Section III: Attachments

Please includeall original completed forms with the original copy of your RFQand two USB drives.

Attachments:

FORM A: Vendor Information
FORM B: MWBE Instructions and Participation Report

FORM C: Reference Information and Instructions(Not Applicable For This Solicitation)

FORM D: Reference Evaluation Survey(Not Applicable For This Solicitation)
FORM E: General Certifications
FORM F: Price Schedule (if applicable) (should be placed in tab 7)
FORM G: EDGAR Certifications
FORM H: Exceptions
FORM I: ConflictofInterest Instructions and Questionnaire (Form CIQ)
FORM J: Instructions for Completion of Disclosure of Interested Persons Certification (HB 1295)
FORM K: IRSFormW‐9
FORM L: Certificate of Insurance (Acord Form) or a letter from its insurance provider stating that Respondent can provide the levels of insurance required in this RFQ.
FORM M: Acknowledgement Form
FORM N: Agreement Letter
APPENDIX A: Questionnaire

FORM A: vendor information

This Form A is required. See HISD Policy CHE (Local).

legal name of vendor:______

data universal numbering system (duns) number: ______

type of business/description of products and/or services provided:______

______

______

vendor mailing address: ______

city: ______ state: ______zip code: ______

vendor street address: ______

city: ______state: ______zip code: ______

telephone: ______fax: ______

contact person’s name: ______

contact person’s telephone number:______fax: ______

contact person’s e-mail address: ______

  1. type of business entity: ☐ publicly traded corporation ☐private corporation ☐ limited partnership

☐ partnership ☐ sole proprietorship ☐ not for profit entity

  1. number of full time employees: ______number of part time employees: ______
  1. is vendorisa residentbidder? ☐yes ☐no

a resident bidder refers to a person whose principal place of business in the state of texas,

Including a vendor whose ultimate parent company or majority owner has its principal place of

business in this state.

  1. cityand stateofvendor'sprincipalplace of business:______

if not texas, does the state have preferential treatment on bids? ☐yes ☐no

if yes, what percentage: ______%

  1. number of years vendor has been in continuous operation:______
  1. number of years vendor has been in business under its present business name: ______
  1. has vendor conducted business with the district under another name? ☐yes ☐no

If yes, provide other name(s):______

______

  1. number of years doing business with hisd: ______
  1. does vendor have a parent company or subsidiary that currently conducts or that has previously

conducted business with the district? ☐yes ☐no

If yes, name of parent company and/or subsidiary: ______

______

  1. do you have experience with other school districts? ☐ yes ☐no

if yes, names of school districts______

______

  1. does vendor have any owners, principal shareholders or stockholders, officers, agents, salespeople or key employees who have been members of the hisd board of education during the last 5 years? ☐yes ☐no

If yes, name(s) and title(s): ______

  1. does any officer, partner, owner, sales representative and/or spouse work for hisd? ☐yes ☐no
  1. does vendor have any owners, principal shareholders or stockholders, officers, agents, salespeople or key employees who are district employees or who are members of a district employee’s immediate family who either work or who may potentially work on this contract with the district? ☐yes ☐no

If yes, name(s) and title(s): ______

______

  1. names of authorized agents, including any person or entity authorized to ‘act with’ or ‘act on your behalf,’ such as consultants, sub-contractors, re-sellers, lobbyists, confidants, etc., whether compensated or not compensated:

______

______

______

______

  1. does vendor have relationship(s) with any political action committees? ☐yes ☐no

if yes, name(s) of pac(s)______

  1. has vendor (including any owner, principal shareholder or stockholder, officer, agent, salesperson, or employee) been involved in past, pending, or present litigation involving the District? ☐yes ☐no

if yes, please provide the style and status of the case as well as the type of litigation: ______

______

  1. financial and business references, including bank with which vendor conducts business:

name of bank with which vendor conducts business: ______

_

bank officer: ______officer’s phone number: ______

name of other banking/financial institution(s): ______

______

  1. name of insurance companies:

insurance companies / insurance companies
  1. hisd encourages the participation of minority and women owned business. Is vendor a minority and/or woman owned company? ☐yes ☐no

if yes, what percentage of ownership is minority or woman owned ______%

  1. check one of the following: ☐ vendor will provide goods and services with own work force

☐ vendor will purchase goods directly from the manufacturer or other supplier

  1. hisd can only do business with equal opportunity employers.

