PART III: Attachments

Transcription

1 PART III: Attachments Revised 07/24/2017 Please include all original completed forms with the original copy of your RFP and one electronic copy with the electronic copy. Attachments: FORM A: Supplier Information FORM B: MWBE Instructions and Participation Report FORM C: Reference Survey Instructions FORM D: Reference Survey 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: Conflict of Interest Instructions and Questionnaire (Form CIQ) FORM J: Instructions for Completion of Disclosure of Interested Persons Certification (HB 1295) FORM K: IRS Form W 9 FORM L: Certificate of Insurance (Acord Form) or a letter from its insurance provider stating that Proposer can provide the levels of insurance required in this RFP. FORM M: Acknowledgement Form FORM N: Sample Master Services Contract (MSC) FORM O: Criminal History Background Check Certification FORM P: Checklist

2 FORM A: SUPPLIER INFORMATION This Form A is required. See HISD Policy CHE (Local). LEGAL NAME OF SUPPLIER: DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER: TYPE OF BUSINESS/DESCRIPTION OF PRODUCTS AND/OR SERVICES PROVIDED: SUPPLIER MAILING ADDRESS: CITY: STATE: ZIP CODE: SUPPLIER STREET ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE: FAX: CONTACT PERSON S NAME: CONTACT PERSON S TELEPHONE NUMBER: FAX: CONTACT PERSON S ADDRESS: 1. TYPE OF BUSINESS ENTITY: PUBLICLY TRADED CORPORATION PRIVATE CORPORATION LIMITED PARTNERSHIP PARTNERSHIP SOLE PROPRIETORSHIP NOT FOR PROFIT ENTITY 2. NUMBER OF FULL TIME EMPLOYEES: NUMBER OF PART TIME EMPLOYEES: 3. IS SUPPLIER IS A RESIDENT BIDDER? YES NO A RESIDENT BIDDER REFERS TO A PERSON WHOSE PRINCIPAL PLACE OF BUSINESS IN THE STATE OF TEXAS, INCLUDING A SUPPLIER WHOSE ULTIMATE PARENT COMPANY OR MAJORITY OWNER HAS ITS PRINCIPAL PLACE OF BUSINESS IN THIS STATE. 4. CITY AND STATE OF SUPPLIER'S PRINCIPAL PLACE OF BUSINESS: IF NOT TEXAS, DOES THE STATE HAVE PREFERENTIAL TREATMENT ON BIDS? YES NO IF YES, WHAT PERCENTAGE: % 5. NUMBER OF YEARS SUPPLIER HAS BEEN IN CONTINUOUS OPERATION: 6. NUMBER OF YEARS SUPPLIER HAS BEEN IN BUSINESS UNDER ITS PRESENT BUSINESS NAME: 7. HAS SUPPLIER CONDUCTED BUSINESS WITH THE DISTRICT UNDER ANOTHER NAME? YES NO IF YES, PROVIDE OTHER NAME(S):

3 8. NUMBER OF YEARS DOING BUSINESS WITH HISD: 9. DOES SUPPLIER 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: 10. DO YOU HAVE EXPERIENCE WITH OTHER SCHOOL DISTRICTS? YES NO IF YES, NAMES OF SCHOOL DISTRICTS 11. DOES SUPPLIER 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): 12. DOES ANY OFFICER, PARTNER, OWNER, SALES REPRESENTATIVE AND/OR SPOUSE WORK FOR HISD? YES NO 13. DOES SUPPLIER 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): 14. 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: 15. DOES SUPPLIER HAVE RELATIONSHIP(S) WITH ANY POLITICAL ACTION COMMITTEES? YES NO IF YES, NAME(S) OF OF PAC(S) 16. HAS SUPPLIER (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: 17. FINANCIAL AND BUSINESS REFERENCES, INCLUDING BANK WITH WHICH SUPPLIER CONDUCTS BUSINESS: _ NAME OF BANK WITH WHICH SUPPLIER CONDUCTS BUSINESS: BANK OFFICER: OFFICER S PHONE NUMBER: NAME OF OTHER BANKING/FINANCIAL INSTITUTION(S):

