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PART III: Attachments

Please include all original completed forms with the original hard copy of your submission, one duplicate hard copy of your submission, and two USB drives that

contain the entire response submission.

Attachments:

FORM A: Supplier Information

FORM B: MWBE Instructions and Participation Report

FORM C: Reference Survey instructions

FORM D: Reference Survey (Survey will be requested if needed)

FORM E: General Certifications

FORM F: Price Schedule (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: Master Service Agreement (MSA)

Appendix A: Questionnaire

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 E-MAIL 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 ☐ NOA 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):_______________________________________________________

________________________________________________________________________________

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: 2

____________________________________________________________________________________________________________________________________________

______

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:

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_______________________________

NAME OF OTHER BANKING/FINANCIAL INSTITUTION(S): _______________________________________________________ _______________________________________________________

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: ____________________________________

-----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]

22. NAME OF CONTACT PERSON REGARDING IT ISSUES IN YOUR COMPANY: __________________________________________________

23. IS SUPPLIER PARTICIPATING IN THE OPTIONAL E-COMMERCE METHOD DESCRIBED IN SECTION 3.4 OF THIS RFP? ☐ YES ☐ NO

24. CAN SUPPLIER PROVIDE HISD WITH PERIODIC PREFORMATTED FLAT FILE UPDATES OF YOUR CATALOG? ☐ YES ☐ NO

25. DOES SUPPLIER HAVE E-COMMERCE CAPABILITY? ☐ YES ☐ NO

26. DOES SUPPLIER HAVE PUNCH-OUT CATALOGS IN PLACE TODAY? ☐ YES ☐ NO

27. DOES SUPPLIER HAVE ANY INTERNAL ELECTRONIC CATALOGS WITH ANY CUSTOMERS? ☐ YES ☐ NO

28. IS SUPPLIER CAPABLE OF PROVIDING A DEDICATED WEBSITE WITH YOUR CATALOG WITH HISD’S PRICING? ☐ YES ☐ NOIF 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 SUPPLIER INFORMATION TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE.

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______________________________________________OFFICER’S SIGNATURE

______________________________________________PRINTED NAME

______________________________________________TITLE

FORM B: MWBE INSTRUCTIONS

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

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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 reputation of Proposer’s goods or services in its evaluation of this Proposal.

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;

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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

________________________________________ ________________________________________

Email Address Mailing Address

________________________________________________________________________________

Phone Number Goods and/or services provided

(2) ________________________________________ ________________________________________


________________________________________ ________________________________________


________________________________________________________________________________


(3) ________________________________________ ________________________________________


________________________________________ ________________________________________


________________________________________________________________________________


FORM D: REFERENCE SURVEY

(SURVEY WILL BE REQUESTED IF NEEDED)

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FORM E: GENERAL CERTIFICATION FORMS

CERTIFICATION OF CODE OF SILENCEThe 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.

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http://www.houstonisd.org/HISDConnectEnglish/Images/PDF/CAA(LOCAL)%20-%20marked%20version.pdf

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 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 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.


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.


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 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; and4. 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.


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

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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 24-48 hours.


CERTIFICATION OF SUPPLIER (AND IF APPLICABLE, SUBCONTRACTOR) NATIONWIDE CRIMINAL BACKGROUND CHECKS

Pursuant to sections 22.085 and 22.0834 of the Texas Education Code Sections 22.085 and 22.0834 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 § 22.085(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).


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:

☐ 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: ______________________________________________

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________________________________________________________________________________________________________________________________________________________________________________________


CERTIFICATION OF INSURANCE REQUIREMENT

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.


CERTIFICATION OF NON-COLLUSION STATEMENT

I, the undersigned Supplier, 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) 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 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.


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: ____________________________________

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Printed Name and Title of Authorized Representative: __________________________________________________________

Email Address: ________________________________________________________________________________________

Signature of Authorized Representative: _____________________________________________________________________

Date: ___________________________

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RFP #16-10-54 RESEARCH AND EVALUTIONS FOR CONTRACTED EXPERTISE

FORM F:

PRICE AND PRICING SCHEDULE

PROPOSER SHALL SUBMIT PRICING AS IDENTIFIED IN PART II, SECTION 2.7. PRICING SHEETS INCLUDING ELECTRONIC SUBMITTAL REQUIREMENTS. INCLUDE THE COVER PAGE AND THE

FIRST 10 PAGES (IF APPLICABLE) OF A HARD COPY OF FORM F UNDER TAB 7 OF THE PROPOSAL. INCLUDE FORM F IN THE ORIGINAL EXCEL FORMAT ON BOTH COPIES OF THE

USB DRIVE SUBMISSION.

PRICING CANNOT BE CHANGED OR ALTERED AFTER RESPONSE SUBMISSION

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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.


(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 60-1.3 must include the equal opportunity clause provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, “Equal Employment Opportunity” (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, “Amending Executive Order 11246 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. 3141-3148). 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. 3141-3144, and 3146-3148) 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 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

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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.


(E) Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). 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. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 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. 3704 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.


(F) Rights to Inventions Made Under a Contract or Agreement. If the Federal award meets the definition of “funding agreement” under 37 CFR §401.2 (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.


(G) Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), 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. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251- 1387). 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.


(H) Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) 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 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (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 12549.

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

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principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency.


(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. 1352. 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.


RECORD RETENTION REQUIREMENTS FOR CONTRACTS INVOLVING FEDERAL FUNDSWhen 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 § 200.333. Supplier further certifies that it will retain all records as required by 2 CFR § 200.333 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.


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. 6321 et seq.; 49 C.F.R. Part 18).

Does Supplier agree? YES ________ Initials of Authorized Representative of SupplierCERTIFICATION OF EQUAL EMPLOYMENT STATEMENT

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.


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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. § 200.336

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.


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.


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: _______________________________________________________________________________________


Phone Number: ____________________________________ Fax Number: ____________________________________ Printed Name and Title of Authorized Representative: __________________________________________________________

Email Address: ________________________________________________________________________________________


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 accepted.

YOU MUST SIGN AND SUBMIT THIS FORM WITH YOUR PROPOSAL REGARDLESS OF WHETHER THERE ARE EXCEPTIONS LISTED OR NOT.

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Supplier Name

Officer’s Signature

Printed Name

Date

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. § 200.318 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.

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http://www.houstonisd.org/HISDConnectEnglish/Images/PDF/BBFA_Local.pdf


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.