do you advertise as an equal opportunity employer? ☐ yes ☐ no

do you have a written non-discriminatory policy of employment? ☐ yes ☐ no

has this policy been circulated throughout your organization? ☐ yes ☐ no

person to contact regarding equal opportunity information issues:

name: ______title: ______

-----QUESTIONS REGARDING PROCUREMENT E-COMMERCE SOLUTIONS----

more information regarding the following questions and hisd’s e-procurement system may be found on the district’s website at [PROVIDE LINK TO PROCUREMENT E-COMMERCE SOLUTIONS FORMERLY ON PAGE 28 OF TEMPLATE]

  1. name of contact person regarding it issues in your company: ______
  2. is vendor participating in the optional e-commerce method described in section 3.4 of this RFQ? ☐ yes ☐no
  3. can vendor provide hisd with periodic preformatted flat file updates of your catalog? ☐ yes ☐no
  4. does vendor have e-commerce capability? ☐ yes ☐no
  5. does vendor have punch-out catalogs in place today? ☐ yes ☐no
  6. does vendor have any internal electronic catalogs with any customers? ☐ yes ☐no
  7. is vendor capable of providing a dedicated website with your catalog with hisd’s pricing? ☐ yes ☐ no

if yes, can your website interface with sap public section 7.0 / ecc 6.0 open catalog interface (oci)

compliant? ☐yes ☐no

i attest that i have answered the questions regarding vendor information truthfully and to the best of my knowledge.

______

officer’s signature

______

printed name

______

title

FORM b: MWBE INSTRUCTIONS

DO NOT SUBMIT EXAMPLE DOCUMENT

Please refer to Attachment B-MWBE Participation Report. MWBE Submission is required and must be submitted with the SOQ submission. Failure to submit this report shall cause the submission to be marked non-responsive. Do not Mark N/A on this Document. All question reference this document should be reference to the Houston Independent School District Business Assistance Office at 713-556-7273.

FORM C: REFERENCE INFORMATION AND INSTRUCTIONS

(Not Applicable For This Solicitation)

FORM D: REFERENCE SURVEY

(Not Applicable For This Solicitation)

FORM E: General CERTIFICATION FORMS

CERTIFICATION OF CODE OF SILENCE

The Board of Education (Board) has adopted a “Code of Silence” policy (Board Policy CAA (Local)) attached by URL link hereto and incorporated by reference.

The “Code of Silence" prohibits any communication regarding any RFQ, bid, or other competitive solicitation between:

  • Any person who seeks an award from the District or its affiliated entities (including, but not limited to, the HISD Foundation and the HISD Public Facility Corporation), including a potential vendor or vendor's representative, and
  • Board members, the Superintendent of Schools, senior staff members, principals, department heads, directors, managers, or other District representatives who have influence in the evaluation or selection process.

The “Code of Silence” time period shall begin when the RFQ is issued and ends upon the execution of the Contract. During the “Code of Silence,” campaign contributions, gifts, donations, loans, and any other items of value are prohibited between these parties, including candidates who have filed for election to the Board.

I hereby certify that I have reviewed Board Policy CAA (Local) pertaining to the “Code of Silence,” I and agree and understand that non-compliance with the “Code of Silence” policy may result in disqualification.

______Initials of Authorized Representative of Vendor

CERTIFICATION OF COMPLIANCE WITH TEXAS FAMILY CODE PROVISION

As per Section 14.52 of the Texas Family Code, added by S.B. 84, Acts, 73rd Legislature, R.S. (1993), all bidders must complete and submit with the bid the following: I, the undersigned Vendor, do hereby acknowledge that NO sole proprietor, partner, majority shareholder of a corporation, or an owner of 10% or more of another business entity is 30 days or more delinquent in paying child support under a court order or a written repayment agreement. I understand that under this provision, a sole proprietorship, partnership, corporation or other entity in which a sole proprietor, partner, majority shareholder or a corporation, or an owner of 10% or more of another entity is 30 days or more delinquent in paying child support under a court order or a written repayment agreement is NOT eligible to bid or receive a state contract.

______Initials of Authorized Representative of Vendor

CERTIFICATION OF AUTHORIZATION, PERMITS, AND BUSINESS CERTIFICATES REQUIREMENT

For the duration of the Contract,Vendor must have and maintain current licenses, permits, fees, business certificates and similar authorizations required by the City of Houston, Harris Country, and the State of Texas to conduct business and provide awarded goods and/or services to the District. Upon the request of the District, Vendor shall provide copies of all licenses, business certificates permits and fees as being paid and current that are required to do business by the city, county and State for the type of business Vendor provides, or seeks to provide, to the District.