4 18. NAME OF INSURANCE COMPANIES: INSURANCE COMPANIES INSURANCE COMPANIES 19. HISD ENCOURAGES THE PARTICIPATION OF MINORITY AND WOMEN OWNED BUSINESES. IS SUPPLIER A MINORITY AND/OR WOMAN OWNED COMPANY? YES NO IF YES, WHAT PERCENTAGE OF OWNERSHIP IS MINORITY OR WOMAN OWNED % 20. CHECK ONE OF THE FOLLOWING: SUPPLIER WILL PROVIDE GOODS AND SERVICES WITH OWN WORK FORCE SUPPLIER WILL PURCHASE GOODS DIRECTLY FROM THE MANUFACTURER OR OTHER SUPPLIER 21. 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 SUPPLIER INFORMATION TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE. OFFICER S SIGNATURE PRINTED NAME TITLE

5 FORM B: MWBE INSTRUCTIONS Please refer to Attachment B-MWBE Participation Report that is located on HISD s Procurement Web Site with this RFP. Place this document in Tab 2

6 FORM C: REFERENCE SURVEY INSTRUCTIONS Proposer must complete and return Form C as part of this RFP. The Evaluation Committee considers Proposer s reputation and quality of Proposer s goods or services in the evaluation of this Proposal. To aid in this process, the District requests that Proposer send the attached Form D, Reference Survey to three (3) clients. Proposer must fill out the top portion of Form D, Supplier Name on each Survey. No other portion of the Survey may be completed by Proposer. It is Proposer s sole responsibility to ensure that Surveys are sent to Proposer s desired references. Recipients must return the completed survey to HISD by one of the methods outlined on the Survey. The District will not accept a Reference Survey returned by Proposer or a Reference Survey returned after the assigned deadline, September 14, 2017, 10:00 a.m. While Proposer may choose its recipients, more weight is given to the following references: Clients who are governmental entities, and, in particular, school districts; and Clients provided with similar goods and/or services as called for by this RFP; Please provide the name and contact information of all references to whom Proposer intends to send the Survey. (1) Name of Entity or Business Contact Name Address Phone Number Mailing Address Goods and/or services provided (2) Name of Entity or Business Contact Name Address Phone Number Mailing Address Goods and/or services provided (3) Name of Entity or Business Contact Name Address Phone Number Mailing Address Goods and/or services provided

7 FORM D: REFERENCE SURVEY TO THE ATTENTION OF: Demetria Thomas, Houston Independent School District REQUEST FOR PROPOSALS: RFP /Rental of Extra Curricular Charter & School Bus Services SUPPLIER NAME: To Whom It May Concern: The Houston Independent School District (HISD) has implemented a process to collect Supplier performance evaluations. HISD may use the information provided in its assessment of the above Supplier in order to determine a responsive and responsible procurement. The Supplier listed above has chosen to participate in this process and listed you as a past or present client for whom it has provided goods and/or services. HISD would greatly appreciate your completion of the survey below. (I) Please evaluate the performance of the Supplier on a scale of one (1) through ten/fifteen (10/15), with 10/15 being the highest. If you do not have sufficient knowledge of Supplier s past and/or current performance in a particular area, please leave it blank. NO. CRITERIA UNIT SCORE 1 Ability to Manage Cost (1-15) 2 Quality of Product(s) and/or Services (1-15) 3 Quality of Customer Service (1-10) 4 Quick Response Time (1-10) 5 Ability to Maintain Confidentiality (1-10) 6 Close Out Process (invoicing, no unexpected fees) (1-10) 7 Communication (1-10) 8 Ability to Follow Rules, Regulations, and Requirements (1-10) 9 Overall Customer Satisfaction Based on Performance (comfort level using company (1-10) again) TOTAL POINTS (out of 100) : (II) How long have you done business with the Supplier? (III) Please provide a brief description of the goods and/or services provided to you by the Supplier and include any additional information you believe might assist HISD in its evaluation (attach additional sheets if necessary): Thank you for your time and effort. Please sign below and return this completed survey to the Houston Independent School District by September 14, 2017, 10:00 a.m. through the following method: Via dthoma30@houstonisd.org Printed Name Signature Date

