) Acknowledged: (If Applicable) #1 Yes: _________________ NO:_______________

#2 Yes: _________________ NO:_______________

#3 Yes: _________________ NO:_______________

#4 Yes: _________________ NO:_______________

Sealed Bids are due no later than Wednesday, May 24, 2023 at 3:00 p.m.

864 Broad Street – 4th Floor Augusta, Georgia 30901 – 1215

(706) 826-1000 Fax: (706) 826-4612

Charlie B. Walker Jr. KENNETH BRADSHAW, Ed.D. BOBBY A. SMITH, CPA President Superintendent of Schools Chief Financial Officer

You are invited to contract with the County Board of Education of Richmond County, Georgia, (herein after referred to as “Richmond County School System”, “RCSS” or “Owner”) to provide products for the 2023-2025 FROZEN TREATS RFQ #23-146. Items will be F.O.B., Augusta, Georgia, marked for and delivered to each individual school specified on the order and marked to the attention of the lunchroom manager of each individual school.

Product specification, and general information and conditions pertaining to each category of products issued by the Richmond County School System Nutrition Program Department are considered to be a part of this Request for Quotes and are to be used for reference. Richmond County School System adheres to the Buy American provisions found in the regulations of the National School Lunch Program (NSLP) at 7 CFR 210.21(d) and the School Breakfast Program (SBF) at CFR 220.16(d). According to Section 104(d) of the William F. Goodling Child Nutrition Reauthorization Act, Section 12(n) of the National School Lunch Act, Richmond County School System will purchase domestically grown and processed foods to the maximum extent practicable. In some cases, the supplier may be asked to certify the percentage of U.S. content in products supplied.

All freight and delivery charges MUST be included in the unit cost. THIS DEPARTMENT WILL

NOT ACCEPT ANY OVER OR UNDER SHIPMENTS. PLEASE INDICATE PACKAGING CLOSEST

TO AMOUNT SPECIFIED AS THE ESTIMATED USAGE.

The company awarded any portion of this bid is expected to deliver frozen treats weekly to each individual school as ordered by the School Nutrition Program. Some frozen treats may be delivered every other week with prior approval from School Nutrition. Also note further requirements under the following Standard Terms and Conditions.

TO:

DEALERS IN FROZEN TREATS

FROM:

RICHMOND COUNTY BOARD OF EDUCATION

DATE:

May 8, 2023

SUBJECT:

FROZEN TREATS 2023-2025; RFQ #23-146

RICHMOND COUNTY SCHOOL SYSTEM

MAY 8, 2023

NUTRITION SERVICES

FROZEN TREATS 2023-2025

RFQ #23-146

STANDARD TERMS AND CONDITIONS

1) TIME AND PLACE: Bids will be received by the Richmond County School System until 3:00 p.m.

EST, on Wednesday, May 24, 2023, at 864 Broad Street, Augusta, Georgia 30901.

2) LATE BIDS AND PROPOSALS: Regardless of cause, late bids and proposals will not be accepted and will automatically be disqualified from bid consideration. It shall be solely the vendor’s risk to ensure delivery at the designated office by the designated time. Late bids and proposals will not be opened and may be returned to the vendor.

3) BID FORM: Each bid must be submitted on the bid form provided. All blank spaces must be filled in with ink or typewritten. Only one copy of the Bid Form is required. Failure to use the bid form provided may result in rejection of bid.

4) SEALED BID REQUIREMENT: Each bid must be submitted in a sealed envelope addressed to Dr.

Kenneth Bradshaw, Superintendent of Schools, c/o Mr. Bobby A. Smith, Chief Financial Officer, Richmond County School System, 864 Broad Street, Augusta, Georgia 30901. Each sealed envelope containing a bid must be plainly marked on the outside “FROZEN TREATS 2023-2025 RFQ #23-146” and the envelope must bear on the outside the name and complete address of the vendor. If forwarded by mail, the sealed envelope containing the bid must be enclosed in another envelope addressed to Dr. Kenneth Bradshaw, Superintendent of Schools, c/o Mr. Bobby A. Smith, CFO, Richmond County School System, 864 Broad Street, Augusta, Georgia 30901, RFQ #23-146.

