HomeMy WebLinkAboutContract 55761CSC N o. 55761
FORT WO�RTH
� ,�
CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement ("Agreement") is entered into by and between You Name It
Specialties ("Vendor") and the City of Fort Worth, ("City"), a Texas home rule municipality.
The Cooperative Purchase Agreement includes the following documents which shall be construed in the
order of precedence in which they are listed:
1. This Cooperative Purchase Agreement;
2. Exhibit A— Seller's Quote, Scope of Services or Purchase Order;
3. Exhibit B— Cooperative Agency Contract (e.g., NJPA, DIR, BuyBoard); and
4. Exhibit C— Conflict of Interest Questionnaire.
Exhibits A, B, and C which are attached hereto and incorporated herein, are made a part of this
Agreement for all purposes. Vendor agrees to provide City with the services and goods included in
Exhibit A pursuant to the terms and conditions of this Cooperative Purchase Agreement, including all
exhibits thereto.
City shall pay Vendor in accordance with the fee schedule in Exhibit A and in accordance with
the provisions of this Agreement. Total payment made under this Agreement for the first year by City
shall be in the amount of One Thousand Two Hundred Twenty-Two Dollars and Fifty Cents ($1,222.50).
Vendor shall not provide any additional items or services or bill for expenses incurred for City not
specified by this Agreement unless City requests and approves in writing the additional costs for such
services. City shall not be liable for any additional expenses of Vendor not specified by this Agreement
unless City first approves such expenses in writing.
The term of this Agreement shall be for one year beginning on May 12, 2021 and ending on May
12, 2022.
Vendor agrees that City shall, until the expiration of three (3) years after final payment under this
Agreement, or the final conclusion of any audit commenced during the said three years, have access to
and the right to examine at reasonable times any directly pertinent books, documents, papers and records,
including, but not limited to, all electronic records, of Vendor involving transactions relating to this
Agreement at no additional cost to City. Vendor agrees that City shall have access during normal
working hours to all necessary Vendor facilities and shall be provided adequate and appropriate work
space in order to conduct audits in compliance with the provisions of this section. City shall give Vendor
reasonable advance notice of intended audits.
Notices required pursuant to the provisions of this A�reement shall be conclusively dctcrmincd
to have been delivered when (1) hand-delivered to the other party, its agents, employees, servants or
representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3)
received by the other party by United States Mail, registered, return receipt requested, addressed as
follows:
�FFICIAL REC�RD
CITY SECRETARY
FT. W�RTH, TX
To CITY:
To VENDOR:
City of Fort Worth You Name It Specialties
Attn: Dana Burghdoff, Assistant City Manager Josh King
200 Texas Street 4730 College Park
Fort Worth, TX 76102-6314 San Antonio, TX 78249
Facsimile: (817) 392-8654 Facsimile: 210-344-9909
With copy to Fort Worth City Attorney's Office
at same address
The undersigned represents and warrants that he or she has the power and authority to execute this
Agreement and bind the respective Vendor.
CITY OF FORT WORTH:
(J a�ii�/ Off/�.NA2lZ(/(7'TT :3t1 1 CDT)
sy:
Name: Dana Burghdoff
Title: Assistant City Ma►�ager
Date: 05/25/21
APPROVAL RECOMMENDED:
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract, including ensuring all performance
and reporting requirements.
Bv: / l`QG/ �!G/lr
Name: Traci Akin
Title: Sr. Administrative Assistant
I�
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W Johnson (Ma 13, 2021 09:00 CDT)
Name: William Johnson
Title: TPW Director ,0,�o44pR ��a
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ATTEST:
By: `������
Name: Mary Kayser
Title: City Secretary
VENDOR:
You Name
��
: osh King
�tle: CEO
APPROVED AS TO FORM AND LEGALITY:
� (�,..-�—
Hy:
Name: Taylor Paris
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: N/A
OFFICIAL RECORD
CITY SECRETARY
FT. W�RTH, TX
Date: [INSERT DATE] r�� Ll Z�
�/V � C
1 ����
Fort Worth Transportation and Public Works
Traci Akin
4100 Columbus Trail
Fort Worth TX 76133
QUOTATION
Number
Date
Contact
Phone
SHIP TO
Fort Worth Transportation and Public Works
Traci Akin
4100 Columbus Trail
Fort Worth TX 76133
1342595-1
04/13/2021
Josh King
(210)344-9906
Ship Via FOB Production Time Terms
Our Discretion Factory 10 working days from artwork approval Net 30 Days
Quantity Description Unit Price Extension
170 Odyssey 30 Oz Stainless Steel/Polypropyelene $5.00 $850.00
Travel Tumbler in White w/ Clear Lid
170 Digital Full Color Wraparound Imprint $1.25 $212.50
1 Setup Charge $55.00 $55.00
BuyBoard Contract 58--19 Pricing Applied
Customer Instructions/Comments Artwork NO CHARGE
S & H $105.00
Tax EXTRA
TOTAL $1,222.50
Decorating Specifications
Item Color at imprint position White Print Colors (PMS System)
No. of Print Colors Four Color Process Four Color Process
Is color matching required No
Imprint Location(s) Wrap Imprint, Max Imprint Area: 11.75" wide by 2.25" high
CONDITIONS & AGREEMENTS
DUE TO THE PROCESS OF MANUFACTURING ITEMS TO CUSTOM SPECIFICATIONS, OVERRUNS OR UN�ERRUNS, OF NOT MORE THAN 10% WILL OCCUR THESE WILL BE DEEMEDACCEPTABLE AND BILLED ON A
PRO-RATA BASIS. THIS QUOTE SHALL NOT BE ACCEPTED AS AN ORDER UNTILACCEPTANCE THEREOF BYYou Name IlSpecialtie5lnc. AND SUCH ACCEPTANCE MAY BE EITHER BY NOTIFICATION TO CUSTOMER OR
BY OUR COMMENCEMENT OF WORK ON THE MERCHANDISE ORDERED.
YOUR SIGNATURE BELOW INDICATES ACCEPTANCE OF THIS �UOTATION ANDAUTHORIZES You Name I� Speciallies, Inc. TO PROCEED WITH THIS ORDER. VALID FOR 30 DAVS.
ACCEPTANCE
NAME SIGNATURE DATE PURCHASE ORDER #
You Name It Specialties, Inc., 4730 College Park, San Antonio, TX, United States 78249
Tel :(210) 344-9906 Fax :(210) 344-9909 Toll Free :(800) 905-5900
Website : www.younameitspecialties2.com
� Board�
Caoperative Purchasing
P.O. 8ox 40U
Austin, TX 78767-D4Q0
SUO. 695. 2819 J 512.467. 0222 � Fax: 8U0.217, 5454
kuybaard.com
April 29, 2019
Sent Via Email: josh@ynis.net
Josh King
You Name It Specialties
4730 College Park
San Antonio, TX 78249
Welcome to BuyBoard!
Re: Notice of The Loca/ Government Purchasing Cooperative Award
Proposal Name and Number: Awards, Trophies, and Personal Recognition Products, Proposal No. 588-19
Congratulations, The Local Government Purchasing Cooperative (Cooperative) has awarded your company a
BuyBoardO contract based on the above-referenced Proposal. The contract is effective 7/1/2019 through
6/30/2020, with two possible one-year renewals. The contract documents are those identified in Section 3 of
the General Terms and Conditions of the specifications.
To view the items your company has been awarded, please review the proposal tabulation No. 588-19 on the
following web-site: www.buyboard.com/vendor. Only items marked as awarded to your company can be sold
through the BuyBoard contract. In addition, on this website you will find the membership list which will provide
you with the names of all entities with membership in our purchasing cooperative.
Enclosed with this letter you will find the following documents:
1. Vendor Quick Reference Guide 2. BuyBoard License and Identiry Standards
You are advised that receipt of a purchase order directly from a Cooperative member is not within
the guidelines of the Cooperative. Accepting purchase orders directly from Cooperative members may
result in a violation of the State of Texas competitive bid statute and termination of this Cooperative BuyBoard
contract. Therefore, all purchase orders must be processed through the BuyBoard in order to
comply. Please forward by email to info@buyboard.com any order received directly from a Cooperative
member. If you inadvertently process a purchase order sent directly to you by a Cooperative member, please
fax the order to the above number and note it as RECORD ONLY to prevent duplication.
As an awarded vendor a BuyBoard user id and password will be sent via e-mail 2 to 3 business
days prior to the start of your contract.
On behalf of the Texas Association of School Boards, we appreciate your interest in the Cooperative and we
are looking forward to your participation in the program. If you have any questions, please contact
Cooperative Procurement Staff at 800-695-2919.
Sincerely,
;�.
�-.:�.. -,,�,� ._
Arturo Salinas
Department Director, Cooperative Procurement
��— The Local Goverr�menC Furchasing Cooperative is enciorsed by fhe Iexas Association ot School Boards,
TM�, ° : T� 7
���� Texas M�rriicipal League, Texas Assoaalion of Cauntres, and the Texas Rssociatron of School Adminrstratars.
' Bva�d� �
' t:�c�,,n:a �ciu,��l
�+.�.�.. ,.,-ran:�rC:s��rr:,r Endorsedby ti56A [l�rir�is:l�����ia[�un
April 29, 2019
Sent Via Email: josh@ynis.net
Josh King
You Name It Specialties
4730 College Park
San Antonio, TX 78249
Welcome to BuyBoard!
Re: Notice of National Purchasing Cooperative Piggy-Back Award
Proposal Name and Number: Awards, Trophies, and Personal Recognition Products, Proposal No. 588-19
Congratulations, The National Purchasing Cooperative (National Cooperative) has awarded your company a BuyBoardO
contract based on the above-referenced Proposal. As provided for in the Proposal and your National Purchasing Cooperative
Vendor Award Agreement, you are authorized to sell the goods and services awarded under the Proposal to National
Cooperative members in states other than Texas through the BuyBoard. The contract is effective 7/1/2019 through
6/30/2020, with two possible one-year renewals.
The National Cooperative membership list is available at our website www.buyboard.com/vendor. The list identifies the
current members that may purchase awarded goods and services under your National Cooperative BuyBoard contract.
You are advised that receipt of a purchase order directly from a National Cooperative member is not within
BuyBoard guidelines. Accepting purchase orders directly from Cooperative members may result in a violation of applicable
competitive procurement law and termination of this National Cooperative BuyBoard contract. Therefore, all purchase
orders from National Cooperative members must be processed through the BuyBoard. Please forward by e-mail
to info@buyboard.com any order received directly from a National Cooperative member. If you inadvertently process a
purchase order sent directly to you by a National Cooperative member, please fax the order to the above number and note
it as RECORD ONLY to prevent duplication.
As an awarded vendor a BuyBoard user id and password will be sent via e-mail 2 to 3 business
days prior to the start of your contract.
On behalf of the National Cooperative, we are looking forward to your participation in the program. If you have any
questions, please contact Cooperative Procurement Staff at 800-695-2919.
Sincerely,
; (..`.