8 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 RFP, 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 supplier or supplier'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 RFP 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 Supplier CERTIFICATION OF COMPLIANCE WITH TEXAS FAMILY CODE PROVISION As per Section 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 Supplier, 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 Supplier CERTIFICATION OF AUTHORIZATION, PERMITS, AND BUSINESS CERTIFICATES REQUIREMENT For the duration of the Contract, Supplier 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, Supplier 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 Supplier provides, or seeks to provide, to the District. Supplier understands and agrees to abide by the Authorization, Permits, and Business Certificates Requirement above. Supplier 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 Supplier CERTIFICATION OF ANTITRUST CERTIFICATION STATEMENT Texas Government Code Section 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 Proposal/Contract on my own behalf or on behalf of the company, corporation, firm, partnership or individual (Supplier) listed below; 2. In connection with this proposal, neither I nor any representative of Supplier 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 Supplier have violated any federal antitrust law; and

9 4. Neither I nor any representative of Supplier have directly or indirectly communicated any of the contents of this proposal to a competitor of Supplier or any other company, corporation, firm, partnership or individual engaged in the same line of business as Supplier. Initials of Authorized Representative of Supplier CERTIFICATION REGARDING HAZARD ANALYSIS AND CRITICAL CONTROL POINTS (HACCP) All products purchased by HISD must be manufactured in compliance with HACCP regulations. Supplier certifies that: all products on this proposal are processed and packaged in a HACCP compliant plant. Supplier agrees Supplier 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 Supplier 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. Supplier also understands and agrees that if a processor loses inspection/processing rights or has a recall involving product sold to HISD, Supplier must notify HISD within hours. Initials of Authorized Representative of Supplier CERTIFICATION OF SUPPLIER (AND IF APPLICABLE, SUBCONTRACTOR) NATIONWIDE CRIMINAL BACKGROUND CHECKS Pursuant to sections and of the Texas Education Code Sections and and HISD Policy CJA (Legal), Supplier hereby certifies that all of Supplier 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). Supplier 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) a conviction or other criminal history information designated by HISD; (2) a felony or misdemeanor offense that would prevent a person from being employed under Texas Education Code (a), that is: if at the time of the offense, the victim was under 18 or was enrolled in a public school: (a) a felony offense under Title 5, Texas Penal Code; (b) an offense on conviction for which a defendant is required to register as a sex offender under Chapter 62, Texas Code of Criminal Procedure; or (c) an offense under federal law or the laws of another state that is equivalent to (a) or (b). Supplier further certifies that: (1) Supplier will immediately remove an employee, subcontractor, or volunteer from contract duties and notify HISD in writing within 3 business days if: a. Supplier receives information that an employee, subcontractor, or volunteer has a reported criminal history, or b. 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, Supplier 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 Supplier

10 CERTIFICATION OF FELONY CONVICTION NOTIFICATION Pursuant to section 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 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. Please check the following as applicable: ---THIS NOTICE IS NOT REQUIRED OF A PUBLICLY HELD-CORPORATION --- Supplier is a publicly held corporation; therefore the above reporting requirement does not apply. Supplier is not owned nor operated by anyone who has been convicted of a felony. Supplier is operated or owned by the following individual(s) who has/have been convicted of a felony: Name of Individual(s): Detail of conviction(s), attach additional pages if necessary: CERTIFICATION OF INSURANCE REQUIREMENT Initials of Authorized Representative of Supplier I, the undersigned Supplier, do hereby certify that I shall maintain all insurance policies required by and in accordance with Section 5.27 of this RFP. 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 Supplier I, the undersigned Supplier, do hereby certify that: CERTIFICATION OF NON-COLLUSION STATEMENT 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) Such Proposal is genuine and not collusive or sham. d) Supplier 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) Supplier 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) Supplier 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) Supplier 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) Supplier 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 Supplier 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 Supplier nor any subcontractor to be engaged by the principal has been convicted