5) DELIVERY AND FREIGHT REQUIREMENTS: Deliveries will be made WEEKLY to the respective schools on an agreeable schedule with the School Nutrition Manager and the vendor.

Merchandise in full-case quantities shall have an identification mark on the outside of the case for easy review by the receiving personnel. In the event of an emergency where schools are closed, vendor shall contact School Nutrition Director to determine date and time deliveries should be made.

6) QUALITY ASSURANCE: In the event that the successful bidders are unable to perform as required, they shall be responsible for securing goods or services from an alternate source or vendor and pay the vendor any additional costs involved in supplying the goods. In the event that the successful bidder is unable to furnish the brand which was indicated in their bid, DELIVERY MUST NOT BE MADE until the School Nutrition Program Director has been contacted and an alternate selected.

7) STIPULATION FOR BID PRICING: Pricing must remain firm for the period contract period July

1, 2023 to June 30, 2025 and shall include all charges for packing and transportation to the individual schools. Price quotes will not include Federal Excise Tax or State Tax. The Richmond County School System is a tax-exempt organization.

8) OPTION TO RENEW: This contract may be renewed at the same terms and conditions for (2) two one-year terms upon mutual agreement of the awarded vendor(s) and

RCSS.

9) ESTIMATED QUANTITIES: Quantities needed for the breakfast and lunch programs will be determined by individual School Nutrition Managers who will place their orders directly with the vendor. Quantities listed in the bid are an estimate and can vary according to usage.

10) METHOD OF AWARD: Contract will be awarded based on lowest responsible and responsive bidder meeting specifications and overall general value received. The Richmond County School System reserves the right to award complete bid based on the total price and the ability of the vendor to perform services. This bid will be awarded based on service to ALL SCHOOLS in Richmond County.

11) WARRANTY: The successful vendor will provide to the Richmond County School System, in writing, a warranty to replace at no expense to the Director of School Nutrition or the Richmond County School System, any or all items found to be defective within a week of acceptance by the school.

12) REJECTION OF PROPOSALS: The Richmond County School System reserves the right to reject, in whole or in part, any and all proposals received, to waive technicalities, or to negotiate any term(s) or provision(s) of such proposals as meet the requirements and specifications of this RFP, such rejection, waiver, or negotiation to be accomplished in any manner necessary to serve the best interests of the Richmond County School System. The Richmond County School System also reserves the right to be the sole judge of the suitability of any and all proposals for use by the Richmond County School System.

The Richmond County School System reserves the right to reject or otherwise disregard, in whole or in part, any ambiguous proposals or proposals which are uncertain as to terms or compliance with specifications.

13) RIGHT TO RE-BID: The Richmond County School System reserves the right to reject any and all bids. The right is reserved to reject any and all quotations, to omit any item called for or to accept the bid deemed best for the Richmond County School System. The school system may waive any informalities or minor defects. The Richmond County Board of Education shall be sole arbiter as to the quality of the product furnished.

14) NON-WITHDRAWAL PERIOD: Proposals may not be withdrawn for a period of thirty (30) days from the date of bid opening.

15) STATE-MANDATED WALK AWAY PROVISION: In the event a contract is awarded for more than one year:

202-2-506 (b) (1)

“Pursuant to O.C.G.A. § 20-2-506, notwithstanding any other provision herein this contract shall terminate absolutely and without further obligation on behalf of the School System at the close of each calendar year in which it was executed and at the close of each successive calendar year for which it may be renewed provided thirty (30) days prior written notice is given by the School System to the vendor prior to the end of such calendar year.

In addition, this contract shall terminate immediately and absolutely at such time that appropriated and otherwise obligated funds are no longer available to satisfy the obligation of the School System under the contract.

This contract shall be deemed to obligate the School System for the sums payable during the calendar year the agreement was executed or in the event of a renewal by the School System for those sums payable at the end of any renewed calendar year.

The contract shall be deemed to have been automatically renewed for each applicable calendar year, not to exceed the initial term of contract, unless positive action is taken by the School System to terminate such contract herein as set forth.”

16) JURISDICTION AND VENUE: “This contract shall be governed and constructed in accordance with the laws of the State of Georgia, Richmond County. Venue and jurisdiction will be that of a court of competent jurisdiction in Richmond County, Georgia.