Vendor understands and agrees to abide by the Authorization, Permits, and Business Certificates Requirement above. Vendor certifies that it has all current licenses, certificates, similar authorizations required by the City of Houston, Harris County, and the State of Texas to conduct business and/or provide awarded goods and/or services to the District.

______Initials of Authorized Representative of Vendor

CERTIFICATION OF ANTITRUST CERTIFICATION STATEMENT –Texas Government Code Section 2155.005

My initials below affirms under penalty of perjury of the laws of the State of Texas that:

  1. I am duly authorized to execute this Submission/Contract on my own behalf or on behalf of the company, corporation, firm, partnership or individual (Vendor) listed below;
  2. In connection with this submission, neither I nor any representative of Vendor have violated any provision of the Texas Free Enterprise and Antitrust Act, Tex. Bus & Comm. Code Chapter 15;
  3. In connection with this bid, neither I nor any representative of the Vendor have violated any federal antitrust law; and
  4. Neither I nor any representative ofVendor have directly or indirectly communicated any of the contents of this submission to a competitor of Vendor or any other company, corporation, firm, partnership or individual engaged in the same line of business as Vendor.

______Initials of Authorized Representative of Vendor

CERTIFICATION REGARDING HAZARD ANALYSIS AND CRITICAL CONTROL POINTS (HACCP)

All products purchased by HISD must be manufactured in compliance with HACCP regulations.Vendorcertifies that:all products on this submission are processed and packaged in a HACCP compliant plant. Vendor agrees Vendor further understands that HISD requires processors to maintain records and monitoring logs pertaining to HACCP compliance, at a minimum, in the following Key Areas of HACCP compliance:

  • Hazard Analysis
  • Critical Control Points established and limits set
  • Planned procedures in place to correct processes when deviation may occur
  • Detailed and accurate record keeping
  • Verification procedures
  • Equipment installation and maintenance
  • Master cleaning and sanitation schedule
  • Orientation for all employees
  • Ongoing training on food safety and HACCP procedures
  • Separation of food and chemical products
  • Refrigerated dock receiving and loading
  • Master cleaning and sanitation schedule
  • Time/Temperature monitoring
  • Pest Control

Vendor further understands and agrees that documentation and monitoring logs must be verified by an acceptable third party auditing firm or government agency and provided to HISD upon request. Vendor also understands and agrees that if a processor loses inspection/processing rights or has a recall involving product sold to HISD, Vendor must notify HISD within 24-48 hours.

______Initials of Authorized Representative of Vendor

CERTIFICATION OF VENDOR (AND IF APPLICABLE, SUBCONTRACTOR)

NATIONWIDE CRIMINAL BACKGROUND CHECKS

Pursuant to sections 22.085 and 22.0834 of the Texas Education CodeSections 22.085 and 22.0834 and HISD Policy CJA (Legal), Vendor hereby certifies that all of Vendor’s employees, subcontractors and volunteers (including those hired before January 1, 2008) who have, or will have, continuing duties related to the contracted services, and who have, or will have, direct contact with students, have passed a national criminal history background record information review as required by those sections and by HISD Policy CJA (Legal). Vendor understands that if an employee subcontractor, or volunteer has a Disqualifying Criminal History, the District may elect not to enter into this Contract or may elect to cancel the Contract.

“Disqualifying Criminal History” means:(1)aconvictionorothercriminalhistoryinformationdesignatedbyHISD;(2)afelonyormisdemeanoroffensethatwouldpreventapersonfrombeingemployedunderTexasEducationCode§22.085(a),thatis:ifatthetimeoftheoffense,thevictimwasunder18orwasenrolledinapublicschool:(a)afelonyoffenseunderTitle5,TexasPenalCode;(b)anoffenseonconvictionforwhichadefendantisrequiredtoregisterasasexoffenderunderChapter62,TexasCodeofCriminalProcedure;or(c)anoffenseunderfederallaw orthelawsofanotherstatethatisequivalent to(a)or (b).

Vendor further certifies that:

(1)Vendor will immediately remove an employee, subcontractor, or volunteer from contract duties and notify HISD in writing within 3 business days if:

  1. Vendor receives information that an employee, subcontractor, or volunteer has a reported criminal history, or
  2. HISD objects to the assignment of an employee, subcontractor, or volunteer on the basis of the individual(s) criminal history review information (CHRI).