11 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 Supplier SUPPLIER AGREES TO COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, RULES, REGULATIONS, AND ORDINANCES. IT IS FURTHER ACKNOWLEDGED THAT SUPPLIER CERTIFIES COMPLIANCE WITH ALL PROVISIONS, LAWS, ACTS, REGULATIONS, ETC. AS SPECIFICALLY NOTED ABOVE. Supplier s Name: Address, City, State, and Zip Code: Phone Number: Fax Number: Printed Name and Title of Authorized Representative: Address: Signature of Authorized Representative: Date:

12 FORM F: PRICE AND PRICING SCHEDULE PRICE AND PRICING SCHEDULE Proposer is asked to submit pricing as identified in Part II, Section 2.7. A hard copy of Form F must be submitted under Tab 7 in the proposal. Please refer to Form F Price Schedule the Excel document that is located on HISD s Procurement Web Site. Your company s pricing must be submitted on the attached Form F Price Schedule in Excel Format; unlocked. A hard copy must also be submitted as noted below: Proposer shall complete and submit a copy of Form F: Price Schedule unlocked on USB. Submit with your company s proposal: One (1) hard copy original of Form F: Price Schedule, one (1) hard copy duplicate of the original, and two (2) USB drives. Form F: Price Schedule shall be on the same USB drive as your company s proposal. Form F: Price Schedule contains five (5) tabs: 1. Supplier Instructions 2. Rental Rates 3. List of Buses and Vehicle Identification Number (VIN) 4. Locations & Contract Information 5. Other Related Services A. Pricing: Refer to Part III, Form F Price Schedule 1. HISD is requesting multiple pricing schedules for various trips. 2. These trips shall include all charges and do not include a fuel surcharge. 3. The Proposer shall provide a price for the general District use and for the Athletics Department. 4. Pricing shall be determined by the radius 30 miles from downtown Houston (City Hall). 5. Pricing will be based on a four hour trip and then each additional hour as needed. 6. Pricing shall include all charges and should not include a fuel surcharge. 7. If fuel prices increase to the point where quoted trip price is no longer viable then the supplier can negotiate a fuel surcharge with Procurement Services at that time. Once the price decreases, then billing will not include the fuel surcharge any longer. 8. Penalties for late trips: a. If the supplier is late by the following amount of time from scheduled pick then the following penalties shall incur. Late 15 minutes 10% of trip Late 30 minutes 20% of trip Late 45 minutes or greater 50% b. If late due to HISD not being on time then there will not be any penalty.