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 176.003(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 176.001(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 176.001(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 176.001(4).“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 176.001(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: ________________________________________________________________________


Date: ___________________________

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__________________________________________________COMPANY NAME

CORPORATE OFFICER’S SIGNATURE

PRINTED NAME

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TITLE

Affiant certifies that he or she is duly authorized to submit the above information on behalf of the Proposer, that Affiant is associated with the Proposal in the capacity noted above and has personal knowledge of the accuracy of the information provided herein, and that the information provided herein is true and correct to the best of Affiant’s knowledge and belief.

Affiant

SWORN TO AND SUBSCRIBED before me this _____day of ______________, 20___.

(seal) Notary Public

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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 2252.908, Disclosure of Interested Parties. Section 2252.908 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; orb) 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 https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm. Proposers must use the filing application on the Texas Ethics Commission’s website to enter the required information on Form 1295. 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.

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https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm


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FORM K: IRS FORM W-9

24

Example


FORM L: CERTIFICATE OF INSURANCE (ACORD FORM)

THE PROPOSER(S) MUST PROVIDE THE ACORD ISSURANCE FORM, OR A LETTER FROM THE INSURANCE CARRIER ON THE INSURANCE CARRIER’S LETTERHEAD INDICATING COMPLIANCE IN ACCORDANCE WITH THE REQUIREMENTS SET FORTH IN THIS RFP.

IF THE LETTER OF INSURABILITY IS SUBMITTED WITH THE RESPONSE SUBMISSION, THE SUPPLIER MUST SUBMIT TO RISK MANAGEMENT AND PROCUREMENT SERVICES THE ACTUAL ACORD FORM PRIOR TO BEING RECOMMENDED TO THE BOARD OF EDUCATION FOR CONTRACT APPROVAL. UPON RECEIPT OF A LETTER OF INTENT TO AWARD, THE SUPPLIER WILL HAVE THREE (3) BUSINESS DAYS FROM THE DATE OF NOTIFICATION TO SUBMIT THEIR ACORD CERTIFICATE(S) OF INSURANCE TO BOTH RISK MANAGEMENT AND PROCUREMENT SERVICES. FAILURE TO PROVIDE ALL THE REQUIRED DOCUMENTS MAY CAUSE YOUR PROPOSAL TO BE DEEMED NON-RESPONSIVE.

ALL QUESTION REFERENCE INSURANCE CERTIFICATION SHOULD BE DIRECTED TO THE HOUSTON INDEPENDENT SCHOOL DISTRICT RISK MANAGEMENT DEPARTMENT AT 713-556-9225 (add email address) PRIOR TO THE RFP SUBMISSION DUE DATE.

FAILURE TO PROVIDE EITHER THE ACORD FORM OR LETTER OF INSURABILITY AT THE TIME OF SUBMISSION MAY CAUSE YOUR PROPOSAL TO BE CONSIDERED NON-RESPONSIVE.

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FORM M: ACKNOWLEDGEMENT FORM

RFP/RFQ Number: 16-10-54

Project Name: Research and Evaluations for Contracted Expertise

RFP/RFQ Due Date / Bid Opening: July11, 2017 at 10:00 am CST

THIS ACKNOWLEDGEMENT FORM MUST BE SIGNED AND RETURNED WITH YOUR PROPOSAL RESPONSE TO ACKNOWLEDGE AND AFFIRM AGREEMENT TO ALL OF THE STATEMENTS AND TERMS & CONDITIONS CONTAINED IN THIS REQUEST FOR PROPOSAL/QUALIFICATION. THE AUTHORIZED SUPPLIER REPRESENTATIVE MANUALLY SIGNING THIS ACKNOWLEDGEMENT FORM WARRANTS THAT THEY ARE IN RECEIPT OF THE FULL REQUEST FOR PROPOSAL AND ARE DULY AUTHORIZED TO COMMIT ON BEHALF OF THEIR COMPANY TO CONTRACTUAL OBLIGATIONS AND PRICING.

I hereby acknowledge that I have received and read the following parts of the proposal in its entirety:

Documents InitialsPart I: General Terms and Conditions Part II: Request for Proposals - Scope of WorkPart III: Attachments

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: _______________________________________________________________________________________


Phone Number: ____________________________________ Fax Number: ____________________________________ Printed Name and Title of Authorized Representative: __________________________________________________________

Email Address: ________________________________________________________________________________________


Date: ___________________________

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27


Appendix A

Responses to the questions in this section should be placed in the vendors proposal Section/Tab 5 as outlined in section I. INSTRUCTIONS, SUBMISSION REQUIREMENTS AND PROCEDURES

SECTION I

1) Individual or Company Name________________________________________

2) Address_________________________________________________________

3) City, State and Zip Code____________________________________________

4) Telephone Number ________________________________________________5) E-mail address ___________________________________________________

6) Web address ____________________________________________________

7) Are you a Minority/Women Owned Business (MWBE)? _____Yes; _____No

8) If so, are you MWBE certified? _____Yes; _____No

9) If you are MWBE certified, who issued your certification?

________________________________________________________________

10) Attach a copy of your certification as the last page of Appendix A in your proposal.

SECTION II: COST

1) Complete the attached Pricing Schedule considering the unit of measure(s) below.

Unit of measure for serviceHourly rateDaily rate (6 hours)Project ScopeIndicate the timeframe, if applicable (ie. # of days, # of months, etc.)

2) Describe other associate costs, if applicable

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Please place responses to Appendix A to TAB 5


3) Are discounts to cost considered? ______________ If yes, define.

Discount Explanation

SECTION III

SUPPLIER SURVEY QUESTIONS FOR SCOPEI. BID SUBMISSION AREA(S)

Check () the area(s) in which proposal is aligned. Check all that apply.

2.1.1 Research and Evaluation: Program Evaluation and External Evaluation/Auditor

2.1.2 Research and Evaluation: Stakeholder Survey and Analysis

2.1.3 Research and Evaluation: Needs Assessment/ Gap Analysis

2.1.4 Research and Evaluation: Technical Assistance

SUPPLIER SURVEY QUESTIONS FOR SCOPE

2.1.1 RESEARCH AND EVALUATION: PROGRAM EVALUATION AND EXTERNAL EVALUATION

1. What is the mission of your organization? Optional: May attach a 1 page service summary.

2. Given our context as a district, why is your organization qualified to succeed in this partnership with Houston ISD? Please provide supporting examples from previous work.

3. What will distinguish your evaluation from a similar analysis done by an expert within HISD?

4. Has your organization recently provided this product or similar services to other districts or government agencies? If so, please list them. If so, please provide the contact information for two references familiar with that work. Describe the product or services. What was the impact of your product(s) or services on the district or government agencies?