17) CANCELLATION: In the event at any time during the contract period the vendor cannot provide acceptable service, the Richmond County School System reserves the right to make other temporary arrangements for the procurement of frozen treats.

18) DUTY TO PROTECT: The Contractor (or Vendor) shall not knowingly send any employee, agent or subcontractor personnel who is a registered sex offender or who has been convicted of sexual abuse to any school building or school property when students are attending school or a school related activity.

The Contractor (or Vendor) shall make periodic criminal history record inquiries as authorized by O.C.G.A. §35-3-34, as now written, or here-after amended; or allowed by all or any other laws allowing such inquiry, to identify these persons who have been convicted of sexual abuse or any other act which would require such person to be entered into a national or state sexual offender registry.

For the purpose of this policy, the term periodic shall mean that the criminal history record inquiries shall be made current upon the awarding of a successful bid on contract and checked no less than annually during the duration of the contract. See ATTACHMENT 1 for Sex Offender Acknowledgement Form.

19) E-VERIFY: The Contractor agrees to comply with the requirements of A.R.S. § 41-4401.

a. The Contractor warrants compliance with all Federal immigration laws and regulations relating to employees and warrants its compliance with Section A.R.S. § 23-214, Subsection A. (That subsection reads: “After December 31, 2007, every employer, after hiring an employee, shall verify the employment eligibility of the employee through the E- Verify program.)

b. A breach of a warranty regarding compliance with immigration laws and regulations shall be deemed a material breach of the contract and the Contractor may be subject to penalties up to and including termination of the contract.

c. The Owner retains the legal right to inspect the papers of any employee who works on the contract to ensure that the Contractor or its subcontractor(s) is/are complying with the foregoing warranty under paragraph (a).

See ATTACHMENT 2 for E-Verify Affidavit Form.

20) CERTIFICATION REGARDING DEBARMENT: The vendor certifies, by submitting proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any governmental agency. Signed certification regarding lobbying;

debarment, suspension and other responsibility matters; and drug-free work place requirements form (ATTACHMENT “3”) must be completed and submitted with the vendor’s proposal quotes.

21) SMOKE FREE ENVIRONMENT: Bidder shall post notice and prohibit employees from using or displaying tobacco products, including smokeless tobacco, while the employee is on duty at the assigned location. There shall be no use of any tobacco products on any property of the Richmond County School System.

22) TIME OF THE ESSENCE: Failure of the successful vendor to deliver the merchandise within the required time shall constitute a material breach of contract. If a breach occurs, the vendor may be responsible for any damages the school system incurs.

22) NONDISCRIMINATION CLAUSE

In accordance with Federal civil rights law and the U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its agencies, offices, and employees, and institutions participating in our administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by

USDA.

Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State of local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at https://www.ascr.usda.gov/filing-program-discrimination-complaint-usda-customer;

or at any USDA office, write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call

(866) 632-9992. Submit your completed form or letter to USDA by:

(1) Mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410

(2) Fax: (202) 690-7442

(3) Email: program.intake@usda.gov.

This institution is an equal opportunity provider.

23) INSPECTION: All items shall be subject to inspection upon arrival at destination. If any items are found defective or otherwise not in conformity with the specification requirements, the school system shall have the right to reject such articles, with no cost to the school system. Further, it will be the responsibility of the vendor to defray any cost involved in the delivery and return of rejected articles.

https://www.ascr.usda.gov/filing-program-discrimination-complaint-usda-customer https://www.ascr.usda.gov/filing-program-discrimination-complaint-usda-customer mailto:program.intake@usda.gov

24) HANDLING OF INVOICES: The handling of statements and invoices will be as follows:

a. Two invoices will be given with each delivery.

b. Invoices will be signed by managers after the quantity and quality has been checked to meet specifications.

c. One invoice will remain in the school’s office files and the other is to be sent directly to the

School Nutrition Program office.

d. All invoices will be paid through the Richmond County Board of Education after the approval of school officials.

The successful bidder shall be paid in payments or in full, upon submission of an itemized invoice with the prices stipulated herein for items delivered and accepted. All prices are to be net with all discounts deducted before prices are submitted.