_ r "- r� _
_�
Arturo Salinas
Department Director, Cooperative Procurement
v.6.5
� �
P. �. Box 4D0, A�rstir�, Texas 18767-040li
800.695.29]9 • buybaard.com �
i Board �
Caoperafive Putshasing
12007 Research Boule�ard � Austin, Texas 78759-2439 • PH: 800-b95-2919 ' FAX: 840-211-5454 • buvbaard.com
PROPOSER`S AGREEMENT AND SIGNATURE
Pr_oposal Name: Awards, Trophies, and Personal
Recognitian Products
Proposal NuMber: 58$-19
Contract Time Period: July 1, 2Q19 through 7une
30, Z020 w�th two (2) possible one-year renewals.
Pronosal Due DatelOnenina Date and T'ime:
lVo�ember 20, 2Q1$ at 4:0� PM
Location of Proposal Opening:
Texas Associatinn of School Boards, Inc.
�uyBoard Department
12007 Research Bl�d.
Austin, iX 78759
Ant�tipated Cooperative Board Meeting Date:
April 2019
You Name it Specialtie:
Name of Proposing Company
4730 College Park
Street Address
San Antonio, TX 78249
City, State, Zi p
210-344-9906
1�11612�15
Date
Signatur o uth�orized Company Offcial
Telephone fVumE�er of Authorized Company Official
2� 4-344-9909
Josh King
Printed Name of Authorized Campany Dfficial
CE4
Position or Title of A�tharized Company Official
74-2942463
Fax N�mber of Auihorized Campany Official Federal ID Number
Page 8 of 61
Praposa! Farms C4MM/5VC5 v.pfi,14, 2p 1$
� Board�
Cooperative Purchasing
12007 Research Boulevard • Aus�in, Texas 78754-2439 • PH: 800-695-2919 • FAX; 800-211-5454 � buvhoard.cam
The propasir�g company ("you" or "your"} hereby acknowlecfges and agrees as follows:
1. You have carefully examined and understand all Goaperative infarmatian and documentation associated with this
Praposal Invitation, including the Instructions to PropoSers, General Terms and Conditions, attachments/farms, item
specifications, and iine items (colleetively "Requirements'�;
2. By your response ("Proposal"} ta this Proposai In�itation, you propose to supply the products or services submitted at
the prices quoted in ynur Proposal and in strict compliance with the Requirements, unless specifc deviations or
exceptions are noted in khe Proposal;
3, Any and all deviatians and exceptions to the Requirements have been noted in yaur Proposal and no others will be
claimed;
4, If the Caoperati�e accepts any part of your Proposal and awards you a contract, you will furnish all awarded products
or serrrices at the prites quoted and in strict compliance with the Requirements (u�less specific exceptions are noted in
the Proposal and accepted by the Cooperative}, including without limitatian the Requirements related to:
a. canducting business with Cooperative members, including o�fering pricing to mernbers that is the best you offer
cornpared to similar customers;
b, payment af a service fee in the amount specified and as provEded �'or in this Praposal invitation;
c. the possihie award af a piggy-6ack contract by another go�ernmental entity or nanprafit entity, in which event
yau will offer the awarded goods and services in accordance with the Requirements; and
d. submitting price sheets or cataings in the proper format as required by the Caoperative as a prerequisite to
activation of your contract;
5. Yau have dearly identified on the included form any informa�ion in yaur Proposal that you believe to be confidentiaf or
proprietary or that you do not consider to be public information sub�ect to public disclosure under a Texas Public
Information Act request or similar puf�lic information law;
6. The indi�idual signing this Agreement is duly authorized ta �nter into the contractual relationship represented by this
Proposal Invitation an your behalf and bind you to the Requirements, and such indi�idual (and any individual signing a
form) is a�thorized and has the requisite kr�owledge to pra�ide the information and make the representations and
certifications requ9red in the Req�irements;
7. You have carefully re�iewed your Proposal, and certify �hat all information pro�ided is true, complete and accurate,
and you authorize the Cooperati�e ta take such action as it deems appropr9ate to verify such information; and
8. Any misstatement, falsificatian, or omission in your Proposal, whene�er or howe�er discovered, may disqualify you
from consideration for a cor�tract award under this Proposal In�itation or result in termination of an award or any other
remedy ar action provided for �n the General Terms and Conditi�ns or by law.
Page 9 of bl
Proposal Forms COMM/SVCS v.06.14.2a18
s Board�
Coaperative Purchasing
12007 Research 8oule�ard ' Austin, Texas 78759-2439 • PH: 806-695-2919 • FAX: 800-211-5454 � buvboard.com
VENDOR CONTACT INFORMATION
co�,pa�y: You Name it Spec�alties
Vendor Contact Name and Mailing Address For �Voti[es: �OSh Klilg, 4730 College Park, SAT 78249
Cornpany Website: �W'YOLJilaii�@ItSp@CIaI�IeS.001'71
Pureh�se Order�: All purchase arders frorn Cooperative merribers will be available through the Intern�t. Vendors need
Internet access and at least one e-mail address so that notification of n�w orders can be sent to the Internet contact when
a new purehase order arrives, An information guide wil3 be provided ta �endors to assist them wifh retrieving their orders.
Please select optians below for receipt of purchase orders and pro�ide the requested information:
0 I will use the internet to receive purchase orders at the fallowing address:
E-mail Address: 10Sh�y1'lIS.t1�t
�nternet Contact: �OSh Klllg
Alternate E-mail Address: OI"C�eC`S��/IIIS.ile�
Alternate In�ernet Conta[t:
P�one: 210-344-9946
Pt�one: 210-344-9906
❑ Purchase orders may be received by the Designated Dealer(s} identified on my company's Dealer
Designation form as pro�ided ta the Cooperative administrator. I understand that my campany shall remain
responsibie far the Cor�tract and the performance af all Designated Dealers under ancf in accordance with the
Contract.
R�quest for Quotes {"RF�): Cooperati�e members will send RFQs to you by e-r►�ail. Please pro�ide e-mail addresses
for the re�ipt of RFQs:
�-mail Address: ��SII@j/C11S.net
Altemate E-rrEail Address: OC'C�erS p�)/C11S.C1E�f
In�oices: Your company will be billed manthly for the service Fee due under a contract awarded under this Proposal
Envitation. AII invoices are a�ailable on the BuyBaard website and e-mail notifications will be sent when they
are ready to be retrie►red. Pfease provide the following address, eantact and e-mail information for receipt of service fee
invoices and related communicatians:
Page 10 of 51
Praposal �orrns COMMISVCS v.6b.i4.2p18
i Board�
Caaperative Pt►rchasing
i2007 Research Boule�ard • A�stin, Texas 78759-2439 � PH; 8Qp-b95-2919 � FAX: 840-211-5454 • buvboard.com
Please choose oni� one !il of the following options for receipt of in�oices and proaide the requested
information:
❑■ Service fee invoices and related communications should be pro�ided directiy to my company at:
Mailing address: 4730 College Park aepartment:
���: San Antonio State: Texas ��p Code: 7824g
Contact Name: JOSh King P�o��; 210-344-9906
Fax: 21 �-344-9909 �_ma�� Add�ess: in�oices@ynis.net
Alternati�e E-mail Address:
❑ In lieu oi my company, I request and autharize all service fee in�oiCes �o be provided directly to the following billing
agent**:
Maiiing address:
Department:
City: State: Zip Code:
Cantact Name:
Fax: E-mail Address:
Alternati�e E-mail Address:
Phone:
❑ in li�u nf my company, I request and authorize service fee invoices to be provided ta the Designated Dealer(s}
recei�ing the purchase order(s) ta whEch the in�oiced service fees relate at the address and cantact information designated
on my campany's Dealer Designation farm as pra�ided to the Coaperati�e administrator.**
** If Vendor authorizes a 61111ng agent or Des/gnated Dea/er(s) ta rece/vE and process servlce fee Jn vo/ces,
In accordance w/th ihe Genera/ Terms and Condltlans ofthe Contract, I/endorspeciflcal/y acknow/edges and
agrees that nathing /n that deslgnatlan shall relleve Vendar aflts respons16111ties and obllgatlons under the
Contract /nc/ud/ng, but not Umlted to, payment of al/ serv/ce fees under any Contract awarded Vendor.
P�ge 11 of 61
Propos8l Porms COMM/SVCS v.06.14.2018
� Board �
Cooperative Purs,hasiRg
12007 Research Boule�ard � Austin, Texas 78759-2439 • PH: 80a-695-2919 ' FAX; 800-23.J.-5454 � buyt�aard,com
FELONY CONVICTION DISCLOSURE AND QEBARMENT CERTIFICATION
FELONY CONVICTION DISCtOSURE
5ubsection {a) af Sertion 44.034 of the Texas Education Code (Natification of Criminal History of Contractor)
states: "A p�rson or �usiness entiry that enters into a contract with a schaol district must give advance natice ta the district
if the persan or an awner or aperator has been canvicted of a felony. The notice must include a general description of the
canduct resulting in the con�iction of a felony."
Section 44A34 further states ir� 5ubsection (b): "A schoo! distric� may terminate a cantract with a person ar
business entity if the district determines that the perso� or business entity failed to give notice as required by Subsection
(a} or misrepresented the conduct resuEting in the conviction. �he district must compensate the person ar business entity
for servi�es perFormed before the terrr�ination of the contract."
Please check {�/} one of the foliawing:
❑ My CDmp811y is d j�U�7liCly-helCi COrpOC&$lOf�. (Advance natice requirement does not �pply to publicly-held corporatlon.)
❑� My campany is not owned ar operated by anyone who has been convicted af a felony.
❑ My company is owned/operated by the following individua4(s) who has/have 6een convicted af a felony:
Name of Felon(s):
De[ails of Con�iction(s};
By s9gnature below, I certify fhat the abo�e informatian is true, complete and accurate and that I am aut�orized by my
eompany to make this certiflcation.
You Name it Specialties
Company Name
Josh King
Signature of oriz ompany Off+cial Printed Name
DEBARMENT CERTIFICATI.ON
Neither my company nor an awner ar principal of my company has been debarred, suspended or atherwise made ineiigibfe
for participation in Federal Assistance programs under Executive Order 12549, "Debarment and Suspension," as described
in the Federal R�gist�r an� RuEes and Regulations. I�either my company nor an owner or principal of my company fs
currently listed or� the government-witle exclusior�s in SAM, debarTed, suspended, ar otherwtse excluded by agencies or
cieclared ineligible under any statutory or reguiatory authoriiy. My company agrees to immediately notify the CooperaCive
and all Coop�rati�e members with pending purchases ar seeking to purchase from my company if my company or an
owner or prirscipal is later iisted on the gavemment-wide �xcEusions in SAM, or is debarred, suspended, or atherwise
excluded by agencies or declared ineligible u€�der any sta�utory ar regulatory autharity.
By signature below, I certify that the abave is true, campiete and accurate and that I am authorized by my company to
make this certifitatian.