13 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 Contract between the District and [name of supplier] ( Supplier ) in all situations where Supplier has been paid or will be paid with federal funds: REQUIRED CONTRACT PROVISIONS FOR NON-FEDERAL ENTITY CONTRACTS UNDER FEDERAL AWARDS APPENDIX II TO 2 CFR PART 200 (A) Contracts for more than the simplified acquisition threshold currently set at $150,000, which is the inflation adjusted amount determined by the Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 U.S.C. 1908, must address administrative, contractual, or legal remedies in instances where contractors violate or breach contract terms, and provide for such sanctions and penalties as appropriate. Pursuant to Federal Rule (A) above, when HISD expends federal funds, HISD reserves all rights and privileges under the applicable laws and regulations with respect to this procurement in the event of breach of contract by either party. Does Supplier agree? YES Initials of Authorized Representative of Supplier (B) Termination for cause and for convenience by the grantee or subgrantee including the manner by which it will be effected and the basis for settlement. (All contracts in excess of $10,000) Pursuant to Federal Rule (B) above, when HISD expends federal funds, HISD reserves the right to immediately terminate any agreement in excess of $10,000 resulting from this procurement process in the event of a breach or default of the agreement by Supplier in the event Supplier fails to: (1) meet schedules, deadlines, and/or delivery dates within the time specified in the procurement solicitation, contract, and/or a purchase order; (2) make any payments owed; or (3) otherwise perform in accordance with the contract and/or the procurement solicitation. HISD also reserves the right to terminate the contract immediately, with written notice to Supplier, for convenience, if HISD believes, in its sole discretion that it is in the best interest of HISD to do so. Supplier will be compensated for work performed and accepted and goods accepted by HISD as of the termination date if the contract is terminated for convenience of HISD. Any award under this procurement process is not exclusive and HISD reserves the right to purchase goods and services from other Supplier s when it is in HISD s best interest. Does Supplier agree? YES Initials of Authorized Representative of Supplier (C) Equal Employment Opportunity. Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of federally assisted construction contract in 41 CFR Part must include the equal opportunity clause provided under 41 CFR (b), in accordance with Executive Order 11246, Equal Employment Opportunity (30 FR 12319, 12935, 3 CFR Part, Comp., p. 339), as amended by Executive Order 11375, Amending Executive Order Relating to Equal Employment Opportunity, and implementing regulations at 41 CFR part 60, Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor. Pursuant to Federal Rule (C) above, when HISD expends federal funds on any federally assisted construction contract, the equal opportunity clause is incorporated by reference herein. Does Supplier agree to abide by the above? YES Initials of Authorized Representative of Supplier (D) Davis-Bacon Act, as amended (40 U.S.C ). When required by Federal program legislation, all prime construction contracts in excess of $2,000 awarded by non-federal entities must include a provision for compliance with the Davis-Bacon Act (40 U.S.C , and ) as supplemented by Department of Labor regulations (29 CFR Part 5, Labor Standards Provisions Applicable to Contracts Covering Federally Financed and Assisted Construction ). In accordance with the statute, contractors must be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. In addition, contractors must be required to pay wages not less than once a week. The non-federal entity must place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The non-federal entity must report all suspected or reported violations to the Federal awarding agency. The contracts must also include a provision for

14 compliance with the Copeland Anti-Kickback Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29 CFR Part 3, Contractors and Subcontractors on Public Building or Public Work Financed in Whole or in Part by Loans or Grants from the United States ). The Act provides that each contractor or subrecipient must be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work, to give up any part of the compensation to which he or she is otherwise entitled. The non-federal entity must report all suspected or reported violations to the Federal awarding agency. Pursuant to Federal Rule (D) above, when HISD expends federal funds during the term of an award for all contracts and subgrants for construction or repair, Supplier will be in compliance with all applicable Davis-Bacon Act provisions. Does Supplier agree? YES Initials of Authorized Representative of Supplier (E) Contract Work Hours and Safety Standards Act (40 U.S.C ). Where applicable, all contracts awarded by the non-federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C of the Act, each contractor must be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The requirements of 40 U.S.C are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence. Pursuant to Federal Rule (E) above, when HISD expends federal funds, Supplier certifies that Supplier will be in compliance with all applicable provisions of the Contract Work Hours and Safety Standards Act during the term of an award for all contracts by HISD resulting from this procurement process. Does Supplier agree? YES Initials of Authorized Representative of Supplier (F) Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the definition of funding agreement under 37 CFR (a) and the recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of parties, assignment or performance of experimental, developmental, or research work under that funding agreement, the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, Rights to Inventions Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements, and any implementing regulations issued by the awarding agency. Pursuant to Federal Rule (F) above, when federal funds are expended by HISD, Supplier certifies that during the term of an award for all contracts by HISD resulting from this procurement process, Supplier agrees to comply with all applicable requirements as referenced in Federal Rule (F) above. Does Supplier agree? YES Initials of Authorized Representative of Supplier (G) Clean Air Act (42 U.S.C q.) and the Federal Water Pollution Control Act (33 U.S.C ), as amended Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non-federal award to agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.C q) and the Federal Water Pollution Control Act as amended (33 U.S.C ). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Pursuant to Federal Rule (G) above, when federal funds are expended by HISD, Supplier certifies that during the term of an award for all contracts by HISD resulting from this procurement process, Supplier agrees to comply with all applicable requirements as referenced in Federal Rule (G) above. Does Supplier agree? YES Initials of Authorized Representative of Supplier (H) Debarment and Suspension (Executive Orders and 12689) A contract award (see 2 CFR ) must not be made to parties listed on the government wide exclusions in the System for Award Management (SAM), in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders (3 CFR part 1986 Comp., p. 189) and 12689