25) TAX EXEMPT: The Richmond County School System is exempt for State sales taxes. Bid prices shall exclude Federal or State taxes that can be eliminated in sales to public school systems in the state of Georgia.

26) QUESTIONS, REQUESTS FOR CLARIFICATION, OR INTERPRETATIONS REGARDING

THIS REQUEST FOR QUOTATION: All communications concerning this request for proposal must be submitted in writing by electronic mail to:

Richmond County School System – Business Office Attn: Ms. Cecilia Perkins Email perkice@boe.richmond.k12.ga.us

Only written questions submitted by email will be accepted. No response other than what is written and distributed by the Business Office will be binding upon the Richmond County School System.

Originating departments may be called upon for clarification in their area of expertise at the discretion of the Business Office. Written responses to questions, requests for clarification, or interpretations will be furnished to all participating vendors.

All requests for clarification or interpretations must be submitted to the Business Office on or before the close of business May 17, 2023, 5:00 P.M.

27) ADDENDUMS: In the event an addendum becomes necessary, it will originate in the

Business Office and will be distributed via the website www.rcobe.org/bids to all participating contractors. Any addenda issued during the time of the request for proposal distribution should be acknowledged by the participating contractor and attached to their response form.

28) INSPECTION OF PUBLIC RECORDS: All information received from vendors shall be subject to inspection once the bid is awarded under Georgia Public Records Act.

mailto:perkice@boe.richmond.k12.ga.us http://www.rcobe.org/bids

FURTHER REQUIREMENTS: The successful bidder or bidders must:

1. Comply with Executive Order 11246, entitled “Equal Employment Opportunity” as amended by Executive order 11375 and as supplemented in the Department of Labor regulations.

2. Meet regulations relating to energy efficiency which are contained in the State Energy

Conservation Plan issued in compliance with the Energy and Conservation Act (PL 94- 165).

3. Allow access by duly authorized representatives of the School Food Authority State

Agency, United States Department of Agriculture Comptroller General to any books, documents, papers and records which are directly pertinent to this contract.

4. Maintain all required records for the three (3) years after final payment and all other pending matters are closed.

5. Comply with all applicable standards, orders, or requirements issued under Section

306 of the Clean Air Act, Executive Order 11738, and Environmental Protection Agency regulations.

6. Comply, sign and return the attached certification form regarding lobbying, debarment and drug-free workplace requirements. (ATTACHMENT 1)

If any potential bidder is in doubt as to the true meaning of this request for quotation, they may submit to the Business Office, Richmond County School System, 864 Broad Street, 4th Floor, Augusta, GA 30901 or 706-826-1298 a request for an interpretation thereof. Any interpretation will be made by addendum duly issued and a copy thereof posted on the Richmond County School System’s website at www.rcboe.org. The Richmond County School System will not be responsible for any other explanation or interpretation of such documents which anyone presumes to make on behalf of the School System before expiration of date set for receipt of bids.

Vendors shall not submit a bid for the contract if a conflict of interest real or apparent, would be involved. Conflicts of interest arise when any of the following has a financial or other interest in the firm:

a. An employee, officer or agent of the local school system.

b. Any member of the immediate family of the above named persons.

c. The partner of any of the above name persons.

http://www.rcboe.org/

The undersigned offers and agrees to furnish those items for which bids are awarded (1) at the quoted prices, (2) in the required quantities, (3) of the quality defined by the specifications, and (4) will deliver said products to the school(s) location designated.

This contract shall be binding for the period July 1, 2023 through June 30, 2025.

Termination of this contract will be immediate if the vendor fails to meet the requirements established herein. Any other termination shall be accepted only upon the written agreement of both parties.

By submitting this bid, the undersigned bidder certifies they have read, understand, and agree to the foregoing conditions.

COMPANY NAME:

ADDRESS:

TELEPHONE NUMBER:

FAX NUMBER:

EMAIL:

SUBMITTED BY:

SIGNATURE AND DATE:

TITLE:

A signed copy of this contract along with the RFQ and Standard Terms and Conditions must be received by Wednesday, May 24, 2023 at 3:00 p.m.

INSTRUCTIONS AND SPECIFICATIONS FOR

FROZEN TREATS 2023-2025 RFQ #23-146

These instructions shall govern the selection of frozen treats furnished and delivered to the Richmond County School System. Bids which in any way qualify or vary the terms of these instructions, conditions and specifications shall be considered non-responsive.

