HomeMy WebLinkAboutContract 57904 CSC No. 57904
FORT WORTH
CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement ("Agreement") is entered into by and between Air Relief
Technologies, Inc DBA Tex Air Filters ("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 BuyBoard 631-20; 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 not exceed Eighty-Two Thousand Dollars ($82,000.00). 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 is effective beginning on the date signed by the Assistant City
Manager below("Effective Date") and ending on November 30, 2022 in line with cooperative contract.
Upon the expiration of this Term, the Agreement shall renew automatically under the same terms and
conditions for up to one (1) one-year renewal period (December I to November 30),unless City or
Contractor provides the other party with notice of non-renewal at least 60 days before the expiration of
the Initial Term or renewal period. However, if funds are not appropriated, the City may cancel the
Agreement 30 calendar days after providing written notification to the Contractor.
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 Agreement shall be conclusively determined
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:
To CITY: To VENDOR:
City of Fort Worth Air Relief Technologies,Inc DBA Tex Air Filter
Attn: Fernando Costa,Assistant City Manager Benny Aycoth,Dallas Regional Manager
200 Texas Street
Fort Worth,TX 76102-6314 Address:
Facsimile: (817) 392-8654 5757 E. Rosedale
Fort Worth,TX 76112
With copy to Fort Worth City Attorney's Office at
same address Facsimile: 817-496-3430
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:
CONTRACT COMPLIANCE MANAGER:
5�— By signing I acknowledge that I am the person
By: responsible for the monitoring and administration
Name: Fernando Costa of this contract,including ensuring all performance
Title: Assistant City Manager and reporting requirements.
Date: J U 1 26, 2022
APPROVAL RECOMMENDED: By: Sao Kane(Ju 25,202216:03 CDT)
Name: Sasha Kane
Title: Sr. Contract Compliance Specialist
By. Nei[Noakes(Jul 26,202209:20CDT) ppa FORr��a APPROVED AS TO FORM AND LEGALITY:
•7 Name: Neil Noakes p�°°°°°°° 0°"
d
Title: Police Chief v�0 °�9��
.vo g=d
ATTEST: 'p o °o a� By:
°
°°°°°°°°°° d Name: Taylor Paris
a��nEXASbA Title: Assistant City Attorney
By. jaS.Goodall(Jul 7�`I`S.G��G c�6,2000��LL CONTRACT AUTHORIZATION:
Name: Jannette Goodall M&C: N/A
Title: City Secretary
VENDOR:
Air Relief Technologies, Inc DBA Tex Air Filters
By: 8&KK5 'kgco-tk
Name: Benny Aycoth
Title: Dallas Regional Manager OFFICIAL RECORD
Date: 7/20/2022 CITY SECRETARY
FT. WORTH, TX
EXHIBIT A
PRICING City of Fort Worth Gun Range
CPL James Howard 817.228.1173
Mid-Filters
Location Filter Qty. Price Sub-Total
Range 1 -50 yd. Mid-Filters
FAU - 6 V-Cell 24x24x12 95% Filter 20 $ 124.99 $ 2,499.80
V-Cell 12x24x12 95% Filter "1- 3 $ 86.79 $ 260.37
FAU -7 V-Cell 24x24x12 95% Filter 20 $ 124.99 $ 2,499.80
V-Cell 12x2412 95% Filter 3 $ 86.79 $ 260.37
FAU - 8 V-Cell 242412 95% Filter 20 $ 124.99 $ 2,499.80
V-Cell 12x2412 95% Filter 3 $ 86.79 $ 260.37
FAU -9 V-Cell 242412 95% Filter 20 $ 124.99 $ 2,499.80
V-Cell 12x24x12 95% Filter 3 $ 86.79 $ 260.37
Range 2 -Small 25 Mid-Filters
FAU - 5IV-Cell 242412 95% Filter 15 $ 124.99 $ 1,874.85
IV-Cell 12x24x12 95% Filter 3 $ 86.79 1 $ 260.37
Range 3 - Large 25 Mid-Filters
FAU -3 V-Cell 242412 95% Filter 20 $ 124.99 $ 2,499.80
V-Cell 12x24x12 95% Filter 8 $ 86.79 $ 694.32
FAU -4 V-Cell 242412 95% Filter 20 $ 124.99 $ 2,499.80
V-Cell 12x24x12 95% Filter 8 $ 86.79 $ 694.32
Range 4- 100 yd.
FAU - 1 V-Cell 20x24x12 95% Filter Y4SW 15 $ 118.79 $ 1,781.85
V-Cell 12x24x12 95% Filter 8 $ 86.79 $ 694.32
FAU -2 V-Cell 20x24xl2 95% Filter 15 $ 118.79 $ 1,781.85
V-Cell 12x2412 95% Filter 8 $ 86.79 $ 694.32
Total Mid-Filters $ 24,516.48
HEPA Continued on next page
C�H, �C; NG City of Fort Worth Gun Range
CPL James Howard 817.228.1173
HEPA Filters
Location IFilter Qty. I Price I Sub-Total
Range 1 -50 yd. HEPA Filters
FAU - 6 HEPA 99.97% 242411.5 DTF 15 $ 200.04 $ 3,000.60
HEPA 99.97% 12x24x11.5 DTF 5 $ 150.37 $ 751.85
FAU -5 HEPA 99.97% 242411.5 DTF 15 $ 200.04 $ 3,000.60
HEPA 99.97% 12x24x11.5 DTF 5 $ 150.37 $ 751.85
FAU -8 HEPA 99.97% 242411.5 DTF 15 $ 200.04 $ 3,000.60
HEPA 99.97% 12x24x11.5 DTF 5 $ 150.37 $ 751.85
FAU - 9 HEPA 99.97% 242411.5 DTF 15 $ 200.04 $ 3,000.60
HEPA 99.97% 12x24x11.5 DTF 5 $ 150.37 $ 751.85
Range 2 -Small 25 HEPA Filters
FAU - 5 IHEPA 99.97% 242411.5 DTF 1 10 $ 200.04 1 $ 2,000.40
HEPA 99.97% 12x24x11.5 DTF 5 $ 150.37 1 $ 751.85
Range 3 - Large 25 HEPA Filters
FAU - 3 IHEPA 99.97% 24x24x11.5 DTF 20 $ 200.04 1 $ 4,000.80
FAU -4 1 HEPA 99.97% 24x24x11.5 DTF 20 $ 200.04 1 $ 4,000.80
Range 4- 100 yd.
FAU - 1 IHEPA 99.97% 2424x11.5 DTF 15 $ 200.04 1 $ 3,000.60
FAU - 2 1 HEPA 99.97% 24x24x11.5 DTF 15 $ 200.04 1 $ 3,000.60
HEPA Total 1 $ 31,764.85
TexmwAirfiltel C30
Lee Reffey, CAFS
0) 817.261.3791
C) 214.505.9291
leereffey@texairfilters.com
PRICING City of Fort Worth Gun Range
CPL James Howard 817.228.1173
Pre-Filters
Location Filter Qty. Price Sub-Total
Range 1-50 yd. Pre-Filters
FAU -6 Pleated 24242 Filter 15 $ 5.10 $ 76.50
Pleated 12x24x2 Filter 3 $ 3.44 $ 10.32
Pleated 20x24x2 Filter 5 $ 4.21 $ 21.05
FAU -7 Pleated 24242 Filter 15 $ 5.10 $ 76.50
Pleated 12x24x2 Filter 3 $ 3.44 $ 10.32
Pleated 20x24x2 Filter 5 $ 4.21 $ 21.05
FAU -8 Pleated 24242 Filter 15 $ 5.10 $ 76.50
Pleated 12x24x2 Filter 3 $ 3.44 $ 10.32
Pleated 20x24x2 Filter 5 $ 4.21 $ 21.05
FAU -9 Pleated 24242 Filter 15 $ 5.10 $ 76.50
Pleated 12x24x2 Filter 3 $ 3.44 $ 10.32
Pleated 20x24x2 Filter 5 $ 4.21 $ 21.05
Range 2-Small 25 Pre-Filters
FAU -5 IPleated 24242 Filter 1 15 $ 5.10 1 $ 76.50
Pleated 12x24x2 Filter 1 3 $ 3.44 1 $ 10.32
Range 3-Large 25 Pre-Filters
FAU -3 Pleated 24242 Filter 15 $ 5.10 $ 76.50
Pleated 12x24x2 Filter 8 $ 3.44 $ 27.52
Pleated 20x24x2 Filter 5 $ 4.21 $ 21.05
FAU -4 Pleated 24242 Filter 15 $ 5.10 $ 76.50
Pleated 12x24x2 Filter 8 $ 3.44 1 $ 27.52
Pleated 20x24x2 Filter 5 $ 4.21 1 $ 21.05
Range 4-100 yd. Pre-Filters
FAU - 1 Pleated 24242 Filter 15 $ 5.10 $ 76.50
Pleated 12x24x2 Filter 8 $ 3.44 $ 27.52
FAU -2 Pleated 24242 Filter 15 $ 5.10 $ 76.50
Pleated 12x24x2 Filter 8 $ 3.44 $ 27.52
Pre-Filter Total $ 976.48
MAId!"Oflirs
Location Filter Qty. Price Sub-Total
Range 1 Pleated 24242 Filter 32 $ 5.10 $ 163.20
Pleated 18x24x2 Filter 16 $ 3.98 $ 63.68
Range 2 Pleated 24242 Filter 8 $ 5.10 $ 40.80
Range 3 Pleated 16x25x2 Filter 42 $ 3.89 $ 163.38
Pleated 16x20x2 Filter 14 $ 3.57 $ 49.98
Range 4 Pleated 24242 Filter 16 $ 5.10 $ 81.60
Pleated 18x24x2 Filter 8 $ 3.98 $ 31.84
Total MAU Filters $ 594.48
PFBoard® EXHIBIT B
Capperative Purchasing
P.0.Box 400
Austin, TX 78767-0400
800.695.2919 1512.467.0222 / Fax.800.211.5454
buyboard.com
October 22, 2020
Sent Via Email: iimrosenthal5757(daol.com
Jim Rosenthal
Texas Air Filters
5757 E. Rosedale
Fort Worth, TX 76112
Welcome to BuyBoard!