15 (3 CFR part 1989 Comp., p. 235), Debarment and Suspension. SAM Exclusions contains the names of parties debarred, suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than Executive Order Pursuant to Federal Rule (H) above, when federal funds are expended by HISD, Supplier certifies that during the term of an award for all contracts by HISD resulting from this procurement process, Supplier certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency. Does Supplier agree? YES Initials of Authorized Representative of Supplier (I) Byrd Anti-Lobbying Amendment (31 U.S.C. 1352) Contractors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 U.S.C Each tier must also disclose any lobbying with non-federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the non-federal award. Pursuant to Federal Rule (I) above, when federal funds are expended by HISD, Supplier certifies that during the term and after the awarded term of an award for all contracts by HISD resulting from this procurement process, the Supplier certifies that it is in compliance with all applicable provisions of the Byrd Anti-Lobbying Amendment (31 U.S.C. 1352). The undersigned further certifies that: (1) No Federal appropriated funds have been paid or will be paid for 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 sub-awards exceeding $100,000 in Federal funds at all appropriate tiers and that all subrecipients shall certify and disclose accordingly. Does Supplier agree? YES Initials of Authorized Representative of Supplier RECORD RETENTION REQUIREMENTS FOR CONTRACTS INVOLVING FEDERAL FUNDS When federal funds are expended by HISD for any contract resulting from this procurement process, Supplier certifies that it will comply with the record retention requirements detailed in 2 CFR Supplier further certifies that it will retain all records as required by 2 CFR for a period of three years after grantees or subgrantees submit final expenditure reports or quarterly or annual financial reports, as applicable, and all other pending matters are closed. Does Supplier agree? YES Initials of Authorized Representative of Supplier CERTIFICATION OF COMPLIANCE WITH THE ENERGY POLICY AND CONSERVATION ACT When HISD expends federal funds for any contract resulting from this procurement process, Supplier certifies that it will comply with the 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 (42 U.S.C et seq.; 49 C.F.R. Part 18). Does Supplier agree? YES Initials of Authorized Representative of Supplier CERTIFICATION OF EQUAL EMPLOYMENT STATEMENT

16 It is the policy of HISD not to discriminate on the basis of race, color, national origin, gender, limited English proficiency or handicapping conditions in its programs. Supplier agrees not to discriminate against any employee or applicant for employment to be employed in the performance of this Contract, with respect to hire, tenure, terms, conditions and privileges of employment, or a matter directly or indirectly related to employment, because of age (except where based on a bona fide occupational qualification), sex (except where based on a bona fide occupational qualification) or race, color, religion, national origin, or ancestry. Supplier further agrees that every subcontract entered into for the performance of this Contract shall contain a provision requiring non-discrimination in employment herein specified, binding upon each subcontractor. Breach of this covenant may be regarded as a material breach of the Contract. Does Supplier agree? YES Initials of Authorized Representative of Supplier CERTIFICATION OF COMPLIANCE WITH BUY AMERICA PROVISIONS HISD has a preference for domestic end products for supplies acquired for use in the United States when spending federal funds (purchases that are made with non-federal funds or grants are excluded from the Buy America Act). Supplier certifies that it is in compliance with all applicable provisions of the Buy America Act. Does Supplier agree? YES Initials of Authorized Representative of Vendor CERTIFICATION OF ACCESS TO RECORDS 2 C.F.R Supplier agrees that the District s Inspector General or any of their duly authorized representatives shall have access to any books, documents, papers and records of Supplier that are directly pertinent to Supplier s discharge of its obligations under the Contract for the purpose of making audits, examinations, excerpts, and transcriptions. The right also includes timely and reasonable access to Supplier s personnel for the purpose of interview and discussion relating to such documents. Does Supplier agree? YES Initials of Authorized Representative of Supplier CERTIFICATION OF APPLICABILITY TO SUBCONTRACTRS Supplier agrees that all contracts it awards pursuant to the Contract shall be bound by the foregoing terms and conditions. Does Supplier agree? YES Initials of Authorized Representative of Supplier SUPPLIER AGREES TO COMPLY WITH ALL APPLICABLE FEDERAL, STATE, AND LOCAL LAWS, RULES, REGULATIONS, AND ORDINANCES. IT IS FURTHER ACKNOWLEDGED THAT SUPPLIER CERTIFIES COMPLIANCE WITH ALL PROVISIONS, LAWS, ACTS, REGULATIONS, ETC. AS SPECIFICALLY NOTED ABOVE. Supplier s Name: Address, City, State, and Zip Code: Phone Number: Fax Number: Printed Name and Title of Authorized Representative: Address: Signature of Authorized Representative: Date: FORM H: EXCEPTION FORM All deviations and exceptions to the RFP must be expressly stated in this Exception Form (additional pages to this form may be added if necessary). In the absence of any entry on this Exception Form, Supplier assures HISD of its full agreement and compliance with all specifications, terms and conditions, requirements and obligations of the RFP. All exceptions must detail the section number, paragraph number, page number, and the specific language excepted.