According to Section 104(d) of the William F. Goodling Child Nutrition Reauthorization Act, Section 12 (n) of the National School Lunch Act, Richmond County will purchase domestically grown and processed foods, to the maximum extent practicable. In some cases, the supplier may be asked to certify the percentage of U.S. content in products supplied.

METHOD OF AWARD

1. The bid shall be awarded to the lowest responsible and responsive bidder for the Richmond County School System. This will be based on approximate annual usage rates multiplied by the price bid. The bidder with the lowest price of all these prices totaled will be awarded the bid.

2. The school system reserves the right to reject any and all bids and/or to accept the bid that in its judgment will be in the best interest of the Richmond County School System.

3. By the submission of this bid, the bidder agrees that he will accept one hundred (100) percent of the Richmond County School System frozen treat requirements.

4. The decision of the Richmond County School System shall be final.

CONTRACT

1. CONTRACT PERIOD: The contract shall commence on July 1, 2023 and end on June 30, 2025

2. OPTION TO RENEW: This contract may be renewed at the same terms and conditions for (2) two one-year terms upon mutual agreement of the awarded vendor(s) and RCSS.

PRICING

1. Prices are to be quoted on the box of twenty-four (24) unless specified as a different pack.

2. Pricing must remain firm for the period of the contract: July 1, 2023 to June 30, 2025 and shall include all charges for packing and transporting to the individual schools.

Prices quoted will not include Federal Excise Tax or State Tax. The Richmond County School System is a tax exempt organization.

ORDERS

The individual School Nutrition Manager shall place orders weekly, based on their needs, as has been the practice.

TEMPERATURE

At the time the frozen treats are delivered to Richmond County Schools, it shall be frozen solid.

BILLING

1. At the time of delivery to the schools, two (2) copies of the vendor's invoice shall be left with the School Nutrition Manager.

2. In the event of errors, a credit or debit (as the case may be) is to be issued against the invoice as it was presented to the School Nutrition Manager.

a. The credit, or debit, shall show the original invoice number, date and error being corrected on the face of said credit or debit.

b. The credit, or debit, shall be sent, in duplicate, directly to the School Nutrition Manager.

3. All invoices are to clearly indicate the school name.

FREEZER

The successful bidder will provide each school with a frost free display freezer specific to the size required by space in each school. The top must be well sealed with the ability to lock and be secured when not in use. Schools with multiple serving lines may request more than one freezer, depending on usage.

ALL PRODUCTS BID must be Smart Snack Compliant (https://www.fns.usda.gov/tn/guide-smart-snacks-school). Nutritional information for all products is required with submission.

QUOTE FORM

ITEM PACK PRICE

1. Vanilla Ice Cream Sandwich

2. Cookies and Cream Sandwich or Bar

3. Push Up

4. Dream Bar

5. Fudge Bar

6. Twist Cone

7. Ice Cream Cups – 3 oz., list flavors

8. Specialty Twister Cups – 3 oz., list flavors

9. Specialty Bar – 36, list flavors

The above prices are effective July 1, 2023 to June 30, 2025 with an option to renew for two

(2) additional one-year terms at the same cost, terms and conditions.

Company Name Phone Number

Address City, State, Zip

Signature of Representative Title

Email of Representative https://www.fns.usda.gov/tn/guide-smart-snacks-school https://www.fns.usda.gov/tn/guide-smart-snacks-school

FROZEN TREATS 2023-2025 - RFQ #23-146 ATTACHMENT 1

SEX OFFENDER ACKNOWLEDGEMENT FORM

Read, sign and return this form to the Richmond County Board of Education along with bid proposal

The Contractor (or Vendor) shall not knowingly send any employee, agent or subcontractor personnel who is a registered sex offender or who has been convicted of sexual abuse to any school building or school property when students are attending school or a school related activity.

The Contractor (or Vendor) shall make periodic criminal history record inquiries as authorized by O.C.G.A. §35-3-34, as now written, or here-after amended; or allowed by all or any other laws allowing such inquiry, to identify these persons who have been convicted of sexual abuse or any other act which would require such person to be entered into a national or state sexual offender registry.