5. Has your organization recently provided this product or similar services to HISD schools or departments? If so, please provide the name and contact information for two references familiar with that work. Describe the product or services. What was the impact of your product(s) or services on the schools or departments?

4. What are your organization’s areas of expertise? Please indicate which programs, content, or subject areas your organization has the expertise to address.

5. Describe your data management plan and your process for understanding HISD’s data within the context of the project.

6. Describe your proposed research design and methods for this project.

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o Please indicate which of the following your organization is equipped to provide: focus groups; stakeholder interviews; online or paper surveys; document review; observations or site visits; analysis of existing HISD data; collection of new data, etc.

o Wherever possible, please address the statistical characteristics of the items or instruments planned for this project. If these characteristics are not known, please indicate as such.

7. Is your organization prepared to implement cost-effectiveness analysis or benefit-cost analysis? Please provide examples from recent work.

8. What supports will your organization provide to HISD to ensure the success of this work (e.g., project management, presentation of findings, web-based reports, help desk, etc.)?

9. What specific resources or support will be required from HISD for your organization's services for this product?

10. Is your organization incorporated as a nonprofit entity, a for-profit entity, an institute of higher education, or a government entity?

11. Name and Contact Information for Primary Investigator

12. Name and Contact Information for Project Manager for RFP

13. Provide an example of a recent report, slide deck, or executive summary that illustrates your organization's quality of work on a similar project. Please redact identifying information as appropriate.

14. Provide a short professional biography of the key personnel for this proposed project (one page max).

15. Additional Comments:

2.1.2 RESEARCH AND EVALUATION: STAKEHOLDER SURVEY AND ANALYSIS1. What is the mission of your organization? Optional: May attach a 1 page service summary.


3. What will distinguish your surveys and analyses from a similar analysis done by an expert within

HISD?



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7. Describe your proposed survey design and methods for this project.

o Please indicate which of the following your organization is equipped to provide: focus groups; stakeholder interviews; online or paper surveys; document review; observations or site visits; analysis of existing HISD data; collection of new data, etc.

o Wherever possible, please address the statistical characteristics of the items or instruments planned for this project. If these characteristics are not known, please indicate as such.

8. Who will administer the survey(s), and how? Which HISD audience(s) or stakeholder(s) will be invited to participate? If there is a low response rate, how will it be addressed?

9. Is your organization prepared to implement post-survey weighting? If possible, provide examples from recent work.










2.1.3 RESEARCH AND EVALUATION: NEEDS ASSESSMENT / GAP ANALYSIS



3. What will distinguish your needs assessment/gap analysis from a similar analysis done by an expert within HISD?


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7. Describe your proposed research design and methods for this project.

o If a specific project is not addressed in this RFP, please indicate which of the following your organization is equipped to provide: focus groups; stakeholder interviews; online or paper surveys; document review; observations or site visits; analysis of existing HISD data; collection of new data, etc.

o Wherever possible, please address the statistical characteristics of the items or instruments planned for this project. If the statistical characteristics of the items are not known, please indicate as such.










2.1.4 RESEARCH AND EVALUATION: TECHNICAL ASSISTANCE




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6. What specific technical expertise will your organization provide during this project that may be outside the scope of HISD's own staff expertise?

7. Describe your proposed plan and methods for strengthening HISD's technical knowledge through this project.

o If a specific project is not addressed in this RFP, please give an overview of what your organization is equipped to provide.










Authorized Signature Date

Title

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APPENDIX BMASTER SERVICE AGREEMENT (MSA) & DATA SHARING AGREEMENT (DSA)

NO DEVIATIONS OR EXCEPTIONS TO THIS FORM WILL BE ACCEPTED. THE PROPOSER(S) ASSURES HISD OF THEIR FULL AGREEMENT AND COMPLIANCE WITH ALL SPECIFICATIONS, TERMS AND CONDITIONS, REQUIREMENTS AND OBLIGATIONS

OF THE RFP. MASTER SERVICE AGREEMENT AND DATA SHARING AGREEMENT MUST BE SIGNED BY EACH PROPOSER(S) ON PAGE 9, PAGE 12, PAGE 15 AND PAGE 20. THE

MSA AND DSA MUST BE RETURNED WITH THE RFP RESPONSE SUBMISSION.

FAILURE TO PROVIDE THESE DOCUMENTS WITH THE REQUIRED SIGNATURES COULD CAUSE YOUR PROPOSAL TO BE CONSIDERED NON-RESPONSIVE.

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MASTER SERVICES CONTRACT

BETWEEN

HOUSTON INDEPENDENT SCHOOL DISTRICTAND

PROJECT # 16-10-54

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“RESEARCH AND EVALUATIONS FOR CONTRACTED EXPERTISE”(No exceptions will be accepted)

THIS SERVICES CONTRACT (“Contract”) is made and entered into by and between the Houston Independent School District (“HISD” or “District”), 4400 West 18 th Street, Houston, Texas 77092, and multiple Providers, as shown on the attached signature pages (each of which is a “Provider”).

WHEREAS, HISD desires to hire Provider to perform services as outlined in the scope section of this Contract.

WHEREAS, HISD has determined that such services are in support of its educational objectives;

NOW THEREFORE, in consideration of the mutual promises herein contained, and other good and valuable consideration, the parties hereto agree as follows:

I. SERVICES TO BE PROVIDED BY PROVIDER (SCOPE OF SERVICES):

Provider agrees to provide to HISD:

Services and or materials in a timely and satisfactory manner as outlined in Request for Proposal (“RFP”) #16-10-54 “RESEARCH AND EVALUATIONS FOR CONTRACTED EXPERTISE”, and Form F that will be attached to the invoice(s) submitted by the schools where Provider services are rendered. Pricing will not exceed the rates listed in Form F of the RFP submission.

All work outlined herein shall be deemed “Work” under the terms of this Contract.

II. ORDER OF PRECEDENCE:

Any inconsistency or ambiguity in this Contract shall be resolved by giving precedence in the following order:

a. General Terms and Conditions b. RFP 16-10-54 Research and Evaluations for Contracted Expertise c. Response Submission (i.e. Exhibits/Appendices/Attachments)d. Contract and any associated documents

III. SERVICES TO BE PROVIDED BY HISD:

HISD agrees to provide to Provider:

Space for Provider services if applicable. Other items necessary must be agreed upon between HISD and Provider

and listed in an exhibit that will be attached to the purchase order.