Re: Notice of The Local Government Purchasing Cooperative Award
Proposal Name and Number: HVAC Equipment, Supplies, and Installation of HVAC Equipment, Proposal No. 631-20
Congratulations, The Local Government Purchasing Cooperative (Cooperative) has awarded your company a BuyBoard®
contract based on the above-referenced Proposal. The contract is effective 12/1/2020 through 11/30/2021, 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. 631-20 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.
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 email the order info@buyboard.com 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
v.6.5
101 wir The Local Government Purchasing Cooperative is endorsed by the Texas Association of School Boards,
= Texas Municipal League, Texas Association of Counties,and the Texas Association of School Administrators.
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12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
PROPOSERrS AGREEMENT AND SIGNATURE
Proposal Name: HVAC Equipment, Supplies, and
Installation of HVAC Equipment Proposal Due Date/Opening Date and Time:
July 14, 2020 at 4:00 PM
Location of Proposal Opening:
Texas Association of School Boards, Inc.
BuyBoard Department
Proposal Number: 631-20 12007 Research Blvd.
Austin, TX 78759
Anticipated Cooperative Board Meeting Date:
Contract Time Period: December 1, 2020 October 2020
through November 30, 2021 with two (2) possible
one-year renewals.
Air Relief Technologies, Inc. DBA Tex Air Filters 06/15/2020
Name of Proposing Company Date
5757 E. Rosedale ApAtme-_
Street Address Signature of ruthorized Company Official
Fort Worth, TX 76112 Benny Aycoth
City, State, Zip Printed Name of Authorized Company Official
817-261 -3791 Dallas Regional Manager
Telephone Number of Authorized Company Official Position or Title of Authorized Company Official
817-496-3430 75-2775217
Fax Number of Authorized Company Official Federal ID Number
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The proposing company ("you"or"your' hereby acknowledges and agrees as follows:
1. You have carefully examined and understand all Cooperative information and documentation associated with this Proposal
Invitation, including the Instructions to Proposers, General Terms and Conditions, attachments/forms, item specifications,
and line items (collectively"Requirements';
2. By your response ("Proposal") to this Proposal Invitation, you propose to supply the products or services submitted at
the prices quoted in your Proposal and in strict compliance with the Requirements, unless specific deviations or exceptions
are noted in the Proposal;
3. Any and all deviations and exceptions to the Requirements have been noted in your Proposal and no others will be
claimed;
4. If the Cooperative accepts any part of your Proposal and awards you a contract, you will furnish all awarded products or
services at the prices quoted and in strict compliance with the Requirements (unless specific exceptions are noted in the
Proposal and accepted by the Cooperative), including without limitation the Requirements related to:
a. conducting business with Cooperative members, including offering pricing to members that is the best you offer
compared to similar customers;
b. payment of a service fee in the amount specified and as provided for in this Proposal Invitation;
c. the possible award of a piggy-back contract by another governmental entity or nonprofit entity, in which event you
will offer the awarded goods and services in accordance with the Requirements; and
d. submitting price sheets or catalogs in the proper format as required by the Cooperative as a prerequisite to activation
of your contract;
5. You have clearly identified on the included form any information in your Proposal that you believe to be confidential or
proprietary or that you do not consider to be public information subject to public disclosure under a Texas Public
Information Act request or similar public information law;
6. The individual signing this Agreement is duly authorized to enter into the contractual relationship represented by this
Proposal Invitation on your behalf and bind you to the Requirements, and such individual (and any individual signing a
form) is authorized and has the requisite knowledge to provide the information and make the representations and
certifications required in the Requirements;
7. You have carefully reviewed your Proposal, and certify that all information provided is true, complete and accurate, and
you authorize the Cooperative to take such action as it deems appropriate to verify such information; and
8. Any misstatement, falsification, or omission in your Proposal, whenever or however discovered, may disqualify you from
consideration for a contract award under this Proposal Invitation or result in termination of an award or any other remedy
or action provided for in the General Terms and Conditions or by law.
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VENDOR CONTACT INFORMATION
Name of company: Air Relief Technologies, Inc DBA Tex Air Filters
Vendor Proposal/Contract Contact Name: Jim Rosenthal
Vendor Proposal/Contract Contact E-mail Address: jimrosenthal5757@aol.com
Vendor Contact Mailing Address for Proposal/Contract Notices: 5757 E. Rosedale
Fort Worth, TX 76112
Company Website: WWW.texairfiIters.com
Purchase Orders: All purchase orders from Cooperative members will be available through the Internet. Vendors need
Internet access and at least one e-mail address so that notification of new orders can be sent to the Internet contact when
a new purchase order arrives. An information guide will be provided to vendors to assist them with retrieving their orders.
Please select options below for receipt of purchase orders and provide the requested information:
0 I will use the internet to receive purchase orders at the following address:
Purchase Order E-mail Address: jimrosentha15757@ao1.com
Purchase Order Contact: Jim Rosenthal Phone: 817-261 -3791
Alternate Purchase Order E-mail Address: tammi@texairfilters.com
Alternate Purchase Order Contact: Tammi Aycoth Phone: 972-247-7101
0 Purchase orders may be received by the Designated Dealer(s) identified on my company's Dealer Designation
form as provided to the Cooperative administrator. I understand that my company shall remain responsible
for the Contract and the performance of all Designated Dealers under and in accordance with the Contract.
Request for Ouotes ("RFO"): Cooperative members will send RFQs to you by e-mail. Please provide e-mail addresses
for the receipt of RFQs:
RFQ E-mail Address: jimrosenthal5757@aol.com
RFQ contact: Jim Rosenthal Phone: 817-261 -3791
Alternate RFQ E-mail Address: tammi@texairfilters.com
Alternate RFQ Contact: Tammi Aycoth Phone: 817-243-5740
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Invoices: Your company will be billed monthly for the service fee due under a contract awarded under this Proposal
Invitation. All invoices are available on the BuyBoard website and e-mail notifications will be sent when they
are ready to be retrieved. Please provide the following address, contact and e-mail information for receipt of service fee
invoices and related communications:
Please choose only one (1) of the following options for receipt of invoices and provide the requested
information:
0 Service fee invoices and related communications should be provided directly to my company at:
Invoice Mailing address: 5757 E. Rosedale Department: Accounting
City: Fort Worth State: TX Zip Code: 76112
Contact Name: Misael Moreno Phone: 817-261 -3791
Invoice Fax: 817-496-3430 Invoice E-mail Address: aafantx@yahoo.com
Alternative Invoice E-mail Address: tammi@texairfilters.com
❑ In lieu of my company, I request and authorize all service fee invoices to be provided directly to the following billing
agent":
Billing agent Mailing address: Department:
City: State: Zip Code:
Billing Agent Contact Name: Phone:
Billing Agent Fax: Billing Agent E-mail Address:
Alternative Billing Agent E-mail Address:
**If Vendor authorizes a billing agent to receive and process service fee invoices, in accordance with the
General Terms and Conditions of the Contract, Vendor specifically acknowledges and agrees that nothing in
that designation shall relieve Vendor of its responsibilities and obligations under the Contract including,but
not limited to,payment of allservice fees under any Contract awarded Vendor.
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FELONY CONVICTION DISCLOSURE AND DEBARMENT CERTIFICATION
FELONY CONVICTION DISCLOSURE
Subsection (a) of Section 44.034 of the Texas Education Code (Notification of Criminal History of Contractor)
states: "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 has been convicted of a felony. The notice must include a general description of the
conduct resulting in the conviction of a felony."
Section 44.034 further states in Subsection (b): "A school district may terminate a contract with a person or business
entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or
misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for
services performed before the termination of the contract."
Please check W) one of the following:
❑ My company is a publicly-held corporation. (Advance notice requirement does not apply to publicly-held corporation.)