For the purpose of this policy, the term periodic shall mean that the criminal history record inquiries shall be made current upon the awarding of a successful bid on contract and checked no less than annually during the duration of the contract.

The Contractor (or Vendor) is certifying to the Richmond County Board of Education that periodic criminal history record checks are made by the company for all employees and that to the best of the Contractor’s (or Vendor) knowledge it has no employee or agent who has been convicted of a sex offense or who is a registered sex offender, who will be assigned to any school building or school property while students are attending school or a school related activity.

I have read and understand the above Richmond County Board of Education Policy regarding me or my company’s obligation as a contractor (or vendor). I further acknowledge that the failure to comply with the requirements to identify a sex offender, to comply with any part of this policy, to assign a sex offender to any school building or school property while students are attending school or a school related activity will constitute a breach of the contract.

Company Name:

Contractor/Vendor Signature Date Signed

Witness Signature

Date Signed

FROZEN TREATS 2023-2025 - RFQ #23-146 ATTACHMENT 2

E-VERIFY AFFIDAVIT

under O.C.G.A. § 13-10-91(b)(4)

Read, fill out and return this form to the Richmond County School System

By executing this affidavit, the undersigned Contractor verifies its compliance with Immigration Reform and Control Act of 1986 (IRCA), Pub.L. 99-603, stating affirmatively that the individual firm or corporation which is engaged in services on behalf of the Richmond County School System has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established by federal law and regulation.

Furthermore, the undersigned Contractor will continue to use the federal work authorization program throughout the contract period. Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number:

Date of Authorization:

Name of Project: Frozen Treats

Solicitation Number (if applicable): RFQ #23-146

Name of Public Employer: Richmond County School System

I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on _______________________, _________, 202_______ in ____________________ (city), ______________ (state).

Signature of Authorized Officer or Agent

Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE ______________________ DAY OF _______________________________________________ ,202_____________.

NOTARY PUBLIC

My Commission Expires:______________________________________________________________________________________

AD-1047 OMB No. 0505-0027 Expiration Date: 09/30/2025

Certification Regarding Debarment, Suspension, and Other Responsibility Matters Primary Covered Transactions

The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. § 552a, as amended). This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, and 2 CFR § 180.335, Participants' responsibilities. The regulations were amended and published on August 31, 2005, in 70 Fed. Reg. 51865-51880. Copies of the regulations may be obtained by contacting the Department of Agriculture agency offering the proposed covered transaction.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0505-0027. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The provisions of appropriate criminal or civil fraud, privacy, and other statutes may be applicable to the information provided.

(Read instructions on page two before completing certification.)

A. The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:

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

2. Have not within a 3-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

3. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (A.2.) of this certification; and

4. Have not within a 3-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.

B. Where the prospective primary 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

NAME(S) AND TITLE(S) OF AUTHORIZED REPRESENTATIVE(S)

SIGNATURE DATE

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.

USDA is an equal opportunity provider, employer, and lender.

https://www.usda.gov/oascr/how-to-file-a-program-discrimination-complaint mailto:program.intake@usda.gov

Instructions for Certification

(1) By signing and submitting this form, the prospective primary participant is providing the certification set out on page 1 in accordance with these instructions.

(2) The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant must submit an explanation of why it cannot provide the certification set out on this form. The certification or explanation will be considered in connection with the Department or agency's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation will disqualify such person from participation in this transaction.

(3) The certification in this clause is a material representation of fact upon which reliance was placed when the Department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the Department or agency may terminate this transaction for cause or default.

(4) The prospective primary participant must provide immediate written notice to the Department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

(5) 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 the rules implementing Executive Order 12549, at 2 CFR Parts 180 and 417. You may contact the Department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations.

(6) The prospective primary participant agrees by submitting this form that, should the proposed covered transaction be entered into, it may 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 entering into this transaction.

(7) The prospective primary participant further agrees by submitting this form that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions," provided by the Department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

(8) A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that 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 General Services Administration’s System for Award Management Exclusions database.

(9) 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 is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

(10) Except for transactions authorized under paragraph (6) 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 may terminate this transaction for cause or default.

Form AD-1047 (REV 12/22)