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IV. TERM OF CONTRACT

The term of this Contract shall be from June 29, 2017 through June 30th, 2018. HISD has the option to renew this contract annually for four (4) additional terms of service upon the same terms, conditions and rates set forth in RFP 16-10-54 Research and Evaluations for Contracted Expertise. However, this Contract may be terminated prior to the expiration of the term as provided in the Termination Section of this Contract.

V. TERMINATION

This Contract may be terminated prior to the expiration of the term hereof as follows:

• By HISD upon 3 days’ notice if the work is not provided in a satisfactory and proper manner as determined by HISD

• By mutual written agreement of the parties;

• By HISD with or without cause, upon thirty (30) days prior written notice to the Provider; or

• By HISD immediately if Provider commits a material breach of any of the Terms of this Contract.

In the event this Contract is terminated because of a violation or breach of the contract terms by Provider, HISD shall be entitled to all administrative, contractual and legal remedies, including sanctions and penalties as may be appropriate.

VI. COMPENSATION

For and in consideration of the services to be provided by Provider under this Contract, HISD will pay Provider for the performance of services at the rates set forth in the attached Exhibit.

The compensation to be paid will be charged to the budget determined by the purchase order submitted. Original invoices should be sent for processing to the Controller’s Office. Upon receipt by the Controller’s Office, undisputed invoices will be processed for payment within 30 days of its receipt.

In the event this Contract is terminated prior to the end of the stated term, payments will only be made to the extent that work satisfactory to HISD has been performed and is undisputed prior to termination.

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FEDERAL GRANT FUNDING AND HOUSTON INDEPENDENT SCHOOL DISTRICT'S BOARD POLICY OBLIGATIONS

To the extent that HISD's obligation hereunder for payment of compensation is limited to and expressly subject to receipt of any funds from TEA under the provision of the Elementary and Secondary Education Act of 1965 as amended by Public Law 100-297, ESEA Title I-Part A and that such funds are specifically designated for this program, Provider agrees to comply with all of the following requirements. In the event such funds are not received by HISD, or only partial funding is received from TEA, HISD may terminate this contract and not be liable for the remaining balance of the contract to the extent that the work has not been performed.

In the event HISD is ever required to refund any funds received from TEA specifically designated for this program, based upon Provider’s failure to adhere to the requirements herein, then it is understood and agreed that Provider shall be liable for and shall refund such amounts received by them to HISD within fifteen (15) days of receipt of written notice from HISD.

Provider agrees to comply with all rules, regulations, ordinances, statutes, and other laws, whether local, state or federal, including, but not limited to, all audit and other requirements of the Single Audit Act of 1984. In the event an audit occurs and any expenditures relating to this Contract are disallowed, based upon Provider’s failure to adhere to the requirements herein, Provider agrees to reimburse HISD immediately for the full amount of such disallowed expenditures.

Provider shall provide all services and perform all functions in accordance with the U.S.

Office of Management and Budget (OMB) Circular Nos. A-133, A-110, and any other

applicable OMB circulars, and in accordance with HISD’s Procedures which HISD shall

provide to Provider, regarding regulatory and financial matters so that the Grant can be

carried out in accordance with the requisite federal and state requirements.

VII. PURCHASE ORDERS REQUIRED

This Contract is intended to allow the District to purchase services from the Provider through the HISD Procurements Services Department by using the District’s requisition and purchase order process. This Contract shall govern all conditions and service terms between the Provider and HISD. The Provider agrees that contracted personnel will not begin work at HISD until the Provider receives a valid District purchase order issued by the Procurement Services Department. In the event that the contracted personnel begin work before Provider receives a valid purchase order, the Provider agrees that the District is not liable for payment of such services rendered.

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VIII. RELATIONSHIP OF THE PARTIES

It is understood and agreed that Provider is a separate legal entity from HISD and neither it nor any of its employees, volunteers, or agents contracted by it shall be deemed for any purposes to be employees or agents of HISD. Provider assumes full responsibility for the actions of its personnel and volunteers while performing any services incident to this Contract, and shall remain solely responsible for their supervision, daily direction and control, payment of salary (including withholding of income taxes and social security), workers’ compensation, disability benefits and like requirements and obligations.

Nothing in this Contract shall be deemed or construed to create any third party beneficiaries or otherwise give any third party any claim or right of action against any party to this Contract.

IX. NO WAIVER OF IMMUNITY

HISD does not waive or relinquish any immunity or defense on behalf of itself, its trustees, officers, employees, and agents as a result of its execution of this Contract and performance of the functions or obligations described herein. Nothing herein shall be construed as creating any personal liability on the part of any trustee, officer, director, employee or representative of HISD.

X. RETURN OF MATERIAL

Upon termination or expiration of this Contract, each Party will return to the other Party any items in its possession containing any intellectual property of HISD or Provider, as the case may be, to be used in connection with this Contract, including but not limited to: all Marks, patents, patent applications, copyrighted content, hypertext links, domain names, icons, buttons, banners, graphic files, images, technology (“Intellectual Property”) and all Confidential Information pertaining to such Intellectual Property. As used herein, the term “Marks” shall mean the words, terms, characters, emblems, logos, service marks, trade names or trademarks, designs or parts thereof, in any size or dimension, presently used or hereafter acquired by any person to identify such Party, its services and/or equipment. As used herein, the term “Confidential Information” shall mean all information and ideas in whatever form, tangible or intangible, pertaining in any manner to the current or contemplated business or operations of the Parties hereto, or their respective affiliates, including but not limited to: customer lists and documents; individual account information; business plans; business concepts; business practices; marketing strategies; ideas and theories; underwriting; origination and servicing systems practices;

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management processes; systems; practices and strategies; and business development methods, ideas and strategies.

Alternatively, upon request of the disclosing Party, the receiving Party shall destroy all such Intellectual Property or Confidential Information of the disclosing Party and any other materials furnished to the other Party pursuant to this Contract, and certify in writing that they have been destroyed.

XI. AUTHORIZATION OF CONTRACT

Each Party represents and warrants to the other that: (i) it has the right and authority to enter into and perform all obligations under this Contract; (ii) it shall materially comply with all Applicable Laws, with respect to its performance of this Contract; (iii) no authorization or approval from any third party is or will be required in connection with such Party’s execution, delivery or performance of this Contract (iv) the execution and performance of this Contract does not violate or conflict with the terms or conditions of any other agreement to which it is a party or by which it is bound; and (v) this Contract has been duly executed and delivered and constitutes a valid and binding agreement enforceable against such Party in accordance with its terms.