0 My company is not owned or operated by anyone who has been convicted of a felony.
❑ My company is owned/operated by the following individual(s) who has/have been convicted of a felony:
Name of Felon(s):
Details of Conviction(s):
By signature below, I certify that the above information is true, complete and accurate and that I am authorized by my
company to make this certification.
Air Relief Technologies, Inc DBA Tex Air Filters
Company Name
Benny Aycoth
Signature of Authorized Company Official Printed Name
DEBARMENT CERTIFICATION
Neither my company nor an owner or principal of my company has been debarred, suspended or otherwise made ineligible
for participation in Federal Assistance programs under Executive Order 12549,"Debarment and Suspension,"as described in
the Federal Register and Rules and Regulations. Neither my company nor an owner or principal of my company is currently
listed on the government-wide exclusions in SAM, debarred, suspended, or otherwise excluded by agencies or declared
ineligible under any statutory or regulatory authority. My company agrees to immediately notify the Cooperative and all
Cooperative members with pending purchases or seeking to purchase from my company if my company or an owner or
principal is later listed on the government-wide exclusions in SAM, or is debarred, suspended, or otherwise excluded by
agencies or declared ineligible under any statutory or regulatory authority.
By signature below, I certify that the above is true, complete and accurate and that I am authorized by my company to make
this certification.
Air Relief Technologies, Inc DBA Tex Air Filters
Company Name
Benny Aycoth
Signature of Au orized Company Official Printed Name
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12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
RESIDENT/NONRESIDENT CERTIFICATION
Chapter 2252, Subchapter A, of the Texas Government Code establishes certain requirements applicable to proposers who
are not Texas residents. Under the statute, a "resident" proposer is a person whose principal place of business is in Texas,
including a contractor whose ultimate parent company or majority owner has its principal place of business in Texas. A
"nonresident" proposer is a person who is not a Texas resident. Please indicate the status of your company as a "resident"
proposer or a "nonresident" proposer under these definitions.
Please check (i/) one of the following_
❑■ I certify that my company is a Resident Proposer.
❑ I certify that my company is a Nonresident Proposer.
If your company is a Nonresident Proposer, you must provide the following information for your resident state (the state in
which your company's principal place of business is located):
Company Name Address
City State Zip Code
A. Does your resident state require a proposer whose principal place of business is in Texas to under-price proposers
whose resident state is the same as yours by a prescribed amount or percentage to receive a comparable contract?
❑ Yes ❑ No
B. What is the prescribed amount or percentage? $ or
VENDOR EMPLOYMENT CERTIFICATION
Section 44.031(b) of the Texas Education Code establishes certain criteria that a school district must consider when
determining to whom to award a contract. Among the criteria for certain contracts is whether the vendor or the vendor's
ultimate parent or majority owner (i) has its principal place of business in Texas; or (ii) employs at least 500 people in Texas.
If neither your company nor the ultimate parent company or majority owner has its principal place of business in Texas, does
your company, ultimate parent company, or majority owner employ at least 500 people in Texas?
Please check W) one of the following:
❑ Yes 0 No
By signature below, I certify that the information in Sections 1 (Resident/Nonresident Certification) and 2 (Vendor
Employment Certification) above is true, complete and accurate and that I am authorized by my company to make this
certification.
Air Relief Technologies, Inc DBA Tex Air Filters
Company Name
Ao�: ,� Benny Aycoth
Signature of Authorized Company Official Printed Name
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NO ISRAEL BOYCOTT CERTIFICATION
Effective September 1, 2017, as amended effective May 7, 2019 (H.B. 793), a Texas governmental entity may not enter into
a contract with a value of $100,000 or more that is to be paid wholly or partly from public funds with a company (excluding
a sole proprietorship) that has 10 or more full-time employees for goods or services unless the contract contains a written
verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the
contract. (TEx. GOV'T CODE Ch. 2270). Accordingly, this certification form is included to the extent required by law.
"Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is
intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity
doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business
purposes. TEx. Gov'T CODE§808.001(1).
By signature below, I certify and verify that Vendor does not boycott Israel and will not boycott Israel during the term of any
contract awarded under this Proposal Invitation,that this certification is true, complete and accurate,and that I am authorized
by my company to make this certification.
Air Relief Technologies, Inc DBA Tex Air Filters
Company Name
ApAaLn Benny Aycoth
Signature of Authorized Company Official Printed Name
Note; If Vendor does not wish to make this certification,return the blank form in lieu of completed
certification,
NO EXCLUDED NATION OR FOREIGN TERRORIST ORGANIZATION CERTIFICATION
Effective September 1, 2017, Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may
not enter into a contract with a company engaged in active business operations with Sudan, Iran, or a foreign terrorist
organization —specifically, any company identified on a list prepared and maintained by the Texas Comptroller under Texas
Government Code §§806.051, 807.051, or 2252.153. (A company that the U.S. Government affirmatively declares to be
excluded from its federal sanctions regime relating to Sudan, Iran, or any federal sanctions regime relating to a foreign
terrorist organization is not subject to the contract prohibition.)
By signature below, I certify and verify that Vendor is not on the Texas Comptroller's list identified above; that this certification
is true, complete and accurate; and that I am authorized by my company to make this certification.
Air Relief Technologies, Inc DBA Tex Air Filters
Company Name
ApAtillen Benny Aycoth
Signature of Authorized Company Official Printed Name
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HISTORICALLY UNDERUTILIZED BUSINESS CERTIFICATION
A proposer that has been certified as a Historically Underutilized Business (also known as a Minority/Women Business
Enterprise or"MWBE"and all referred to in this form as a "HUB' is encouraged to indicate its HUB certification status when
responding to this Proposal Invitation. The electronic catalogs will indicate HUB certifications for vendors that properly
indicate and document their HUB certification on this form.
Please check(1/) all that apply:
❑ I certify that my company has been certified as a HUB in the following categories:
❑ Minority Owned Business
❑ Women Owned Business
❑ Service-Disabled Veteran Owned Business (veteran defined by 38 U.S.C. §101(2), who has a
service-connected disability as defined by 38 U.S.C. § 101(16), and who has a disability rating
of 20% or more as determined by the U. S. Department of Veterans Affairs or Department of
Defense)
Certification Number:
Name of Certifying Agency:
0 My company has NOT been certified as a HUB.
By signature below, I certify that the above is true, complete and accurate and that I am authorized by my
company to make this certification.
Air Relief Technologies, Inc DBA Tex Air Filters
Company Name
Benny Aycoth
Printed Name
AOAM&
Signature of Authorized Company Official
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CONSTRUCTION-RELATED GOODS AND SERVICES AFFIRMATION
A contract awarded under this Proposal Invitation covers only the specific goods and services awarded by the BuyBoard. As
explained in the BuyBoard Procurement and Construction Related Goods and Services Advisory for Texas Members
("Advisory's, Texas law prohibits the procurement of architecture or engineering services through a purchasing
cooperative. This BuyBoard contract does not include such services.Architecture or engineering services must
be procured by a Cooperative member separately, in accordance with the Professional Services Procurement
Act (Chapter 2254 of the Texas Government Code) and other applicable law and local policy.
The Advisory, available at buyboard.com/Vendor/Resources.aspx, provides an overview of certain legal requirements that
are potentially relevant to a Cooperative member's procurement of construction or construction-related goods and services,
including those for projects that may involve or require architecture, engineering or independent testing services. A copy of
the Advisory can also be provided upon request.
By signature below, the undersigned affirms that Proposer has obtained a copy of the Advisory, has read and understands
the Advisory, and is authorized by Proposer to make this affirmation. If Proposer sells construction-related goods or services
to a Cooperative member under a BuyBoard contract awarded under this Proposal Invitation, Proposer will comply with the
Advisory and applicable legal requirements, make a good faith effort to make its Cooperative member customers or potential
Cooperative member customers aware of such requirements, and provide a Cooperative member with a copy of the Advisory
before executing a Member Construction Contract with the member or accepting the member's purchase order for
construction-related goods or services, whichever comes first.
Air Relief Technologies, Inc DBA Tex Air Filters
Company Name
Benny Aycoth
Signature of A thorized Company Official Printed Name
06/15/2020
Date
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DEVIATION AND COMPLIANCE
If your company intends to deviate from the General Terms and Conditions, Proposal Specifications or other requirements
associated with this Proposal Invitation, you MUST list all such deviations on this form, and provide complete and detailed
information regarding the deviations on this form or an attachment to this form. The Cooperative will consider any deviations
in its contract award decision, and reserves the right to accept or reject a proposal based upon any submitted deviation.
In the absence of any deviation identified and described in accordance with the above, your company must fully comply with
the General Terms and Conditions, Proposal Specifications and all other requirements associated with this Proposal Invitation
if awarded a contract under this Proposal Invitation. A deviation will not be effective unless accepted by the Cooperative.
The Cooperative may, in its sole discretion, seek clarification from and/or communicate with Proposer(s) regarding any
submitted deviation, consistent with general procurement principles of fair competition. The Cooperative reserves the right
to accept or reject a proposal based upon any submitted deviation.
Please check(1/) one of the following_
■❑ NO; Deviations
❑ Yes; Deviations
List and fully explain any deviations you are submitting:
PLEASE PROVIDE THE FOLLOWING INFORMATION:
1. Shipping Via: ❑■ Common Carrier ❑■ Company Truck ❑ Prepaid and Add to Invoice ❑ Other:
2. Payment Terms: ❑■ Net 30 days ❑ 1% in 10/Net 30 days ❑ Other:
3. Number of Days for Delivery: TBD ARO
4. Vendor Reference/Quote Number:
5. State your return policy: No returns on special sized filters
6. Are electronic payments acceptable? X]Yes ❑ No
7. Are credit card payments acceptable? ❑■Yes ❑ No
Air Relief Technologies, Inc DBA Tex Air Filters
Com any Name
Benny Aycoth
Signature of A horized Company Official Printed Name
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LOCATION / AUTHORIZED SELLER LISTINGS
If you have more than one location/authorized seller that will service a contract awarded under this Proposal Invitation,
please list each location/authorized 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 performance of all locations and authorized sellers under and in accordance with the Contract.
If you are a product manufacturer and wish to designate Designated Dealers as defined in the General Terms and Conditions
to receive Cooperative member Purchase Orders on your behalf, you must complete the Manufacturer Designated Dealer
form.
Air Relief Technologies, Inc DBA Tex Air Filters
Company Name
11251 Leo Ln.
Address
Dallas TX 75229
City State Zip
972-247-7101 972-247-5178
Phone Number Fax Number
Benny Aycoth
Contact Person
Air Relief Technologies, Inc DBA Tex Air Filters
Company Name
2209-A Rutland Drive Suite 150
Address
Austin TX 78758
City State Zip
512-833-3330 512-833-3335
Phone Number Fax Number
Patrick Rosenthal
Contact Person
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MANUFACTURER DEALER DESIGNATION
If Vendor is a manufacturer that sells products through a dealer network and wishes to designate a dealer or multiple dealers
("Designated Dealers' to receive Cooperative member Purchase Orders on Vendor's behalf, you must complete this form for
each dealer you wish to designate.
Regardless of any Designated Dealers submitted by Vendor, Vendor specifically agrees and acknowledges that any such
designations are for Vendor's convenience only and shall not, if Vendor is awarded a Contract, relieve Vendor of any
obligations under the Contract, including payment of Cooperative service fees on all Purchase Orders submitted to Vendor or
any Designated Dealer. In accordance with the General Terms and Conditions, an awarded Vendor shall remain responsible
and liable for all of its obligations under the Contract and the performance of both Vendor and any of Vendor's Designated
Dealers under and in accordance with the Contract and remain subject to all remedies for default thereunder, including, but
not limited to suspension and termination of Vendor's Contract for nonpayment of service fees.
If awarded, Vendor authorizes the Cooperative, in its sole discretion, to list any Vendor Designated Dealers in the BuyBoard
system and to receive Purchase Orders directly from Cooperative members on behalf of Vendor. To the extent a Vendor with
Designated Dealers receives a Purchase Order directly, it shall be the responsibility of Vendor to appropriately process such
Purchase Order in accordance with the Contract, including but not limited to timely forwarding such Purchase Order to a
Designated Dealer for processing.
The Cooperative reserves the right, in its sole discretion, to refuse addition of, or request removal of, any Designated Dealer,
and Vendor agrees to immediately require such Designated Dealer to cease accepting Purchase Orders or otherwise acting
on Vendor's behalf under the Contract. Further, the Cooperative's administrator shall be authorized 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 service a contract awarded under this Proposal Invitation, please list the Designated
Dealer below and have this form signed by an official of your company authorized to make such designation. If you wish to
designate multiple dealers, please duplicate this form as necessary.
Designated Dealer Name
Designated Dealer Address
City State Zip
Phone Number Fax Number
Email address Designated Dealer Tax ID Number* (*attach W-9)
Designated Dealer Contact Person
Your Company Name Signature of Authorized Company Official
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TEXAS REGIONAL SERVICE DESIGNATION
The Cooperative (referred to as"Texas Cooperative" in this form and in the State Service Designation form) offers vendors
the opportunity to service its members throughout the entire State of Texas. If you do not plan to service all Texas
Cooperative members statewide, you must indicate the specific regions you will service on this form. Ifyou propose to
serve different regions for different products or services included in your proposal,you must complete and
submit a separate Texas Regional Service Designation form for each group of products and clearly indicate
the products or services to which the designation applies in the space provided at the end of this form. By
designating a region orregions,you are certifying that you are authorized and willing to provide the proposed
products and services in those regions. Designating regions in which you are either unable or unwilling to
provide the specified products and services shall be grounds for either rejection of your proposal or, if
awarded, termination of your Contract. Additionally, if you do not plan to service Texas Cooperative members (i.e., if
you will service only states other than Texas), you must so indicate on this form.
Regional Education Service Centers ■❑ I will service Texas
Cooperative members
statewide.
1 ❑ I will not service Texas
Cooperative members
statewide. I will only
service members in the
regions checked below:
u
m � Reaion and Headauarters
❑ 1 Edinburg
-- ❑ 2 Corpus Christi
❑ 3 Victoria
4tA.. ❑ 4 Houston
❑ 5 Beaumont
3 ❑ 6 Huntsville
J�- ❑ 7 Kilgore
F ❑ 8 Mount Pleasant
❑ 9 Wichita Falls
❑ 10 Richardson
❑ 11 Fort Worth
b Y.
❑ 12 Waco
❑ 13 Austin
" ❑ 14 Abilene
❑ 15 San Angelo
`'r ❑ 16 Amarillo
Air Relief Technologies, Inc DBA Tex Air Filters ❑ 17 Lubbock
❑ 18 Midland
Co any Name ❑ 19 El Paso
❑ 20 San Antonio
Signature of Authorized Company Official
Benny Aycoth ❑ I will not service members of
Printed Name the Texas Cooperative.
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If this Texas Regional Service Designation form applies to only one or some of the products and services proposed by
Vendor, list the products and services to which this form applies here:
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STATE SERVICE DESIGNATION
The Cooperative offers vendors the opportunity to service other governmental entities in the United States, including
intergovernmental purchasing cooperatives such as the National Purchasing Cooperative BuyBoard. You must complete 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 Texas Cooperative members, be sure that you complete the Texas Regional Service Designation form.)
If you serve different states for different products or services included in your proposal,you must complete
and submit a separate State Service Designation form for each group of products and clearly indicate the
products or services to which the designation applies in the space provided at the end of this form. By
designating a state or states,you are certifying that you are authorized and willing to provide the proposed
products and services in those states Designating states in which you are either unable or unwilling to
provide the specified products and services shall be grounds for either rejection of your proposal or, if
awarded, termination of your Contract.
Please check(1/) all that apply:
❑ I will service all states in the United States.
■❑ I will not service all states in the United States. I will service only the states checked below:
❑ Alabama
❑ Alaska ❑ Nebraska
❑ Arizona ❑ Nevada
❑ Arkansas ❑ New Hampshire
❑ California (Public Contract Code 20118 &20652) ❑ New Jersey
❑ Colorado ❑ New Mexico
❑ Connecticut ❑ New York
❑ Delaware ❑ North Carolina
❑ District of Columbia ❑ North Dakota
❑ Florida ❑ Ohio
❑ Georgia ❑ Oklahoma
❑ Hawaii ❑ Oregon
❑ Idaho ❑ Pennsylvania
❑ Illinois ❑ Rhode Island
❑ Indiana ❑ South Carolina
❑ Iowa ❑ South Dakota
❑ Kansas ❑ Tennessee
❑ Kentucky ❑■ Texas
❑ Louisiana ❑ Utah
❑ Maine ❑ Vermont
❑ Maryland ❑ Virginia
❑ Massachusetts ❑ Washington
❑ Michigan ❑ West Virginia
❑ Minnesota ❑ Wisconsin
❑ Mississippi ❑ Wyoming
❑ Missouri
❑ Montana
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This form will be used to ensure that you can service other governmental entities throughout the United States as
indicated. Your signature below confirms that you understand your service commitments during the term of a contract
awarded under this proposal.
Air Relief Technologies, Inc DBA Tex Air Filters
Company Name
Benny Aycoth
Signature of Authorized Company Official Printed Name
If this State Service Designation form applies to only one or some of the products and services proposed by Vendor,
list the products and services to which this form applies here:
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NATIONAL PURCHASING COOPERATIVE VENDOR AWARD AGREEMENT
In accordance with the Terms and Conditions associated with this Proposal Invitation, a contract awarded under this Proposal
Invitation may be "piggy-backed" by another governmental entity. The National Purchasing Cooperative is an
intergovernmental purchasing cooperative formed by certain school districts outside of Texas to serve its members throughout
the United States. If you agree to be considered for a piggy-back award by the National Purchasing Cooperative, you agree
to the following terms and agree to serve National Purchasing Cooperative members in the states you have indicated on the
State Service Designation form, in your Proposal.
By signing this form, Proposer (referred to in this Agreement as"Vendor") agrees as follows:
1. Vendor acknowledges that if The Local Government Purchasing Cooperative ("Texas Cooperative's awards Vendor a
contract under this Proposal Invitation ("Underlying Award"), the National Purchasing Cooperative ("National Cooperative")
may - but is not required to - "piggy-back" on or re-award all or a portion of that Underlying Award ('Piggy-Back Award").
By signing this National Cooperative Vendor Award Agreement ("Agreement's, Vendor accepts and agrees to be bound by
any such Piggy-Back Award as provided for herein.
2. In the event National Cooperative awards Vendor a Piggy-Back Award, the National Cooperative Administrator ("BuyBoard
Administrator") will notify Vendor in writing of such Piggy-Back Award, which award shall commence on the effective date
stated in the Notice and end on the expiration date of the Underlying Award, subject to annual renewals as authorized in
writing by the BuyBoard Administrator. Vendor agrees that no further signature or other 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 National Cooperative, unless such changes are agreed to by its
BuyBoard Administrator in writing.
3. Vendor agrees that it shall offer its goods and services to National Cooperative members at the same unit pricing and
same general terms and conditions, subject to applicable state laws in the state of purchase, as required by the Underlying
Award. However, nothing in this Agreement prevents Vendor from offering National Cooperative members better(i.e., lower)
competitive pricing and more favorable terms and conditions than those in the Underlying Award.
4. Vendor hereby agrees and confirms that it will serve those states it has designated on the State Service Designation Form
of this Proposal Invitation. 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 Cooperative the service fee provided for in the Underlying Award based on the amount of
purchases generated from National Cooperative members through the Piggy-Back Award. Vendor shall remit payment to
National Cooperative on such schedule as it specifies (which shall not be more often than monthly). Further, upon request,
Vendor shall provide National Cooperative with copies of all purchase orders generated from National Cooperative members
for purposes of reviewing and verifying purchase activity. Vendor further agrees that National Cooperative shall have the
right, upon reasonable written notice, to review Vendor's records pertaining to purchases made by National Cooperative
members in order to verify the accuracy of service fees.
6. Vendor agrees that the Underlying Award, including its General Terms and Conditions, are adopted by reference to the
fullest extent such provisions can reasonably apply to the post-proposal/contract award phase. The rights and responsibilities
that would ordinarily inure to the Texas Cooperative pursuant to the Underlying Award shall inure to National Cooperative;
and, conversely, the rights and responsibilities that would ordinarily inure to Vendor in the Underlying Award shall inure to
Vendor in this Agreement. Vendor recognizes and agrees that Vendor and National Cooperative are the only parties to this
Agreement, and that nothing in this Agreement has application to other third parties, including the Texas Cooperative. In
the event of conflict between this Agreement and the terms of the Underlying Award, the terms of this Agreement shall
control, and then only to the extent necessary to reconcile the conflict.
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7. This Agreement shall be governed and construed in accordance with the laws of the State of Rhode Island and venue for
any dispute shall lie in the federal district court of Alexandria, Virginia.
8. Vendor acknowledges and agrees that the award of a Piggy-Back Award is within the sole discretion of National
Cooperative, and that this Agreement does not take effect unless and until National Cooperative awards Vendor a Piggy-Back
Award and the BuyBoard Administrator notifies Vendor in writing of such Piggy-Back Award as provided for herein.
WHEREFORE, by signing below Vendor agrees to the foregoing and warrants that it has the authority to enter into this
Agreement.
Air Relief Technologies, Inc DBA Tex Air Filters 631 —20
Name of Vendor Proposal Invitation Number
Benny Aycoth
Signature o Aut orized Company Official Printed Name of Authorized Company Official
06/15/2020
Date
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FEDERAL AND STATE/PURCHASING COOPERATIVE EXPERIENCE
The Cooperative strives to provide its members with the best services and products at the best prices available from vendors
with the technical resources and ability to serve Cooperative members. Please respond to the following questions.
1. Provide the dollar value of sales to or through purchasing cooperatives at or based on an established catalog or market
price during the previous 12-month period or the last fiscal year: $500,000 . (The period of the 12 month
period is 06/01/2019 /06/01/2020 ). In the event that a dollar value is not an appropriate measure of the sales, provide
and describe your own measure of the sales of the item(s).
2. By submitting a proposal, you agree that, based on your written discounting policies, the discounts you offer the
Cooperative are equal to or better than the best price you offer other purchasing cooperatives for the same items under
equivalent circumstances.
3. Provide the information requested below for other purchasing cooperatives for which Proposer currently serves, or in
the past has served, as an awarded vendor. Rows should be added to accommodate as many purchasing cooperatives
as required.
CURRENT FORMER VENDOR (Y/N)?— AWARDED
PURCHASING VENDOR? OD
GROUP DO. O.
1. Federal General Services Administration N
2. T-PASS (state of Texas) N
3. OMNIA Partners N
4. Sourcewell (NJPA) N
5. E&I Cooperative N
6. Houston-Galveston Area Council (HGAC) N
7. Choice Partners N
8. The Interlocal Purchasing System (TIPS) N
9. Other N
■❑ MY COMPANY DOES NOT CURRENTLY HAVE ANY OF THE ABOVE OR SIMILAR TYPE CONTRACTS.
CURRENT BUYBOARD VENDORS
If you are a current BuyBoard vendor in the same contract category as proposed in this Proposal Invitation, indicate the
discount for your current BuyBoard contract and the proposed discount in this Proposal. Explain any difference between your
current and proposed discounts.
Current Discount (o/u): 55/45 Proposed Discount (o/u): 55/45
Explanation:
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By signature below, I certify that the above is true, complete and accurate and that I am authorized by my company to make
this certification.
Air Relief Technologies, Inc DBA Tex Filters
Company Name
A04tiftet- Benny Aycoth
Signature of Authorized Company Official Printed Name
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GOVERNMENTAL REFERENCES
For your Proposal to be considered, you must supply a minimum of five (5) individual governmental entity references. The
Cooperative may contact any and all references provided as part of the Proposal evaluation. Provide the information
requested below, including the existing price/discounts you offer each customer. The Cooperative may determine whether
prices/discounts are fair and reasonable by comparing prices/discounts stated in your Proposal with the prices/discounts you
offer other governmental customers. Attach additional pages if necessary.
Quantity/
Entity Name Contact Phone# Email Address Discount Volume
1 Dallas County Ella Daniels 214-653-6717 wfmail@dallascounty.com 50/45 30,000
2 DCCD Lalo Gonzalez 972-860-5012 Ionzalez@dccd.edu 50/45 45,000
3 Wylie ISD Ronnie Bayless 214-236-8262 ronniebayless@wyleisd.net 50/45 30,000
4 Irving Convention Seth Vanhouser 972-401-7745 svanhousrr@irvingconventioncenter.com 46/45 38,000
5 UTA Carmen Blackwell 817-272-2795 Carmen.blackwell@uta.edu 46/31 72,000
Do you ever modify your written policies or standard governmental sales practices as identified in the above chart to give
better discounts (lower prices) than indicated? YES ❑ NO 0 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
certification.
Air Relief Technologies, Inc DBA Tex Filters
Company Name
Signature of uthorized Company Official
Benny Aycoth
Printed Name
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MARKETING STRATEGY
For your Proposal to be considered, you must submit the Marketing Strategy you will use if the Cooperative accepts all or
part of your Proposal. (Dams/e: Explain how your company will initially inform Cooperative members of your BuyBoard
contract, and how you will continue to support the BuyBoard for the duration of the contract period.)
Attach additional pages if necessary.
Tex Air Filters will use the members listing provided by
buyboard and our sales team will contact them via phone or email.
This generates sales for our company.
Air Relief Technologies, Inc DBA Tex Filters
Company Name
AoAtmen—
Signature of Authorized Company Official
Benny Aycoth
Printed Name
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CONFIDENTIAL/PROPRIETARY INFORMATION
A. Public Disclosure Laws
All Proposals, forms, documentation, or other materials submitted by Vendor to the Cooperative in response to this Proposal
Invitation, including catalogs and pricelists, may be subject to the disclosure requirements of the Texas Public Information
Act(Texas Government Code chapter 552.001, et. seq.) or similar disclosure law. Proposer must clearly identify on this form
any information in its Proposal (including forms,documentation,or other materials submitted with the Proposal)that Proposer
considers proprietary or confidential. If Proposer fails to properly identify the information, the Cooperative shall have no
obligation to notify Vendor or seek protection of such information from public disclosure should a member of the public 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 for information in a Proposal that Proposer has identified in this form as proprietary
or confidential.
Does your Proposal (including forms, documentation, or other materials submitted with the Proposal) contain information
which Vendor considers proprietary or confidential?
Please check()one of the following:
NO, I certify that none of the information included with this Proposal is considered confidential or proprietary.
YES, I certify that this Proposal contains information considered confidential or proprietary and all such information is
specifically identified on this form.
If you responded "YES", you must identify below the specific information you consider confidential or proprietary. List each
page number, form number, or other information sufficient to make the information readily identifiable. The Cooperative
and its Administrator will not be responsible for a Proposer's failure to clearly identify information considered confidential or
proprietary. Further, by submitting a Proposal, Proposer acknowledges that the Cooperative and its Administrator will disclose
information when required by law, even if such information has been identified herein as information the vendor considers
confidential or proprietary.
Confidential / Proprietary Information:
(Attach addition/sheets if needed.)
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B. Coavriaht Information
Does your Proposal (including forms, documentation, or other materials submitted with the Proposal) contain copyright
information?
Please check(-v)one of the following:
NO, Proposal (including forms, documentation, or other materials submitted with the Proposal)does not
contain copyright information.
❑ YES, Proposal (including forms, documentation, or other materials submitted with the Proposal)does
contain copyright information.
If you responded "YES", identify below the specific documents or pages containing copyright information.
Copyright Information:
(Attach additional sheets if needed.)
C. Consent to Release Confidential/Proprietary/Coavriaht Information to BuyBoard Members
BuyBoard members (Cooperative and nonprofit members) seeking to make purchases through the BuyBoard may wish to
view information included in the Proposals of awarded Vendors. If you identified information on this form as confidential,
proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBoard contract
award constitutes your consent to the disclosure of such information to BuyBoard members, including posting of such
information on the secure BuyBoard website for members. Note: Neither the Cooperative nor its Administrator will be
responsible for the use or distribution of information by BuyBoard members or any other party.
D. Consent to Release Proposal Tabulation
Notwithstanding anything in this Confidential/Proprietary Information form to the contrary, by submitting a Proposal,Vendor
consents and agrees that, upon Contract award, the Cooperative may publically release, including posting on the public
BuyBoard website, a copy of the proposal tabulation for the Contract including Vendor name; proposed catalog/pricelist
name(s); proposed percentage discount(s), hourly labor rate(s), or other specified pricing; and Vendor award or non-award
information.
By signature below, I certify 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.
Air Relief Technologies, Inc DBA Tex Filters
Compa
ny Name
Signature of Authorized Company Official
Benny Aycoth
Printed Name
06/15/2020
Date
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VENDOR BUSINESS NAME
By submitting a Proposal, Proposer is seeking to enter into a legal contract with the Cooperative. As such, a Proposer must
be an individual or legal business entity capable of entering into a binding contract. Proposers, must completely and accurately
provide the information requested below or your Proposal may be deemed non-responsive.
Name of Proposing company: Air Relief Technologies, Inc DBA Tex Filters
(List the leaal name of the company seeking to contract with the Cooperative. Do NOT/1st an assumed name,dba,aka, etc,here. Such information may
be,provided below. If you are submitting a joint proposal with another entity to,provide the same proposed goods or services,each submifting entity should
complete a separate vendor information form. Separately operating legal business entities, even if aifliated entities, which,propose to,provide goods or
services separately must submit their own Proposals.)
Please check(A one of the following
Twe of Business:
Individual/Sole Proprietor
Corporation X
Limited Liability Company
Partnership
Other If other, identify
State of Incorporation (if applicable): Texas
Federal Employer Identification Number: 75-2775217
(Vendor must include a completed IRS W-9 form with their proposal)
List the Name(s) by which Vendor, if awarded,wishes to be identified on the BuyBoard: (Note. Ifdifferentthanme Name ofPro,posing
Company listed above,only valid trade names(dba, aka, etc.)of the Proposing Company maybe used and a copy of your Assumed Name Certificate(s),if
applicable,must be attached.)
Tex Air Filters
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Form ■■{� _wi 9 Request for Taxpayer
Give Farm to this
tRev.October 2o18f Identification Number and Certification requester. rap not
Deparlment of the Treasury send to the IRS.
Internal Revenue Service ►Go to www.irs.gov/FormW9 for instructions and the latest information.
i Name(as shown on your income tax returni.Name is required on this line;do r•ol Leave this line blank.
Air Relief Technologies, Inc.
2 Business narnerdisreyarded entity same if different Irony above
DBA Tex Air Filters
3 Check appropriate box Ivr federal tax classrficauvii of tht:person whose name is entered on line t.Check only one of the 4 Exemptions(codes apply only to
m following seven boxes, certain entities,not individuals:see
o- instructions on page 3);
a ❑ IndlviduaL'sole proprietor or Q C Corporation ❑ S Corporation ❑ Partnership ❑ Trustlestate
single member LLC Exempt payee code(if any)
❑ Limited liability company.Enter the tax cfassiticatiun(CzC cvrpurahon,S=S corporation,P=Partnership)!
q Nvte:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not Check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is'1 C anclner LLC that 6n%A disregarded from the owner fur U.S.federal tax purposes.Otherwise.a single-member LLC that code(If any?
a v is disregarded from the owner should check the appropriate box fur the tax classificatior of its owner.
U ❑ Other,see instructions,') {Apphes to d=ur,rs aitiviiii wdoursp+me U.S)
r 5 Address(number,street,and apt,of suite no.l See inslruchen5• Requester's name and address?optional)
5757 E. Rosedale St.
Cn
6 City,state,and ZIP corle
Fort Worth TX. 76112
7 List account numbers)here(optionall
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given un line 1 to avoid Social security number
backup wlien.sole
o r ie or,oraiss this is generally see
r)t Social security number(S$Nr. However.for a -m _�❑
resident alien,sole proprietor,or disregarded Entity,see ttte ir�struc±eons for Pan 1,later. For other
entities.it is your employer identification number ON). If you do not have a number,see Now to get a FAM
TIN, later. or
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer ldentiftcatfon number
Number To Give the Requester for guidelines on whose number to enter,
EE__EE=
Certification
Under penalties cif perjury. I ceruty that:
1.The numger shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2.t am not subject to'backup vvitnholdmg because:(a)I an,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.!am a U.S.citizen or other U.S.person(defined below);ana
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 it you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,
acquisition or abandonment of secured property,cancellation of debt,Contributions to an individual retirement arrangement(IRA),and generally,payments
other than interest and dividends,you are not required to sign the certification,but you most provide your correct TIN.See the Instructions for Part it,later.
Sign Signature of
Here u.s.pe Date► td 2 0 z to
General Instru — +Furrri 1099-DIV(dividends,including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise +Form 1099-MISC(various types of income, prizes,awards,or gross
noted.
proceeds)
Future developments.For the latest information about developments +Form 1099-B(stock or mutual fund sales and certain other
related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.irs.gov1FormW9. +Form 1099-5(proceeds from real estate transactions)
Purpose of Form +Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to file an +Form 1098(home mortgage interest), 1098-E(student loan interest),
information return with the IRS must obtain•your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security dumber +Fofm 1099-C(canceled debt)
(SSN),individual taxpayer identification number(ITIN),adoption +Form 1099-A(acquisition or abandonment of secured property)
taxpayer identification number f'ATIN),or employer identification number
(EIN),to report ran an information return the amount paid to you,of other -;se Form W-9 only if you are a U.S.person(including a resident
amount reportable on an information return. Examples of information alien).to provide your correct TIN.
returns include, but are not limited to,the following. If you do not return Form W-9 to the requester with a TM,you might
+Form 1099-INT{interest earned or paid) be subject to backup withhofding.See What is backup withholding,
later:
-'a! 'VE, t0231x Form W-9 tRev.10-2018)
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EDGAR VENDOR CERTIFICATION
(2 CFR Part 200 and Appendix II)
When a Cooperative member seeks to procure goods and services using funds under a federal grant or contract, specific
federal laws, regulations, and requirements may apply in addition to those under state law. This includes, but is not limited
to, the procurement standards of the Uniform Administrative Requirements, Cost Principles and Audit Requirements for
Federal Awards, 2 CFR 200 (sometimes referred to as the "Uniform 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 maybe applicable to specific Cooperative member purchases using federal grant funds. This completed
form will be made available to Cooperative members for their use while considering their purchasing options when using
federal grant funds. Cooperative members may also require Vendors to enter into ancillary agreements, in addition to the
BuyBoard contract's general terms and conditions, to address the member's specific contractual needs, including contract
requirements for a procurement using federal grants or contracts.
For each of the items below, Vendor should certify Vendor's agreement and ability to comply, where
applicable, by having Vendor's authorized representative complete and initial the applicable boxes and sign
the acknowledgment at the end of this form. If you fail to complete any item in this form, the Cooperative
will consider and may list the Vendors response on the BuyBoard as "NO,'the Vendor is unable or unwilling
to comply, A"NO"response to any of the items may, if applicable, impact the ability of a Cooperative member to purchase
from the Vendor using federal funds.
1. Vendor Violation or Breach of Contract Terms:
Contracts for more than the Simplified Acquisition Threshold,which is the inflation adjusted amount determined by the Civilian
Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 USC 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.
Provisions regarding Vendor default are included in the BuyBoard General Terms and Conditions, including Section E.18,
Remedies for Default and Termination of Contract. Any Contract award will be subject to such BuyBoard General Terms and
Conditions, as well as any additional terms and conditions in any Purchase Order, Cooperative member ancillary contract, or
Member Construction Contract agreed upon by Vendor and the Cooperative member which must be consistent with and
protect the Cooperative member at least to the same extent as the BuyBoard Terms and Conditions.
The remedies under the Contract are in addition to any other remedies that may be available under law or in equity. By
submitting a Proposal, you agree to these Vendor violation and breach of contract terms.
2. Termination for Cause or Convenience:
For any Cooperative member purchase or contract in excess of$10,000 made using federal funds,you agree that the following
term and condition shall apply:
The Cooperative member may terminate or cancel any purchase order under this Contract at any time, with or without cause,
by providing seven (7)business days advance written notice to the Vendor. If this Agreement is terminated in accordance
with this Paragraph, the Cooperative member shall only be required to pay Vendor for goods or services delivered to the
Cooperative member prior to the termination and not otherwise returned in accordance with Vendor's return policy. If the
Cooperative member has paid Vendor for goods or services not yet provided as of the date of termination, Vendor shall
immediately refund such payment(s).
If an alternate provision for termination of a Cooperative member purchase for cause and convenience, including the manner
by which it will be effected and the basis for settlement, is included in the Cooperative member's purchase order, ancillary
agreement, or Member Construction Contract agreed to by the Vendor, the Cooperative member's provision shall control.
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3. Equal Employment Opportunity:
Except as otherwise provided under 41 CFR Part 60, all Cooperative member purchases or contracts that meet the definition
of"federally assisted construction contract" in 41 CFR Part 60-1.3 shall be deemed to 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."
The equal opportunity clause provided under 41 CFR 60-1.4(b) is hereby incorporated by reference. Vendor agrees that such
provision applies to any Cooperative member purchase or contract that meets the definition of"federally assisted construction
contract"in 41 CFR Part 60-1.3 and Vendor agrees that it shall comply with such provision.
4. Davis-Bacon Act:
When required by Federal program legislation, Vendor agrees that, for all Cooperative member prime construction
contracts/purchases in excess of$2,000,Vendor shall comply with the Davis-Bacon Act (40 USC 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, Vendor is required to pay wages
to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determinate made by the Secretary
of Labor. In addition, Vendor shall pay wages not less than once a week.
Current prevailing wage determinations issued by the Department of Labor are available at wdol.aov. Vendor agrees that,
for any purchase to which this requirement applies, the award of the purchase to the Vendor is conditioned upon Vendor's
acceptance of the wage determination.
Vendor further agrees that it shall also comply with the Copeland "Anti-Kickback"Act (40 USC 3145), as supplemented by
Department of Labor regulations (29 CFR Part 3,"Contractors and Subcontractors on Public Building or Public Work Financed
in Whole or in Part by Loans or Grants from the United States'. The Act provides that each contractor or subrecipient must
be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work,
to give up any part of the compensation to which he or she is otherwise entitled.
5. Contract Work Hours and Safety Standards Act:
Where applicable, for all Cooperative member contracts or purchases in excess of $100,000 that involve the employment of
mechanics or laborers, Vendor agrees to comply with 40 USC 3702 and 3704, as supplemented by Department of Labor
regulations (29 CFR Part 5). Under 40 USC 3702 of the Act, Vendor is 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 USC 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.
6. Right to Inventions Made Under a Contract or Agreement:
If the Cooperative member's 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 or 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.
Vendor agrees to comply with the above requirements when applicable.
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7. Clean Air Act and Federal Water Pollution Control Act:
Clean Air Act(42 USC 7401-7671q.)and the Federal Water Pollution Control Act(33 USC 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 USC 7401-7671q.) and
the Federal Water Pollution Control Act, as amended (33 USC 1251-1387). Violations must be reported to the Federal
awarding agency and the Regional Office of the Environmental Protection Agency (EPA).
When required, Vendor agrees to comply with all applicable standards, orders, or regulations issued pursuant to the Clean
Air Act and the Federal Water Pollution Control Act.
8. Debarment and Suspension:
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 1966 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.
Vendor certifies that Vendor is not currently 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 Cooperative and all Cooperative members with pending purchases
or seeking 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 declared ineligible under statutory or regulatory authority other than
Executive Order 12549.
9. Byrd Anti-Lobbying Amendment:
Byrd Anti-Lobbying Amendment (31 USC 1352) -- Vendors 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 USC 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. As applicable, Vendor agrees to file all certifications and disclosures required by, and otherwise
comply with, the Byrd Anti-Lobbying Amendment (31 USC 1352).
10. Procurement of Recovered Materials:
For Cooperative member purchases utilizing Federal funds, Vendor agrees to comply with Section 6002 of the Solid Waste
Disposal Act, as amended by the Resource Conservation and Recovery Act where applicable and provide such information
and certifications as a Cooperative member may require to confirm estimates and otherwise comply. The requirements of
Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR
Part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory
level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the
preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and
resource recovery, and establishing an affirmative procurement program for procurement of recovered materials identified in
the EPA guidelines.
11. Profit as a Separate Element of Price:
For purchases using federal funds in excess of the Simplified Acquisition Threshold, a Cooperative member may be required
to negotiate profit as a separate element of the price. See, 2 CFR 200.323(b). When required by a Cooperative member,
Vendor agrees to provide information and negotiate with the Cooperative member regarding profit as a separate element of
the price for a particular purchase. However, Vendor agrees that the total price, including profit, charged by Vendor to the
Cooperative member shall not exceed the awarded pricing, including any applicable discount, under Vendor's Cooperative
Contract.
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12. General Compliance and Cooperation with Cooperative Members:
In addition to the foregoing specific requirements, Vendor agrees, in accepting any Purchase Order from a Cooperative
member, it shall make a good faith effort to work with Cooperative members to provide such information and to satisfy such
requirements as may apply to a particular Cooperative member purchase or purchases including, but not limited to,applicable
recordkeeping and record retention requirements.
Vendor Certification:
YES, I agree or
Vendor Certification Item No. NO, I do NOT agree Initial
1. Vendor Violation or Breach of Contract Terms Yes BA
2. Termination for Cause or Convenience Yes BA
3. Equal Employment Opportunity Yes BA
4. Davis-Bacon Act Yes BA
5. Contract Work Hours and Safety Standards Act Yes BA
6. Right to Inventions Made Under a Contract or Agreement Yes BA
7. Clean Air Act and Federal Water Pollution Control Act Yes BA
S. Debarment and Suspension Yes BA
9. Byrd Anti-Lobbying Amendment Yes BA
10. Procurement of Recovered Materials Yes BA
11. Profit as a Separate Element of Price Yes BA
12. General Compliance and Cooperation with Cooperative Members Yes BA
By signature below, I certify 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.
Air Relief Technologies, Inc DBA Tex Filters
Company Name
�h�09_�
Signature of uthorized Company Official
Benny Aycoth
Printed Name
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PROPOSAL INVITATION QUESTIONNAIRE
The Cooperative will use your responses to the questions below in evaluating your Proposal and technical and financial
resources to provide the goods and perform the services("Work' under the BuyBoard contract contemplated by this Proposal
Invitation ("Contract"). Proposers must fully answer each question, numbering your responses to correspond to the
questions/numbers below. Proposers must complete below or attach your responses to this questionnaire, sign where
indicated below, and submit the signed questionnaire and your responses to all questions in one document with your Proposal.
You must submit the signed questionnaire and responses with your Proposal or the Proposal will not be
considered.
1. List the number of years Proposer has been in business and former business names (if applicable). Note whether your
company is currently for sale or involved in any transaction that would significantly alter its business or result in acquisition
by another entity.
22 years
2. Describe Proposer's direct experience(not as a subcontractor) performing the work proposed under this contract. Include
a brief description of the projects you have completed for Texas governmental entities in the last 5 years, and include for
each the project name, scope, value, and date, and the name of the procuring government entity and entity contact
person. Identify the contracts that best represent Proposer's capabilities relative to this contract.
2012-Present UTA Filters on entire campus approximately
78,000 3 year contract. Carmen Blackwell 817-272-2795
3. Describe the resources Proposer has to manage staff and successfully perform the Work contemplated under this
Contract. State the number and summarize the experience of company personnel who may be utilized for the Work,
including those who will be available to Cooperative members for assistance with project development, technical issues,
and product selection for Work associated with this Contract.
Tex Air Filters has more than 75 experienced employees with over
30 years of experience. We have four locations with Branch managers
to serve Texas with any needs. We change over 90,000 filters each month
with our experienced technicians.
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4. The Contract does not include architectural or engineering services, which must be procured separately, outside of the
Cooperative, in accordance with Chapter 2254 of the Texas Government Code (Professional Services Procurement Act).
If you are performing work under the contract on a project that requires the services of an architect or professional
engineer, how will you work with a Cooperative member and its designated architect or engineer with respect to services
that must be procured outside the contract?
N/A
5. Describe the tasks and functions that can be completed by Proposer in-house without the use of a subcontractor or other
third party.
All functions are performed in house. Manufacturing to delivery.
6. Describe Proposer's financial capability to perform the Contract. State or describe the firm's financial strength and rating,
bonding capacity, and insurance coverage limits. State whether the firm, or any of the firm's past or present owners,
principal shareholders or stockholders, or officers, have been a debtor party to a bankruptcy, receivership, or insolvency
proceeding in the last 7 years, and identify any such debtor party by name and relationship to or position with your firm.
Solid financial business with top rating
1 ,000,000 general liability
5,000,000 umbrella
No bankruptcy
7. Does your company have any outstanding financial judgments and/or is it currently in default on any loan or financing
agreement? If so, provide detailed information on the nature of such items and prospects for resolution.
No
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8. List all contracts, if any, in the last 10 years on which Proposer has defaulted, failed to complete or deliver the work, or
that have been terminated for any reason. Include any contract for which the surety was notified of a potential claim in
regards to a payment or performance bond. For each such contract, provide the project name, scope, value and date
and the name of the procuring entity. Fully explain the circumstances of the default, notice to surety, failure to complete
or deliver the work, or termination.
N/A
9. List all litigation or other legal proceedings (including arbitration proceedings and/or claims filed with a surety in regards
to a payment or performance bond), if any, in the last 10 years brought against your firm, or any of the firm's past or
present owners, principal shareholders or stockholders, officers, agents or employees, that relates to or arises from a
contract similar to this Contract or the work contemplated under this Contract. Provide the style of the lawsuit or
proceeding (name of parties and court or tribunal in which filed), if applicable, nature of the claim, and resolution or
current status.
N/A
10. Describe in detail the quality control system Proposer will use, including third party auditing certification, to support the
long-term performance and structural strength of the products to be used in a project under the Contract.
Yearly inventory
Our in house computer database
11. If the work will require Proposer to tender performance or payment bonds, provide the name of the bonding company
or surety that will issue such bonds.
N/A
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12. Describe in detail all documented safety issues, if any, that have involved Proposer in the last three (3) years related to
the type of work contemplated under this contract. Provide a 3-year history of your firm's workers compensation
experience modifier.
N/A
By signature below, I certify that the information contained in and/or attached to this Proposal Invitation
Questionnaire in response to the above questions is true and correct and that I am authorized by my company
to make this certification.
Air Relief Technologies, Inc DBA Tex Filters
Company Name
10AMAde
Signature o uthorized Company Official
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REQUIRED FORMS CHECKLIST
(Please check(v)the following)
0 Completed: Proposer's Agreement and Signature
0 Completed: Vendor Contact Information
0 Completed: Felony Conviction Disclosure and Debarment Certification
0 Completed: Resident/Nonresident Certification
0 Completed: No Israel Boycott Certification
0 Completed: No Excluded Nation or Foreign Terrorist Organization Certification
0 Completed: Historically Underutilized Business (HUB) Certification)
0 Completed: Construction Related Goods and Services Affirmation
0 Completed: Deviation/Compliance
0 Completed: Location/Authorized Seller Listings
0 Completed: Manufacturer Dealer Designation
0 Completed: Texas Regional Service Designation
0 Completed: State Service Designation
0 Completed: National Purchasing Cooperative Vendor Award Agreement
0 Completed: Federal and State/Purchasing Cooperative Experience
0 Completed: Governmental References
0 Completed: Marketing Strategy
0 Completed: Confidential/Proprietary Information
0 Completed: Vendor Business Name with IRS Form W-9
0 Completed: EDGAR Vendor Certification
0 Completed: Proposal Invitation Questionnaire
0 Completed: Proposal Specifications (Discount (%) off Catalog/Pricelist and/or other required pricing
information including Catalogs/Pricelists(or no bid response)must be submitted with proposal response or
response will not be considered.), Manufacturer Authorization Letters and License
0 Completed: Required Forms Checklist
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PROPOSAL SPECIFICATION SUMMARY
The categories and items specified for this Proposal Invitation are summarized below. For full Proposal
Specifications, you must review and complete the Proposal Specification information in the electronic proposal
submission system in accordance with the Instructions to Proposers (or, if submitting a hard copy Proposal, timely
request and complete the Proposal Specification Form in accordance with the Instructions to Proposers).
Section I: Eauipment, Products, and Supplies
1 . Discount (%) off catalog/pricelist for HVAC Equipment (all types - rooftop units, split systems, chillers, compressors,
cooling towers, heat pumps, furnaces, unit heaters, duct furnaces, and related items).
2 . Discount (%) off catalog/pricelist for HVAC Controls, Software and Monitoring Systems (all types).
3 . Discount (%) off catalog/pricelist for HVAC Air Handling Products (all types - coils, fans, and related items).
4 . Discount (%) off catalog/pricelist for HVAC Supplies (all types).
5 . Discount (%) off catalog/pricelist for HVAC Filters (all types).
6 . Discount (%) off catalog/pricelist for HVAC Indoor Air Quality Products (all types).
7 . Discount (%) off catalog/pricelist for HVAC Repair Parts (all types).
8 . Discount (%) off catalog/pricelist for HVAC Refrigerants (all types).
9 . Discount (%) off catalog/pricelist for HVAC Refrigerant Recovery Equipment (all types).
10. Discount (%) off catalog/pricelist for UVC Emitters/Lamps (used to incorporate downstream of all cooling coils and
above all drain pans to control airborne and surface microbial growth and transfer. Fixtures and lamps must be
manufactured for this purpose and safety interlocks/features shall be provided to limit hazard to operating staff).
11. Discount (%) off catalog/pricelist for Insulation Products for HVAC Equipment.
12. Discount (%) off catalog/pricelist for HVAC Maintenance Agreements.
Section II: Installation and Repair Service
13. Hourly Labor Rate for Installation of HVAC Filter Change Out Service (including labor,filters and removal/
disposal of product), not to exceed hourly labor rate for Installation of HVAC Filter Products.
14. Standard Hourly Labor Rate for Installation/Repair Service of HVAC Equipment and Products, not to
exceed standard hourly labor rate for Installation/Repair Service of HVAC Equipment and Products.
15. Non-Standard Hourly Labor Rate for Installation/Repair Service of HVAC Equipment and Products, not to
exceed non-standard hourly labor rate for Installation of HVAC Equipment and Products.
16. Coefficient for Standard Hours of Installation/Repair Service of HVAC Equipment and Products - RSMeans
Cost Data from the Total INCL C&P column (most current edition).
17. Coefficient for Non-Standard Hours for Installation/Repair Service of HVAC Equipment and Products -
RSMeans Cost Data from the Total INCL 0&P column (most current edition).
Proposal Forms CONST v.01.07.2020
Page 43 of 66
EXHIBIT C
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICEUSEONLY
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received
has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the
vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local governmental entity not later
than the 7th business day after the date the vendor becomes aware of facts that require the statement to be
filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code.An
offense under this section is a misdemeanor.
jJ Name of vendor who has a business relationship with local governmental entity.
2
❑ Check this box if you are filing an update to a previously filed questionnaire.(The law requires that you file an updated
completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which
you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information is being disclosed.
N/A
Name of Officer
4j Describe each employment or other business relationship with the local government officer, or a family member of the
officer,as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.
Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form
CIQ as necessary.
A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income,
other than investment income, from the vendor?
Yes F-1 No
B. Is the vendor receiving or likely to receive taxable income,other than investment income,from or at the direction
of the local government officer or a family member of the officer AND the taxable income is not received from the
local governmental entity?
Yes F-1 No
5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or
other business entity with respect to which the local government officer serves as an officer or director, or holds an
ownership interest of one percent or more.
6
❑ Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts
as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).
7
6& W A Iycv 4 7/20/2022
Signature of vendor doing business with the governmental entity Date
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
A complete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.Iegis.state.tx.us/
Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.
Local Government Code§176.001(1-a):"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.
Local Government Code§176.003(a)(2)(A)and(B):
(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
(2) the vendor:
(A) has an employment or other business relationship with the local government officer or a
family member of the officer that results in the officer or family member receiving taxable
income, other than investment income, that exceeds $2,500 during the 12-month period
preceding the date that the officer becomes aware that
(i) a contract between the local governmental entity and vendor has been executed;
or
(ii) the local governmental entity is considering entering into a contract with the
vendor;
(B) has given to the local government officer or a family member of the officer one or more gifts
that have an aggregate value of more than$100 in the 12-month period preceding the date the
officer becomes aware that:
(i) a contract between the local governmental entity and vendor has been executed; or
(ii) the local governmental entity is considering entering into a contract with the vendor.
Local Government Code§ 176.006(a)and (a-1)
(a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship
with a local governmental entity and:
(1) has an employment or other business relationship with a local government officer of that local
governmental entity,or a family member of the officer,described by Section 176.003(a)(2)(A);
(2) has given a local government officer of that local governmental entity, or a family member of the
officer,one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B),excluding any
gift described by Section 176.003(a-1);or
(3) has a family relationship with a local government officer of that local governmental entity.
(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator
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 the local governmental
entity; or
(B) submits to the local governmental entity an application,response to a request for proposals
or bids, correspondence, or another writing related to a potential contract with the local
governmental entity;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,described by Subsection(a);
(B) that the vendor has given one or more gifts described by Subsection (a);or
(C) of a family relationship with a local government officer.
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021