17 YOU MUST SIGN AND SUBMIT THIS FORM WITH YOUR PROPOSAL REGARDLESS OF WHETHER THERE ARE EXCEPTIONS LISTED OR NOT. Supplier Name Officer s Signature Printed Name Date

18 FORM I: CONFLICT OF INTEREST CERTIFICATION AND CONFLICT OF INTEREST QUESTIONNAIRE (CIQ) INSTRUCTIONS I. CONFLICT OF INTEREST CERTIFICATION The Board of Education (Board) has adopted a Conflict of Interest Disclosures policy (Board Policy BBFA (Local)) attached by URL link hereto and incorporated by reference. HISD is required to comply with Texas Local Government Code Chapter 176, Disclosure of Certain Relationships with Local Government Officers as well as the conflict of interest standards set forth in EDGAR, 2 C.F.R when HISD expends federal funds. No employee, officer, or agent may participate in the selection, award, or administration of a contract if he or she has a real or apparent conflict of interest. HISD local government officers must disclose conflicts of interest by completing Form CIS, Local Government Officer Conflicts Disclosure Statement. I hereby certify that I have read Board Policy BBFA (Local) pertaining to Conflict of Interest Disclosures, and I agree and understand that the failure of a Board member to disclose a conflict of interest may result in the debarment of a Supplier for 24 months. Initials of Authorized Representative of Supplier II. CONFLICT OF INTEREST QUESTIONNAIRE (CIQ) INSTRUCTIONS HISD is required to comply with Texas Local Government Code Chapter 176, Disclosure of Certain Relationships with Local Government Officers. H.B. 23 significantly changed the laws relating to Conflict of Interest Disclosures as well as the corresponding forms and required disclosures. As of September 1, 2015, Supplier must sign and complete the new Conflict of Interest Questionnaire (CIQ) and submit the CIQ with its proposal. In accordance with Chapter 176 of the Texas Local Government Code, any Supplier who does business with HISD or who seeks to do business with HISD must fill out the new Conflict of Interest Questionnaire (CIQ) whether or not a conflict of interest exists. A conflict of interest exists in the following situations: 1) If the Supplier has an employment or other business relationship with a local government officer of HISD or a family member of the officer, as described by section (a)(2)(A) of the Texas Local Government Code; or 2) If the Supplier given a local government officer of HISD, or a family member of the officer, one or more gifts with the aggregate value of $100, excluding any gift accepted by the officer or a family member of the officer if the gift is: (a) a political contribution as defined by Title 15 of the Election Code; or (b) a gift of food accepted as a guest; or 3) If the Supplier a family relationship with a local government officer of HISD. Supplier means a person who enters or seeks to enter into a contract with a local governmental entity. The term includes an agent of a Supplier. The term includes an officer or employee of a state agency when that individual is acting in a private capacity to enter into a contract. The term does not include a state agency except for Texas Correctional Industries. Texas Local Government Code (7). Business relationship means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Texas Local Government Code (3). Local government officer means: (A) a member of the governing body of a local governmental entity; (B) a director, superintendent, administrator, president, or other person designated as the executive officer of a local governmental entity; or (C) an agent of a local governmental entity who exercises discretion in the planning, recommending, selecting, or contracting of a Supplier. Texas Local Government Code (4).