XII. INSURANCE

Provider will cover Provider’s staffing operations for HISD with at least the types and limits of insurance or other coverage as set forth below. HISD reserves the right to require additional insurance coverage to be carried by the Provider as deemed desirable by HISD, depending on the type of project.

The Provider shall carry insurance with responsible insurance carriers acceptable to HISD and with minimum limits of liability coverage, as stated below, against claims for damages caused by bodily injury, including death, to employees and third parties, and claims for property damage. The Provider hall furnish certificates of insurance to HISD indicating compliance with this paragraph.

Type of Coverage Minimum Limits

1. Workers' Compensation and Employer's Liability

Statutory

$100,000 per accident

2. Automobile Liability:

Bodily Injury & Property Damage

For all owned, non-owned vehicles and

$1,000,000 Combined Single Limit

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hired vehicles.

3. Commercial General Liability $1,000,000 Combined Single Limit

The Provider shall submit evidence at the time of any execution of the Contract that it has in full force and effect all insurance requirements listed above. The Provider shall maintain such insurance in full force and effect throughout the duration of the Contract. In the event that it is not commercially feasible to maintain insurance during the period required by the Contract, Provider shall supply HISD with equivalent assurance to the required insurance, acceptable to HISD.

HISD shall be listed as certificate holder. HISD shall be named as an additional insured on the automobile and commercial general liability policy. HISD shall be named as an alternate employer on the workers’ compensation policy. A waiver of subrogation shall be issued in favor of HISD in the workers’ compensation, automobile and commercial general liability policies.

The Provider shall provide HISD with original certificates of insurance after the bid has been awarded and before the beginning of the project when requested by the owner contact. Such certificates shall indicate an agreement by each carrier not to cancel or significantly diminish coverage without a minimum of thirty (30) days prior written notice to HISD.

XIII. NO WAIVER

No waiver of a breach of any provision of this Contract shall be construed to be a waiver of any breach of any other provision. No delay in acting with regard to any breach of any provision shall be construed to be a waiver of such breach.

XIV. NOTICE

Any notice required to be given under the provisions of this Contract shall be in writing and shall be duly served when it shall be hand-delivered to the addressees set out below, or shall have been deposited, duly registered or certified, return receipt requested, in a United States Post Office addressed to the other party at the following addresses:

To: Provider, as shown on the attached signature page

To: Houston Independent School District

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Attn: Richard A. Carranza, Superintendent of Schools

4400 West 18th Street

Houston, Texas 77092

Any party may designate a different address by giving the other party ten (10) days prior written notice in the manner provided above.

XV. NO ASSIGNMENT OR CHANGES

No change, amendment or modification of any provision of this Contract will be accepted. This Contract, including its Exhibits, sets forth the entire Contract and supersedes any and all prior agreements, written or oral, of the Parties with respect to the transactions set forth herein. Neither Party may assign or otherwise transfer this Contract or any rights or obligations hereunder, in whole or in part, without the other Party’s prior written consent. Notwithstanding the foregoing, either Party may assign or otherwise transfer this Contract or any rights or obligations hereunder, upon notice to the other Party, to an affiliate, or other person or corporate entity resulting from a sale, merger or other transaction involving the transfer of Provider’s assets, stock and/or business.

XVI. LIMITATION ON MARKETING AND SALES ACTIVITIES

Neither Party intends under this Contract to be a marketing or sales agent for the other, nor shall either Party have any obligation to recommend the products or services of the other to any potential clients; provided, however, that HISD may, pursuant to this Contract, advise its clients, and prospective clients, of the availability of the Provider Services and Materials.

XVII. SECTION HEADINGS

The headings of sections contained in this Contract are for convenience only, and they shall not, expressly or by implication, limit, define, extend, or construe the terms or provisions of the sections of this Contract.

XVIII. GOVERNING LAW

This Contract is made in Texas and shall be construed, interpreted, and governed by the laws of such state. The parties irrevocably consent to the sole and exclusive jurisdiction and venue of the courts of Harris County, Texas, for any action under this Contract.

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In connection with HISD’s defense of any suit against it and/or HISD’s prosecution of any claim, counterclaim or action to enforce any of its rights and/or claims hereunder, in which HISD prevails as to all or any portion of its defense(s), claims, counterclaims or actions, HISD shall be entitled to recover its actual attorney’s fees and expenses incurred in defending such suit and/or in prosecuting such claim or action.

Provider shall comply with Executive Order No. 11246, entitled “Equal Employment Opportunity”, as amended by Executive Order No. 11375, and as supplemented in Department of Labor Regulations (41 CFR Part 60).

Provider shall comply with all applicable standards, orders, or requirements issued under Section 306 of the Clean Air Act (42 USC 7606), Section 508 of the Clean Water Act (33 USC 1368), Executive Order No. 11738, and Environmental Protection Agency regulations (40 CRF, Part 51), which prohibit the use under non-exempt federal contracts, grants, or loans of facilities included on the EPA list of violating facilities. Violations shall be reported to the Texas Education Agency and to the USEPA Assistant Administrator for Enforcement (EN-329).

Provider shall recognize 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 (P.L. 94-163).

Provider agrees to comply with all applicable requirements of all federal laws, executive orders, regulations, applicable guidelines, and policies governing this program, particularly relating to nondiscrimination. These include but are not limited to: (i) Title VI of the Civil Rights Act of 1964, as amended; (ii) Title IX of the Education Amendments of 1972; as amended; (iii) Section 504 of the Rehabilitation Act of 1973, as amended; the Age Discrimination Act of 1975, as amended; and (iv) the American with Disabilities Act, as amended.

XIX. ORIGINALS

This Contract is executed in multiple counterparts, with a separate signature page as to each vendor, each of which shall have the full force and effect of the original Contract, and each of which shall constitute but one of the same instruments.

XX. REPORTS

To the extent applicable, HISD and Provider shall furnish operating reports to designated representatives on a schedule to be mutually agreed upon. No written reports of any kind shall be released to any third parties without prior

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written approval of HISD.

XXI. INDEMNITY

Provider shall hold HISD and its past and present and future trustees, officers and employees harmless and shall indemnify all such parties against any and all claims, demands, and causes of action of whatever kind or nature asserted by any third party, occurring or in any way incident to, arising out of, or in connection with any acts of Provider and its agents, employees, and subcontractors done in connection with this Contract.

Nothing in this Contract shall be construed to create a claim or cause of action against the District for which it is not otherwise liable, nor to waive any immunity or defense to which the District may be entitled nor to create an impermissible deficiency debt of the District.