(2)Upon request, Vendor will provide HISD with the name and any other requested information of an employee, subcontractor, or volunteer so that HISD may obtain the CHRI on the individual(s).

______Initials of Authorized Representative of Vendor

CERTIFICATION OF FELONY CONVICTION NOTIFICATION

Pursuant to section 44.034 of the Texas Education Code, a person or business entity entering into a contract and/or agreement with HISD must give advance notice to HISD if the person or an owner or operator of the business entity has been convicted of a felony. The disclosure should include a general description of the conduction resulting in the conviction of a felony. HISD may terminate a contract with a person of business entity if HISD determines that the person or the business entity failed to give notice as required by section 44.034 or misrepresented the conduct resulting in the conviction. In such a case, HISD will compensate the person or business entity for services performed before the termination of the contract.

---THIS NOTICE IS NOT REQUIRED OF A PUBLICLY HELD-CORPORATION ---

Please check the following as applicable:

☐Vendorisapubliclyheldcorporation;thereforetheabovereportingrequirementdoesnotapply.

☐Vendoris notowned noroperated byanyonewho has beenconvicted ofa felony.

☐Vendoris operated or ownedby thefollowingindividual(s)whohas/have beenconvicted ofa felony:

Name ofIndividual(s):______

Detailofconviction(s),attachadditionalpagesifnecessary:______

______

______

______Initials of Authorized Representative of Vendor

CERTIFICATION OF INSURANCE REQUIREMENT

I, the undersigned Vendor, do hereby certify that I shall maintain all insurance policies required by and in accordance with Section 5.27 of this RFQ. I further understand and agree that I must make the certificates of insurance and insurance policies available to HISD upon request.

______Initials of Authorized Representative of Vendor

CERTIFICATION OF NON-COLLUSION STATEMENT

I, the undersigned Vendor, do hereby certify that:

a)All statements of fact in such submission are true.

b)SuchSubmission was not made in the interest of or on behalf of any undisclosed person, partnership, company, association, organization or corporation.

c)SuchSubmission is genuine and not collusive or sham.

d)Vendor has not, directly or indirectly by agreement, communication or conference with anyone, attempted to induce action prejudicial to the interest of the District or of any other bidder or anyone else interested in the proposed procurement.

e)Vendor did not, directly or indirectly, collude, conspire, connive or agree with anyone else that said bidder or anyone else would submit a false or sham bid or submission, or that anyone should refrain from bidding or withdraw his bid or submission.

f)Vendor did not, in any manner, directly or indirectly seek by agreement, communication or conference with anyone to raise or fix the bid or submission price of said bidder or of anyone else, or to raise or fix any overhead, profit or cost element of his bid or submission price, or that of anyone else.

g)Vendor did not, directly or indirectly, submit his bid or submission price or any breakdown thereof, or the contents thereof, or divulge information on data relative thereto, to any corporation, partnership, company, association, organization, bid depository, or to any member or agent thereof, or to any individual or group of individuals, except to the District, or to any person or persons who have a partnership or other financial interest with said Respondent in his business.

h)Vendor did not provide, directly or indirectly to any officer or employee of the District any gratuity, entertainment, meals, or anything of value, whatsoever, which could be construed as intending to invoke any form of reciprocation or favorable treatment.

i)No officer or principal of the undersigned Vendor is related to any officer or employee of the District by blood or marriage within the third degree or is employed, either full or part time, by the District either currently or within the last two (2) years.

j)No officer or principal of the undersigned Vendor nor any subcontractor to be engaged by the principal has been convicted by a court of competent jurisdiction of any charge of fraud, bribery, collusion, conspiracy or any other act in violation of any state or federal anti-trust law in connection with the bidding, award of, or performance of any public work contract and/or agreement with any public entity.

k)I have answered the questions regarding non-collusion truthfully and to the best of my knowledge.

______Initials of Authorized Representative of Vendor

VENDOR AGREES TO COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, RULES, REGULATIONS, AND ORDINANCES. IT IS FURTHER ACKNOWLEDGED THAT VENDOR CERTIFIES COMPLIANCE WITH ALL PROVISIONS, LAWS, ACTS, REGULATIONS, ETC. AS SPECIFICALLY NOTED ABOVE.

Vendor’s Name: ______

Address, City, State, and Zip Code: ______

Phone Number: ______Fax Number: ______

Printed Name and Title of Authorized Representative: ______

Email Address: ______

Signature of Authorized Representative: ______

Date: ______


FORM F (PRICE SCHEDULE)