19 Family relationship means a relationship between a person and another person within the third degree by consanguinity or the second degree by affinity, as those terms are defined by Subchapter B, Chapter 573, Government Code. Texas Local Government Code (2-a). SUPPLIER MUST SIGN AND SUBMIT FORM CIQ EVEN IF NO CONFLICT EXISTS. If no conflict exists, Supplier must fill out Box 1 and write N/A in Box 3. I hereby certify that I have read Form I, Conflict of Interest Questionnaire (CIQ) Instructions, and I agree and understand that the failure to disclose a conflict of interest and/or the failure to sign and submit Form CIQ, even if no conflict exists, with this proposal may result in disqualification. Name of Authorized Representative: Signature of Authorized Representative: Date:

20

21 FORM J: HISD CERTIFICATE OF INTERESTED PARTIES FORM 1295 Certificate of Interested Parties (Form 1295 must be filled out electronically with the Texas Ethics Commission s online filing application, printed out, signed, notarized, and attached to Supplier s response to this solicitation. Houston ISD ( HISD ) is required to comply with House Bill 1295, which amended the Texas Government Code by adding Section , Disclosure of Interested Parties. Section prohibits HISD from entering into a contract resulting from this RFP with a business entity unless the business entity submits a Disclosure of Interested Parties (Form 1295) to HISD at the time business entity submits the signed contract. The Texas Ethics Commission has adopted rules requiring the business entity to file Form 1295 electronically with the Texas Ethics Commission. Interested Party means a person: a) who has a controlling interest in a business entity with whom HISD contracts; or b) who actively participates in facilitating the contract or negotiating the terms of the contract, including a broker, intermediary, adviser, or attorney for the business entity. Business Entity means an entity recognized by law through which business is conducted, including a sole proprietorship, partnership, or corporation. As a business entity, all Supplier s must electronically complete, print, sign, notarize, and submit Form 1295 with their proposals even if no interested parties exist. Proposers must file Form 1295 electronically with the Texas Ethics Commission using the online filing application, which can be found at Proposers must use the filing application on the Texas Ethics Commission s website to enter the required information on Form Proposers must print a copy of the completed form, which will include a certification of filing containing a unique certification number. The Form 1295 must be signed by an authorized agent of the business entity, and the form must be notarized. The completed Form 1295 with the certification of filing must be filed with HISD by attaching the completed form to the Supplier s solicitation response. HISD must acknowledge the receipt of the filed Form 1295 by notifying the Texas Ethics Commission of the receipt of the filed Form 1295 no later than the 30 th day after the date the contract binds all parties to the contract. After HISD acknowledges the Form 1295, the Texas Ethics Commission will post the completed Form 1295 to its website with seven business days after receiving notice from HISD. The acknowledgement of your 1295 form does not guarantee that you will be selected as an approved Supplier. An evaluation committee will select the Supplier (s) for the project and the Board of Education will approve it during the next available board meeting. An award or regret letter will be sent once the selection and approval process is complete. In the event that your proposal is not selected, we will request you to withdraw your 1295 form from the Texas Ethics Commission website.

22 Form W-9 (Rev. August 2013) Department of the Treasury Internal Revenue Service Name (as shown on your income tax return) RFP /Rental of Extra Curricular Charter & School Bus Services Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. Business name/disregarded entity name, if different from above Check appropriate box for federal tax classification: Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Other (see instructions) Address (number, street, and apt. or suite no.) City, state, and ZIP code Exemptions (see instructions): Exempt payee code (if any) Exemption from FATCA reporting code (if any) Requester s name and address (optional) List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the Name line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Social security number Employer identification number Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below), and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Sign Here Signature of U.S. person Date General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. The IRS has created a page on IRS.gov for information about Form W-9, at Information about any future developments affecting Form W-9 (such as legislation enacted after we release it) will be posted on that page. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, payments made to you in settlement of payment card and third party network transactions, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the