XXII. CRIMINAL HISTORY BACKGROUND CHECK

Pursuant to Sections 22.0834, 22.0835 and 22.085 of the Texas Education Code, Provider hereby certifies that all employees, subcontractors and volunteers of the Provider who are hired by Provider on or after January 1, 2008, and who have or will have continuing duties related to the contracted services, and have or will have direct contact with students, have passed a national criminal history background record information review as required by those sections. Provider must provide a list of the names and dates of birth of all employees who have passed the background check to District.

Provider shall send or ensure that the employee or applicant sends to the Texas Department of Public Safety (“DPS”) information that is required by the DPS for obtaining national criminal history record information, which may include fingerprints and photographs. DPS shall obtain the person’s national criminal history record information and report the results through the criminal history clearinghouse as provided by Section 411.0845, Government Code.

Providers that have more than 1 employee must set up an account with the Texas Department of Public Safety (“DPS”) in order to obtain criminal

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XProvider's Signature


histories on their covered employees. To set up an account with DPS, a Provider should contact the crime records service bureau at 512-424-2474.

Providers with a single employee must obtain a FAST PASS from the District in order to obtain their criminal history. Providers should contact the District’s Human Resources Department to obtain the FAST PASS at 713 556-7343.

Providers must present a list of all employees who may have direct contact with students to HISD.

Provider must also obtain certifications from all subcontractors that their employees to whom Section 22.0834 applies have also passed a national criminal history background record information review.

Provider must also provide assurances that all of its employees, subcontractors and volunteers, including those hired before January 1, 2008, who have contact with students have passed a criminal history background check current within the last year. If an employee, subcontractor or volunteer of the Provider has a criminal conviction or has received deferred adjudication for a felony offense or a misdemeanor involving moral turpitude, the District may elect not to enter into this Contract, or cancel the Contract.

WARNING: Section 44.034 of the Texas Education Code requires that a person or business entity that enters into a contract with a school district must give advance notice to the district if the person or an owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony.

The District may terminate this Contract if the district determines that the person or business entity failed to comply with any of these provisions, failed to give notice as required by Section 44.034 (a) or misrepresented the conduct resulting in the conviction. The District will compensate the person or business entity for undisputed services performed before the termination of the contract.

XXIII. RELEASE OF INFORMATION

Unless required by law, the existence and terms of this Contract may not be disclosed by Provider to any third party without the prior written consent of HISD. Provider may not publish or use any publicity materials relating to this Contract or use HISD’s name without the written consent of HISD.

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XXIV. RECORDS RETENTION AND AUDITSHISD or its authorized representative, shall be afforded unrestricted access to and permitted to inspect and copy all the Provider’s records, which shall include but not be limited to accounting records (hard copy as well as computer readable data), correspondence, instructions, drawings, receipts, vouchers, memoranda and similar data relating to this Contract. The Provider shall preserve all such records for a period of five (5) years, or for such longer period as may be required by law, after final payment under this Contract. If this Contract is funded from contract/grant funds provided by the U. S. Government or the State of Texas, the Contract, books, and records shall be available for review and audit by the Comptroller General of the U.S. and/or the Inspector General of the federal sponsoring agency, or the State of Texas and its duly authorized representatives.

I.II.III.IV.V.VI.

VII.VIII.

IX.X.XI.

XII.XIII.XIV.XV.

XVI.XVII.

XVIII.XIX.XX.

XXI.XXII.

XXIII.XXIV.XXV. STUDENT RECORDS

To the extent that Provider will come into possession of student records and information, and to the extent that Provider will be involved in the survey, analysis, or evaluation of students, incidental to this Contract, Provider agrees to comply with all applicable requirements of the Family Educational Rights and Privacy Act.

XXVI. TEXAS PUBLIC INFORMATION ACT In the event that HISD is required to furnish information or records pursuant to the Texas Public Information Act, Provider shall furnish

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all such information and records to HISD and HISD shall have the right to release such information and records.

XXVII. BUSINESS ETHICS

During the course of pursuing contracts, and the course of contract performance, Provider will maintain business ethics standards aimed at avoiding real or apparent impropriety or conflicts of interest. No substantial gifts, entertainment, payments, loans or other considerations beyond that which would be collectively categorized as incidental shall be made to any employees or officials of HISD, its authorized agents and representatives, or to family members of any of them. At any time Provider believes there may have been a violation of this obligation, Provider shall notify HISD of the possible violation. HISD is entitled to request a representation letter from Provider, its subcontractors or vendors at any time to disclose all things of value passing from Provider, its subcontractors or vendors to HISD’s personnel or its authorized agents and representatives.

REQUIRED DISCLOSURES

a. For all contracts in excess of $50,000.00, or which require Board approval, Provider must execute and electronically file Form 1295, which is available at https://www.ethics.state.tx.us/forms/1295.pdf listing all interested parties, including a person who has a controlling interest in Provider’s business, or who actively participates in facilitating the contract or negotiating the terms of the contract, including a broker, intermediary, adviser, or attorney for the business, to HISD at the time it executes the contract in compliance with Section 2252.908 of the Texas Government Code. Instructions for filing Form 1295 are attached hereto as Exhibit “1”.

b. Provider must also file a completed conflict of interest questionnaire, in compliance with Section 176.006 of the Texas Local Government Code, attached hereto as Exhibit “2”, or available at https://www.ethics.state.tx.us/forms/CIQ.pdf with the HISD records administrator, if the Provider has an employment or other business relationship with a local government officer of HISD, or a family member of the officer; has given a local government officer of HISD, or a family member of the officer, one or more gifts with the aggregate value of more than $100 in the 12-month period preceding the date of the contract; or has a family relationship with a local government officer of HISD. The questionnaire must be filed not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with HISD; or (B) submits an application, response to a request for proposals or bids, correspondence, or another writing related to a

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https://www.ethics.state.tx.us/forms/CIQ.pdf

https://www.ethics.state.tx.us/forms/1295.pdf


potential contract with HISD; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer of HISD; (B) that the vendor has given one or more gifts to a local government officer of HISD of more than $100 in the aggregate; (C) of a family relationship with a local government officer of HISD.

XXVIII. BUSINESS CERTIFICATES / TAXES

All Provider or Professional Services Providers entering into a contract with HISD must adhere to the following applicable Texas laws as they pertain to their individual type of ownership.