You Name it Specialties
Campany Name
Josh King
Signatur of Au ized Company Off'icial Printed Name
Page 12 of 61
Proposal Forms COMM/SUCS v.�6.14.2018
s Board�
Cooperative Purchasing
12007 Research Boule�ard ` Austin, Texas 78759-2439 • PH: 800-695-2919 •�AX: B00-211-5454 • buvbaard,cam
RESIDENTI NONRESIDENT CERTIFICATION
Chapter 2252, 5ubchapter A, of the Texas Government Code esta�lishes certain requirements applicable to prapasers who
are not Texas residents, Under the statute, a"resicient" proposer is a person whose principal pla�e of business is in Texas,
including a contrackor whose uitimate pare�t company or majarity owner has its principa{ place af business in Texas. A
"nonresident" propaser is a person who is not a Texas �esident. Pkease indicate the status of you� company as a"resident"
prapnser or a"nanresident" praposer under these definitions.
Please check (,/� one af the follawinq:
❑■ I certify that my campany is a Resident Proposer.
❑ I certify that my company is a Nonresident Praposer.
IF yaur company is a lVonresident Praposer, yau must pravide the fallowing information for yo�r resident state (tl�e state in
which your campany's principal place of business is located):
Campany Name
Ciry
Address
State
Zip Code
A. Does your resident state require a propas�r w�ose pr�ncipal place af b�siness is in Texas ta �nder-price proposers
whose resident state is the same as yours by a prescribed amount or percentag� to recei�e a comparable contract?
❑ Yes ❑ No
What is the prescribed arr�ount ar percentage? $ or
%
VEND4R EMPLOYMENT CERTIFICATI()N
Section 44.031(b) of the Texas �ducation Code establishes certain criteria that a school district must cansider when
determining to whom to award a contract. Among the criteria for certain contracts is whether the �endor or the vendor's
ultimate parent or majority owner (i) has its prin�ipal place of business in Texas; or (ii) empioys at least 500 people in
Texas.
If neither your corrEpany nar the uftimate parent campany or majority owner has its principal place of business in Texas,
does your campany, ultimate parent company, or majority owr�er emplay at least 500 people in Texas?
Please check (,/� one_of the faliawinq_
� Yes ❑ No
By signature belaw, I certify that the inforrnation in Sections 1(Resident/Nonresident Certification) anc! 2(�endor
Employment Certification} above is true, complete and accurate and that I am authorized by my company to make this
certification.
You Name it Specialties
Company Name
Signature af Autherlt�'Campany Official
Josh King
Printed Name
Page 13 of 61
Praposal Forrns COMM/�CS v.06.14,2618
i Board�
Cvoperative PurchasiRg
12aD7 Research Boule�ard ' Austin, Texas 78759-2439 � PH: 80D-695-2919 ' FAX: 80a-21I-5454 ' huvboard.com
IVO ISRAEL BOYCOTT CERTIFiCATI4N
EfFective September 1, 2017, a Texas go�ernmental entity may not enter into a contract wjth a company for goods or
serviees unless the contract contains a written verification from the company that it: (1) does r�at boycott Israei; and (2}
will not boycott Tsrael during the term of the contract. (TEx. Gov`Y' CodE Ch. 2270)
"Boycatt Israel" means reFusing to deal with, terminating business activities with, or atherwise taking any action that is
intended ta penalize, inFlict economic harm on, or limit commercial relations specifica!!y wit� Israel, or with a person or
entity doing business in Israel or in an Israeli-confrolled territory, but does not include an action made for ordinary b�siness
purposes. TEX. GOV'T CODE �808.001{1}.
By signature below, i certify and �erify that Vendor daes nat boycotk Israel and will not boyco�t Israel during th�e term of
any contract awarde� under this Praposa! Invitation, that this certification is true, complete and accurate, and that I am
authorized by my company to make this certification.
You Name it Specialties
Company Name
Josh King
Printed Name
NO EXCLUDED NATION OR F4REIGN TERRORIST ORGANIZATION CERTIFICATION
EfFecti�e Septerr�ber 1, 2017, Chapter 2252 of the Texas Go�ernment Code pro�ides that a Texas governmental entity may
not enter into a contract with a compar�y engaged in active business operatians with Sudan, Iran, or a fareign terrorist
arganization — specifically, any company identified on a list prepared and maintained by the Texas Comptroller u�der Texas
Government Code §�806.051, 807.051, or 2252.153. (A company that the U.S. Government affirrnatively declares to be
excluded from its federal sanctions regime rElating to 5udan, Iran, or any federal sanctions regime relating to a fareign
terrorist arganization is not subjeet to t�e contract prohibition.)
By signature belaw, I certify and �erify that Vendor is not on the Texas Comptrallers list identified abo�e; that this
certification is true, complete and accurate; and that � am autharized by my company to make this certification.
You Name it Specialties
Campany �ame
Josh King
Printed Name
Page f 4 of b].
Proposal Forms C�MMJ5VC5 v,p5.14,2p18
s ������
Caaperatfve Purchasi►rg
12007 Research Bo�levard ' Austin, Texas 78759-Z439 • PH: 8a0-695-2919 ' FAX: 8Q0-211-5454 • buyboard.com
HISTORICALLY UNDERUTILIZED BUSINE55 CERTIFICATI4N
A propaser that has been certified as a Historically lJnderutilized Busin�ss (also knowrs as a Minority/Women 8usiness
Enterprise or "MWBE" and all referred to in this form as a"HUB'� is encauraged to indicate its Hll8 certification status
when responding to this Propasal Invitation. The electronic catalogs will indicate HUB certi�icatians for �endors that
properly indicate and document their HUB certification on this form.
Please check (�/� a!I that a�plv:
� I certify that my company has been certified as a HUB in the following categories:
❑ Minoriiy Owned Busir�ess
x❑ Women Owned Business
❑ Service-Disabled Veteran Ownetf Business (�eteran defined by 38 U.S.C. §101(�,), wha has a
service-cannected disahility as defined by 38 U.S.C. § 101(16), and who has a disability rating
af 20% or more as determined by the U. 5. Department af Veterans Affairs or Department of
Defense)
Certification Number:
Name of Certifying Agency:
❑ My cornpany has NOT been certified as a Ffl1B.
By signature below, I cer�ify that the above is true, complete and accurate and that I am authorizeci by my
company to make this certifcation.
You Name i# Specialties
Company Name
Josh King
Printed Nar�e
gr�ature of Aut�d Cqfnpany QfFcial
Page L5 of 51
Proposa! Fwms COMf�?/SVCS v.6b.14.2018
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May 31, 2Di8
Faith King
King Dauble J, LLC
4730 College Park
San Antonio, TX 78249
Deaf Faith King:
South Central Texas Re iona� Certif�cat�on A enc
"�ncxeasing economic prosperiry by creating opportuniries and
eliminating barriers"
av�ar� sclrGa.org
We are pleased to inform you that your application for certification in our Small, Minarity, Woman and Veteran Business Enterprise
(SIMfWN) Pragram has been approved. Your Firm met the requirements o# the SCTRCA Policy and Procedure Manual anci is curr�ntly
certified as a:
�sse we�
Certification �tumber. 218059330
Certification Expiration: May 31, 2020
Pro�iding the following products or services:
NAICS 54187d. ADVERT151NG MATERIAL bIS1`RIBU"fION SERVIC�S
NAtCS 541890: OiHER SERViCES RELATED TO ADVERTISING
On the two year anniversary date of yaur certification, you are required to pro�ide a renewal application affirming that no changes have
occured afiecfing your certification status. The SCTRCA witl send you a Certification Renewal reminder sixty (50} days pr'�or to your
expiration dat�. The SCTRCA will no lonc�er inciude a certificate uqon certification renewals. Your expiration date is May 31, 2Q20.
Please notify this office within thirty (34j days of any changes affecting the size, ownership, control requirements, or any materiai change
ir� the informaiion provided in the submsssion of the certification appfication. Thank you in advance.
Sincerely _ . . -_� ,
}
� '"--lc.s-=_s-4.-}
Charles Johnson,
Executive Director --
32C)l Cherrt= Ridge F7r., F3iulding C, Suite �#379 San :Lcitonio TX 7$230
Phone: (210) 227-4RC,, (=4722)
GE,NTI�
� Board�
Cooperatfve Purshasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH; 800-695-2919 � FAX: 800-Z11-5454 • buvbaard.cam
CONSTRUCTION-RELATED GOODS AND SERVICES AFFIRMATION
A contract awarded under this Praposal Invitatinn covers only the specific goads and 5ervices awarded by the Buy6oard, As
explained in the BuyBoard Procurement and Cor�struction Related Goods and Services Advisory for Texas Members
('}Advisory'�, Texas law prohibits the procurement of architecture or engineering services through a
purchasing cooperati�e. ihis SuyBoard contract does not include such services. Architecture ar engir�eering
servic�s must be procured by a Cooperati�e member separately, in accordance with #he Rrofessional
Services Procurement Act {Chapter 2254 of the Texas Governrnent Code) and other applicable law and focai
policy.
The Advisory, a�ailable at puvbaard.comlVendorlResources,as�, provides an o�erview of certain legal requirements that
are potentially rele�ant ta a Coopera�ive member's pracurement of canstruction ar constructian-related goods and s�rvi�es,
inckuding thase for projects that may involve or require architecture, engineering or independent testing services. A capy
af the Advisory can akso bE pro�ided upon request.
By signature belaw, the undersigned affirms that Proposer has obtained a copy of the Advisory, has read and understands
the Ad�isory, and is autharized by Proposer to make this affirmation. If �ropaser sells construction-related goods ar
services ta a Cooperative member under a BuyBoard contract awarded under this Propasal Inv':tation, Proposer wil� tomply
with the Ad�isory and applicable legal requirerr�ents, make a good faith effart ta make its Cooperative member c�stomers
or potential Cooperati�e member customers aware of such requirements, and pro�ide a Cooperafi�e rr�ember with a copy
of the Ad�isory k�efore executing a Member Construction Contract with the member or accepting the member's purthase
order for can5iruction-related gaods or services, whichever comes first.
You Name it Specia�ties
Company Name
Signature of Autho�d�ompany Official
101161�8
Date
Josh King
Printed Name
Page 16 of bl
Propo5al Fo�ms COMM/SVCS v.06.14.20i8
� Board �
Caaperative Purchasirrq
i2a07 Research Baulevard ' Austin, Texas 78759-2439 • PH: 800-695-2919 ' FAX: SQO-211-5454 '�board.com
DEVIATION AND COMPLIANCE
If y�ur company intends to de�iate fram the General Terms and Conditions, Proposal 5pecifications or ather requirements
associated with this Praposal In�itatior�, you ML}ST fist all such deviations o� this form, and provide complete and detailed
information regarding the de�iations on this form or an attachment to this form. Ti�e Cooperati�e will consider any
deviat9ons in its contract award deciSion, and reserves the right to accept or reject a proposal based upan any subm'stted
de�ia�ian.
In the absence of any deviation identifled and described in accardance with the above, your company must fully comply
with the General Terms and Conditions, Propasal Specificatians and all other requirements associated with this Propflsal
In�itation if awarded a contract under this Proposal Invitation. A deviatian will not be effective unless accepted by the
Caoperative, The Cooperati�e may, in its soke discretion, seeic clarificatian from and�or communicate with Proposer(s}
regarding any s�bmi�ted deviation, consistent wit#� general procurement principles of fair cornpetitian. The Cooperati�e
reser�es the right tn accept nr rejecE a proposal based upon any submitted deviation.
