Construction form AISD/DISCLOSURE FORM (Rev.Nov. ’16)

Austin Independent School District

DISCLOSURE FORM

PROJECT NUMBER______

The Austin Independent School District (AISD) encourages full participation in all phases of procurement activities and shall afford a full and fair opportunity to all vendors to compete for District contracts.

AISD encourages all respondentsto provide opportunities to qualified minority and women-owned businesses assubcontractors. A “subcontractor” is a vendor who provides work (i.e., labor, materials, equipment, supplies and/or services, as applicable) to a primefirm to fulfill a portion of the prime firm’s contractual obligations to AISD. Each respondent is encouraged to create a single point of contact in its organization to facilitate its outreach to and utilization of qualified minority and woman-owned businesses as subcontractors. For purposes of this Disclosure Form, the attached Disclosure Statement/HUB Utilization Report (HUR), the term “subcontractors” is intended to refer to subcontractors, suppliers, consultants, sub-consultants, vendors or other contracting parties, as applicable.

Name of Prime Firm:______(Full legal name of the firm, including DBA if applicable)

  1. If your firm will provide alllabor, materials, equipment, supplies and/orservices required for this procurement, please complete Sections A and C of this Disclosure Form, and complete the required information for your firm on the attached Disclosure Statement.

SECTION A

Our firm has not identified any subcontracting opportunities and will not subcontract any portion of the work. We have explained in Section C below how our firm will perform all work required to fulfill our contractual obligations to AISD.

Authorized Signature:______

Printed Name:______Date:______

  1. If your firm will subcontract any portion of this procurement, please complete Section B below, and complete the attached Disclosure Statement.

SECTION B

Our firm will subcontract portions of the work to one or more subcontractors.

Authorized Signature:______

Printed Name:______Date:______

Failure to complete this form may result in the disqualification of your RESPONSE.

All Information provided is subject to verification.

SECTION C

SELF-PERFORMANCE EXPLANATION / JUSTIFICATION

Please complete the following to identify the scope of work required to fulfill your firm’s contractual obligations to AISD and justify your firm’s intention to self-perform all of the necessary work and duties required by the scope of the Project.

IDENTIFY THE REQUIRED SCOPE OF WORK FOR THE PROJECT / EXPLAIN HOW YOUR FIRM WILL SELF-PERFORM THE REQUIRED SCOPE

Authorized Signature:______

Printed Name:______Date:______

Project Number______Page 1