Corporations (domestic or foreign *) shall be properly registered with the Texas Secretary of State and the Comptroller of Public Accounts as required by TITLE 34, Part 1, Chapter 3, Subchapter V, Rule 3.546 of the Texas Administrative Code. A current "Certificate of Good Standing" from the Texas Comptroller of Public Accounts shall be made available upon request stating that the corporation charter is current and all Texas Franchise Reports and Taxes are paid.

Partnerships and Joint Stock Companies, and Limited Liability Partnerships (domestic or foreign*) shall be properly registered with the Texas Secretary of State in accordance with TITLE 105--PARTNERSHIPS AND JOINT STOCK COMPANIES, CHAPTER ONE --- PARTNERSHIPS, LIMITED PARTNERSHIPS, TEXAS REVISED LIMITED PARTNERSHIP ACT, Article 6132a-1. "Texas Revised Limited Partnership Act." All partners in a partnership must file a "Certificate of Limited Partnership" with the secretary of state, which shall be made available for inspection upon request.

The Provider whether corporate, partnership or sole owner must be current on HISD Property Taxes. If commercial personal property is located in the jurisdiction, current renditions of these properties must be filed with the Chief Appraiser, as required by Chapter 22, Section 22.01, of the Texas "PROPERTY TAX CODE".

*Note: Foreign means formed under laws of another state; Domestic means

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XProvider's Signature


formed under Texas laws.

Assumed NamesAn assumed name certificate (or DBA) shall be properly registered with the Harris County Clerk's Office for anyone wishing to do business under another name. This applies to corporate entities as well as individuals. The contract should be in the name of the individual or entity d/b/a the assumed name, rather than just the assumed name. Chapter 71, Texas Business and Commerce Code.

XXIX. CONFIDENTIAL & PROPRIETARY INFORMATION The parties may provide technical information, documentation and expertise to each other that is either (1) marked as being confidential or, (2) if delivered in oral form is summarized in writing within 10 working days and identified as being confidential (“Confidential Information”). The receiving party shall for a period of five (5) years from the date of disclosure (i) hold the disclosing party’s Confidential Information in strict confidence, and (ii), except as previously authorized in writing by the disclosing party, not publish or disclose the disclosing party’s Confidential Information to anyone other than the receiving party’s employees on a need-to-know basis, and (iii) use the disclosing party’s Confidential Information solely for performance of this Contract. The foregoing requirement shall not apply to any portion of a party’s Confidential Information which (a) becomes publicly known through no wrongful act or omission on the part of the receiving party; (b) is already known to the receiving party at the time of the disclosure without similar nondisclosure obligations; (c) is rightfully received by the receiving party from a third party without similar nondisclosure obligations; (d) is approved for release by written authorization of the disclosing party; (e) is clearly demonstrated by the receiving party to have been independently developed by the receiving party without access to the disclosing party’s Confidential Information; or (f) is required to be disclosed by order of a court or governmental body or by applicable law, provided that the party intending to make such required disclosure shall promptly notify the other party of such intended disclosure in order to allow such party to seek a protective order or other remedy.

XXX. DATA AND PROPRIETARY RIGHTS

All Work, as defined under this Contract, shall be deemed “Work Made For Hire” as defined by the United States Copyright Law, and HISD retains for itself sole ownership of all proprietary rights in and to all designs, engineering details and other data pertaining to any discoveries, inventions, patent rights, software, improvements and the like made by Provider personnel in the course of performing the Work.

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HISD acknowledges and agrees that (i) as between Provider and HISD, Provider owns all right, title and interest in and to Provider’s Intellectual Property, (ii) nothing in this Contract shall confer in HISD or any of its affiliates any right of ownership in any of Provider’s Intellectual Property, and (iii) HISD shall not now or in the future contest the validity of any of Provider’s Marks.

XXXI. DEBARMENT AND SUSPENSIONS

Provider certifies, to the best of its knowledge and belief, that it is not presently debarred, suspended for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency.

XXXII. COMPLETE UNDERSTANDING

This Contract shall constitute the complete understanding of Provider and HISD, and may not be modified in any manner. No changes, amendments, or modifications of any provision of this Contract will be accepted.

The terms of this Contract shall control over any conflicting terms contained in any attached Exhibit, Addendum, Purchase Order, website, software pop-up agreement, or other document of any kind.

By signing the Contract, the Provider affirms that there is no personal or financial conflict of interest between the Provider or the Provider’s family and the District.

IN WITNESS THEREOF, HISD and Provider have executed this Contract effective on the date of the last signature to this Contract.

Project #: 16-10-54Name: Research and Evaluations for Contracted Expertise

PROVIDER INFORMATION

Company: __________________

Address: _______________________

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______________________________

______________________________

By (Signature): _________________ Date _____

Name (Print): ______________________

Title: ________________________

_________________________

Taxpayer Identification Number

DATA SHARING AGREEMENTBETWEEN

THE HOUSTON INDEPENDENT SCHOOL DISTRICTAND

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___________________________________

This Data Sharing Agreement, herein referred to as “DSA”, for confidential data sharing is entered into by and between the Houston Independent School District (“HISD”) and ______________________ (“____________________”) who, as parties to the DSA, elect to accept its terms, to wit:

PREAMBLE

The mission of ________________________ is to _______________________. To that end, data is being requested as part of the DSA to fulfill the organization’s mission. ________________________ agrees that the data transferred from HISD to ________________________ is and shall remain the sole and exclusive property of HISD. The DSA establishes that individually-identifiable health information that falls under the protection of the Health Insurance Portability and Accountability Act (“HIPAA”), data that deals with confidentiality provisions of the Patient Safety Rule, and social security numbers will not be released. Data that are released must be used consistent with the Family Education Rights and Privacy Act (FERPA), HIPAA and HISD’s policies for managing student education records and other confidential information. HISD grants ________________________ license to use such data only for the following purpose and for no other purpose.

The scope of the project addressed in this DSA is limited to the use of teacher and student data solely for the purpose of 16-10-54 Research and Evaluations for Contracted Expertise.

Any annual and final reports based on the data provided to ________________________ must be submitted to HISD.

THEREFORE, the parties agree to the following terms of this DSA:

1. Data Sharing

The data shall be provided by HISD to ________________________. The format will vary depending on integration method and requirements. Any data received by ________________________ pursuant to this DSA shall be destroyed when it is no longer needed for the designated purpose. Notwithstanding the foregoing, or anything contained hereto the contrary, to the extent that ________________________ maintains regular back-up or centralized retention of electronically created data or electronically stored information (collectively “ESI”), such ESI may be retained as necessary to comply with the existing policy for back-up and archiving of ESI, so long as no information required to be kept confidential hereunder is otherwise accessible to any of ________________________’s employees, contractors or agents.

2. Confidentiality

________________________ will maintain the confidentiality of any and all student data obtained from HISD as a part of this DSA. The confidentiality requirements under this paragraph shall survive the termination or expiration of this DSA or any subsequent agreement intended to supersede this DSA. To ensure the continued confidentiality and security of the student and staff data processed, stored, or transmitted under this DSA, ________________________ shall establish a system of safeguards that will at minimum include the following:

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a. ________________________ shall develop, implement, maintain and use appropriate administrative, technical and physical security measures to preserve the confidentiality, integrity and availability of all data, including electronically-maintained or transmitted data received from, or on behalf of HISD. These measures will be extended by contract to all subcontractors used by ________________________.

b. ________________________ and its employees, subcontractors and agents involved in the handling, transmittal, and/or processing of data provided under this DSA will be required to maintain the confidentiality of all student and staff-related personally identifiable information.

c. Procedures and systems that shall require the use of secured passwords to access computer databases used to process, store, or transmit data provided under this DSA.

d. Procedures and systems, such as good practices for assigning passwords, shall be developed and implemented to maintain the integrity of the systems used to secure computer databases used to process, store, or transmit data provided under this DSA.

e. Procedures and systems that ensure that all confidential student and staff data processed, stored, and/or transmitted under the provisions of this DSA shall be maintained in a secure manner that prevents the interception, diversion, or other unauthorized access to said data.

f. The procedures and systems developed and implemented to process, store, or transmit data provided under this DSA shall ensure that any and all disclosures of confidential student and staff data comply with all provisions of federal (HIPAA, FERPA, E-Government, etc.) and Texas state laws relating to the privacy rights of students and staff as such laws are applicable to the parties to this DSA.

g. ________________________ shall return to HISD all data or any portions thereof requested by HISD, or, at HISD’s election and subject to clause 1 above, ________________________ shall destroy all or any part of HISD’s data that is within the possession or control of ________________________ and shall upon request by HISD, provide certification of such destruction.

h. Permission shall be obtained from HISD prior to publications or disclosure of data, or other uses not outlined in this DSA.

3. Indemnification

________________________ shall hold HISD and its past and present and future trustees, officers and employees harmless and shall indemnify all such parties against any and all claims, demands, and causes of action of whatever kind or nature asserted by any third party, occurring or in any way incident to, arising out of, or in connection with any acts of ________________________ and its agents, employees, and subcontractors done in connection with this DSA.

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Nothing in this DSA shall be construed to create a claim or cause of action against the District for which it is not otherwise liable, nor to waive any immunity or defense to which the District may be entitled nor to create an impermissible deficiency debt of the District.

4. Right to Audit

________________________ shall provide HISD and its designees with information and access to its premises (upon giving reasonable notice) as HISD may reasonably require evidence of compliance with the DSA and applicable state and federal law.

5. Entire Agreement

This document states the entire agreement between ________________________ and HISD with respect to its subject matter and supersedes any previous and contemporaneous or oral representations, statements, negotiations, or agreements.

6. Execution

Each of the persons signing this DSA on behalf of a party or entity other than a natural person represents that he or she has authority to sign on behalf and to bind such party.

7. Assignment

None of the signatories to this DSA may assign their rights, duties, or obligations under this DSA, either in whole or in part, without the prior written consent of the other signatories to this DSA.

8. Severability

If any provision of this DSA is held to be illegal, invalid, or unenforceable under present or future laws effective during the term of this DSA such provision shall be fully severable. This DSA shall remain in full force and effect unaffected by such severance, provided that the severed provision(s) are not material to the overall purpose and operation of this DSA.

9. Waiver

Waiver by any signatory to this DSA of any breach of any provision of this DSA or warranty of representation set forth herein shall not be construed as a waiver of any subsequent breach of the same or any other provision. The failure to exercise any right under this DSA shall not operate as a waiver of such right. All rights and remedies provided for in this DSA are cumulative.

10. Modification and Amendments

This DSA may be amended or modified at any time by mutual agreement of the authorized representatives of the signatories to this DSA. HISD and ________________________ further agree to amend this DSA to the extent amendments are required by an applicable law or policy issued by an appropriate regulatory authority if the amendment does not materially affect the provisions of this DSA. However, if new laws, policies,

54


or regulations applicable to HISD and ________________________ are implemented which materially affect the intent of the provision of this DSA, the authorized representatives of the signatories to this DSA shall meet within a reasonable period of time, from the date of notice of such change of law, policy, or regulations, to confer regarding how and/or if those laws, policies, or regulations will be applied or excepted.

11. Term of this DSA

This DSA shall be in effect for a term commencing from the effective date, which is the date when the DSA is fully executed by both parties, until the date the current business relationship ends between HISD and ________________________.

12. Criminal History Background Check

Pursuant to Sections 22.0834 and 22.085 of the Texas Education Code, ________________________ hereby certifies that all employees, subcontractors and volunteers of ________________________ who are hired by ________________________ on or after January 1, 2008, and who have continuing duties related to the contracted services; and has or will have direct contact with students have passed a national criminal history background record information review as required by those sections.

________________________ shall send or ensure that the employee or applicant sends to the Texas Department of Public Safety (“DPS”) information that is required by the DPS for obtaining national criminal history record information, which may include fingerprints and photographs. DPS shall obtain the person’s national criminal history record information and report the results through the criminal history clearinghouse as provided by Section 411.0845, Government Code.

________________________ must also obtain certifications from all subcontractors that their employees to whom Section 22.0834 applies have also passed a national criminal history background record information review.

________________________ must also provide assurances that all of its employees, subcontractors and volunteers, including those hired before January 1, 2008, who have contact with students have passed a criminal history background check current within the last year. If an employee, subcontractor or volunteer of the ________________________ has a criminal conviction or has received deferred adjudication for a felony offense or a misdemeanor involving moral turpitude, the District may elect not to enter into this contract, or cancel the contract.

WARNING: Section 44.034 of the Texas Education Code requires that a person or business entity that enters into a contract with a school district must give advance notice to the district if the person or an owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony.

The district may terminate this contract if the district determines that the person or business entity failed to give notice as required by Section 44.034 (a) or misrepresented the conduct resulting in the conviction. The district will compensate the person or business entity for services performed before the termination of the contract.

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Legal Business Name: _______________________________________

By (Signature): _________________________________________ Representative Date

____________________________________Name (Print)

____________________________________Title

______________________________Taxpayer Identification Number

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