Pfease check one of the fallowin ;
❑■ NO; Deviations
❑ YeS; Deviatians
List and fully explain any de�iations you are submitting:
� ; • � • • • � s �
1. Shipping Via: ❑ Cammon Carrier ❑ Company Truck ■� Prepaid and Add to Invaice ❑ Other:
2. �ayment Terms: ❑■ Net 30 days ❑ 1% in 10/Net 30 days ❑ pther:
3. N�mber of Days far Delivery: 5-� 5 ARO
4. Vendor Reference/Quote Number:
5. sta�e yo�� �et���, Pa���: Only product that is defective or misprinted may be
returned with a return au�horization
6. Are electroni� payments acceptabl�? �]■Yes ❑ No
7, Are credif card payments accepta6le? ❑Yes ❑■ No
You Name it Specialties
Campany Name
Josh King
Signature of Authariz ny Official Printed Nam�
�r
Page 17 af 61
Proposa! Forms COMM/SVCS v.D6.14.2018
R Baard �
Caaperative Purchasing
12007 Research Baulevard • Austin, Texas i8759-2439 � PH; 800-695-2919 � FAX: 800-211-5454 � buyboard.com
LOCATION AUTHORiZED SELLER LISTINGS
If yau ha�e mare than one location/authorized se!!er that will service a contract awarded under this Proposal Invitatian,
please list each location�a�thorized seller below. If additional sheets are required, please duplicate this form as necessary.
NOTE; Awarded Vendors shall remain responsible for all aspects of the Contract, including processing of Purchase Orders,
and shall be responsible for the perfarmance nf all locations and authorized sellers under ar�d in accordance with the
Contract. If yau are a p�oduct manufacturer and wish to designate Designated Dealers as defined in the General Terms
and Conditions to receive Coaperati�e member Purchase Orders on your behalf, you must campiete the Manufacturer
pesignated Dealer form,
NIA
Campany Name
Address
City
�hone N�mber
Contact Per5on
NlA
Company Name
Address
City
Phone Number
Contact Person
State Zip
Fax Number
5tate Zi p
�ax Number
Page 18 of 61
Proposal Forms COMM/SUCS v.Dfi.14.2019
� Board�
Cvvperative Purchasing
12007 Research Baulevard • Austin, Texas 78759-2439 � PH; 800-695-2919 • FAX: 800-21i-5454 • btavboard.com
MANUFACTURER DEALER DESIGNATION
If Vendor is a manufacturer that se�Es praducts thro�gh a dealer network and wishes to designate a dealer or multiple
dealers {"Designated Dea�ers"} to receive Cooperative member Purchase Orders on Vendor's behalf, you must complete
this farm for each deaier you wish to designa�e.
Regardless of any Designated dealers submitted by Ven�ar, Vendor specificaliy agrees and acknawledges that any such
designations are for Vendor's convenience anly and shall nat, if Vendor is awarded a Contract, refieve Vendor of any
obligatians under the Contract, including payment of Caoperati�e servjce fees on all Purchase Orders submitted to V2ndor
or any DEsignated �eaier. In accordance with �t�� General Terms and Conditians, an awarded Vendor shall rema�n
responsible and liable for all of its obligatinns under the Conkract and the performance of both Vendar and any of Vendar's
Designated Dealers under and in accordance with the Contract and remain subject to all remedies for default thereunder,
induding, but not limited to suspension and termina�ion of Vendor's Contract for nanpayment of service fees.
If awarded, Vendor authorizes the Cooperati�e, in its sole discretion, to list any Vendor Designated Dealers in the BuyB�ard
system and ta recei�e Pur�hase Orders directly firom Cooperative mernl�ers on behalf oF Vendor. Ta the extent a Vendor
with Designated Dealers reeei�es a Purchase Order direckly, it shall be the responsibility of Vendor to appropriatefy process
such Purchase Order in accordance with �he Cantract, including but not limited ta timely forwarding such Purchase �rder to
a Designated Realer for pracessing.
The Cooperative reserve� the right, in its sole discretior�, to refuse a�dition of, or request removal of, any �esignated
Dealer, and Vendor agrees to immediately require such Designated Dealer to cease accepting Purchase Orders nr otherwise
acting on Vendor's behalf under Ene Contract. Further, the Cooperati�e's administrator shall be authnrized to remove or
suspend any or all Designated Dealers from the BuyBoard at any time in its sole discretion.
If you wish to designate a dealer to sen,ice a cantract awarded �nder this Proposal Invitation, please list the Designated
Dealer below and have this form signed by an official of yaur company autharized to make such designation. If you wish
to designate multiple dealers, pfease duplicate thls farm as necessary.
NIA
Designated Dealer Name
Designated Dealer Address
Citj/
Phane Number
Email address
Designated Dealer Contact Person
State
Fax Number
Zi p
Designated Dealer Tax ID Number* (*attach W-9)
yvv nla�c. ; t Spe U,1-�'es ---�----
our Company Name Signa of rized Cornpany Offiicial
Page 19 of bl
Proposai Forms COMNi/SVCS �.6614.2018
� Board�
Cnoperative Purehasieg
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: $00-695-z919 •�AX: B00-Z11-5454 • huyboard.com
TEXAS REGIONAL SERVIC� DESIGNATION
The Cooperative (referred to as "Texas Coaperative" in this form and in the State Service D�signatian form) ofFers vendors
the opportunity to service its members throughout the entire Stafie of Texas. If you do nat plan to service all Texas
Cooperati�e mernbers statewide, you must indicate the specific regions you will service on �his form. If you propase ta
serve dlff�rent reglons for d/fferent products ar servlces /ncluded /n your propvsal, yau must complete and
submlt a separate Texas Regiana/ Serv/ce Deslgnatlon farm for each group r�f products and clearty /nd/cate
the products or servlces to whlch the des/gnatlon applles /n the space provlded at the end af thls form. By
deslgnaiing a regi�n or regions, you are c�rtlfy/ng that you are authoNzed and wllling ta prov/de the
proposed products and servlces /n ihose reglans, Deslgnat/ng reg/ans In whlch you are e/ther unab/e or
unwl/Iing to prov/de the spec/f/ed products and serv/ces shall 6e grounds for elther rejectlon of yaur
proposal or, Ifawarded, termination af yau� Contract. Additionally, if yau do nat plan ta service Texas Coop�rative
members (i.e., if you will service only states other than Texas), you must so indicate on this form.
0 I will service Texas
Cooperative mentbers
statewide.
You Name it Speeialties
Compan e �- -
Signat�re A rized Company Official
Jos ing
Printeci iVame
❑ I will not senrice Texas
Cooperative mem6ers
stateviride. I will only
service members in the
regions checked below:
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
i n H�adauarters
1 Edinburg
2 Corp�s Christi
3 Victaria
4 Hou5ton
5
6
7
8
9
1�
11
12
13
i4
15
�.6
17
18
19
20
Beaumant
H�nts�ille
i(ilgore
Mount Pleasant
Wichita Falls
Richardson
�ort Worth
Waco
Austin
Abilene
San Angela
Amarillo
Lubbock
Mic!land
EI Paso
San Antor�io
❑ I will nat se�vice members
of the Texas Cooperati�e,
Page 2Q of 61
Proposal Farms COMM�SVCS v.06.14.2618
Regi�r�al �€�u�ation S+Brvic� Cer�t��5
� Board�
Caaperative Purchasing
1�007 Research Boule�ard • Austin, Texas 78759-Z439 • PH: $Oa-695-2919 ' FAX: 840-z7.1-5454 • buvt�oard.com
If this Texas Regional Service Designation fo�m applies ta only ane or some af the praducts and services proposed by
Vendor, list the products and services to which this form applies here:
Page 21 of 61
Proposal Forms CDMMJSVCS v.(16.14.201B
s Y oard �
Canperative Purchasing
12007 Research Boule�ard ' Austin, Texas 78759-2439 • PH: 800-695-2919 • FAX: $00-211-5454 � buv�oard.com
STATE SERVICE DESIGNATION
The Cooperative offers �endors the opportunity ta seruice other gavernmental entities in the United States, including
intergovernrnental purchasing coaperatives such as the National Purchasing Caoperative BuyBoard. Yau must carrjplete
this form if you plan to service the entire United States, or will service only the specific states indicated. (Note: If you plan
to service %xas Cooperative mem6ers, 6e sure that you complete the Texas Regional Service Designatron form.)
If you s�rve d11�'erent states far dlfferent products or serv/ces Included In your propasal, you must complete
and su6mlt a separate State Servlce Des/gnatlan form for each group vf products and c/early Ind/cate thE
prvducts ar servlces to whlch the deslgnat/on applles M the space provlded at the end of th/s farm. By
des/gnating a state or states, you are certify/ng that you are authoNzed and wllling to prov/de the proposed
products and servlces /n those states Deslgnating states In whlch you are elther unahle or unwllling to
provlde the speclfled products and servlces sha/l be grounds for e/ther rejecilon of your propasal ar, If
awarded, terminat/on of your Contract.
Please check �,/� all that a�ly_:_
0 i wilf serviee a�l states in the United States.
❑ I will not service all states in the United States. I wi{I service only khe states checked beiow:
❑ Alabama
❑ Aiaska
❑ Arizona
❑ Arkansas
❑ Califarnia (Public Contract Code 24118 & 20652)
❑ Calarado
❑ Connecticut
❑ Defaware
❑ District of Columbia
❑ Florida
❑ Georgia
❑ Haw�ii
❑ Idaho
❑ Tllinais
❑ Indiana
❑ �owa
❑ Kansas
❑ Kentucky
❑ �ouisiana
❑ Maine
❑ Maryland
❑ Massachusetts
❑ Michigan
❑ Minnesota
❑ Mississippi
❑ Missouri
❑ Mantana
❑ Nebraska
❑ Nevada
❑ New Hampshire
❑ New ]e�-sey
❑ New Mexica
❑ New York
❑ Narth Carolina
❑ North Dakota
❑ Ohio
❑ Oklahoma
❑ Oregan
❑ Pennsyl�ania
❑ Rhade Island
❑ South Carolina
❑ Sot�th Dakota
❑ Tennessee
❑ Texas
❑ iltah
❑ Vermont
❑ Virginia
❑ Washington
❑ West Virginia
❑ Wisconsin
❑ Wyoming
Page 22 of 61
Propasal Forms COMM/SVCS v.06.14.2018
� Board�
Caaperative Purchasing
12Q07 Research Bou9evard • Austin, Yexas 7$759-2439 • PH: 806-695-29i9 • FAX: 8Q�-211-5454 •}�uvboard,com
This form wilt be used to ensure that you can service other governmental entities throughout the United States as
indicated. Your signature beiow confirms that you understand your service commitments during the term af a
contract awarded und�:r this proposal,
You Name it Specialties
Company O�icial
Company Name
Josh King
Printed Name
If this State Service Designatian form applies to only one or 5ome of the products and services proposed by Vendor,
list the products and services ta which this form appkies here;
Page 23 of 61
Proposal Forms COMM/SVCS v.06.14.2018
i Board�
Cooperative Purchasing
12007 Research Boulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 � FAX: $00-211-5454 � buvbaard.com
NATIONAL PURCHASING COOPERATIVE VEN�OR AWARD AGREEMENT
In ac�ordance with the Terms and Conditions assnciated with this Proposal Invitation, a contract awarded under this
Praposal Invitatian rnay be "piggy-backed" by anather gavernmental entity, The National Purchasing Cooperati�e is an
i�tergovernmental purchasing caaperative formed by eertain schnol distritts outside of Texas ta serve its members
throughout the United States. If you agree ta be considered for a piggy-back award by the National Purchasir�g
Cooperati�e, you agree to the foilowing terms and agree to serve National Purc�asing Caaperative members in the states
you have indicated on the State Senrice Designatian form, in your Proposal.
By sigrting this form, Proposer (referred to in this Agreement as "Vendor") agrees as follows:
1. V�ndor acknowledges that if Th� LocaE Government Purchasing Cooperative ("Texas Caoperati�e") awards Vendor a
tontract under this Praposa� Invitation �`Underlying Award'�, the National Purchasing Cooperati�e ("Nationa� Cooperative")
may - but i5 not required to -"�iggy�back" on or re-award all or a portian of that Underlying Award �"Piggy-Back Award"}.
By signing this I�ational Cooperative Vendor Award Agreement ("Agreement"}, Vendar accepts and agrees to be baund by
any such Piggy-Back Award as provided for herein.
2. In the e�enk Natianal Caoperative awards Vendor a Piggy-Back Award, the Natianal Caoperative Adrt�inistrator
�`BuyBoard Administrator"} will notify Vendor in writing of such Piggy-Back Award, which award shall commence on �he
efFecti�e date stated in the Notic� and end on tF�e expiration date of the lJnderlying Award, subject to annual renewals as
autharized in writing by the BuyBoard Administrator. Vendor agr�es that no further signature or ather action is required of
Vendor in order for the Piggy-Back Award and this Agreement to be binding upon Vendor, Vendor further agrees that no
interlineations or changes to this Agreement by Vendor will be binding on iVational Cooperati�e, unless such changes ar�
agreed to by its BuyBoard Administrator in writing.
3. Vendar agrees that it shail ofFer its gaods and se+vices to National Cooperative members at the same unit pricing and
same general terms and conditior�s, subject ta applicable state laws in the state af purchase, as required by the lJnderlying
Award, Hawever, nathing in this Agreement pre�ents Vendor from offering Nationak Conperative members beEter (i.e.,
Inwer} competitive priei�g and more favarable terms and eonditions than thos� in the Underlying Award,
4. Vendar hereby agrees and confirms that it will serve those states it has d�signated on the State 5ervice Designation
Form of this Praposal In�itation. Any changes to the states designated on the State Service Designation Form must be
approved in writing by the BuyBoard Administrator,
5. Vendor agrees to pay National Cooperati�e th2 service fee provided for in the Underlying Award based on the amount oF
purchases generated fram Natianal Cooperati�e members thraugh the Piggy-Back Award. Vendor shall remit paym�nt to
National Cooperative on such schedule as it speci�es (which shall not be more aften than monthly). Further, upon
request, Vendor shall provide National Caoperative with capies of all purchase orders generated from National Cooperati�e
members for purposes of re�iewing and verifying purchase activity, Ver�dor f�rther agrees that National Cooperative shall
ha�e the right, upon reasonable written notice, to re�iew Vendor's recards pertaining to purchases made by National
Coopera�ive m�mbers in arder ta verify the accuracy of service fees.
6. Vendor agrees that the Underlying Award, including its General Terms and Conditions, are adopted by referenee ro the
fuilest extent such pro�isions can reasonably apply to the past-proposal/contract award phase. The righ�s and
responsibilities that would ordinarily inure ta the Texas Cooperati�e pursuant ta tYte LJnderlying Award shall inure to
�Jational Cooperative; andr eonversely, the rights and responsibi{ities that wouid ordinarily inure to Vendor in the Underlying
Award shall inure ta Vendor in ihis Agreement. Vendor recognizes and agrees that Vendar and Natinnal Cooperati�e are �he
only pat-ties ta this Agreement, and that nothing in this Agreement has applicatian to nther third parties, inciuding the
Texas Cnnperati�e, In the event of canflict �etween this Agreement and the terms af the Underlying Award, fhe terms of
this Agreement shall control, and then only ta the extent nec�ssary to reconcile the canflict.
Proposa! Farms COM�+�}�SllCS v,06.14.2018
Page 24 of 61
� Board�
Coaperafive Furchasing
1ZD�7 Research Boulevard � Austin, iexas 78759-2439 • PH: 8Q0-695-2919 • FAX: 8QQ-211-5454 • buyboard.cam
7. This Agreement shall be governed and construed in accordance with the laws of the 5tate af R�ode Island and venue
for any dispute shall lie in the federal district eourt af Alexandria, Virginia.
8. Vendor acknowledges and agrees that the award of a Piggy-Back Award is within the sole discretion of National
Caoperative, and that this Agreement daes nat take efFect unless and until National Cooperative awards Vendor a Piggy-
Back Award and th� BuyBoard Administratar notifies Vendar in writing of such Piggy-Back Award as provided for herein.
WHEREFORE, by signing belaw Vendor agrees to the faregoing and warrants that it has the authority to enter into this
Agreement.
You Name it 5pecialties
:; •
Name af Vandor
Signature of oriz d Company Offcial
1Q116/2018
Date
�raposal Invitation Number
Josh King
Prinied Name af Autharized Campany Official
Proposal Forms COMM/SVCS v.06.14,2018
Page 25 af 61
� Baard�
Caaperative Purchasing
1��67 Research Boulevard • Austin, Texas 78759-2439 � PH: 800-695-29Z9 ' FAX; 800-2i1-5454 •�uyboard.Com
FEDERAL AND �ATE PURCHASING COOPERATNE EXPERIENCE
The Coaperati�e strives to pravide its members with the best seEvices and products at �he best prices a�ailable from
vendors with the technical resources and ability ta serve Cooperative m�mbers. Please respond to the following questians.
1. Pro�ide the dollar value af sales to or through purchasing cooperati�es at or based nn an established catalog or
market price during the pre�ious 12-month period or the last fiscal year; $�4fl,372.oa ,(The period of the 12
mantih period is ��1161» /�oi�si�8 ). In the e�ent that a dollar vaiue is not an appropriate measure of the sales,
pro�ide and describe yaur awn measure of the sales af the item(s).
2. By submitting a praposal, yau agree that, based an your written discounfing policies, the discounts you of�er the
Caape�ative are equal to or better than the best pr9ce yau offer ather purchasir�g coaperatives for t�e same items
under equivalent circums�ances.
Pravide the information requested below for other purc�asing cnoperatives far which Proposer currently serves, or in
the past has served, as an awarded �endor, Rows should be added to accommodate as many purchasing
cooperati�es as required.
.. �. ��. •� e
. i�• s �o
,� • r�• b°
1. Federal Ger�eral Services Administratinr} N
�. T-PASS (State of Texas) N
3. U.S. Gommunities Purchasing Alliance N
4. �Vatianal IPAJTCPN N
5. Houston-Galveston Area Council (rtGaC) N
6. National ]oint Powers Aliiance (NJPA) N
7. E&I Caoperati�e N
8. The Interlocal Purchasing System (TIPS) N
9. Other
❑ MY COMPANY DDES NOT CURRENTLY HAVE ANY OF THE ABOVE OR SIMILAR TYPE CONiRACTS.
CURRENT BUYBOARD VENDORS
If you are a current BuyBoard �endar in the same contract category as praposed in this Praposal Invitatior�, indicate the
discount for your current BuyBoard contract and the propased discaunt in this Proposal. Explain any difFe�ence between
your current and propased discounts,
Current Dis�ount {%):?�
Explanation; Buyboard contract 508-16
Proposed Dis�ount {%): 25
Page 26 of 61
Praposal Forms COMM�SVCS v.06.14.2fl18
! Baard �
Cvoperative Purchasiag
12067 Research Baulevard • Austin, Texas 78759-2439 • PH: 800-695-2919 • FAX: Stia-211-5454 •�uvboard.com
By signature belaw, I certify that the above is true, complete and accurate and that I am autharized by my company ta
make this certification.
You Name it Specialtie�
Campany EVame
� �� Josh King
Signature t�orized Company Qffieial Printed Name
Proposai Forms COMM/SVCS v.06.14.2p18
Page 27 af 61
� Board�
Caoperative Purchasrng
120�7 ResearCh Baule�ard • Austin, Texas 78759-2439 • PH: $00-695-2919 • FAX: 800-21 i-5454 ' b€�ybnard.com
GOVERNMENTAL REFERENCES
For yaur Proposal to be considered, you must su�pfy a minimum of fi�e (5) individua! governmental entity references. The
Cooperati�e may cantact any and all references pro�ided as pa�# of the Proposal evaluatian. Pravide the information
requested 5elow, including the existing price/discounts you offer each customer. The Cooperati�e may determine whether
prices/discounts are fair and reasonable by comparing prices/discaunts stated in your Propasal with the prices/discounts
you offer other goverr�mentaf customers. Attach additional pages if necessary.
quantity/
En i Nart�e on n# Email i n V I
f7!3) 1�P��:2Lo�
1. t��,, �,�,}�� �.� �,�,�-�.� �n�n aw 1 a..r c,�.� .�J .�t Zo 6I � �' I I o:.��
. �
gn�ciotn� G e+r�n+e,�a. +avwvl• ecI �t
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Gbr�Mue�la� .edc�
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ckG�ni�t.brs..tle.� �sJi+,S-S�.co• ,
4.�Y�`�s►�' �1tyl� S�k� Df:n�:e. B�r.d1� C�z.�,a 3s -vi�i. �-0 7b �30o p�o
�3�� 69Q-�a4�
�j. � I��il Y�1 D�% � i 1 '�- t m N7 1�-rl'i � vM !� ri� v �'/M1 �1 rif0✓•l��4 �° o T��, ��
Do you ever modify yaur written policies or standard go�ernmental sales practices as identified in the above chart to gi�e
better discounts {lower �rices) than indicated? YES ❑ NO ❑■ If YES, please explain:
By signature below, I certify that the above is true and correct and that I am authorized by my company to make this
certificatian.
You Name it Specialties
Signatur�,,ef',�ut�zed Company Official
�J�
Name
Proposal Forms COMM/SUC5 v.06.14.2018
Page Z$ of 61
� Board �
Cooperative Purchasiag
12007 Research Boulevard • Austin, Texas 78759-2439 � PH: 800-695-2919 • FAX: 800-211-5454 • b�vboard.com
MARKETING STRATEGY
For your Propasal to be considered
Attach additional pages if necessary.
YNIS is currently under�aking a email marketing campaign �nfroducing our
company to BuyBoard members. We ha�e grown our participafion and
number of cooperati�e members purchasing from �he BuyBoard contract
o�er the time frame we ha�e been awarded and will continue to attempt to
do so.
You Name it Speciaities
Com pa ny�
Signature of Autho�d C�mpany Official
JOSh �
Printed Name
all or
Praposal Forms COM M/SVCS v.66.14.�01 B
Page 29 of 61
i Board�
Coop�raiive Purshasing
12007 Research Boule�ard � Austin, Texas 78754-2439 • PH: 80Q-b45-2919 • FAX; 800-211-5�54 � buyboard.cnm
CONFIDENTTAL PROPRIETARY INFORMATION
A. Public Disclosur� Laws
All Rraposals, farms, documentation, or other materials submitted by Vendor to the Cooperati�e in response to this
Proposal Invitation, 9ncluding catalogs and pricelists, may be subject to the disdasure requiremer�ts of the Texas Public
Information Act (Texas Ga�ernment Code chapter 552.00i, et. seq.) or similar disclosure law. Proposer must clearly
identify on this form any information in its Proposal (including farms, documentiation, or other materials submitted witF� the
Proposal) that Praposer cansiders praprietary or confidential. If Propaser fails to properly identify the informatian, the
Cooperati�e shall have no obligation to notify Vendor or seek protection of such information from pub�ic disclosure shauld a
member af the pubiic or other third party request access to the information under the Texas Public Information Act or
similar disclosure law. Proposer will be notiFied of any third party request far information in a Proposal that Proposer has
identiFed in this form as proprietary or confidential.
Does your Proposal (including forms, documentatian, or other materials subrnitted with the Proposal) contain infarmation
which Vendor considers proprietary or confidential?
�ase check (� one of the fallowina:
� N0, I certify thai none of the information included with this Proposal +s considered confidential or proprietary.
� YES, I eertify that this Proposal contains information considered confidential or proprietary and all such informatian is
specifically icfentified on this form.
If you responded "YES", you must identify below the specifie information yau cansider confide�tial or proprietary. List each
page number, form r�umber, or ather information sufficient to make the informaiian readily identi#iable. The Cooperative
and its Administrator will not be responsible �or a Pro�oser's failure to clearly identify information considered confidential or
proprietary. Further, by submitting a Proposal, Proposer acknowledges that the Cooperative ar�d its Administratar will
disc�ose informatian when requ�red by law, even if such information has b�en identiFed herein as informatian the �endor
considers confidential or praprietary.
Con�dential / Proprietary Information:
Afl of the information contained within the governmental references
section is considered confident�al and proprietary {page 28)
(Attath additronal sheets ifneeded.J
Proposal Forms COMM/NCS �.06.14.2018
Page 30 of 61
� Board�
Caoperative Purchasing
12007 Research Boulevard ` Austi�, Texas 78759-2439 • Pti: 800-695-Z919 • FAX; 8�0-211-5454 � buybaard.cam
B. CopyriAht Information
Does your Praposal (including forms, documentation, or other materials submitted with the Proposal) contai� copyright
infnrmation?
Please check (� one of tt�e followina:
� NO� Praposal (including forms, documentation, or other materials submitted with the Proposal) does not
contain copyright information.
❑ YES, �roposal (incl�ding forms, datumentation, ar other materials submitted with the Proposalj does
contain capyright information.
If you responded "YES", identify below the specific documents or pages containing copyright infarmatian.
Copyright Informatian:
(Attach addrtional sheets rfneeded.)
C. Consent bo Release Confdential/Propriet�arylCopyright Inforntation to BuyBoard M�mbers
BuySnard members (Cooperative and nonprnfit mem�ers) seeking to make purchases through the 8uy�oard rr�ay wish to
�iew information included in the PropaSals of awarded Vendors. If yo� identified inforr�atian on this form as confidential,
proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBaard contract
award constitutes your cansent to the diselosure of suc� informatian to BuyBoard members, including posting of such
informatian on the secure BuyBoard website for members. Nate: Neithe�- the Caoperative nor its Administrator will be
responsible for the us� or distribution of inforrr�atian �y BuyBoard members or any other patty.
D. Consent to Release Proposal Tabulation
Notwithstanding anything in this Confidential/Proprietary Information form to the contrary, by submitting a Proposal,
Vendar consents a�d agrees that, upon Contract award, the Cooperative may publically release, incfuding pos�irtg an the
public BuyBaard website, a copy of the propasal tabulation for the Cantract including V�ndor name; proposed
catalog/pricelist name(s); proposed percentage discount(s), hourly labar rate(s), or oth�r speciFed prici�ng; and Vendor
award or non-aw�rd informatian.
By signature below, I certify that the infor�tation in this form is true, cnmplete, and accurate and that I am authorized by
my company ta make this ce�tification and a!I consents and agreernents contained herein.
You Name i 'alt�es
Compa me �'
Signature of Au riz ompar�y OfFicial
Josh K�
Printed iVame
10/16/18
Date
Proposal Forms COMM/SVCS v.�6.14.203.8
Page 31 of 51
� Board �
Caaperative Purchasiag
12007 Research Boulevard • Austin, Texas 78759-2439 � PH: 80a-695-2919 ' FAX: 804-211-5454 • buvboard.eom
VENDOR BUSINESS NAME
By submitting a Proposal, P�oposer is seeking tn enter into a legal cantract with the Caoperative. As such, a Praposer must
be an individual or legal business entiry capable of entering into a bincfing contract. proposers, must completely and
accurately pro�ide the information requested below or your Proposal may be deemed nan-responsive.
Name of Praposing Company; � ��� C�
(List the leaal name of the company seeking to cvntract wrth the Caoperative, Oo NDT list an assumed name, dba, aka, etc. here. Such rnfarmatian may
be provrded 6elow. If you are su6mittrng a joint proposal with another entity to provrde the same proposed gaods or s�rurces, each su6mrttmg entity
should complete a separate vendor information form. Separately operatrng leqal 6usiness entities, even if af�rliated entitres, which propose to provrde
goods or servrces separately must su6mrt their or�vn Propasals.)
Please check ld) one of the fallowin�
Tvae of Business:
Individual/Sole Proprietor
Corporation X
Limited Liabiiiry Company
Partnership
Other If other, identify
State of Incorporation (�f appi�caeie): TeXaS
Federai Em�loyer ldenti�cation Numb�r: 74'�2g424�3
(i/endor must include a completed form with their proposal)
List the Name(s} by which Vendor, if awarded, W15I1�5 t0 bE id�tltlFfE?CI Ofl th� BUyBOafd: (Note: If drh`erent than the Name of
Proposrng Company Irsted a6ove, onty ualyd trade names (dba, aka, etcJ of the Proposing Gompany may 6e used and a ropy of your Asscemed Name
Certrficate(s), rfapplica6le, mustbe attached.)
You Name it Specialties
Proposal Forms COMM/SVCS v.Ob.14.2019
Page 32 of 61
Form ���
(Rev. November 2017)
Department of the Treasury
Internal Revenue Service
1 Name (as shown on your
��L'yS. �nc.
Request for Taxpayer
Identification Number and Certification
► Go to www.irs.gov/FormW9 for instructions and the latest information.
[ax re2um). Name is required on this line; do not leave
e/disregarded entity name, if different from above
�G� V►�c� l t 5,D c' �►c� l i�i �;
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ao
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3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
following seven boxes. /
❑ Individual/sole proprietor or ❑ C Corporation �J S Corporation ❑ Partnership ❑ Trusbestate
single-member LLC
❑ Limited liability company. Enter the tax classification (C-C corporation, S=S corporation, P=Partnership) ►
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
U Other (see instructions) ►
5 Address (number, street, and apt. or suite no.) See instructions.
'-�73c�, CJ C►�c; � P�r�
6 City, state, and ZIP code
5�:,/1 /�n �'o,�, o ~%X 7 � � � i
7 List account number(s) here optional)
Number
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
Exemption from FATCA reporting
code (if any)
/Applies to accounts mainteinetl oufside the U.S.)
Give Form to the
requester. Do not
send to the IRS.
Requester's name and
(optional)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
Social security number
� -m -�
or
Employer identification number
7`I - L`i Y 2�1 6
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or aban rrrof-s red property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest ividends, you ot required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign Signature of
Here U.S. person ►
Generallnstruct' ns '
Section references are to the � tern enue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (fIN) which may be your social security number
(SSN), individual taxpayer identitication number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
Date ► � - � �— �
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-8 (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to ihe requesier with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 11-2017)
� Board�
Caaperative Purchasing
12047 ftesearch Bouie�ard • Austin, Texas 78759-2439 • PH: 806-695-2919 • FAX: 800-211-5454 •�uy�oard.corn
EDGAR VENDOR CERTIFICATION
(2 CFR Part 200 and Appenciix II)
When a Coaperative member seeks to procure goods and s2rvices using funds under a federal grant or contract, spe�ific
federal laws, regulations, and requirements may apply in addition to those unde� state law. This includes, bu� is not limited
ta, the procurement standards af the LJnifarm Administrative Requirements, Cost Principles and Audit Requirements for
Federal Awards, � CFR 200 (sometimes referred to as the "Uniforrr� Guidance" or new "EDGAR'�. All Vendors submitting
proposals must complete this EDGAR Certification Form regarding Vendor's willingness and ability to comply with certain
requirements which m�y be applitable to specific Coaperati�e member purchases using federal grant funds. This
completed farm will be made a�ailahfe to C�op�rati�e members for their use while considering their purchasing options
when using federal grant funds. Cooperati�e member5 may also require Vendors to enter into ancillary agreements, �n
addition to the BuyBoard contract's general terms and canditions, to address the member's speeific cantractual needs,
including cantract requirements for a pracurement using federal grants or contracts.
For � of the Items 6e/ow, �endor should certlfy Vendor's agreement and a6111ty to comp/y, where
appllcah/e, 6y having Vendor's autharized representative comp/ete and initial the applica6le 6oxes and slgn
the acknowledgment at the end of th/s form. If you fall to complete any Item In fh/s form, the Co�perative
wlll canslder �nd may l/st the �endor's response on the BuyBoard as "NO,"the #/endor Is unab/e or unwill/ng
to compty. A"NO" res�onse to any o� the items may, if applicabfe, impact the ability af a Cooperati�e member to
purci�ase from the Vendor using federal funds.
1. Vendor Violation or Breach of Contract Terms:
Contracts fnr more than the simplified acquisitian threshoid currently set at $f50,040, which is the inflation adjusted
amount determined by the Ci�ilian Agency Acquisition Council and the Defense Acquisitio� Regulations Council (Cauncils)
as authorized by 41 USC 1908, �nust address administrati�e, contractual, or legal remedies in i�stanees where contractors
violate or breach contract terms, and provide for such sanctions and penalties as appropriate.
Pravisions regarding Vendor d�fa�it are included in the BuyBoard General Terms and Canditians, including Sectian E.18,
Remedies for Default and Terminatio� of Contract. Any Cantract award wili be subject to such BuyBoard General Terms
and Conditions, as well as any additional terms and conditions in any Purchase Order, Cooperative member ancillary
cantract, or Member Construction Contract agreed upon by Venc�or and the Conperative member which must be consistent
with and protect the Cooperative member at least ta the same extent as the BuyBoard Terms and Conditions.
The remedies under the Con�ract are in addition to any other remedies that may be a�ailable und�r law or in equity. By
submitting a Proposal, you agree to these Vendor vialation and breach of contract terms.
2. Termination for Gause or Convenience:
For any Cooperative member purchase or contract in excess of $14,000 made using federal funds, you agree that the
follawing term and condition shall apply:
The Cooperative mem6er may terrninate or cance/ any purchase order under this Contract at any trme, with or without
cause, by provirling seven (7) business days advance written notrce to the l/endor. If this Agreement is terminated in
accordance with this Paragraph, the Caoperati�e mem6er shall only 6e required ta pay I/endor far goods or services
delivered to the Cooperative mem6er prior to the fermination and nat otherwise returned in accordance with k�endor's
return policg! If the Cooperative member has paid I/endor for gaods or servrces not yet pro�ided as af the date of
termrnatron, �endor shall immediately refund such payment(s).
If an alternate provision for termination of a Cooperattve member purchase for cause and con�enience, including the
manner by which it will be efFected and the basis for settlement, is inciuded in the Cooperati�e member's purchase order,
an�illary agreement, or Member Ganstr€�ctian Contract agreed to by the Vendar, the Cooperative r�ember`s provision shall
cantrol.
Proposal Forms CaMM/51/CS v.06.14.2018
Page 33 of 61
� Board �
Cavperatfve Purchasing
12007 Research Bouie�ard • Austin, Texas 7$759-�439 • PH: 804-695-2919 • FAX; 800-211-5454 •�uu,board.cam
3. Equal Employrnent Oppartunity:
Except as otherwise provided under 41 CFR Part 60, all Caoperative mer€�ber purchases ar contracts that meet the
definition of "federally assisted constructian contract" in �F1 CFR Part 60-1.3 shall be deemed to include the equal
oppartunity clause provided under 41 CFR 60-1.4(b), in accardance with Executi�e Order 11246, "Equal Employment
Opportunity" (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339}, as amended by Executi�e Order 11375,
"Amenciing Executive Order 11246 Relating ta Equal Employment Opportunity," and implem�nting rEgulatinns at 41 CFR
Part 60, "Office of Federal Contract Corrtpliance Pragrams, Equal Employment Opportunity, Department of Labor,"
The equal opportunity clause pro�ided under 41 CFR 60-1.4(b} is hereby incarporated by reference, Vendor agrees that
such provision applies to any Gooperative member purchase or contract tha[ rr�eets the definition of "federally assisted
construction contract° in 41 CFR Part 50-i.3 and Vendor a rees that it shall com I with such ro�ision.
4. Davis-Bacon Act:
W�en required by F�deral program fegislation, Vendor agrees that, for all Coo�era�ti�e member �rime canstructian
contracts/purchases in excess of $2,Opp, Vendor shall comply with the Davis-Bacon Act {40 USC 3141-3144, and 3146-
3t48) as supp�emented by bepartment af L.abor regulations (29 CFR Part 5, "Labor Standards Pro�isians Applicat�le to
Contracts Cavering F�derally Financed and Assisted Canskruction'�. In accordance with the statute, Vendor is required to
pay wages to laborers and mechanics at a rate not less than the prevailing wages s�ecifiec! ir� a wage determinate made by
the Secretary of Labor. In addition, Vendor shall pay wages not less than o�ce a week.
Current prevailing wage determinations issued by the Department of Labor are a�ailable at wdal.qov. vendar agrees that,
for any purchase to which this requirement applies, the award af the purchase to the Vendor is conditioned upon Vendor's
acceptance of the wage determination.
Vendor further agrees that it shall also comp4y with the Copeland "Anti-Kickback" Act (40 USC 3145}, as supplemented by
bepartrr�ent of Labor regufations (29 CFR Part 3, "Contractors and Subcontractors on Publie Building or Public Work
Financed in Whole or in Part #�y Loans ar Grants from the United States"�. The Act provides that each cnntractor or
subrecipient rr�ust be prohibited from inducing, by any means, any person emplayed in the construction, completion, ar
repair of public wark, to give up any part of the compensation to which he or she is otherwise entitled.
5. Contract Work Hours and Safeiy Standards Act:
Where appEical�le, for all Cooperati�e rr�ember contracts or purchases in excess of $100,000 that invol�e the employment af
mechanics or laborers, Vendor agrees to com�ly with 40 USC 3702 and 3704, as supplemented �y Department of Labor
regulations (29 CFR Part 5). Under 40 USC 37D2 af the Act, Vendor is required to compute the wages af every mechanie
and laborer on the basis of a standard wark week of 4D hours. Work in excess af the standard work week is permissible
pra�ided ti�at the worker is compensated at a rate of not less than one and a half times the basic rate of pay far all hours
worl�ed in excess of 40 hours in the work week. The requirements of 40 USC 3704 are applicable to construction work and
provide that no laborer or mechanic m�st be requir�d to work in surroundings or under working conditions whieh are
unsanitary, hazardaus or dangeraus. These requirements do not apply to the purchases of supplies or materials or articles
ordinaril available on the a�n market or contracts for trans ortation or transmission of intelli ence.
G. Right to In�entions Made Under a Contract or Agreement;
If the Cooperati�e member's Federal award meets the definition of "funding agreement" under 37 CFR 4a1.2(a) and the
recipient or subrecipient wishes to enter in�o a contract with a small business f�rm or nonpraft arganization regarding the
substjtution of parties, assignment or perFormance ar experimental, developmental, or research work under thak "funding
agreement," the recipient or subrecipient must comply with the requirements of 37 CF�t Part 401, "Rights ta Inventions
Made by Nonprofit Organizatians and Small Business Firms Under Go�ernment Grants, Contracts and Caoperative
Agreements," and any implementing regulations issued by the awarding agency.
Vendo� agrees to comply with the above requireme�nts when applicable.
Page 34 af 61
PrOpOSdI F6rm5 COMM/SlCS v.06.14.2p18
� Board�
Cooperative Furchasfeg
iZ007 Research Boulevard • A�st�n, Texas 78759-2439 ' PH; 86a-69S-2914 ' FAX: 800-211-5454 • buybaard,com
7. Clean Air Act and Federal Water Pollution Control Act:
Clean Air Act (42 USC 74Q1-7fi71q.) and the Federal Water Pollution Contral Act (33 USC I251-1387}, as amended —
Contracts and subgrants af amounts in excess of $150,060 must contain a provision that requires the non-Federal award to
agree to �omply with all applicable standards, orders, or regulations issued pursuant ta the Clean Air Act (42 USC 7401-
7671�,) and the Federal Water Pollution Control Act, as amended (33 USC 1251-1387). lliolations must be reported to the
Federal awarding agency a�d the Regional Office of the Environmental Protection Agency {EPA).
When required, Vendor agrees ta comply with all applicable standards, orders, ar regulations issued pursuant to the Cl�an
Air Act and the Federal Water Pollutian Control Act,
8. Debarment and Suspension:
pebarment and Suspension (Executi�e Orders 12549 and 12689) — A contract award (see 2 CFR 18d.220) must not be
made to parties iisted on the go�ernment-wide exclusions in the System far Award Management (SAM), in accordance wfth
th� OMB guidelines at Z CFR 180 that irnplement Exe�uti�e Orders 12549 (3 CFR Part 1956 Camp. p, 189} and 12689 (3
CFR Part 1989 Comp. p. 235}, "bebarment and Suspension." SAM ExclusEons contains the �ames of parties debarred,
suspended, or otherwise excluded by agencies, as well as parties declared ineligibfe ►�nder statutary or regulatory autharity
other than Executi�e Order 1�549.
Vendor certifies that Vendor is no� c�r�entfy listed on the government-wide exclusions in SAM, is not debarred, suspended,
or otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than Executive Order
12549. Vendor further agrees to immediately notify the Cooperati�e and aA Cooperative members with pending p�rchases
ar seekir�g to purchase from Vendor if Vendor is later listed on the government-wide exclusions in SAM, or is debarred,
suspended, or otherwise excluded by agencies or deciared ineligible under statutary or regulatory authority o�her than
Executive Order 1Z549.
9. Byrd Anti-Lobbying Amendment:
Byrd Anti-Lobbying Amendment (31 USC 1352) -- Vendors that apply or bid far an award exceeding $100,000 must fil� the
requir�d certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds ta
pay any person or organization for in�luencing or attempting to influence an officer or emplayee of any agency, a member
of Cangress, officer or empinyee of Congress, ar an employee af a member af Congress in cannection with nbtaining any
Federal eontract, grant or any other award covered by 31 I�SC 135Z, Each tier must alsa discfose any lobbying w�th non-
Federal funds that takes place in connection with obtairting any Federal award. Such discfosures are forwarded from tier tn
tier up to the non-Federal award. As applicable, Vendor agrees ta f!e all certifications and disciosures required by, and
otherwise com I with the 8 rd Anti-Lobb in Amendment 31 USC 1352 ,
10. Procurement of Reco�ered Materials:
For Gaaperati�e memb�r purchases utilizing Federal funds, Ve�dor agrees to comply with Section b002 of the 5olid Waste
Disposaf Act, a5 amended by the Resource Conservation and Recovery Act where applicable and pro�ide such informatian
and certifications as a Caaperati�e member may require to confirm estimates and otherwise cnmply. T�e requirements of
Sectian 50�2 include pracuring only items designated in guidelines of the En�ironmental Pratection Agency (EPA) at 40 CFR
Part 247 that cantain the highest percentage of recovered materials practicab�e, tonsistent with maintaining a satisfactory
level of competitian, where the purchase price af the item exceeds $10,000 or the valu� of the quantity acquired during the
preceding fiscal year exceeded $10,D00; pracuring salid waste management services in a manner that maximizes energy
and resaurce reco�ery, and establishing an affirmative prac�rement program far procurement of recavered mate�iafs
identified in the EPA Quidelines.
li. Rrofit as a Separate Eleme�t of Price:
For purchases using federal funds in excess of $�50,000, a Coaperafive member may be req�ired to negotiate profit as a
separate element of the price. See, 2 CFR 20a.323(b}. When required by a Cooperative member, Vendar agrees to
pro�ide information ar�d negotiate with the Cooperative member r�garding profit as a separate eiement of the price For a
particular purchase. Howe�er, Vendar agrees that tl�e total price, including prafit, charged by Vendar ta the Coaperative
member shall not exceed the awarded pricing, inciuding ar�y applicable discount, under Vendor's Coaperative Contrac#.
Proposal Forms COMM/�CS v.06.14.2018
Page 35 af 61
� Board�
Caaperative Purchasfog
12007 Research Boulevard • Austin, Texas 7$759-2439 • PH; 800-695-2419 ` FAX: 8�0-Zii-54S4 • buyboard.com
12. General Compliance and Cooperation with Cvoperati�re Members:
In addition to the foregoing speciFc requirements, Vendor agrees, in ac�epting any Purchase Order fram a Cooperative
member, it shall make a good faith effart to work with Coaperative members to pravide s�ch inforrr�ation and fa satisfy
s€�ch requirements as may apply ta a particular Cooperative merrtber purchase or purchases including, but not limited to,
a kicable recordkee in and reeord retention re uirements.
� ; �. � - � ,� � �� r��� .� �,��
.,.._
, : "
1�� f � �.���'
,: , �, - , .... ���; t ���°�� �ar '
, , ° i��r��� ��r�i������r� p�p� g.� �,y
,. ¢' j�� �y, .]('� +�yy}-�!�yry $�'{{J�!
- '.L��I63����,1��.0. ��Ml .�-w+,[J ���, L!'-§i ['i�5:,. . " ai,iSLt�F . - -
1, Vendor Violation or Breach of Contract Terms YE�
2, 7'ermination fnr Cause ar Car��er�ience YES
3. Equal Employment Opportunity YES
4. Da�is-Bacon Act YES
5. Contract Waric Hours and Safety Standards Act YES
6. Right to Inventions Made Under a Contract ar Agreement YES
7. C�ean Air Act and Federal Water Pollutia� Control Act YES
8. Debarment and S�spension YES
9. 8yrd Anti-Lobbying Amendment YES
10. Procurerr3ent of Reco�ered Materiais YES
11. Profit as a Separate Element of Price YES
12, General Compliance and Cooperation with Cooperati�e Members YES
By signature below, i GertiFy that the information in this form is true, complete, and accurate and that I am authorized by
my company to make this certification and all consents and agreements contained herein.
You Name it Specia�ties
Compa e
��.
Signature of Au r� Company Official
Josh King
Prir�ted Name
Proposal Fqrms CQMM�SVCS v.06,14,2618
Page 36 of 61
� Board�
Coaperative Prrrchasing
12007 Research Boukevar[! • Austin, Texas 78759-2439 • PH; 800-695-2419 • FAX: 800-211-5454 • buvboard.com
PROPOSAL INVITAT�ON QUESTIONNAIRE
The Cooperative will use your responses to the questions t�elow ir� evaluating your Proposal and technical and financial
resources to pravide the goads and perfor�n the serr�ices ("Work"� under the BuyBaard cantract tontempiated by this
Proposa! Invitation ("Contract`�. Proposers must fully answer each ques�ion, numbering yaur responses to correspond to
the questions/numbers helaw. Prapasers must comple�e below or attach your responses ta this questionnaire, sign where
indicated below, and submit the signed questionnaire and your responses ta all questions in one document with your
Proposal. You must submit the signed questionnaire and responses with yaur Proposal or the Proposal will
not be cansidered.
1. List the number of years Proposer has i�een in business and former business names (iE applicable). Note whether your
company is currently far sale or involved in any transactian that would significantly alter its business or result in
acquisitian by anather entity.
You Name it Specialties was founded in 1990 and has been in business
continually for 28 years. No change o€ ownership is currently being
contemplated.
2. Describe the resaurces Proposer has to manage staff and successfully perform the Work cantemplated under this
Contratt. 5tate the number and summarize the experience of company personnel who may be utilized for the Work,
including those who will be a�aila6le ta Cooperati�e members for assistance with praject development, technical issues,
and product se�ection for Wark assaciated with this Contract.
Key contact has 23+ years of exper�ence in the promotiona! product
industry. YNIS utilizes a industry specific, enterprise software application
#hat is state of the art. YNIS currently employees 20 staff members
including graphic designer, production staff and sales staff.
3. Describe Proposer's financial capability to perform the Contraet. 5tate or des�ribe the firm's financial strength and
rating, bonding capacity, and insurance coverage limits, State whether the Firm, or any of the Frm's past ar present
owners, �rincipal sharehalders ar stoc�Cholders, or nfFcers, have been a debtor party to a bankruptcy, receivership, or
insoivency proceeding in t�e last 7 years, and identify any such debtar party by name and relationship to or position
with your firm,
YNIS has several untapped lines of credit and has the financial health to
service this contract. No person in the ownership group has been
in�orved with a bankrup#cy either personal or business.
Proposal Forms COMM�SVCS �.I]6.14.2p16
Page 37 of fil
� Board �
Coaperative Purchasing
12aQ7 Research Boulevard ' Austin, Texas 78759-2434 • PH: $00-695-2919 ' FAX: 800-211-5454 � buvboa�d.com
4. Daes your company ha�e any autstanding financial judgments and�or is it currently in default on any loan or financing
agreement? If sa, provide detailed information on the nature of such items and praspects far resolution.
YNIS does not ha�e any financial obligations that are in default.
S. List all cantracts, if any, in the last 10 years an which Proposer has defaulted, faiied ta complete or deliver the work, or
that ha�e been terminated for any reason, For each such contract, p�ovide the project name, scope, value and date
and the name of the procuring entity. Fully explain the circumstances of the default, failure to comp4ete or deli�er the
work, or termination,
YNIS has not defaulted on any cvn#racts, or had a contract cancelied due
to nonwperFormance or poor performance. YNIS �s not aware of any
contracts to which #hey were a party that ha�e e�er been eancelled or
discontinued.
6. List all litiga�ian or other legal proce�dings (including arbitration proceedings}, if any, in the last 10 years brought
against your firm, or any of the firm's pasti or present owners, principai sharehalders or stackholders, afFicers, agen�s or
emplayees, that relates to ar arises from a contract similar to this Cantract or t�e work contemplated under this
Contract. Provide the styie of the lawsuit or pro�eeding (name of parties and court or tribunal in whic� filecf), nat�re of
the claim, and resolutior� or current status.
No litigat�on or legal proceedings ha�e been brought agains� YNIS or
present ownership group in the last 10 years.
By signature below, Y certify that the informa#ion contained in and�or attached to this Proposal In�itaiion
Questiannaire in response to the above questions is true and correct and tf�at i am autharized by my
company ta make this certification.
You Name it Specialties
Company Name_
�ignature�f'Au�zed Company Official
Proposal Forms COMM/SUCS v.Ofi14.2016
Page 38 of 61
� Board�
Caaperaxive Purchasing
12007 Research Boulevard • Austin, Texas 78iS9-2439 • PH; 8a0-695-2919 • FAX: 8�0-211-5454 • bu�aard.com
REQUIRED FQRMS CHECKLIST
(Pleasa check (� the foliowinq)
�J Com�leted: Proposer's Agreement and Signature
� Completed: Ve�dor Co�tact Information
[� Cam Iry eted: Felony Con�ictian Disclosure and Debarment Certification
ld Comqleted: Resident/Nonresident Certification
L►� Gam ieted: No Israei BoyCott Certification
�/f Completed; Na Excluded Nation nr Foreign Terrorist Organization Certi�catian
� Campleted: Historically llnderutilized Business (HUB} Certificatian)
� Completed: Constructian Rela�ed Goods and Services Affirmation
L�' Cornnle�ed: Deviation/Compiiance
� Campleted: Locativn/Authorized Seller Listings
� Com�leted: Manufacturer Dea�er Designation
��" Completed: Texas Regional Serv�ice Designatior�
� Comr�leted: State Serrrice Designation
[.� . Completed: National Purchasing Cooperati�e Vendor Award Agreement
� Completed; Federal and State/Purchasing Cooperative Experience
/� Completed: Governmentaf References
� Completed: Marketing Stra�egy
� Completed: Confidential/Proprietary Information
L� Com�leted: Vendor Business Name with IRS Form W-9
L� Campleted: EDGAR Vendor Certifieation
L� Comoleted: Propasal Inrritation Questionnaire
L✓� Campleted: Required Forms CheckHst
CJ Campleted: Proposal Speci�cation Form with Catalogs/Pricelists
Proposal Forms CaMM/SVCS v.p6.14.2p18
Page 39 of 51
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GONFLICT E�F INTEREST QUESTIE?NNAIF'tE
Far ve�ndor do�ng business �rith locai gavemmental �ntity
This q„es�tort�sir. n+n.cis cAar�ges rr�da �c► trrs far by H.�. 2�, a4th Laq, Negulsr s�slon.
Th�s q�staonr�a�re is b�ir�g filed ir► �ccQrdance with Gtta�tar t i6, Lnc�l Gavamm�nt G�,
by a verxior rK�eo h�s a busir�s relatior�.hi�z as detir�xi by Secti4n t T6.Q(�t �t -a} virith a kycal
gave�m�tal �ntity arxi the vendo� meaets re�uEram€�nts ur�r Sacta� 178.fi06�a},
B�r �ae�a lhis �taire must be fi�d with tl�e reoorcts �imi�eator o� itte bc.at gav�rxrEer�ta!
entity r�t [ate� than tha 7th tx�sine�s day after the date it�e ver�ior becc�rr�es aarare of facts
thtat require the ata#ement t�a be 6Eed. �a S�actian 176.�}6(a-1 �, Lacai Gav�rmmenf CacieE.
A YBtK�I' C96EfiP€!li$ flF1 OffO(i66i R�6 \f6PiCIQC MUIOWi(t�Ilt Y10�8C+8S S6C�FE 'ET�.EH}C, i.O�A�
Gcnrevnrn�t �ode. An ofi€+nse ur�er th� sectian i� a misderr�ar�oc
Na�ne � venEfar+r�t�o htaa a tsusiet�ss �eiatlortaAip whh %cal gavem�ant�# endtX
y�v�s ��<<
����a�����
• � !�
a s
�
{The ia�no require� that yau file aa� updated camplete�d questicrr�naire with the a�rapriate filing authority not
fater than the 7U� be�x:ess day atter the dste an vr�i+ch you becacrte a+�rers thaait the aigineily i�d quesfio��ce are�s
incanptete or inacct�rate.}
fiar�e of &acaE gaitemm+� esffioer �out rnc��n the inforncatian tn tiNs see�ton is beirt� dlscloaed.
�� /�
` I ptarrte of f?ff'�
Th�e aection ('€tam 3�r�g subparts A, B, C, 8 O) mwsE be � emch officer wi�s vrtiorn the verxlar has an
empkryt�nt fsr o#her bt�ss reEaticxrship as cfefiried by 5e�e i7$.tltft (t-�j, Locsl tiarerrxner�f Gocfia. Attach
�ages to tt�i� Fo�m CiQ as ereaessary.
A,. ts ttna koca�! gwerru�ent affesr rsamed in d�� sectiart re�eevic�g ar i�Cely to raceinre ia�eakais erioome, other the� �4rrierN
�ncarrwe, haai the venclor?
� Yes � N€�
B. ts the vanckx t�eivi�g vr IikePy to raceive t�a�ble irrczxr�e, ottear ti�an irzveff2me�it ertevrrw, ham or at tt� t�tection ot tfia Ioca�E
g�rernmerrt aEfiaer nser�ci in ti�s secNc►� ANO ttms taa��r�e hcome is reot rec��ved fr� the bcal gw ��t�}r�
�Y� �No
C. t� the f�er crf this �tronnaire e�tuyed by a ea�rpwatrcrn or o�er buseness entit�e trith resp�ect to vrhieh tMe tocat
gor��r�ent a�oer seav� as a�r offiaer or d"irectrx, ae twlds an awnerstbp irHerest af � perc�nt cu mae?
o�� o��
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