This Form a Is Required. See HISD Policy CHE (Local). D&B and Safety

FORM A: vendor information

This Form A is required. See HISD Policy CHE (Local). D&B and Safety

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: ______

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

☐ partnership ☐ sole proprietorship ☐ not for profit entity

number of full time employees: ______number of part time employees: ______

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.

cityand stateofvendor'sprincipalplace of business:______

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

if yes, what percentage: ______%

number of years vendor has been in continuous operation:______

number of years vendor has been in business under its present business name: ______

has vendor conducted business with the district under another name? ☐yes ☐no

If yes, provide other name(s):______

______

number of years doing business with hisd: ______

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: ______

______

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

if yes, names of school districts______

______

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): ______

does any officer, partner, owner, sales representative and/or spouse work for hisd? ☐yes ☐no

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): ______

______

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:

______

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

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

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: ______

______

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): ______

______

name of insurance companies:

insurance companies / insurance companies

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

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

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

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: ______

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

Please refer to Separate Attachment B (MWBE) Participation Report and place in Tab 2

FORM C: REFERENCEINFORMATION AND INSTRUCTIONS

Proposer must complete and return Form C as part of its CSP.

The Evaluation Committee considers Proposer’s reputation and reputation of Proposer’s goods or services in its evaluation of this Proposal.

Proposer to complete FORM C

The District requests the proposer to send FORM D (Proposer Reference) to their respected Clients for the purpose of their Client to complete.

The proposer’s Client is then to send the completed FORM D to (Sr. Sourcing Specialist), no later than the proposal due date of September 12, 2017 at 2pm CST

Please provide the name and contact information of all references to whom Proposer intends to send the FORM D (References).

(1) ______

Name of Entity or Business Contact Name

______

Mailing Address City, State, Zip

______

Phone NumberGoods and/or services provided

(2) ______

Name of Entity or Business Contact Name

______

Mailing Address City, State, Zip

______

Phone NumberGoods and/or services provided

(3) ______

Name of Entity or Business Contact Name

______

Mailing Address City, State, Zip

______

Phone NumberGoods and/or services provided

FORM D:PROPOSER’S REFERENCE

Please refer to Separate Attachment D (Reference Request)

Proposer is to send the Reference Request form to 3 of their clients of their choosing.

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 CSP, 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 CSP 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:

I am duly authorized to execute this Proposal/Contract on my own behalf or on behalf of the company, corporation, firm, partnership or individual (Vendor) listed below;
In connection with this proposal, 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;
In connection with this bid, neither I nor any representative of the Vendor have violated any federal antitrust law; and
Neither I nor any representative ofVendor have directly or indirectly communicated any of the contents of this proposal 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 proposal 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:

Vendor receives information that an employee, subcontractor, or volunteer has a reported criminal history, or
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 CSP. 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 proposal are true.

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

c)SuchProposal 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 proposal, or that anyone should refrain from bidding or withdraw his bid or proposal.

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 proposal price of said bidder or of anyone else, or to raise or fix any overhead, profit or cost element of his bid or proposal price, or that of anyone else.

g)Vendor did not, directly or indirectly, submit his bid or proposal 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 Proposer 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:

PRICING / PROPOSAL

legal name of vendor:______DATE:______

Please enter Lump Sum Price per the drawings and specifications in Attachment A, which include: grading, sodding, removal of all spoils, and any work required to complete the project.

Option One: 6’ ft. wide sidewalk

Description / Total Linear Feet / Lump Sum Price
6’ft. wide trail – 2,097’ LF
9’ft.- 8”inch tie into school– 27’ LF
7’ft. tie into the parking lot that stops at the fence - 10’ LF / 2,134’ LF

Alternative Option

Option Two: 8’ ft. wide sidewalk

Description / Linear Feet / Lump Sum Price
8’ft. wide trail – 2,097’ LF
9’ft.- 8”inch tie into school– 27’ LF
7’ft. tie into the parking lot that stops at the fence -10’ LF / 2,134’ LF

Total duration of project: ______weeks

Availability to start work if awarded by HISD ______weeks

______

signature

______

Print Name and Title

**Please attached any proposal documentation if needed.

FORM G:EDGAR CERTIFICATIONS

The following certifications and provisions are required and apply when HISD expends federal funds for any contract resulting from this procurement process.Accordingly, the parties agree that the following terms and conditions apply to the Contractbetween the District and [name of vendor] (“Vendor”) in all situations where Vendor has been paid or will be paid with federal funds: