HomeMy WebLinkAboutContract 582144
CSC No. 58214
To CITY:
City of Fort Wo1th
Attn: Fernando Costa, Assistant City Manger
200 Texas Street
F01t W01th, TX 76102-6314
Facsimile: (817) 392-8654
With copy to Fort Worth City Attorney's Office at
same address
To VENDOR:
Mity-Lite, Inc
John King, Gov. Sales Manager
Address:
1301 West 400 N01th
Orem, UT 84057
Facsimile: NIA
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:
By:
Name: Fernando Costa
Title: ACM, Neighborhood Services
Date:
APPROVAL RECOMMENDED:
By:
Name: Victor Turner
Title: Director, Neighborhood Services
ATTEST:
By:
Name: Jannette Goodall
Title: City Secretary
VENDOR:
Mity-L
�
ite, Inc
£�, By: -�
Name: John K�
Title: Gov. Sales Manager
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract, including ensuring all performance
and reporting requirements.
By:
Name: Arturo Mercado
Title: Community Center Coordinator
APPROVED AS TO FORM AND LEGALITY:
By:
Name: Jessika Williams
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: NIA
Jannette S. Goodall (Oct 10, 2022 16:31 CDT)
Jannette S. Goodall
Exhibit A
Section I: Furniture for Classroorns. Campus, and Schools- Discount (%) off cat�loglpricefist for A!I
Classroam anc� 5chooi Furniture. CataloglPricelist MUST be included or proposal will not be considered.
Total: 56%
Item Notes: PROPOSAI. NOT�: Vendors shall submit catalog(s)Ipricelist(s) with their Proposal res�onse or the
Proposal wil! not be considere�. Vendors shall subn�it catalog(s7lprieelist(s) with the Proposa� in a
readily available and readable electronic format, wikh Excel or searchable PDF praferred No paper
catalogs or manufacturerlvendor websites wili be accepted.
Venclors proposing multiple mai�ufacturer prod�ict lines andlor cataloglpricelist per line item must submit
the information as foflows or proposal ��ay r�ot be considereci:
• 5elect "Add Alternate" for each additional manufacturer product lin� andlar catalog/pricelist
proposed
• Venclor's must list one specific percentage discount for each manufacturer andlor
cataloglpricelist listed
Item Attributes
1. 5tate Name of CataioglPricelist Prapose�d with Discaunt Percentage
NU �E� E7o not Incliide SKLI. Re�erence Numbers, Wehs!#es, andlni "See AltachedlEnclosed".
--Btt�Bo�r�f 242�-Priee-Sheet --- - --- --- -- — - - -- — -- . __... _ _
�
Seciio� I: Furniture far Classrooms, Campus, and Schoals- Discount (%) off cataloglpricelist foi- All
Auditariurr� Seating Furni#ure. Catalc�glPr�celist MIJST be included or propasal will not be considereci
Total: 59%
Item Notss: PROPOSAL NO7�: Vendors shail submit catalog(s)Ipricelist(s) with tl�eir Pro�osal response or the
Praposal will not be considered. Vendors sl�ail submit catalog(s)Ipricelist(s) with the Proposal in a
rea�ily available and rea�able electronic format, with Excei or searchable PDF preferred. Na pap�r
ca�alogs or manufacturerlvendor websites will be aecepted.
Vendors propasing multiple manufaciurer praduct lines andlor cataloglprlcefist per iine itern must submit
fhe inforn�ation as foliows or proposal may not be considerecl:
• Select "Add Alternate" for each addikianal manufacturer product line and/or cataloglpricefist
propos�d
• Vendor's must list ane specific percentage discount for each man�ifact�.irer and/or
cataloglpricelist Itsfed
Page I H of 3� paaes Vef�dor: Mity-Lite 667-22
Itern Attributes
1. State Name af CataloglPricelist Rroposed with Discount Percentage
NO1 E Go nul include� _S'KLI_ Referenu� N�inibN�ti VV«I��i��s ;,3ndlui "See Attach��i�nr„losed"
MityLite F'rice sheet
3 I Section !: F'urniture for Classroorns, Ca,m,pus. and Schools- Discount (%} off catalogl�riceiist for Aff
CafeterialDining Room F'urniture. CataloglPricelisi MUS� be included or proposal will nr}t be cor�sidei-ec�
Totai: 55%
It�m Notes: PROP05AL NOTE: Vendars shall submit catalog(s)Ipricelist(s) with t��eir Propasal response or the
Proposal will not I�e considered. Vendors shall submit catalog(s}lpricelist(s) with the Proposal �n a
readlly a�ailable and readable electronic Format, with Excel or searcha�le PaF preferred. N�aqer
cataloqs or manufacturerlvendor websites will be accepted.
Vendors proposing multiple manufacturer praduct lines andlor cataloglprlcelist per line item must submit
the informafion as follows ar proposal may not be considered:
• Select "Add Aiternate" for eaeh acfditianal manufacturer prod�3ct fine andlor cataloglpricelist
proposeci
• Vendor's must list one specific per�centage discount for each manufacturer and/or
cataloglpricelist listed
Item Attributes
1. 5tate Name of CataloglPricefist Praposed with Discount Percentage
i�JUiE. Dn noi inr:iude SKU ReEer�n<;c; Numbers Websites anr.ilor "See AllachedrEr;clos�d"
MityLite Price sheet
Page ] 9 of 3�l pages Vendor: 19iry-Lite 667-Z2
4�Section I: Furniture for Classrooms, Campus, and Schools- Discount (%) off cataloglpricelist for All
Dormitory Furniture. CataloglPricelist MUST be included or prapasal will no# be considered
Total: 58%
Item Notes: PROP05AL NOTE� Vendors shal! submit catalog(s)Ipricefist(s) with their Proposal res�onse or the
Proposal wili not be cansidered. Vendors shall submit catalag(s)Ipricelist(s) with the Proposal in a
readily available and readable electronic forrnat, with �xcel or searchable PDF preferred. No Aaper
catalogs or manufacturerlvendor websites will b� accepied.
Vendors praposing m�iltiple manufacturer product lines andlor cataloglpricelist per- line item rr�ust submit
the ii��orn�atian as follows or praposal may not be considered:
5elect "Add ,4lternate" for each aclditional manufacturer product line and/ar cataloglpricellst
propased
• Vendor's must list one specific percentage discour�t for each manufacturer andlor
cataloglpricelist listed
�tem Attributes
1. 5tate Name of CataloglPricelist Proposed with Discaunt Percentage
NUI"E Uo no! include SI<U, Reference Numhors. VVehsifes andlor "SeP Attach�ie�d�Enclosed"
- - Mi#yLite-Rrice�heet- - - — — --- ....... — - - - - - — - - . —...- — -
5
Section I: Furniture for Classrooms, Campus. and Schools- Discaunt (%) off cataloglpricelist for Ali Library
Furniture. CataloqlPric�l��t �1lIlJST r�e incl�ideci oi pro�os�l will r�o� hc� r,oR�sidPrecf
Total: 61 %
Item iVokes� PROPOSAE. NOTE: Venclors shall s�.�brr�it catalog(s)Ipricelist(s) with their Proposal response or the
Proposai will not be considered. Vendors shalf submit catalog(s)/pricelist(s) wlth� the Proposal in a
readily available and readable electronic format, with Excei or searchable PDF preferred. Na paper
catalogs or manufacturerlvendor websites,w,ill be accepted.
Vendors proposing multiple manufacturer product lines andlor catafoglpricelist per line item must sul�mit
the inforr�i�tian as follows or proposal rnay not be considered:
• Select "Add Alternate" for each additional manufacturer product line and/or cataloglpricelist
proposed
• Vendor's must list one speciflc percentage discaunt far each manufacturer andlar
catalog/pricefist listed
Page ?0 of 34 pages Vendor. Miry-Lite fi(7-2?
Item Attributes
1. 5tate Name of CataloglPricelist Propased with Discount Percentage
NUTL= Dn rx,l incluile SKI,}, RFfe���+icv �I+���ril���r,_ VV�I'�si��-r. andior "5��: A[Ir�cln��lF_nclused"
MityLite Price Sheet
fi Sectian I: Furniture far Classrooms Carn us and Schools- Discount (%) off cataloglpricelist for All
Science Labaratory Furniture. CaialoglPricelist MUST be included or proposal wifl not be considered
Total: F2%
Item Notes: PROPOSAL NOTE: Vendors shail submit catalog(s)Ipricelist(s) with their Proposal r�sponse or the
Proposal will not be considered. Vendors shall submit catalog(s)Ipricelist(s} wfth th� Propasal in a
readlly available and readab[e eiectronic forrnat, with �xcel or searchable PDF preferred. No paper
cataloc�s or manufacturerlvendor we,b,sikes will be accepted.
Vendors proposing muftiple manufacturer product lines andlor cataloglpricelist per line ftem must subrnit
the i�7farr��atian as follows or propasal rnay not be cansfclerecl:
• 5elect "Add Afternate" for each aclditional manufacturer prod�.ict lin� ar�dlor catalog/pricelist
proposecl
• Vendor's must list one specific percentage discount for each man��facturer andlor
cataloc�lpricelist listed
Item Aitributes
�. State Name of CataloglPricelist Proposed with Discount Percentage
iVUTF Do not Include SKU Rete�e.n�,,��, N�iinbers N1ia�::iEe� �a,ullt�rr "S�e Attached;Enc€,.�s�d'
MityLlte Price Sheet
Page 2l of 34 pages Vendor: Nliry-Llte 667-Z?
7 Sectio� I: Furniture for Classraams. Campus, and Schools- Disco�mt (%) off cataloglpricelist for All Other
Eclucation Related F��rnikure and Products. Cat�loglPricelist MUST be included or propasal wil� noi �e
cor�sfc�Pred
Total: 58%
Item Nofes: PROPOSAL NO7E: Vendors shall subi��it catalog(s)/price{ist('sj with their Proposaf respanse or the
Praposai will not ba considered. Vendors shall submit catalog(s)Ipriceiist(s) with the Prapqsal in a
re�dily availab�e and readable electronic format, with Excei or searchabie PDF preFerred. iV� qaper
catalogs or manufackurerl�endor websites will be acce�ted.
Vei�dors proposing multiple manufacturer producf lines andlor cataloglpricelist per line item must s��bmit
the information as foflows or propasal may not be cnnsid�red:
• 5elect "Add Alternate" for each additional manufacturer product line and/or cataloglpricelist
propased
• Vendar s must list one specific percentage discaunt for each manufacturer andlar
cataloglpriceiist listed
tt�m Attributes
1. State Name ofi CataioglPricelist Propasecf with Discount Perce�tage
NOTE lJ�i noi lnclodw, �I<LJ Ref�re��r.z �li.imbers. VVehsli�as ai��il�x "-5ee AitachedlF_nclosed"
MityLite Price Sheet
0
Seciion I1: Furniture for Business. Offiee, and Workpiace - Discount (%} off cataloglpricelist fQr All Office
Furniture. Ca#aloglPricefist MUST be included or proposal vvill not be considered
Total: 56°/a
It�m Nofes: PROPOSAL NOT�: Vendors shall s�ibrr�it catalog(s)Ipricelist(s) with their Proposal response ar the
Proposai will not be considered. Vendors shail submit catafog(s)Ipr€celist(s) with the Pra�asal in a
readily availab#e and readable electranic format, with Excel or searchable PDF preferred. Na paper
catalogs or manufacturerlvendor websites wilf be accepted.
Vendors proposing mu(t'�ple manufacturer praduct lines andlor cataloglpricelist per line item must stabmit
the infor��nation as follows or praposal may not be considered:
• Select "Add Alternate" for each add'�tio�al n�anufacfurer praduct line anc�/or cataloglpricelist
prapased
. Vendor's must list one specific percentage discaunt for each manufacturer andlor
catalaglpricelist listed
Page ?2 of 3�1 pagcs Vendor: NTity-Lite 667-22
Item Attributes
1. State �lame of CataloglPricelist Proposed with Discaunt Percentage
�VO iE Do i�ot €nclud�; SKU_ Rei��ren�:e Nun�ilrers VVebsrtc;.: a�r,lror 5�:���� titt�i��,i��<l;�n�.;lus��d��
MityLite Price sheet
9�Section I!: Furniture far Business,,, Office. and Workplace - Discou��t (°/Q} off ca#aloglpricelist for All Modular
Furniture (New). CataloglPricelist MUST� be ir�eluded or pr�oposal will not be considered
�Ic� �ic�
Item Notes: PROPOSA� NOTE: Vendors s}�all submit catalog(s)Ipricelist(s) with tneir I roposal respons� or the
Propasal will not be considered. Vendors shall submit catalog(s)Ipricelist(s) with the Proposal in a
readily avai�able and readabfe electronic farmat, with Excel or searchable PDF preferred. No paper
catalogs ar manufacturerl�endor.websites will be acceqted.
Venciors proposing multiple manufacturer product lines andlor cataloglpricelist per line item must subrnjt
t��a informakion as falfows or praposal n�ay not be considered:
• Select "Add Alternate" for each additior�al manufacturer product line andlor cataloglpricelist
proposed
• Vendor's m�ist list one specific percentage discount for each mantifacturer andlor
cataloglpricelist listed
Item Attributes
9. State iVame of CataioglPricelist Prapased with Discount Percen#age
iVOTE� Do noI inclucfa �KIJ. Refe�e,r,re fV�in�l,ear:; �Nr�I.��siE�;:; andlo� "See 1��¢tac-hen'�nclosad�
No �espons�
Pagz 23 of 34 pagcs Vendor: Vlity-Lite 667-22
1� Section II: Furniture for Business, Office, and_Workplace - Discount (%) aff cataloglpricelist for All Modular
Q Furniture (Refurbished). Catalog/Pricelist MUST be included or prapasal will not be considered.
No Bid
Item Notes: PROP05AL N07'E: Venclors shall submit catalog(s)Ipricelist(s) with their Proposai response or the
Proposal will naf be cansidered Vendars shall submit catalag{s)/pricelist(s) with the Proposal in a
re�dily available and readable electranic format, wikh Excel or searchable PDF preferred. No paper
cafaloqs_nr mai�ufacturerlvencfor websiies �ill be acceptec�.
Vendors proposing rnuitiple manufact�irer product lines andlar catalaglpricelist per line item must suhmit
tl�e information as follows or proposal may not be considered:
• Select "Adci Alternate" for each additional manufaciurer product line and/or catalog/pricelist
proposed
• Vendar s must list one specific percentage discount for each manufacturer andlor
cataloglpricelist listed
Item Attributes
�. State Name of CataioglPricelist Proposed wifih Discount Percentage
iVp��E� Du noi include SKU. Rererence Numbers. Wehsites, andlor "Se� AttachedlEnclose{I"
_�t)07�'Sf3"OI7S - - - — - -- --
Section ll: Furniture for Business, Off�ce. and Workplace - Discount (%) off cataloglpricelist for All
Courtroorr� Furniture. CataloglPrice#isi MUS�� he ir�cl�ac#e�1 or propos�l v�till not he considered_
TotaE: 5�%
Item Nates: PROPOSAL NOT�: Ver�dors shall subi�nit catalog(s)Ipricelist(s) with their Praposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)Ipricelist(s) avith the Propasal in a
readily available and readable electronie format, with Excel ar searchable PDF preferred. No paper
cat_aloqs.�r.manufacturerlvendar websit�s will be accepted.
Vendors proposing multipfe manufacturer product iines andlor cataloglpricelist per line item n�ust submit
khe infiormation as fallows or praposal may not be considered�
• Select "Add Afternate" for each additional manufactureT product line and/or cataloglpricelisk
propased
+ Vendor's musk list one specific percentage discount for each manufacturer ancflor
cataloglpricelist listed
Page 24 af 3�l pages Vendor: Mlry-Litc bb7-�2
Item Attributes
1. Stake Name of CataloglPricelist Proposed with Discount Percentage
NO�iE� L7o n��t ioicli�de SKU, Referwn�e Nw>>her UV�bsilr,s andlor "See .G+,tached�Ei�closed"
MityLite Price sheet
1 Sec#ion �I: Fu_rniture for Business. Office, and Woricplace - Discount (%} off cataloglpricelist far All Church
� and Religious Furniture. CataloglPriceiist MUST be included or pro�osal will not be considered
Total- 55%
Item Notes: PROPOSAL NOTE: Venc�ars shall submit catalog{s)Ipricelist{s) wi#h fheir Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)Ipricelist(s) with the Proposal in a
readify available ancl readable electronic format, with Excel or searchable PQF preferred. i�o paper
catalo s or manufacturerlvendor websites will be acce ted.
Vendars proposing multiple manufacturer product lines andlor catalaglpricelist per IFne item must subrnit
the infan7�akion as follows or praposal may nat �e considereci:
• Select "Adc! Alternate" far eacl� additional manufacturer product line andlor catalog/priczlist
propased
e Vendor's must list on2 specific percentage discoui�t for each manufacturer andlor
catalaglpricelist (isted
Item Attributes
1. State Name of CataloglPricelist Rraposed with Discoun# Percentage
NOTE� Dn not indude SKU, Relerence Num�iers iAlebsiFes andlor "See AtiachedlFnclosed"
MityLite Price sheet
Page?5 oi3d pages Vendcx: �Iity-Lite h67-22
Z Sec;tion_II; Furniture_for Business. Office, and Workplace - Discount {%) aff catalog/prEcelist for Ali
� Healthcare Furniturs. CataloglPricelist MUST be included or proposal will r7oi �e considered.
Tatal: 55%
Item Not�s: PROP05AL NOTE: Vendors shall subrnit catalog(s)Ipricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors sl�all submit catalog(s}Ipricelist{s) with the Proposal in a
readiiy �vailable a�d reacfable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturerl�endor websites will be accepted.
Vendors proposing multiple mar�uf�cturer product lines andlor c�talaglpricelist per iir�e iten� must submit
the informatio�� as follows or praposal snay not be cansid�r�d:
• Select "Add Alternate" far sacl� additional manufacturer product line andlor catafoglpricelist
prapased
• Venclor's must list one specific perceniage discaur�t for each n�anufacturer a��dlor
cataloglpricelist listed
Ifem Attributes
1. 5tate Name of CatalaglPricelist Proposed with Discount Percentage
fJU�f E f�o nok ��iclud� SICU, Raforenc;e Numbers. Wel�sifes, ancllur "See Attacher�lEncfosed"
MityL-�#e-P-r-ice-�#eet __ —.... - - - - — - - - -
1
4
Sectior� ll: Furnifure for Business, Office�and Wark�lace - Discount (%) aff cataloglpricelist for All �ther
Business and Warkplace Furniture. C�t�ioglPricelisi MUST �e ir�cl�ideci or� proposaf wili nat he cor�sidered
Total: 55%
ltem Notes: PROPOSAL NOTE: Vendors shall submit catalog(s)I�ricelist(s) with their Praposal respanse or tf�e
Proposal will not be considered. Vendors s��all suhmlt catalog(s)Ipricelist(s} wlth the Froposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No�paper
catalags or man�ifacturerl�endor websites will be accepted.
Vendors proposing multiple manufacturer product lines andlor cataloglpricelist per I�ne iten� must submit
the infarrr�ation as foflows or proposal may nat be considered:
+ Select "Add Alternate" fior each addltional manufacturer produc't line and/or cataloglpricelist
proposed
• Vendor's must list oi�e specif€c percentage discount for each man�rfact�Frer andlar
cataloc�Ipricelist listed
Page 2C oF34 pagcs Vendor: Viity-Lite 667-22
I#em Attrihutes
1. State Name of CataloglPricelist Proposed with Discount Percentage
NV fE pu no1 in:;iudN tiKl.l, F�t terence I�l��mbers. W�l�si€es, andlnr "See Att�chedlEnclusEr6'
MityLlte Price Sheet
1 Section III: Furniture for Storage, WallslPanels, and Accessories - Discaunt (°/o) off cataloglpricelist for All
��iling Cabinets. Cataloglf'riceiisf MUST be incl�ided ar proposal wil� not be considered.
IVc� �ic1
Item Notes: PROPQSAL NOTE: Vendors shall submit catalog(s)Ipricelist(s} with their Proposai response or ths
Proposal will not be considered. Vendors shall subn�it catalog(s)Ipricelisi(s) with the Proposal in a
readily available ar�d i'eadal�le electror�ic format, with Excel or searchable PDF preferrec� No paper
cataloqs or manufacturerl�endor websites wilf be acceptecl.
Vendors prflposir�g multiple n�anufacturer product iines andlor catalogrpricelist per line item must submit
the in�ormation as follows or proposal may r�ot be cansidered:
• Seleck "Add Alternate" fo�- each additiar�al manufacturer product line andlor catabglpricelist
proposed
• Vendor's must list one specific percentac�e discount for each man�ifacturer andlor
cataloglpricelist listed
item Attributes
1. State Name vf CataloglPricelist Proposed with Discount P�rcentage
NU1�E Uo nnl inGliide SItl1 kr.fr-rrr;l'ri�' �iitiTiL�et�s �lilyhs�l��s ��n�liu+ �'tire qY,i'�r,he�{+El�r.lus�r{,�
No respatise
Page 27 of 3� pagcs Vendor. Miry-Lite 657-22
1 I S�ction IIL• F'urniture for Stora e WaIIslPanels and Accessories - Discotmt (%) off cataloglpricefist for All
s Locicers and Locker Products. CataloglPricelist MUST be included ar proposal will r�ot be considered.
No Bid
Item Nates PROPOSAL NQTE: Vendors shall submit catalog(s)Ipricelist(s) wiih their Proposal r�sponse or the
Proposal will not be consider�d. Vendors shall submit catalog(s)Ipricelist{s) with the Proposal in a
readily available and readable electranic forr��at, with �xcel or searchable PDF preferred. No paper
catalops or manufacturerl�endor websites,_will be accepted.
Vendors proposing muEtiple rnanufacturer product lines andlor cataloglpricelist per line Item mus� subrr�it
the information as fallows or propasal may not be cansidered:
• Select "Add Alterna#e" for each additional manufacturer product line andlor cataloglpricelist
propased
• Venclor's must list one specific percentage cfiscount for each manufacturer ancllor
cataloglprlcelist listed
Item Aitril�ufes
1. State Name of CatalaglPricelist Proposec# with Discount Percentage
IVO�TE� I]o nol in<;Iude SKU. F2eference Numbers. Wehslles, andlr�i "See A�t�chedlEnclosed"
AiO�"�S{3�!'2S�' --- — . —
�
7
Seetion fRl: Furnitur� for Starage, WaIIslPanels. and Accessories - Discount (%) of� cataloglprkcelist for Ail
Moveab�e Walls and Partitions. Catalog/Pricelist IV1US1- be included ot� proposal will not be considered
Total: 60%
It�m Notes: PROPOSAL NOTE: Vendors shall submit catalog{s)/pricelist(s) with their Proposal response ar the
Proposal will not be considered. Vendors shali submit catalog(s)Ipricelist(s) with the Praposal in a
readily a�ailable anc� readable electronic format, with Excel or se�rchable PpF preferred. No paper
catalogs or manufacturerl�endor websites wilE be accepted.
Vendors proposing multiple manufacturer praduct lines andlar cataloglpricelist per line iter�7 must subrnit
the information as follows or proposal may not be considered:
• Select "Adcl Alternate" for each additional manufacturer product line andlor cataloglpricelist
proposed
• Vendor's must �ist one specific percentage discount for each manufacturer and/or
cakaloglprfcelist listed
Pagz 28 of 34 pages Vendor. Miry-Lite 667-22
Item A#tributes
1. 5tate Name of CataloglPrice�ist Proposed with Discount Percentage
N(� �E I���� ��o� inriiid� S}<U Reference IVun�iher5 b�.1����, ��,,:; ,�r�d��i� 'See AE[a�;l��e�.l; �n,:los-:tl�
MityLite Price sheet 60
1 Sectian lil: Furniture for Storage, WaIIs,IPanels, and Accessaries - Discaunt {%) off catalagl�ricelist for All
S Types of Acaustic Ceiling, Wall Panels and Refated Materials. CataloglPricelist MUST be included or
proposal will no# be considered
No �i�l
Item Notes: PROPOSAL N4TE: Vendars shall submit catalog(s)Ipricelist(s) with their Proposal �esponse or the
Proposal will not be considered. Vendors s��all subn�it catalag(s)Ipricelist(s) with the Proposal in a
readily �vaiiable and readable electronic format, with Excel or searchable PDF preferred. No pa�er
cataloqs or manufacturerl�endor.websikes will be acceptect.
Vendors proposing multiple manufacturer praducf lines andlor cataloglpricelisE per line iiem must submit
fhe informat�on as foilows or �roposal may not be considerecl:
• Select "Add Alternate" for each additional rr�anufacturer product li��e and/or catalaglprice�ist
proposeci
• Vendar's must iist one specific percentag� discount for� each manufacturer andlor
cataloglpricelist listed
ltem Attributes
1. State Name af CataloglPricelis# Pro�ased with Discaunt Percentage
NO�E� Do nF�Y Inr.,lud�� SKU I�eferenr� nlunibers �1eh:lt�.� �;ntJinf "SeF r1;€ach���rUr,r,r.l�,�s�a�i"
No response
Paoe 29 of 34 pages Vendor: Vlity-Lite b67-22
1 Sectio_n III_; Furnit_ure for Storage, WaI�slPanels, and Accessories - Discount (%) o#f cataloglpriceltst for All
g Window Treatments. CataloglPricelist MUST be include� or proposal wiil not be considered
No Sid
ltem Notes: PROPOSAL NOTE: Vendors shal! s�ibmit catalog(s)Ipricelist(s} with their Proposai response or the
Proposal will nat be cansidered. Vendors sF�all submit catalog(s)Ipriceiist(s) with the Proposal in a
readily avaiiable and r�adable electronic formaf, with Excel or searchable PDF preferred. No paper
catalogs or manufacturerlvendor websites will be accepted.
Vendars proposing rnultiple manufacturer product lines andlor catalogl�ricelist per line item n�ust submit
the informatiar� as follows or praposal may nat be considered;
• Select "Add Alternate" for each additional manufacturer product line andlor catalog/pricelist
praposed
• Vendor's must list one specific percentage discount for each manufacturer andlor
catalog/pricelist listed
ftem Attributes
1. State Narrte of CataloglPriceiist Propased with Discoun# Percentage
NC}TE. Do nol 3nc�,l��de SKU. Ftafer,�a��e N��moers VVehsiles. andlor "See AttachedlEnclosed" �
- - �Q-1"�.��30175E — - -
2 I Section IV: Instalfation and Repair Service - Hour[y Labar Rate fior Instal[ationlRepair Service of All
� Types of Furniture -- Na# to Exceed houriy labor rate far InstallationlRepair Service of All Ty�es af Furniture.
Quantity: 1 UOM: Hourly Labor Rate
�!o Bid
2� Section IV: Installation and Repair Service -Percentage (°/ti} Rate of Totaf �rder for Installafiion of
� Furniiure - Not to Exceed percentage (%) vendar will charge of Total Order Price far Installation of Furniture.
Quantity: 1 UOM: Percentage (%) Rat� af Totaf Ord�r
�� �'i�
2 Section V: Furniture and Equipment Moving Services -Furniture and Equipment Moving Services - per
� square foot price #or furniture and equipm�nt moving. Price to include all necessary supplies, labor, anci related
items to complete moving ofi furniture and equipment.
Quantity: � UOM: Per Square Foot
�Ic� �aci
2 Section V: Furniture and Equipment Movin_,g Services -Removal and Dis�asal Qf Trash Services - per
� square foot price for the remaval and disposal af trash. Price to inclt�deall necessary supplies, la�or, a�d related
items ta compfete rerno�al and dispasal of trash.
Quantity 1 UOM: Per Square Foat
lVc� �id
Page 3D of 3� plges Vendor: Mity-Lite fi67-�2
2 5ection VI: Pro osal No. 667-22 - Furni#ure for Sc�aol Office Science Libra and Dormita : EVALUATION
4 fTEMS -�vafuation Item No. �- Specified Brand, Model, and UOM: Virco — 90QQ Series 4-Leg Stack Chair
(#9018); Qty. �; Size: 18 in. seat height; Calor: Navy Biue; Four leg chrome; For Classroom Seating.
1�€� �i�
IteiT� Notes: 1.Information u�der Section VI is requested and will be �ised only for piirposes of assisting in the
evaluation of Vendor's price campetitiveness. These items will not be indi�idually awarded. THE
FOLLOWING EVALUATION ITEMS MUST B�COMPLETED FOR ElTHER THE AS SPECIFIED OR
ALTERNATE PR�DUCT. Equal alfiernates may be submitt�d only ifyou do nat s�ll the specific procfuct
listed. Evaluaiion iten�s must be fully campleted and submitted, or the PROPOSAL WILLEVOT BE
CONSIDERED.
2.Vendors shall provide AS SP�CI�I�� QR AL7ERNATE PRODUCT pricing b�sed on t�e follawing
pricing struct�ire.
�Calc�a�l��t�;d BuySo�rd Pi�i�� ��at�lt�g/�ric��i�st y�ric� Iess discaunt �aropo�ed = Buy�oard� 4�ri�ce)jl
3.Vendors that do not offer any of the e�aluation or alternate items listed beiow shall s�abmit a written
explanation �o req��est exemption from this requirement ai�d select "No Bid.". The Cooperative
may deterr�ine, in its sole discretion, whether or not to exempt a Vendor from this requirement based on
all information pro�ided with the Proposal.
2 Sec#ion VI: Proaosal No. fi67-22 -�urniture for School, Office, Science, Library and Dorm�torv: EVALUATION
$ ITEMS - Evaluakian Item Na. 2- Specified Brand, Madef, and UOM. Virco — 90�Q Series Chair and Student
Des� Combo (#9400BR); Qty. 1; Size: 18 in. seat height; Color: Navy BIuelGrey; Lar�inate top; Four leg chrome.
Boolcrack; For Classroom Seating.
Na ��c�
It�rr� Nates: 1.Informati�n under Section VI is requested and will be used only for purposes of assisting in the
evaluation of Vendar's price competitiveness. These items will not be indi�idualfy awarded. THE
�OtZD�17i�TG�1IATUA71OTTfTENfS�VfQST-SECDNfPLET�D�OR-E3TFiERTR� A�-SPF�IFIET]�R— —
ALTERNATE PROdUC�. Equal alternates may be submitted anly ifyou do not sell the specific product
listed. Evaluation items must be fully completed and submitted, or the �ROP05AL W�LLNOT BE
CONSIDERED.
2.Vendors shall provide AS SPECfFIED OR ALTERNATE PRODUCT pricing based on the fiollowing
pricing struct�ire.
����cu#ated B�ayBoard Pri�� ��a�aloglpricelist �rr� I'ess di���:nt prap�sed = Buy��ar� Pr�ce��
3.Vendors that do not offer any af the evaluatian or alternate items listed belaw shall submit a written
expEanation to re�uest exemption from this requirement anc! select "Na Bid.". The Cooperative
may determine, in its sole discr�tion, wh�t�er or not to exempt a Vendor from this requir�ment based on
afl information pro�ided with the Proposal.
Page 3l of 34 pages Vendor: N[iry-Lite fib7-22
2 S�ction VI: Proposal No. 667-22 - Furniture for School, Office, Science, Library and Dorrnitory: EVALUATION
� ITEMS - Evaluation Item No. 3- Specified Brand, Model, and UOM: Virco — Cafeteria Tz�l�le with Round
Stools {#MTS� i291212); Qty. 1; Table height: 29"; Seat height: 17"; 12 round stoo�s; Table frame: Chrome legs;
Ci�air Color: Navy Blue; Laminate surface: Gr�y; Edge Banding: Black.
No B�d
Item Notes: 1.Information under Section Vf is requested and will be used only for purposes nf assisting in the
evaluation of Vendor's price competiti�eness. These items will no# be irtdi�iclually awarded. THE
FOL�OWING �VAL.UATION ITEMS MUST BECOMPLETED FOR EiTHER TFfE AS SPECIFIED OR
ALTERNATE PRODIICT. �qual alternates may be submitked or��y ifyou do nat seil the specific product
listed. Evaluation items must be fully compl�ted and subrnitked, or the PROPOSAL WILLNOT BE
CONSiDERED.
2.Vendors shall pro�ide AS SPECIFIED OR ALTERNATE PRODUCT pricing based an the following
pricing str�fcture.
�Calccalated 8�iy�nar€� Pri�e �c.ataloglpricePist prrtce less discoumt propo5�d =��a;��r�ard €�rice)}
3.Vendors that do not offer any of the evaluation or alternate items listec! below shall submit a wrikten
explanation to request exemption frorrt this reAuirement and seiect "No Bid.". The Cooperative
may dekermine, i� its sale discretion, whefher or not to exempt a Vendar from this requirement based on
ail informatlon provided with the Proposal.
2 Sectian VI: Proposal No. 667-22 - Furniture for Schoal. Office, Science. Library and Darmitory: EVALUATI�N
� ITEMS Evaluation Item No. 4- Specified Brand, Madel, and UOM: Diversified Woodcrafts—Octac�on
Science Lab Workstation (#15�4K�); Qty. 1; �our drawer base (56" Diameter); Solid 1" epoxy resin top.
�r� ���
Item Notes: 1.Information under SectiQn VI Is requested and will be used only for p�irposes of assisting in the
evaluation of Vendor's price competitiveness. These items will not be indi�iduallv awarded. THE
A�TEREVATE PRODUCT. �qual alternates may �e submitted only ifyou do not sell the speclfic product
listed. Evaluation iter�is musE be Fully completed and subrrtitted, w the PROPOSAL WILLNOT BE
CONSIDER�D.
2.Vendors shall provide A5 SPECIFIED OR ALTERI�ATE PRODUCT pricing based on the foilowing
pricing structure.
�Calculakt�d BuyBcnarc# �rice (catalo�/q�ri��l�s� �ri�e 4�s�� discaunt propased' _��yBoard Price)�
3.Vendors that do not offer any of the eva�uatian or alternate items listed below shall submit a written
explanatiort to request exemption from this requirement and seleci "!Vo Bid.". T}�e Caoperative
n�ay determine, in its sole dlscretion. whether or not ta exempt a Vendor from this requi�ement �ased on
all information pro�ided with the Proposal.
Page 32 of 34 pa�es Ve��dor. Mity-Litc 667-Z?
$Section VI: Furniture far Schooi. Office, Science, Library and Dormitory: EVALUATION ITEMS Evaluation
Item No. 5- Specified Brand, Model, and UOM: Hon — Task Chair {#5�J01); Qty. 1; Coiar: Blue; Grade 4 fabric,
Arn�iess; 360 Degree Swivel; Tlt Te�sion and Lack; Black Base.
No Bid
Item fVotes: 1.Infarmation u��cler Section VI is req�fested and will be used only for purposes ofi assisting in t��e
eva�uafion of Vendor's price competitiveness. These iterrts wilf not be indi�idually awarded. THE
FOLLOWlNG EVALUA710N ITEMS MUST B�G�MPLE�ED FOR EITMER T�IE AS SPECIFIED OR
AL"�EF2lVATE PRODUCT. Equal alternakes may be submitted anly ifyau do not sell the specific product
listed. Evaluation items must be fully compieted and submitted, or fhe PROPOSAL WILLNOT 8E
CON5IDERED.
2.Vendors shall pro�ide AS SPECIFIED OR ALTERNATE PRO�UCT pricing based on the follawing
pricing structure.
�Calc�ai�a��cf $euy�Boaxd Priee (eatal�o�lpri�eli�t �rice less disco�t�t �arcrpc�sed = 'BuyBoard P�ice}�
3.Vendors that do not offer any of the e�aluation or alternate items fisied below shall submit a written
ex lanation to re uest exem tion from this re uirement and select "No Bid."'. The Cooperative
may determine, in its sole discretior�, whether or not to exempt a Vendar from this requirement based on
all information pravided with the Proposal.
2 5ection VI: Proposal No. 667-22 - Furniture for School. Office, Science, Library and Darmitory: EVALUATION
g ITEMS - Evaluatian Item No. 6- Specified Brand, Model, and UQM: Glabal — Lateral File Ca�inet (#9342-
3F1 H); Qty. 1; Size: 42" Wide; 3-Drawer, Color: Black; Center puil configuration.
No Bid
Itetn Notes: 1.Information under Section Vi is req�rested and will be used oi�ly far purposes ofi assisting in the
eval�iation of Vendor's priee competiti�eness. These items will not be indi�idually awarded. THE
�'OLLOWING EVALUATION iTEMS MUST BEGOMPLETED FOR EITHER THE A5 SPECiFIE17 OR
ALTERNATEPRO�fTCT�qua a ternakes may b�mittec�only i you a not sell the specific prod�cf
listed. E�aluation iterr�s must be fully compieted and submitted, or the PROPOSAL WILLNOT BE
CONSIdERED.
2.Vendars shafl provide AS SPECI�IED OR ALTERNATE PRODUCT pricing based on the fallowing
prlcing structure.
�Cafcwl'�fl�d S���St�ard Ps��ee �catalog/�rie�liist price les� discau�nt �ropased = B�yBoard Prte��i�
3.Vendors that do not afFer any af the evaluation or alternate items listed below shall submit a written
. p, ion,,fr�m this reauirement and select "No Bid.". The Cooperative
exp anation ta req,uest exem t,... .._.
may determine, in its sole discretion, whether or �ot to exempt a Vendor fram this requirernent based on
all i�formation pro�ided with the Proposal.
Pagz i3 of 34 paaes Vendnr: DAiry-Lite b67-2?
3 Sectia� VI: Propasal No. 867-22 - Furniture for School. Office, Science. Library and .Darmitory• EVALUATION
� ITEMS - Evaluation Item No. 7- 5pecified Brand, Model, and UDM: Hon — 1070Q Series U-Workstation
(5ingle Pec�estal Right Desk H107'85R, Sridge H1077a, and Single Pedestal Credenza H10746L); Qty. 1; Size:
Desk-72"W x 36°Q, Bridc�e-47"W, Credenza-72"W x 24"D; Laminate; Calor: Mahogany.
No Bic�
Item Notes 1.Information under Section V1 is requested and will be used only for purposes of assisting in the
evaivation of Vendor's price competiti�e��ess. These ifiems will not be individually awarded. 7"HE
FOLLOWING EVALIJAT10N ITEMS MUST BECOMPLET�D FOR EiTHER THE AS SPECI�fED DR
ALTERNAT� PRODl1CT. Equal alternates may be submitted anly ifyou do not sell the specific procfuct
listed. Evaivation items must 6e fully completed and submitted, or the PROPOSAL WILLNOT BE
C4NSID�RED.
2.Vendors shail pro�ide AS SPECIFIED QR ALTERNATE PRODUCT pricing based on tf�e foflowing
pricing str�icture.
[��Ic�Ea'�ed $uyBoard E�ci.ee (ca�laglpri�elist �rice Isss d;i�s�oui�rt proposed =�u�8��rd P�i����j
3.Vendors that do not offer any of the e�aivation or alternate items listed below shall suhmit a writ#en
explanation to request exemption from this requirement and selec# "No Bid.". The Coope�ative
may determine, in its sole discretion, wheti�er or nol lo exemp# a Vendor from this requirement laased on
all information pravidecf with the Propasal.
Response To#al. $0.00
P�ge 3�1 of 34 pages Vendor: �'Vliry-Lite 667-2?
E�hibit B
.
�11y � � , �
..
February 4, 202Z
5ent Via Email: jahn.Ecing@mityinc.com
John King
Mity-Lite
1301 West 400 North
Orem, UT 840567
Welcome to BuyBoard!
Re; Notice ofNational Purchasing Cooperative Aivard; Praposal Invitation No. 667-22, Furniture far Schpol, Q�ce, Science,
Li�rary and Dormitory
Congratulations, The National Purcha5ing Cooperative (National Caoperati�e) has awarded your company a BuyBoardO
contract based on the above-referenced Proposai Invitation. The contract is efFective for an initiaf one-year term oP April 1,
202Z through March 31, Z0�3 and may be subject to two possible one-year renewals. Pfease refer to the Proposal In�itation
for the contract document5, including the Nationa! Purchasing Cooperative Vendor Award Agreement and General Terms and
Conditions oF t�e Contract.
To review the items your tompany has been awarded, please review Proposal Tabulation No. 677-22 at
www.b�yboard.caml�endor. Only items marked as awarded to your company are incfuded in this contract award, and only
those awarded items may be sold through the BuyBoard tontract. All sales rnust compiy with the contract terms and must
be ak or below the awarded pricing as set forth in the General Terms and Conditians.
_.— �he_contract_wilLb�posted._on_ the...Buyaaar.d__website--as-an-online-electronic catalog(s}, -You-ar�re�incied -that; in
accordance with the General Terms and Conditians, all purchase orders from Nationa� Cooperati�e member5
mus� be processed thraugh ti�e BuyBoard, Except as expressly authorized in writing by the Cooperative's administrator,
you are not authorized to process a purchase order received directly from a Nationa! Cooperative member that F�as nat been
pracessed thro�gh the BuyBoard or provided ta the Copperati�e. If you recei�e a purchase orcler directly from a Nationa!
Cooperative member that you have reason to believe has not been recei�ed by the National Cooperative or processed through
the BuyBoard, you must promptiy forward a copy of the purchase arder by e-mail to info@buyboard,com
A list of National Cooperative members is a�ailable on the buybaard.com website. The BuyBoard �endar relations staff will
be co�tacting you to assist with resources available and pro�ide any support you may need as an awarded BuyBoard vendor.
On behalf of the National Caoperative, we are looking forward to your participation in the program. If you have any questians,
please contact Coopera#irre Procurement Staff at 80a-b95-29I9 (selett option "2").
Sincerely,
� � .
' :� ,, �-
Arturo Salinas, Assf. Di�ision Directar, Coo�erative Purchasing
Texas Association of 5choal Boards, Inc., Procurement Administratar for the National Purchasing CooperaCi�e
� �z.oi.zozi
��
P.Q. Box 400, Austin. Texas 78767-0400
800.695.29 i9 • buy6oard. corn
� �
� Boarc�'
p�ar,Nnsir:c cr�a�eR.Sr;vE
120Q7 Research eoulevard • Austin, Texas 78759-2439 � PH: 800-695-29J.9 • buvboard,com
PROPQSER'S ACCEPTANCE AND AGREEMfNT
Proposal In�itation Name: Furniture for School, Proaosal Rue DatelOveniny �ate and Time:
Office, Science, Library and Dorrrsitary October 28, �021, at 4:00 PM
P ro p osa I I nvitati on,,, iV,u m be r: 6 6 7-Z 2
Contract Term: Apr'�i 1, 2�2Z, through March
31, 2023, with two pqssib�e one-ye�r renewals.
Location of Proaosal Oaening_
Texas Association of School Soards, Inc.
BuyBoard Department
1Z007 Research 81vd.
Austin, TX 7$759
Anticioated Cnnoerative Snard Meeting Date:
]anuary 2022
By signature 6elow, the undersigned acknowledges and aqrees that you are authorized to submit rr�
Proposal, indudinq makinq al/ acknaivledqements, cansents, and certf�cations herein, on 6ehalf of Prapa .
and, ta the best ofyour knowledge, the information provided is true, accurate, and complete.
MityLite, Inc.
Name of Proposing Company
�30� w 40o N
5treet Address
Qrem
City, Stat�, Zip
500-362-5820
14/14/2021
Date
__-_ `�.✓�� �s _
Si nature of Authorized Com -"�__.._....__.:,. _._. _
g pany Official
John King
Printed Name of Autharized Company �ffic�al
Gov. Saies Manager
Telephone Num�er of Authorized Cpmpany OfFicial Position or Title of Authorized Company OfFicial
S� 1-224-6191
87-0652595
Fax Number of Authorized Company OfFFcial Federal ID Number
Page 10 of 72
PrOp05dl Fprms COMMfSV[S v.08.11.202F
e
, • ���..
�� ^U�i:::l.1S���t)1:!:i�Fkit,7TiVF
12007 Research Boulevard ° Austin, Texas 78759-2439 - PH: 840-695-2919 ° huvboard.com
P�(3POSi4L ���tNIS P/�Rl" 1e �OMPLiI�NCE FO�tP75
I��r�uc�r�on�so
Proposer must re�iew and �omplete all forms ir� tF�is Pra�asal Forms Part 1:
■ Prapasaf Acknowfedgements
a Felony Conviction Disclosure
a Resident�Nonresident Certification
m Debarment Certification
a Vendor Employment Certification
� No Baycott Verir�ication
a iVo Excluded Nation or Foreign Terrarist Organization Certi�icaCior�
� Historically Underutilized Business Certifi�ation
° Acknowledgement of BuyBoard Technical Requirements
� Construction-ReEat�d Goods and Services A�rrnation
= Deviation and Compliance
m Vendor Consent for Name Brand Use
m Confidentia!/Proprietary Information
� EDGAR Vendor Certification
� Compliance Forms Signature f'age
Aa� a�a$ho�ized s�epresen�ative �f Pr�����r rn��t ��a�Aa9 in th� bot�om rigpht ccar�er o�' e���a pa� vu�aeo�� ir��iae�+-�.
��a� eornple�e anci sige� the �s�mp9i��ac� F�nrrtns �ar��aature �age. Pro�oser`s fa€lu�� to �aally eomp�et�, ioai$aal, z:�
ssc�� forrns as r�q�ir�d may �asu�t a�n y��ar Pr��n�sa0 lsei¢a� r��je�ed �s ro��a-r�sp�a��ove.
�}��P0��4� ACKNOV�L�DG�MEIViS
The proposing company ("you" ar "your'� hereby acknowfedges and agrees as follows:
f. You have carefully examined and understand all information and documentation associated with this Proposal Invitati�
including the Instructions ta Proposers, General Informafion, General 7erms and Conditions, attachments/forr�
appendices, item SpeciFications, and line ite�ns (collectively "Requirements"};
2. By your respanse ("Proposal'7 to this Prvposal invitation, you propose to supply the products or services suf�mi�ted
the pricing quoted in your Proposal and in strict compliance with the Requirements, unless spec€fic deviatipns
exceptions are noted in the Proposal;
3. By your Proposal, you acknowledge and certify all items set forth in the General Terms ard Canditions, Section B.
(Certifications), including all nvn-collusion c�rtificatior�s and certifications regarding legal, ethicai, and other matters -
forth therein.
4. Any and all deviations and exceptions to the Requirements �ave been noted in your Proposal on the required form a
no others will be claimed;
��sa�i�9:
Page 11 of 72
Proposal Farms COMM�S�CS v,OB.li,292F
` ��a���
.
r�:.ec;�,-��x�,-�a�r� �r,r=
120p7 Research Boulevard • Austin, Texas 7$759-2439 • PH: 80Q-695-2419 • buybaard.com
5. If the Cooperative accepts any part of your f'raposal and awards you a Contract, you wiq furnis� ai[ awarded prod�cts
se�vices at the pricing quoted and in strict compliance with the Reqttirements (unless speciF[ deviations or ex�eptir �
are noted on the required form and accepted by the Cooperative), including without limitation the Requirements relat�:
to;
a. conducting business with Cooperative m�mbers, includi�g ofFering pricing to members that is the best you of
corrparecf to similarly situated customers in similar circumstances;
b. payment of a service fee in the ampunt specified ar�d as provided for in this Proposal Invitatian;
c. the possiisPe award of a piggy-ba�k tontract by the Nationai Purchasing Cooperative or nonprofit entity, in wy'
even� you wil] ofFer th� awarded praducts and services in accordance with the Requirerr�ents; and
d. submitting price sheets or catalags in ti�e proper format as req�ired by the Cooperative as a prerequisite to acki�ati.
af your Contract;
b. You have elearly icientified on the included Form any information in your Proposal that you �elie�e to be confdentia?
praprietary or that you do not cansider to be puhlic information subjec� ta public discfasure under the Texas Put
Information A�t or similar publie information [aw;
7. The individual submitting this proposal is dufy authorized to enter into the contractual relatinnship represen�ed by �
Proposal Tn�itation on your behalf and bind you to the Requirements, and sueh individual (and any individuai signin=
farm or Proposal document; is authorized and has the requisite knowledge ta provide the information and make ��
representations and certifications required in the Requirerr�ents;
8. You ha�e carefully re�iewed your Proposal, and certify that all informatior� provided is true, complete, and accurate
tE�e best of yo�r know[edge, and you authorize the Cooperative to take suCh action as it deems appropriate to verify s�
information; and
9. Any rrriss�temerrt,�ai�frcatron, oromissifl�-in�arProposal,—whenever arhawever-discovered,—witf-be—gr4u�ds---
disqualifying you from consideratian for a contract award under this Proposal In�itation, termina�ion of a contract awa:
or any other remedy or action �ra�ided for in the General Terms and Conditions or by law.
��LO�IIf �O�1VI�TI�N DYSCLOSl1�E
�aa@�section (a) of Sea:#ioua �4.034 �f tiae ��x�s Ed���ti�r� �ad� (�Pati�cation af �u�u�aAn�@ 9�l�story aff Coaatra�:-
stares: "A pe�son or business entity that anters into a contract with a school district must give ad�ance notice to the dist-�
if the persoR or an owner or operator has been con�icted of a felony. The notice must include a general description of t
conduct resulting in tf�e can�iction of a felony."
Sec�aoan 44.��4 furth�a' s��g�s i� Subs�ttavn (�aj: "A school distrfct may terminate a contract with a person or busin�
entity if the distric� determines tf�at the persoii ar business entiry failEd to give notice as required by Subsection (a1
misrepresented �he conduct resuftsng in the con�iction. The district must compensate the person or business entity
servic�s performed before the terrrtination of th� contract,"
Please check J ore o� the followin :
❑ My campany is a publicly-held corporation. ;Ad�ance notice requirement does not apply to publicl/-held corporation.)
� My campany is not owned o� aperated by anyone who has been con�icted af a felony.
❑ My campany is awnQd/operated by the foilowing individual(s} who has/harre bet�n con�icted of a felony:
Nar�e o€ Felon(s):
Details of Convictian(s}:
�����a�:
Page 12 of 72
Proposal Forms COMM(NCS v.08.21.2021
� i I �x;' #�''
W�
12007 Researcf� Boufe�ard ° Austin, Texas 78759-2439 � AH: 800-59�-2919 • buvboard.cam
RESIDEIVT �IOIVRESIDEiVi ��RiiFIICAiION
Chapter 2252, Subchapter A, of the Texas Government Code establishes certain req�irements applicable to proposers v�f
are not Texas residents. Under the statute, a"resident" proposer is a person w�ose printipaf place of business 'ss in iex_
including a contractar whose ulrimate parent company or majQrity owner has its princ�pal place of business in Texas.
"nonresidenY' prqposer is a persan who is not a Texas resider�t. �lease indieate the status of your company as a"reside:
praposer or a"�o�resident" praposer under these definitions.
Please checic (�l one of,the follawinq;
❑ I certify that €ny company is a b8�sud��t P�o��s�re
0 I certify that my campany is a PJ�ro�eS@d�nt ��agros�re
Ef your company is a Nonresident Proposer, you rrtust pro�ide the follpwing infor€r�ation for your resident state (the sta��
which your company's principal pface of business is Iocated):
�/ii�y�ite, ��ce
Campany Name
�rem
c�ty
� 3O� �V 4�� �
Add ress
UT �40�7
Stat� Zip Code
A. Does your resid�nt state require a proposer whose prin[ipa! place of busir�ess is in Texas to under-price propo�c.
-- - whnse-resident state is the same�s-yo�rrs-try a-prescribed-amaurit-orpercentage-to-rereive-a-eomparable-contra;.--
❑ Yes 0 No
What is the presCribed amount or percenkage? $
or
%
DE��,iiM�li�T CERiIFY�AiY�N
By sig�ature on the Compliance Forms Signature Page, I certify that neither my campany nor an owner or principal of -
company has been debarred, susperded or otherwise made ineligible for participatian in Federal Assistance programs ur�c
Executsve Order 12549, "Debarment and Suspensian," as described in �he Federal Regis�er and Rules and Regulatio�
Neither my company npr an owrter or prinCipa] of my eompany is currentiy listed on the gavernment-wide exdusions in S�
debarred, suspended, or otherwrse excluded by agencies or declared ineligible under any statutory or regulatory author-
My company agrees to immediately notify the Cooperati�e and a!! Cooperative members with pending p�rchases or see�C€
to purchase from my cam�any if my company or an owner or principal is later listed on the governrrient-wide exefusions
SAM, or is debarred, suspended, or othe�wise excluded by agencies vr declared ineligible under any statutory or regulat�
authority.
11ENDOR ENIPLOIfM�P�T �ER7'IFiCA'�'�06�
Section 44.031(b) of t�e iexas Education Code establishes certain triteria that a 5choof district mt�st can5ider wh
determining �o whom to award a contract. Among the criteria for certain cantracts is whether the vendor or �he vendc
ultimate parent or majority owner (i) has its principa[ place of business in Texas; or (ii} employs at ieast 50b people in iex�
If neitiner your company nor the �sltimate parent company or majoritjr owner has its principal place of business in Texas, d�
your company, �Itimate parent company, or majority owner employ at [east 500 people in Texas?
PEease chec€c one of the followin ;
❑ Yes � 3Vo
gs�a$i�fa - -' .
Page 13 of 72
Propusal Forms COMM�SVCS u�8.11.2021
�� � f h �
wf=11I �• .: �• _
124D7 Research Boulevard ' Austin, Texas 78759-2439 • PH: 800-b9S-2919 ' buvbcard.com
IV� �Ol(COIi 1/EItIFTC�#TION
A Texas goverrsrnental entity may not enter into a contra�t with a �alue af $1DO,OOa or more tha� is to be paid wholiy�
partiy from pubfic funds with a cornpany (excEuding a sole proprietorship) tha� i�as ffl or mare full-time employees for goc
or services unless the contract contains a written verification from the company that it: {1) does not hoycott Israel and +•
not baycott Israel during the term of the contratt (TEx, Gov'r CoQE Ch. 2271), {2) does not boycott energy cornpanies a
will not baycott energy companies during the term of the contract (TEx. Gov'r Coo� Ch. Z274 e�ective September ]., 202
and (3) does not have a practice, policy, guidance, or directive that discriminates against a firearm er�tity or firearm tr� -
association and will not discriminate during the term of the contraci against a firearm en�iry or firearm trade association (L
Gov'T CooE Ch. 2z74 eT�ective September 1, 20?1}, Accordingly, this certificatian form is incfuded to the extent required
3aw.
"Boycott Israel" m�ans refusing to deal with, i:errr�ir�at'sng business activities with, or othe�-wise taking any action tha�
intended to penaliz�, inflict ecanomi� harm on, ar limit cornmercial relations specifically with Israel, or with a persors or enf
doing business in Israel ar in an Israeli-controlled territory, bu� does not include an a�tion made for ordinary b�asinr
purposes. ��x. Gov'rCo�E §808.001{1).
"Boycott energy company" means, without an ordinary b�siness purpose, refusing to deal with, terminating business acki��t`
w�t1�, or otF�erwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relatians �n'
a company because fhe company: (A) engages in the explaration, production, �kiiization, transportation, sale,
man�facturing of fossil fvel-based energy and daes not comm�t or pledge to meet environrnental stancfards beyond applic��
federal and state law; or (8) dpes business with a company descri�ed by Paragraph (A). T�x. Gov`�r CooE §$Q9.00].�,
(effecti�e September J,, 20Z1).
"Discriminate against a frearm entity or fir�arm trade associatior�" means, ,A) with respect ta the entity or associa�ion, `
(i) refuse ta engage in the trade of any goods or services wiCh ti�e entity or association based solely on ifis status as a fire� �
entity or firearm trade association; (ii) refrain fram continuing an existing business relationship with the er�trty or associati
based solely on ifs status as a firearm entity or firearm trade association; or (iii} terminate ar� existing business relaTiansf-
vv'r�h the entity or association t�ased saleEy on i�s status as a firearm ent�ty or firearm trade association; and (B) does �
include: (i) the established policies of a merchant, retail seller, or platfarm khat restrict or prohibit the listing or sefling
ammunition, �irearrns, or frearrn accessories; and (ii) a corn�any's refusal to engage in the trad� af any goods or servic�
decision to refrain from continuirsg an existir�g business relationship, ar decision to terminate an existing business reiationsh`.
(aa) to comply with federal, state, or local faw, policy, or regulations or a directive 6y a regulatory agency; or (bb} for �
traditional business reason that is speci#ic to kh�e customer or potential customer and not bas2d solely on an entity's
association's status as a firearrrs entity or firearm trade association. TEx. Gov`r Co�E §2274.ODI(3) (effecti�e Septersibe�-
�azi�.
By signature on t1�e Compliance Forrr�s 5igna�ure Page, to the extent applicable, I certify and verify that Vendor does r
boycott Israel, boyeott energy companies, or discr�minate against a firearm �ntity ar �rearm trade association and wil! r
do so during the term of any contract awar�ed under this Proposal Invitation, that this ce�tification is true, complete a-
accurate, and that I am autharized by my company tv make this certification.
�saitia�: -
Page 14 of 72
Proposal Forms COMM�SVCS v.p8.11.�021
" ����
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,,,�„_�:�,���,_ .-.�r-a;,�:.��
12007 Research Boulevard ° Austin, Texas 7$759-2439 • PH; II00-b95-Z419 • 6uyboard.com
1010 EXCLl1DED IVATI�N �@� FOREIGfV 9TERR�l�IST ORG�IIVYZATIO� ��ItTI�I�A�I� �`
Chapter 2252 ofi the Texas Go�ernment Cade provides that a Texas go�ernmentai entity may not ent�r into a contract w�
a company engaged in active business operations with Sudan, Irar�, or a foreign terrorist organization — specifcaify, -
company identified on a list prepared and main�.ained by the Texas Comptroller under Texas Gavernment Cade §§846.�7�
SD7.051, or Z?5z.153. (A company that the U.S. Government a�rmatively declares to be excluded from its federal sanctic
regime relating to Sudan, Iran, ar any federal sanctiqns regime relating to a fareign terrorist arganization is not s�sbje�
�he contract prohibi�ion.)
By signature on the Compliance Forms Signatur� Page, I certify and verify that Vendar is not on the Texas Comptroller's
identified above; that this certification is true, ccmp�ete and accurate, and that I am autharized by my company to make �:-
certification.
�iIST'ORIi�►��Y I�fVDE�tIJTILIZED �USYNESS �Ei��IFY���IQ�9
A Praposer that has been certified as a Historically Underutilized Business (also known as a Minority/Women B�sinr
Enterprise or "MWBE" and all ref�rred to in this form as a"HU6"} is �ncouraged to indicate i�s HUB certifcation status w�=
responding ta this Proposal Invitatson. Ti�e BuyBoard website will indicatz HUB �ertificativns for awarded Vendors t:
properly indicat� and document their HUB certi�cation on this form. Please check {�l) all that appl�
❑ I certify that my company has f�een certified as a HUB in the following �ategories:
❑ P�aa�orit�► ��y��d �e�sie�ess ❑ iNameua �v��aee� �usiness
_—_
_ — _ — Se�vare-Disal�Yed-ttete�ua_R;et�raed_�us����s-(r►���r�� �i�fii�ae�-�iyj-38-9�:5s������2)! �v� a�- --
�er►��c��eou�a��c�ed d�sabili�yy a� ���O�o�d �xy 38 fl9a5.�, §�07,(�.f), �a�d wh� F��s a�is�b'sB04ry ra��r
of ��% �� �ar� as �9et�raa�¢r�ed @�y �#ae l!. S. �ep�rtr��ra� of 4/eterans Affia�rs �r �epartrn��at o�
�ef�ras��
�e�iffie�to�e� Na�Aaab�r:
i�a�rue of Ce�ta�ying dig�ro�yy:
0 My company has N�� been certified as a I�ll6,
�CIC�VO1n1LED�;EfW�NT �F �lil(��ARD �EC1iNYCA� �EC?l1IR�P7ENT5
Vendor shall review the BuyBoard Technical Requirements included in thES Praposal Invitation. By signature on the Compliar
�orms Signature Page, the undersigned affrrms that Proposer has obr�fned a�apy of the BuyBoard Technicaf Requiremer.
has read and understands the requiremer�ts, and eertifies tha� Vendor is able to meet and will comply with those requireme-
except as follows: [List and explain BuyBoard Technic�l Requirem�nts, if any, to which yaur rempany cannat or will r
camply ]
Note: In accordance with the Genera] Terms and Conditions of the Contract, to the extent Vendar is awarded a Con�r�
under this Proposal Invitation but is unabie or �nwilling to rneet the applicable BuyBoard Technical Requirements, r
inforrnatipn availabEe on the BuyBoard for Vendo�-'s awarded products or services may be limited, potentially placing Ver=
at a disad�antage and impactir�g the ability oF Caaperati�e members to search, find, review, and �urChase vendor's awarc
pradt�cts and services on the BuyBoard website. Further, to the exterst Vendor has atknowledged ability to meet artd com•
with the BuyBoard Technical Requirerrtents, any subsequent failure or re�usal by Vendor to promptly provide inforrnati�
upon rec}uest to the Cooperative administrator n� accordance with those technical requirements may be c€eemed an ever��
default under the Contract. Iroi$i��: "` �
Page 15 of 7Z
Prapasai Forms COMMJSVCS v.68.11.2q27
' ��va�rd
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12007 Research Boulevard • Arastin, Texas 78759-2439 • PH: 300-695-2919 • huyboard.com
C�IVSiRIJ�TTOiV-FZ�LA�ED GOODS AND �ER1/IC�S �4��IRI�AiYON
The Cooperative issued the BuyBoard Procurement and Construction-Related Goods and Services Advisary for Texas Memb=
("Advisory"), wF�ich provides information specifically rele�ant to the procurerrsent of constructior�-re[ated goads and servir
by Texas Coape�a�i�e members. The Advisory, ��ailable at bu r�board.com_/Vendor Resources.aspx, provides an o�erview
cerfain lega! requirements that are potentially refevant to a Caoperative rrtember`s pracurement of construction
constr�.�ction-related goods and serviCes, induding those for projects that may invol�e ar require arcf�itecture, engineerinc
independent testing servic�s. A copy of the Advisory can a15o I�e provided upon request. Because many BuyBoard contra�
include goods or installation ser�ice5 that migh: be considered construction-related, Proposer must make tfi�'r, Cons�ruct
Related-Goods and Services Affirmation regardless oP type of goads or services associated with this Proposal Invitation.
A contract awarded under this Proposal Invitatior� covers onfy the specific goods and/or services awar�ed by the Cooperati�
AS explained in ti�� Advisory (��AdvEsory'�, ��.ras Va�n► pPo9tabi�s ��ae �a��cua�emen� o� archit��vu�� �a� �ng�e��e�°
ser�9ces t9�r�ugh � purcFea��n� coopee�$iv�o TBaus �a��p���9 Ysadit�tioav aa�c9 ao�y ��rairac� �v�►a��t��9 �Fo�reu�'
��es nof ia��9a�d� such services. ArcG��t�c��are or �ngAs���rin� servie�s am�s� 9�e prr�cu��d 6��v a��o�es��•:�-
uv�ernber sey��rately, is� ascordarace wi�1� ��� Pr�fas�ior��V Serdu�es PrmCureQnerat A� (C6�ap�er 2�5� �� �ha ��.�'�
���r�rnsnent Cod�) aa�d o$he� a�ap@iCa�n[e 9��nr aaee� 9�c�0 peslicy.
By signature on the Complian�e Forms Sigrtature Page, Proposer affirms that Proposer has obtair�ed a capy of the Advisc
�as read and understands the Advisory, and is authorized by Proposer to make this a�rrrtation. If Proposer sells constructic
related goods or services to a Cooperative mer�3ber under a Contract awarded under khis Proposal Tnvitation, Proposer v
comply srrith the Advisory and applicable legal requirements, make a good faith effort tv make its Cooperative mem�-
customers or potential Cooperative tnember cus�omers aware of such requirernents, and pro�ide a Cooperati�e member �r�r' �
-a-ee�y-ef-the-Ad�isory-before-acc�pt+ng-the rrtern6er'sPurchase-Order or gther-agreemerrt-for-construction=r�fated-goods--
services.
Ynatual:
Page 16 of 72
ProAosal Fvrms COMM�NCS v.08.11.2021
� ���r���
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P!: �rfi�1 "I7!^ C CL'P>"',7 T1'✓ �
12007 Research Baule�ard ° Austin, Texas 78759-2939 • PH: SOQ-695-2919 ° bu board.ram
DEi/IATI0IV e4ND ��6��LIe4NCE
If your company intends to de�iate from the General Terms and Canditions, Proposal Specificatians ar other requireme�
associated with this Proposal Invitation, you MUST list all such deviatians on this form, and provide eomplete and deta}1=
information regarding the deviations on this form ar an attack�rrient to this farm. P�ic�r to com����o�� �h�s fo��a�a, Ve�s-'
sfi�a11 revi�w the �e�eraf 'T��€�ras a�ad C�aaciiti�ns se�aon �.4 (be�iativras froara Itern �pecifica���r�s aeaa� Ger��..
Y��ms aead �onditi��s�. �ieas� nnte that, as pr�dicfec9 un sectiore �.4, eertaan pr�disions �� �h� �eraeral �'�aT
and C�ne�i�6oras are 6�O'T s[ebj�ct tm a9ev�ati�re, aa�ci certain deviatio�s vviE9 9�e a�e�med �ejected +nruthmu� fa�a�'�
�ctiors lay the Con�erati�e. A�y �i�err�pted d�viativn, whether direc#Ey or ia�d'ar�c�l�, fo prodisior�s �c���tif've�l
this Proposa� Ie�vitation as not su�j�ci �o �ed�atBoe� slvaE9 be deemed re3ec�eai �y �9�e �oop�r�g�v� ao�d, u�a39�
�t9�erwg5� w►ithdP�w� by �ertdoo'r may res�a[t in 1/endor's �roposaV tneBng rej�cted a� i�s e�#�re�.
The Cooperative wilf consider any deviations in its contract award decision and reserves thse right to accept or reject a prope
based upon any submitted de�iaiian.
In the absence of any deviation identifed and described in accordance with the abo�e, your company must fully comply �n
the Generai T�rms and Conditions, Proposal Specifications and all ather requirements associated with this Proposal Invitati�.
if awarded a Contract under this Proposal In�station. A d�:viation wifl not be effective unless accepted by the Cooperar��
The Cooperati�e, by and through the Cooperati�e administrator, may, in its sole discretion, seek clarifcation from and;
communi�ate w'sth Proposer(s} regarding any submitted deviation, consist�nt with genera] procurement �rinciples af �`�
competition. The Cooperative reserves the right to accept or rsject a Praposal based u�on any submi�ted deviatian.
P�ease check (d) vne of the following_
❑ ��; DeviaEions
�] ���; Deviations
Information presented by khe VEndor has
been accepted by BuyBaard.
List and fuNy explai� any de�iations you are su�mitting;
� '�.�-,1 �r'��f-.�[ ���_ � : �� ` ����'[� �--`�—
Gonnie W Burkett, CTSBO
Director - Cooperative Operations
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;
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11'9�$9��:
Page 17 af 72
ProposaiF_r-r,- �pMMfSVCS v.a8.11.2021
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12Q�7 Research Boulevard ° Austin, Texas 78759-2439 • PH: 800-b95-2919 ' buyboa•--'.com
1iEND0�t COiVSEIVT FOR NA►�+�IE �I�AND I�SE
BuyBoard members seeking to make pur�Y�ases using a Contract awarded under this Proposal Invitation may �iew informat� .
regarding awarded Vendors, including but not limited to product catalogs, price�i5�s, prieing, and Proposais, through t
BuyBoard website. To irnprove and enhance the experience of BuyBoard members seeking to procure goods and seivir
under the Cantract utilizing the BuyBoard website, any Vertdor logo, product �mages, arsd similar brand and tradem�
information pro�ided by Vendor for purposes of the Co�tract {15Vendor Information'� may be pasted on the BuyBqard websi`
Ymu acicn�wledge that, by s�brnitting y�ur �roposaV, unfess yau speci�calty op� oaat belmw, you �ons�a�t t� --
of yo[�r campa�ay's ilendor Ynforr�atoan ��o th� �uy�o��a9 uuebsage 'sf awardea� a�ontrac�. You further ackrsowlee .
that whether, where, and when �o ir�dude the Vendor Infarmation on the B�yBoard website si�ai! be at the sole discretiar
the BuyBoard Admin3strator. Vendor retains, however, the right of general qualiry contro� o�er the BuySoard Administratc
authorized display oF praprietary Vendor Informakio�. Neither the BuyBoard nor its administrator will be responsible for fi
use or distribtatior� of Vendor Information by BuyBoard members or any other third party using the SuyBoard website. T�
Vendor Conse�t sha�! be effe�tive for the full t2rm of the Contract, including rer�ewals, unless Vendar provides a sign�.
written notice revoking con5ent �o cantr�C�ac1r'tin@buyboard.cam. BuyBoard shall have up to thirty days from the date
receipt of a termination or re�ocation of a Vend�r Consent to remo�e Vendor information from the BuyBoard we6site.
This Vendor Consent is s��ject to fhe Terms �nd Conditivns of the Contract, including, but not limited to, those ter
par�aining ta Disclaimer oP Warranty and Limita�ion of LiabEfity, Indemnifcation, and Intellect�al Property Infringement.
Vendor loga files must be submitted in ane oP the formats set �orth in the BuyBaard Technicaf ReqUirerr�ents. Prqpesers �
requested to su�mit khis information with Vendor's Proposal. (This consent shal! not authorize use af your campany's Venr
Informatiorrby-SuyBoard�f-your-campany is nat-awarded a-�ontr�ct.-j— -- -- -- — - --- — -- - - - - - --
O�� Od97';
If yaur company wishes to opt out of the Vendor Consent for Name Brand Use, you m�st checi� the opt ou� 6ox helow. �
IVOTselect this box unless your company rs opting out of this d/endor ConsEnt for IU�me Brand Use.
❑ By checkirtg thi5 laox, Vendor hereby declines to provide eonsent for use of Vendor InFormation (as deFined here€n) _
the Buy6oard website. �y optdr�� ou�, l/erador acknow9edg�s and a�rees �6aa�, i� !l�eodor is a+�arcl�d ��oa��r:.
u�ssier �his Pro�osal �nvit��i�n, i�fmr�n��tion auaifa&�9� oea th� Buy�oao�e9 for V�ro��a�°s a�nrau�al�cB produ���
s�ev6c� snay �xe limat�s�, p�t�rati��Vy pG�cing V��c9�r at a dasa�[u���age and �e�pa��a�ag �F�e afaa9'sg�
Cooperatave unembers to seaa�eh, farod, reva�w, and pt�rc�a�e Ver�d�r's ��varded pro�vc$s and seruu�c�s on �
�uy�m�rd �nrebsit�o
I�ai�a�9�
Page 16 of 72
Proposal Forms COMM)NCS v.OB.11.2021
�, ��� __.. � � � � �
�
120a7 Research 6oulevard ° Austin, Texas 7$7S9-z439 • PH; 300-695-2919 ��bnard.cam
�ONFI[9ENTIAL�PROPRIE7'Alilf IGVFO�tf�IATI�N
Ae Pub9ic �ffsclosu�e �avus
All Proposafs, Forms, do�umentation, catalogs, pricelists, or ather materials submitted by Vendor to the Cooperative
response to fhis Proposal Invitatiort, may be s�bject to the disclosure requirements pf the Texas Public Infarmation Act (Tex
Government Code chapter 552.001, et. seq.) or similar disciosure iaw. Proposer rr��st clearly iden�ify on this form a
informatian in its Proposal (including forms, documentation, or ather materials s�bmitted with the Proposa�) that Propo=
considers proprietary or confidential. If Propos�r fails to properly identify the 'snformation, the Cooperative shall have
obligation to notify Vendor or seek protection of such information from public disclosure should a member of the public
other tf�ird party request access to the informatian under the Texas Pul�lic Information Act or simifar disclos�re faw. Wh
required by tne TexaS Public Information Act or o�her disdosure law, Proposer may be notified of any third-party request �
informati�n in a Proposa] that Proposer has identified in this forrn as proprietary or confidential.
Does your Proposal (including forn�s, documentation, catafogs, pricelists, or atF�er materiaEs submitted with the Propos�
contain information which Vendar cons'sders praprietary or canfidentiaf?
Please check [�j one of the Following:
� 1l�Q, I certify that none of the informatirii 9ncluded with this Proposal is considered confidential or ?raprietary.
����, I ceriify Yhat this Proposal contains inf�rmation considered confidential or proprietary and aU sucF� information is
specifically identified on this form.
I� you responded "YES", you mu5t clearly identify below the specifiC information you cansider confidential or propriekary. i
each page number, form number, or other information sufficient to make the information readily identifiable. The Cooperat�
and Cooperative administrator shall not be responsib[e for a Proposer`s fail�re to clearly identiiy inforr�atian consida��
confdentiaf or proprietary. Furtf�er, by submitting a Proposal, Praposer acknawledges that the Cooperati�e ar�d Cooperat�
administrator will disclose information whert required by law, e�en if such information has been identifi�d h2rein
information Vendor considers confdential or proprietary.
Confidential J Proprietary Information:
(Attarh addrUonal sheets rf needed. j
Y�sa$a�le
Page 19 of 7z
PrpppSal FOrmg [Cb't�t'SVf,S v.6811.202f
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12007 Research Boule�ard • Austin, Texas 78759-2439 • PH: 300-695-2919 • bwboard.com
�. Copuri�Fa� Yref�rmation
Does your Aroposal (including forms, documentation, price�ists, catalogs, or other materials submitted with the Propo_�
contain copyright information?
Please check (�/ one of the €olfowinq:
a�lOe Proposal {incfuding farms, docume�tation, pri�elisks, catalogs, or other materiafs submitted with the Proposal) does r.c
conta�n copyright information,
❑���y �roposal (including forrrzs, docu€nentation, pricelists, catalogs, or other materials submit�ed with the Proposal} does
contain capyrighC infarmation.
I€ you responded "YES", c[early identify below tF�e specific documents or pages containirtg copyright information.
Copyright Infarma�ion:
(Rltarh addrtianal sheets ifneeded.J
�. Cons��nt tm 9t�Y�ase Con�rden�iaV Pro riefa �v ri ht Ynforn9a�iora to ��a �aard Wiem��rs
B�ty.Boa [d_m�m.b�r_s_(�flaperaki�ar�nc�np.�afit_memb.ers}_seeking_to....r�a ke_.�s�r_chases _thr.ough�i��B�s.y$oar-d-may-uuis h
�iew information included in the Proposals of awarded Vendars. If you identified information on this �orm as confden���
proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBoard contrG
award constitutes yo�r cor�sent to the disclosure of such information to SuyBoard members, including posting of s�,
information on the secure BuyBoard website for members. Note: �deither t}�2 Cooperati�e nor Conperative admirtistrator
be responsible for the use or distribution of information by BuyBoard m<�mbers or any other parfij.
�, Cooaser�t �� 88e9ease Pro �sal �a��ut�$son
Notwithstanding any�i�ing in this Con�dential/Proprietary InFormation form to tf�e contrary, �y submitting a PropasaR, Venr
co�sents and agrees thaE, upon Contract award, the CooperaEive may publicfy release, incfuding posting on the �uc
BuyBoard website, a copy of the proposal tabufation and award information �or th� Contract including Vendor name; prapo� �
catalog�pricelist name(s); propased percentage discount(s), hauriy labor rate(s}, or ot�er specified priting; and Vendor awr �
or non-award informatian.
i�si$eal; -_
Page ZO of 72
Propasal Forn�s COMM/51'CS v.08.11.2021
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q ;�n�;�dc;f: � �COF'EFiL�;LE
12qq7 Resear[h Boulevard ' A�,�stin, Texas i8759-2439 � PH; 800-695-2919 • buvboard.com
ED�AR 1/�N�OFt CERiIFICATION
(� CFR Pa� �00 and App�r�dix �I)
W�en a Cooperative rrtember seeks to proc�re goods and services using funds under a federaf grant or contract, spec'
federal laws, regulations, and requirements may apply �n addition to those under state law. This includes, but is not limi
to, the proturement standards of the Uniform Administrati�e Requirements, CoSt Principles and Audit €tequirements `
Fedefal Awards, 2 C�R 200 (sometimes referred to as the "�lniform GuidanCe" or new °EDGAR"). All Vendors submittinc
Praposaf musC complete this EdGAR Certificati�n Farm regarding Vendor's wilfingness and a�ifity to cor�pfy witF� cer��
requirements which may be applicable to specifc Cooperative member purchases using federal grant fEands. Comp�et=
farms will be made available to Coo�erative members For their use while considering their purchasing aptions when us�
federa] grant funds. Cooperative members rnay a�so require Vendors to enter into ancillary agreements, in adciition to `
terms and conditions of the BuyBoard contrar.t, to address the member's specific cantractual neecis, indudirtg cantr-
requirements for a procurement using federal granEs or contracts.
Far each of the items 6elow, Vendor should certif� Vendor's agr�ement and a6ilit� to comply, �v�-
applicable, by ha�ing Vendors authorized representati�e check ih� applic�bfe box�s, initial each paqe, �
sign the Compliance Forms Signature Page. Ifyou fail to complete any i£�em in this form, the Cnoperatis�e �°
consider and may list the L�endor`s response on the Buy�aard as "ND, � the Vendor is una6le or unwlllin�
comply. A"NO" response to any af the items may, if applicable, impact the ability of a Coaperati�e member to purchr
from the Ven�or using federal funds,
1. O/erodor 11�o��ti�r� oe� ���aeh o� Cvntrac�'�er�5;
Contra�ts for more than the simp[ified acquisition threshold, wi�ic� is the inflation adjusted amount determined by the Ci�i��
- A--en At uis� ion o�ncil and�l�e De e��isifion Ft�ions Councii Cpuncils as authorized
9 CY q �l 9 � ) y 41 IiSC 1908, �
address administrative, eontractuaf, or I�gaE remedies in instances where contractors violate or breact� cantract terms, �
pro�ide for such sanctions and penalties as a�prapriate.
Provisions regarding Vendor default are included in the BuyBaard General Terms and Conditions, inciuding Section E:
Remedies tar Default and Termination of Cantract. Any Contract award wil] be subject to such BuyBoard General Terms =
Conditions, as well as any additional terms and conditions in any Purchase Order or Cooperativa member ancillary contr-_
agreed upon by Vendor and the Cooperative member which must be consistent with and protect �he Copperative member
ieast to fhe same extent as the BuyBoard Terms and Conditions. The remedies under the Can;ract are in addition ta �
other remedies that may be availab[e uncler law or in equity. 6y s�bmitting a Proposal, you agree to these Vendor �iolat'
and breach of contract terms.
`� 1(��, I agree. ❑ 9�0, I do nat agree.
�, ��a�ra�ina$imn fm� Caus� �a� Condenie�cec
For any Coaperative mem6er purchase or �ontra•�t in excess of $10,OD0 rrzade using federal funds, you agree that the follow�
term and condition shal� apply:
The Coopetative mem6er may termrnate or can�el any Purchase Order under this Contract at any �ime, with or wrthout ca! �
6y prauiding seven (7) 6usiness days aduance written natrce to the �endor. If thrs Agreement is terminated in accorda,�
c�s�ith this Paragraph, the Coaperative mem6�r shall only 6e required to pay �endor for goods or seruices delivered tc
Cooperative member prior to fhe termination and not otherwise retumed in accardance with �endor's retum policy. l� -�
Cooperative member has paid Vendor for goods or services nat yef pro�ided as of the date of terminatron, Vendar s�=
immedrately refund such payment(sJ.
If an alternate provision For termirsation of a Cooperative member purchase for cause and con�en�ence, incfuding the man-
by which it will be effected and the basis for settlement, is included in the Cooperati�e member's Purchase Order or ar�cill�
agreement agreed to by the Vendor, the Cooperative mem�er's pro�ision shall control.
.r
� YES, I agree. ❑�10, I do not agree. Init�a�:
Page 21 of 72
Pruposal FOmts COmM/5VC5 v.08.11.2021
' B�ard�
i
�'�uFtc,i,u+h�., cao�E�a,sr,s-F
1ZOD7 Research Bpulevard ° AusYir�, Texas 78759-2439 • PH: 80�-695-2919 ' buvboard.com
3. �q�ua9 Employeeten$ �pport�nit}I:
Except as otherwise provided under �Fl C�R Fart 60, all Caoperative member purchases or contracts that meet the deftniL�
of "federally assisted tanstruction contract" in 41 CF€2 Part 60-1,3 shail be deemed to indude the equal opportunity cfa��:
pro�ided under h1 CFR 60-1.4(b), in accordance with Executive Order 11245, �`Equal Employment Opportunity" (30 FR 123:_
12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order i1375, �`Amending Executi�e Order J 12�
Reiating to �qual Employme�t dpportunity," and implementing regulations at 4Z CFR Part 60, "Office o� Federa! Contr�
Corrlp[ia�ce Programs, Equal Emnloyme�� Opportunity, pepartrnent of Labor."
ihe equal opport�nity clause provided under 41 CFR 60-i.4(b} is hereby incorporated by reference. Vendor agrees that su
provision applies to any Coaperative member purchase or contract that meets t�e definition of "federaify assisted constr�ct;
contract" in �1 CFR Part 60-1.3 and Vendor agrees that it shall comply with such �ro�ision.
� Y�S, I agree, ❑ NO, I da not agree.
4. �avos-�a�mn �4t�;
When required by Federal program legislation, Vendor agrees that, for all Coaperative member prime const�uct::
contracts/purchases in excess of $2,OOfl, Vendor shall comply with ihe Da�is-8acon Act (4Q U5C 3�.4i-3144, and 31�6-31�
as supplemented by bepartment of Labar regulations (Z9 CFR Part 5, "Labqr Standar�s Pro�isions Applicab€e to Contra-
Co�ering Federally Finartced and Assisted Construction"}. In accordance with the statute, Vendar is required to pay wage=
laborers and mechanics at a rate not fess than the pr��aifing wages specified in a wage determinate made by the Secrei-
of La6or. In addition, Vendor sha[I pay wages not less than once a week.
Current prevailing wage determinations issued by the D�partment of Labor are available at beiasam.g��. Vendor agr�
thatr Po� any pUrcha�o w�iich� �s requiremen app ies, he aw�ar o�-fhe purcha�a �h� e dor is con�ifion� upc
Vendor's acceptance of the wage determination.
Vendar further agrees that it shall also camply v�ith the Copeland "Anti-Kickback" Act (40 USC 3145), as supplemented
D�partment of Labor regulations (29 CFR Part 3, "Contrattars and Subcantrattors on Public Building or Public Wo�k Financ�
in Whole or in Part by Loans qr Grants from the Uni�ecE Srates'�. i�he A� pro�ides �hat each co�ttractor or subrecipient m�
be prohibited from inducing, by any means, any person employed in the construckion, completion, or repair of pub�ic we�
to give �p any part af the compensation to which he ar she is otherwise entitied.
IJ V��, I agree. ❑�90, I do not agree.
►o ��PO�PdC� 1%�1���( 0"I0�9P5 �f31� ����'� S��S9R��P�S l�C�:
Where appiicable, for all Cooperative member e>>ntracts or purchases in excess of $1QO,OOa that in�o��e the employment
mechanics or laborer5, Vendor agrees Co comp�y with 40 USC 3702 and 3704, as supplemented by Departrnent of Law
reg�iations (29 CFR Part 5). Uncler 40 USC 3702 of the Act, Vendar is required to carnpute the wages of e�ery mech�nic a�
laborer on th� basis of a standard work week of 40 hours. Work in excess of the standard work weelc is permissi6le pro�i�=
t�at th� worker is campensated at a rate of noi less than ane and a half times the 8asic rate of pay for afl hours worke�
excess pf 40 hours in the work week.
TFse requirements of 40 USC 3704 are applicable to constructian wark and provide that r�o laborer or mechanic mus� ..
required to ��vork in surroundings or under working Condition5 whic� are unsanitary, hazardous or dangerous. Th��
requirernents do not apply to �he purchases of s�pplies or materials or articles ordinarily available on the open market,
contracts for transportation or transmissian af intelligence.
� VE�, I agree. ❑ P�O, I da not agree.
��itia�: �c
Page 2z of 72 !
Proposal Fn•m� �OMM�SV[5 v.08.1L2p21
� Bo�rra��
Pf1?r��{5 ciM; CO E�AER.", Tf Vc
12047 Research Boulevard • Austin, Texas 78759-2439 • PH: 300-695-2919 ` buvboard.eom
fi. Ric�ht t� Indentioras P�ade lJnc�e� a�'ont�act or Agr�ertaerat:
If the Cooperati�e member's Federal award meets the deirnitian af "�unding agreemenY' under 37 CFR 401.2(a) and �
recipient or subrecipient wishes to enter into a contract with a sma�l business firm or nonprp�� organization regarding '-
sul�stitution of parties, assignment or performance or Experimental, developmentai, or research work under that "fuRa�
agreerrient," �he recipient or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Ma
by Nonprp�it Qrganizations and Small Business Firrrts Urtder Government Grants, Cantracts and Cooperarive Agreemen�::
and any impiementing regulations issued 6y the awarding agency.
Vendor agrees to comply with the above requirements when applicable.
� YE�, T agree. ❑ fVO, I do not agree.
7a Cfeaa� A�r A� aeaai ��c��ra0 Wa�e� ��9�u#aoa� Caa�i��9 ,4ct:
Clear� Air Act (42 USC 7401-7671q.) and the Federal Wat�.r ?ollution Control Act (33 USC 1251-1387}, as amended — Contra-
and subgrants of amounts in excess of $150,OOQ must contain a pro�isinn that requires the nor�-Federal award to agree
comply with all ap�[icabfe standards, orders, or regulations issued pursuant to the C{ean Air Act (42 115C 7401-7671q.) a
the Federal Water Poilution Control Act, as amended (33 U5C 1251-1387}. Vioiatians rxiust be reported to the Fede �
awar�ing agency arsd the Regional affice af the Environmental Protection Agency (E�A).
When required, Vendor agrees to cornply with alf appli�able standards, orders, or regulations issued pursuant to the CfE
Air Act and the Federa3 Water Paflution Control Act.
� VE�, I agree. ❑ i��, I do not agree.
�, — -��9��rrne�a�a��8-��is�seovsn�aa� _ —
Debarment and Suspension (Executive Orders 12599 and 12689) — A contract award (see 2 CFR 18fl.22D) must nat be m� �
to parties listed on the govemment-wide exclusions in the System fnr Award Management (SAM), in accordance with �
OM8 guideiine5 at 2 CFR 18� that i3ttplement Execs�ti�e prders �2549 (3 CFR Part 1965 Camp. p. 189) and 12689 (3 C-
Part 1989 Comp. p. 235), "Debarment and Suspension." SAM Exclusians contains the names oF parties debarred, suspendc
or otherwise exciuded by agencies, as wei! as parties decfared ineligible under statutory ar regulatory authority other th=
Executive Qrder 12549.
Vendor certiFes that Vendor is nof currently iistec! on the governrr�ent-wide exclusions �n SAM, is not d�barred, suspendc
or otherwise excfuded by agencies or declared ineligible under statutory or regulatory authority otf�er than Executiva O�c
12549, Vendor furii�er agrees to immediately no�ify �he Cooper�ti�� and all Cooperative members with pending �ur�hases
seeking to purchase from Vendor if Vendor is later listed on the government-wide exclusiprs in SAM, or is debarr�
suspended, or atherwise excluded by ager�cies or declared ineligible under statutory or regulatory autho�iry other t#�=
Executi�e arder 12549,
�l YE�, I agree. ❑�&�, I do not agree.
3, �yrd Aa�t�-L�bbyiotg ,�irnero�rnent:
Byrd An�i-lobbying Arr�endment {31 U5C 1352} - Vendor5 that a�ply or bid Par an award exceeding $100,0�0 must file �
required certification. Each tier c�rtifies to the ti2r above that it will not and has nat used �ederal appropriated funds to �
any person or organization for influencing or a�iempting to influence an offcer or employee of any agency, a member
Congress, officer or employee of Congress, ar an emplayee of a mem6er of Congress in connectian with obtaining any Fede
contract, grant or any other award cavered by 31 USC 1352. Each tier must alsa disclosa any lobbying with non-Federaf fi�r
that takes pface sn connection with obtaining any Federa! award. S�ch disclosures are forwarded from tier to tier up to t�
nan-�ederal award. As applicable, Vendor agrees to file al� certifcations and disclosures required by, and otherwise com-
with, the Byrd Anti-Lobbying Amendment (31 USC 135Z).
�,
� Y�S, I agree. ❑ �l�, T do nat agree.
Iea0�ia9: ..:'7
Page 23 of 72
Propoeal Forms COMM�SVCS v.08.l1,2022
� �oar��
I'J!iCH�751N.n, CGURf(7A 1'iL�
12007 Research Boulevard ° Austin, Texas 78759-2439 • PH: 8fl0-695-2919 • buvboard.com
g�. P�ocu�ement �# Re�oyer�d P�ateria&s:
For Cooperative member purcha5es utilizing FeF�eral funds, Vendor agrees ta comply with Seckion 60o2 of the Sofid Wa-
Disposal Act, as amended by the Resource Conservation and Recovery Act where applicable and provide such informa�.��
and certificatiorss as a Cooperative member m�y require ta confirm estimates and otherwise comply. The requirements
Section 6002 include prQcuring only it�ms designated in guidelines of the Environmental Protection Agency (EPA) at 40 C
Part Z47 that cantain the highest �e.rcentage oF recovered materials practicabie, consistent wifh maintaining a satisfact�
level of comp�titior�, where the purc!��se prite af the item exceeds $10,000 or the vaiue of the quantity acquired d�ring �
preceding fiscal year exceeded $10,000; procuring solid waste tttanagemer�t services in a rnanner that maximizes energy �
reso�rce recovery, and estab�ishing an affirmative procurement ��vgram fflr proc�rer�ent of �ecovered materials identifiec
the EPA guidelines.
�I V��, I agree. ❑ 6V0, I do not agree.
11. D��a�s�ac �r�fer��ees foa� �roca�re�aaents:
Where appropriate and consistent with iaw, 2 CFR §200.322 contains cet'tain considera�ions fcr dornestic preferences
procurements which may be app�icable to Caoperative members usir�g federal funds. When re�uired by a Coopera��
member, Vendor agrees Co pravide such informativn or certifitation as may reasonably be requested by the Cooperat
mem�er regarding Vendor's praducts, including whether goods, products, or materials are produced in the United States.
l0 ��5, I agree. ❑ NO, I do not agree.
12. �r�9�i�iti�n on CarkaB� �'e8��ora�aruvaa�aicatrions and 1l�de� �urveill�eace 5�reroces �o� �a��i�pa��aag
2 CFR §20D.216 prohibits expending federal loan or grant funds to procure or obtain certain kelecommunieations and ��� -
surveillance ser�ices or equipment. To the extent applicabl� and when required by a Cooperati�e member, Vendor agree�
�rovide ��rcF� informa[io`n o E ifi�ion as rnay reasona6Ey be r�ed--6y the Cooperative mem er�fir��
any teleeommunicativns or �ideo sur�eillance ser�ices or equipment pro�ided by Vendor is co�ered equipment or co�e-
services under 2 CFR §200.216.
� V�S, I agree. ❑ I��, I do not agree.
13, ��ofa� as a S�pae��at� �{e�esa� oF �ru�e:
For purchases using federai funds in excess o� the 5implified Acquisition Threshald, a Cooperafive mernber may be requi-
ta negotiate profit as a separate element of the price. See, 2 CFR 2Q0.32A{b). Wh�n required by a Cooperative memh
Vendor agrees to provide inforrnatian and negoi:iate with t�e Cooperative memt�er regarding profit as a se�arate efemer���
the price for a par�icuiar purchase. Howe�er, Vendor agrees that the total price, including profit, charged by Vendor to `�
Cooperati�e member shall nat �xceed the awarded pricing, including any applicable discount, under Uendor`s Coeperat=
Contract.
C;� YE�, I agree. ❑�1�, I do not agree.
,
1�&. Gee�e�a9 Coavepliasa�� arsci ��oper�ti�� �►ith ��o�era�ive P7e��ers:
Irt addition to the foregoing speeific requirements, Vendor agrees, in accepting any Purchase Order from a Cacperat
rnember, it sha�l make a good faith effort tfl work with Cooperative members to provid� such infcrmatian and to satisfy si
requirements as may appfy to a particular Cooperative member purc�ase or purchases including, but not lirnited to, applica'
recordkeeping and recard retention requirements.
����, I agree. ❑�VO, I da not agree.
Inot�a8e
Page �4 of 72
PraRP�l FormS COM14M,'NCS v.08.11.202I
� � r � #
��s
12Q�7 Research Bouievard • Austir�, Texas 78759-2439 • PH: SQO-695-2919 • bu baard.rom
��MPLIA�ICE F�RWIS SIGNATIdRE �AG�
8y initialing pages and by signature below, I c�rtify that I have reviewed the following forms; that the information provr'
therein is true, cornplete, and accurate; and that I am authorized by my company ta make ai! certifications, conse� -
acknowledgements, ancf agreements contained herein:
� Proposaf AcknowledgemPnts
m Fe�ony Conviction Disclosure
m pebarm�nt Certification
a ResideRt/Nonresident Certificatian
@ Vendor Ernploy�rsent Certification
a No Boycott Verifcafion
� No Excluded EVation or Foreign Terrorist Organization Certification
� Historically Underutilized Business Certification
� Construction-Related Goods and Servic�s Affirmation
� Acknowledgement of BuyBoard Technical Requirements
m Deviation and Compliance
m Ver�dor Cpnsent for Name Brand Use
� Can�dential/Proprietary Tnforrnation
� EbGAR Vendor Certification
-- ���-I �f- nc. --- -- ---.__--
-- - -- — - --- --
Compar�y Name
Signature af Authorizec! Corr�pany Official
�ohr� �Canc� �o� S���s �gr
Printed Name and Title
� 0/� 412021
Qate
Page 25 of 72
PrOpOSaI FprmS [pMM/SVCS v.08.11.2021
�:. ..
■ ,
j � �r' �':
�S�
12007 Resea�ch eoulevard • Austin, Texas 78759-2434 • PH: 800-695-2914 ° buxboard.com
�ROP�SIAL F4R1W5 PART �s 11ENQ01� IN�OI�MAT'IOiY ��RP�S
�IIpB� A d6�Y��8�E\�a
Proposer must comp4etely and accurately pravide alf information requested in th� following Vendor Information Forms
your Proposal rnay be r�jected as non-resppnsive:
� Vendor Business Name
� Vendor Contact Information
� �ederal and 5tate/PurcY�asing Cooperative
Experience
� Governmental References
� Company Profile
■ Texas Regional Service Designation
� State 5enrice Designation
■ National Purchasing Cooperative Vendor Aw�
Agreement (�endorsserving ouCsrde Texas onlyJ
� Local/Authorized Sefler l.istings
� Manufacturer Dealer Designation
m Proposal In�itation Questionnaire
m Vendor Request to Self-Report BuyBoard
PufChc35e5 (Optional)
To the extent any information requested is not ap�l�cable to yo�r cvmpany, you must sa indicate on the form.
VE�1�QR �L1S�nI�SS �ANlE
By submitting a Propasal, Vendor is seeKing to enter into a]egal contrac� with tF�e Coaperative. Hs suci�, Vendor must be
individual ar legal business entity capable of entering into a biRdi�g contract.
�amae af �o�oposisvy C�agagsars�: �I��IL���, ��'1C.
(List rhe I�al name of the company seekrng to contract with the Cooperative. Oo NOTli.sf� an assumed name, d6a, aka, etc. here. Such rnformatran c
6e provided below If you are su6nuh`hq a joint proposal w,�'th another entrty to pro vrde tf7e same propnsed gaods or service5, each su6mitting eno'ty shc -
complete a separate vendor infarmatrar, form. Separate/y vperating legal6usrness enGties, even if a�lrated enb7res, which propose to provide goods
services separately must s�bmit their orvrr Proposa/s )
Please check (i/� one of the followina:
� e off �au�6a��ss: ❑ TndivEdualJSofe Praprietor ❑ Corporation ❑ Limited Liabi�ity �ampany ❑ Partnership
❑ Other {Specify: )
�t�$���3�vC�B�t9(f�dYo�a� (ifapplicable): ����
�edera9 �r�a�l�ver �derataf�ca�i�n Number: �5-0652595
(1/endor must include a completed IR.�_ �V_-� forrn cviih their Proposal)
Naeate � 9nrl�ieh Ve�dor af awarc3ed wishes �o �� ideatti��d oro $9�� Bu Board: (Nnte: ffdifierentthan theNameofPrope �
Campany listed a6ove, only yalid trade r, ames (d6a, aka, etc,) of the Proposing Company may be used and a copy of yourAssumed Name Certificate(s,
applica6le, must 6e attarhed.J
r 1. �,.,f � �� �_
Page 26 of 72
Pr000sal Forms COMMI�ICS v.0&.11.2023
Fa� 'W=9
{Aev. �ctoberZ01 B)
❑epartrnent of ine 1'reasury
Intern�l Flevenue Service
Nama {�s shown an yaur
ty-�Ite, InC.
Reqr�est for Taxpayer
Identification Nurnber ar�d Cer�ificat�on
► Go to www.irs.gavl�armW9 far instr�ctians anc[ tha lates# informat9on:
Give Form #a the
requester. Da not
send to the iRS.
nn this line; do not leave this Iine bfank.
apaVe
m
m
m
a
c
0
ai C
a o
�' V
�
Q i
a+ f�/1
C C
a`�
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U
61
Q.
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m
rn
3 Check appropriate hox for iederat tax classifcatlon of the person whose name fs entered on line i. Check anly a.ne of the
fnlfawing seven boxes.
❑ In�tviduaVsoie praprfeFor or � G Corporaiion � S Corporation ❑ Partnership ❑ Trustlestate
single-member E.�C
❑ L€mited liabiiity campany. �nter iha tax classificati6n (C=C corporation, 5=5 corporeEion. P=Parlqership} 1
Heie: Gheck the appropriate box tn the line above for the Eax classiftcatian oF the singie-member owner. �a not check
�LC ifthe LLC is classiiled as a single-mem6er LLC that is disfegarded from ihe ovuner unless ihe owrser of the LLC is
anather LLC that is qak dlsregarded from iita owner iar U.S. federal tax purposes. Dtherwise, a skngfe-member t�_C th�
Is disregarded fram the owner shouid check the appropriate 6ox For ihe iax ciassification of its awner.
�tf10f {SSE If151NC�16[15� i
jress (number, street, and apC. orsufte no.) See instructions,
13Q1 W 4U0 3V
6 City, state, and ZIP code
�rem UT 84057
7 �ist accovnt n�mbe�{s} here (optlonaf}
4 Exemptions {codes apply or�ly to
certain e�tities, nat indiviiivais; sea
insfructions orr page 3):
Eiiempt payee coda {iF anyj
Exemplidn irom FATCA reporiing
t code (if anyJ
(Appl�ps��to arrnur�ts.manlaincy p�lype f+�e U S.j
and address {opFional)
nf u
Enter your T1N in the appropriate bpx. 7�e TI1V provided musY�atch th@ name given on [ine i to avoid �
backup withhalding, For individuals, this is genera0y your spciai security nuRtber (5SN). However, fo� a r
res�dertt alien, sole proprietor, nr disregarded entiFy, see the inst►uctions fa� Part !, later. FoY other �
entities, It is your err3ployer identification number (E!N). [f you do not hav� a num6er, see Fiow to gef a
TIN, �ater.
or
Note: If the account is in more than one name, see the instrucfions ior line 4. Also see What Name and �
lVumi�ar Ta Give the Requesterfor guidelines o� whose_������ to en#��,— -- _— —....__--r`
----- ------------- � $
� Certification
lJnder penalties af perjury, I aertify ihat;
seeurily number
���������
�. T�te number shown on this form is my conect taxpayer icfentiiication number (or I am waiting for a numbei- to �e issued to rneJ; and
2. t am not subjeci to backup withhaiding beoause: {a) I am exempt from backup wit�holdiRg, or (bj E haye not been.notified by the intemal R�venue
5ervice (iRS� tiiat I am subject to ba�[cup withhalding as a result of a feilure fo reporf all interest ar dividends, or (c) the [RS has nptified me that I am
no langer sutrJecf to backup wiihnnlding; and
3. I am e U.S. citizen or olher U.S. perso� (defined below): and
4. The FP,TGA code(s) entered on this'form (if any) indfcat�ng that I am exempt from FATCR reparting is co�rect.
Gert;fcation tnsiructions. You must cross ouk iterr� 2 a�ove if you have tseen noiifiecf by tne IAS that you are currer�tly subject to backup witrihofdi'ng hecause
you have failed to repori alI interest and dividends on your tax retum. Fa� reei estate transactians, Item 2 dnes nqt apply, Far mortgage interest paid,
acquisitiar� or ahandonment of 5acured praperty, cancellation of de6i, caniriButions to an individual retirement arrartgement {1RAJ, and generalfy, payments
other than interest and dividencls, you are not required tp sign ihe certification, but you must provide your carrect TIN_ 5ee ii�e instructions for Part 11, later.
St{�n Signature a�
Here 11,5, person;
Date► � ,�i `�
General �nstructions
Sectian references areto the lnterrtal Revenue Code unless otherwise
nated.
Future develapments. For the latest informa#ian about developriments
related to Form W-9 and its instructions, suah as Iegislation enacted
after the}+ were p�blished, go fn www, irs,govlFomiW9.
Purpose o# Form
An 4ndividual or entity {Form W-9 requester) who is required to fle an
infomjation retum with tfte IRS must oblain your correct taxpayer
identifcatior� num6er (Tlhi} whictt may bs yoursooial security nurnber
[SSM, individual taxpayer identi#ication numtier (fTIN), adoption
iaxpayer identiflcafton number (ATIN), ar empfoyer identiftcatRon nurnber
(EINj, to report an an information return the amaunt paid ta you, or other
amount reporfable on an informat[on return. Exampfes of information
returns inClude, I�ut are nat limited fa, the following.
� Form 1099-1NT {Interest eamed or paEdj
'►-Farm 1099-D4V [dividends, ine[uding those from stac3cs or mutuaE
tunds)
• Form 1099-M15C (various types of income, priaes, awards, or grass
pracseds)
• Farm 1099-6 (siock.vr m�tual fund safes and certain ot6er
transactions by hrakersj
• Form 1099-5 (proceeds from real estate transacEions}
�. Fnrm 1489-K (merchant card and third party neEwgrk trar�sactionsj
• Forrr� 1096 (home mortgage interestj, 1 o98-E. (stvdent ioan interesi),
1 Q9$-T {tu€tion)
• Fortii 'E 099-C {canceled debty
• Fom-i 1099-A (acquisition or abandonment af secured propertyy
iJse �orm W-9 oniy if yoe� are a U_5: person (innluding a resident
aiien}, Eo provide yoiir comectTlN.
!f yau da not return Form W-9 fo the requester with a TIN, ypu rr�ight
be subject fo backt�p withhdlding. See 4V�rat is backup withktolding,
lafer.
CaS, No. 10231 X Form W-s (Rev. t 0-2019)
I .
�� � � � %
�
1�007 Research Baulevard ° Austin, Texas 78759-2439 • PH: 80Q-695-2919 °�uv�oard.com
11ENDOR ��IViACT IIVFORMA'fI�N
� Vendar shall provide the requested Vendor Confact Infarmation in the electronic praposal submission sysi<
including cantract, purchase order, RFQ, and invorce contacts (or, ifsu6mittinq a hard copy Proposal, iim�:� .
requestand complete the I�er�drarConCaci'Informatian form in accordance c�s�ith theTnstructions to Proposer
F�DER►4L AND SiA� PURCH�ING ��O�EF�ATN� E�LI�I�NCE
�i�e Cooperative stri�es to provide Cooperative members with the best service5 and products at the best prices a�ailable fr�
Vendors with the technical resoUrces and abifity to serve Cooperative members. Please respond tv the foiiowing questia� �.
1. Provide tF�e dollar value of sales to ar through purchasing cooperatives at or based on an establ�shed cataing or mar'�
price during �he pTevious �2-month period or the last fiscal year: $ 5�; :'��'� 1, j_�"�_�':` {The period of the 12-rno�
period is �� �2C''� ;' "'._:_`;__). In the event that a doi[ar �alue is not �n �i�j�ropriate measure of the sales, provi.
and describe your own measure of ti�e sales of the item(s}.
2. By submitting a proposal, you agree that, based on your wr€�ten discouriting paficies, the discounts you afFer �
Cooperative are equal to or better than the best price you offer other purchasing cooperatives for the same items unc
equivalent circumstances.
3. Provide the information requested below for other purcE�asing cooperati�es for which Proposer currently serves, or
the past f�as served, as an awarded vendor, Rows should be added ta accommadate as ma�y purchasing cooperati}•
—as_r�qui�ced..
-,�:a
1. �ederaf General Se��ices Admir;istration
2. T-PAS5 (State oP Texas)
3. OMf�IA Partners
4. Sourcewell (NJPA)
5. E&I Coop�rati�e
6. Houston-Gafveston Area Cnuncil (HGAC)
7. Choi�e Partners
8. The Interlacal Purchasing 5ystem (TIPS)
9. Qther ' ti. , ' ... ..,
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❑ r�Y �o���,�v �oes �o� �u����r�.v ��v� A�� o� �r�� ���ve o� si�aa.�� �r�� co�r�cr�.
�u���r��r �a�v�o��o ��H�o�s
If you are a current BuyBoard �endor in the same cantract category as proposed in this Propasal In�itation, indicate `
discount for your current BuyBoard cantract and the propased discount in this Proposal. Explain any difference between yc
current and proposed discoun�.s.
�9JPP�IAt �95CQU[i� (Q%a): 4�% up to B2% �raposed Discmunt (a/n): ��% �� t0 �2%
Expla�ation: W��� rising raw ma#ierl cost cfiscounis wiil rerr�ain the same
Paga 27 of 72
Proposal F^.rr5 �oMMJsVCS v.oa.11.2027
� B�arrda
.,uF�c,r,�sr,4c c�a,•r�:sT;v�
12007 Research Boule�ard ' Aust[n, Texas 78759-2439 • PH: 800-595-2919 • buvboard.cam
G�iIERNMEfVYAL REFEREIVCES
For your Proposa! to be considered, yo� must suppiy a minimum of five (5} individual go�ernmental entity references. -
Coaperative may contact any ar�d al[ referenCes provided as par� of the Praposal evaluation. �rovide the information request�
beEow, incfuding the existing pricirsg/discounts yau o�Fer eaci� customer. The Cooperati�e may deterrnine rvhet�
pricing/d�scounts are fair a�d reasonable by comparing p�icing/discaunts stated in your Proposal wikh the pricing/discou�
you offer other governmenta! custamers. Attath ac{ditional pages if necess�n/.
��a�r��a�!
Entit IVaee9e �ontae� �hoe��# �reiaii,4dclr�ss �is�o��ot V�I�evae
� , 'f � /�
�. �..- —�_.�._!..:.'�_ t-r� ��-�%�L`I � %'`7��'1 �l�%C.�r�;��� rs'' {���.�1i�>t. _ � `�"�'__-
�..—
t
3. ' '7�1 � f -��i t'f_"�r;� ,% "�/ c/C'3 ��3`7_x ��`��1 ����,�1�. ��
�, Ia �,L� ^ .�-� l , / � s _ Tc 1
4."''�-"UT��'��L�1�C�'.� `5'�45�1 �'il�fZ�4 ���`�/� S��C%°���-���n�42_�� P�',4,�C.��r�v�x��
- a
5. _ r r I �L �� �l �; I nl/ r `�� � � 1 f'�-� f TFI� r �` i �,��./;!� � �� — ?/�'/ � �, �.h!,��',,�' , , _ ,�
Do yau ever modify your written pali�ies or standard o ernmental saies practices as identified in the abo�e chart to give
better discounts (lower pricing) than fndicated? VE���dO ❑ If YES, please explain:
� � -;r � � . ; � ,,�-,� :� �� ;'� �'� - - - - � � � �' i � -
— --�.—�-- - `.._—.. -- �.L -=i= �_�__ - — - _.. :
%��1�'�-� -,rr���,�1_ r� '-:<, ` �T,`r�`��� �/ �,,�, ��,_ E � -.�./ /,�,��,. �ti ��
�..
'�i� l�. I�,;,� ' �. �� - .,
� "' ' �!;
I�formation on awarded Caop�rative Contracts is availabfe to Cooperative Members an the BuySoard website. If yc
�ompany is awarded a Contract under this Proposal Invitation, P[ease pro�ide a brief company description that you wot
lilce to ha�e ineluded with your �ompany �rofile on the BuyBoard website. .�'iufuese�� y�aa� �ar8a��ny p�o�le iro a s�p��-
f@s, i� 1�1��€� ff�rmat, vvith yo�ar Po�oposa8. l�lote: Vendor is sole]y responsible for any con�ent pravided for inclusion �
the BuyBoard website. The Cooperative reser�es the right to excfude ar remo�e any content in its sole discretifln, with
without pripr notice, incEuding but not ]imited to any content deemed by the Cooperative to be inappropriate, irr�=,}evar�
the Contract, inaccurate, or misleading.)
Page 26 of 72
Pm�sa€ F�rT= COMMf5VC5 v.08.11.2021
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120D7 Research Boulevard • AusCin, Texas 78759-2439 • PH; 800-695-2914 ° buyboard.com
TEXAS REGI�NEIL SEI2�/ICE DESICIYAiIQN
' This form must 6e comp/eted in the e/ectronic prnpasa/ su6mission system (or, ifsu6rnitten� � h�r��' co
Pra�osal� timeJ�request and complete the form in accordance �vith the Instructir�ns t� f�rOppSzrs ,__
The Caoperative (referred to as "Texas Coaperative" in this form and in the State Service �esignation form) o�fers vend�
the oppartunity to service its members throughout the entire State of 7�xas. In the electronic proposal submission syster
you must indicate if yau will se�vice Texas Cooperati�e members statewide or, if you do nat plan to service all Tex=
Cooperative members statewide, you m�s� irtdicate the specific regions you wil! service. If you propose to serve differe
regions for di`ferent products or senrices included ir� your Proposal� you must complete and s�bmit a separate Texas Regior
Servic� Desicnatian forrn for each group of praducis and cEearly inclicate the producfs or services to which the designat�:
applies. (A��utional �arms ��r� Ire ob$aoeae� flsy cont�c:tuaay bids@buvboard..rom at least fi�e {5� business days prior
the Proposal_D�e Date. Bydesignating a region or regions, you are certifying that yau ar� autharizedand vvlif`
to provide t�e proposed praducts and services in tho.se regions. Designating regions in which you are eit�
una6le or un willing to pra �ide the speclfied products and services shall be graunds for either rej�cti�R of yr
Proposal or, ifarvarded, termination afyour Cantract. Additionally, if you do not plan to service Texas Cooperat�
members {i.e., if you wil� service only states ether than Texas), ou must sa indicate an ti�e form in the eiectronic ro o-
submission systern.
R?c�ional Educafion Service �e����•s
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4 Hous�on
5 Beaumont
6 Hunts�ille
7 Kilgore
8 Mount Pleasant
9 Wichita Falls
10 Richardson
11 Fort Worth
12 waCO
13 Austin
14� Abiiene
15 San Angelo
�.6 Amarillo
17 �ubbock
18 Midland
19 EI Paso
ZO San Antonia
Page 29 of 72
PropoSal Fpfmg [OMMJNCS v.08-U.2021
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12007 R�search 6oulevard ° Austin, Texas 78759-2439 • PM: 800-695-2919 • FAX: 800-21l-5454 ° buvboard.com
�T{�TE �ERI/YCE �FSIGIVAT'Y�D�t
ihis form must 6e cnmpleted in th� electronic,�raposal su6mission system tUr, ifsu6mittinq � hard co�;>_
Proposal, timel� request and complete the in accordance wrth thc� Instructro�7s t� Pro�asers�.
As set forth in tF�e Pr-aposal Invitation, it is the Cooperative's intent that other go�ernmentaf entities in the United 5tates ��
the opportunity to purchase goods or services ai�rarded under the Contract, subject to applicable state law, through a pig,
back award or simifar agreemen� thro�gh the f�atianal Purchasing Caoperati�e BuyBoard. IF you plan to service the en�f
United 5tates or anly specific states, you must complete the State Service Desiqnatiors i�formation in the electronic proAoG
submission system. (NotP • If you plan to service Tsxas Caoperative mem6ers, be sure that you complete th� Texas R�gio,-
Service Designation form,) In addition to this form, to 6e considered far a piggy back aa�vard by the IVatiar
Purchasing Coaperati�e, you must have an autharired represPr�fative sign the IVational Purchas:��
Cooperative f/endorAward,4gresmenf that follvws this page.
If you serve d��ferent states for differenx prnducts or services included in your Proposal, you must complete and submi�
separate State Service Designatio� form far each group of products ar�d clearly indicate the products or ser�ices ko which t`
designatian applies. d,4ddit4aroai fforraas can be obtain�� @ry ema�tactin� 9�ids btr �Sa�rc9,co�n at least five {5� busin�
days prior to the Proposal Due Date.l By desi,gnating a state or sfates, you are certiFying that yau are authori�-
and willing to provide the proposed prodvcts and services in thase states. Designating states in czrhich you �
either una6le or unwilling to pravide the sDecified products and services shall 6e grnunds for either rejecti
of your Proposal ar, if awarded, termination of your Contract.
•� �3 will service all states in the United States.
-- —�—riltnot ser��ce alf st�es in fh� United-S a es.
Alabama
Alasf�a
Arizona
Arkansas
California (Public Contract Cod�: 2D118 & 20652)
Colorado
Connecticut
Delaware
District of Calumbia
Flo�ida
Georgia
Hawdii
Idaho
Illinais
Indiana
Iowa
Kansas
Ken�ucky
Louisiana
Maine
Mary[and
Massachuse�s
Michigan
Minnesota
Mississippi
Missouri
Mor�tana
Nebraska
Ne�ada
New Hampsi�ire
New Jessey
New Mexico
�lew York
€Vorth Carolina
North Dakota
ahia
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
5outh Dakota
Tennessee
Texas
Uta h
Vermont
Virginia
Washington
West Virgi�ia
Wiscansin
Wyoming
Yropcsal Forms C6MM/NCS v.08.11.20�1
Page 30 of 7Z
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12007 Research Boulev�rd ° Austin, Texas 76759-2439 � PH: 800-695-2919 ° FAX: 800-21E-5�354 ° buvboard.com
IVATI�IVAL PURC1ii4SI1VG COOPERATIVE VENDO� AV41AR� �IGR��M�Ni
In accordance with the Terrns and Conditions associated with this Proposal In�itation, a contraet awarded under this Prapo=
Invitaiion may be "piggy-backed" 6y anot�er governmental entity. The Natianal Purchasing Cooperative is �
intergovernmental purchasing cooperative formed by certain school districts outside of Texas to ser�e its rr}embers throughc
the United States. If you agree to be considered for a piggy-baCk award by the Natianai Purchasing Caopera�i�e, yau agr�
to the following terms and agree to se�'ve iVa�iona! Purchasing Cooperafi�e mernb�rs in the states you ha�e indicated an t
State 5ervice Designation form, in your Propasal.
��j �Sii�139f1 J til1S �O�iP3� P�o�oser (r�%rred #� �� this Ags�eerv�ent as "Vendo�"� aga�ees as fo9��vvs:
1. Vendor acknowledges that if The Local Governrr�ent Purchasing Cooperati�e ("Texas Cooperati�e") awards Vendo�
tontra�t under tF�is Proposal In��tat�on ("Under�ying Award'�, the Natio�al Purchasing Cooperative ("iVational Cooperaii�e
may - but is not required to -"piggy-back" on or re-award all or a poriion af that Underlying Award ("�iggy-Back Awara
By signing this Natianal Cooperati�e Vendor Award Agreement {"Agreement'�, Vendor accepts and agrees to be bound
any such Piggy-Ba�k Award as pro�ided for herein.
2. In the event �lational Cooperarive awards Vendor a Piggy-Back Award, the National Caoperati�e Aclministrator ("BuyBo=
Administrator'� will natify Vendor [n writing of such Piggy-Back Award, which award shall commence on the ef�ective d�
sCated in the Nqtice and end on the expiration date of the Underlying Award, subject to annuaE renewals as authorized
writing by the SuyBoarci Administrator. Vendor zgr�es that no furth�r signature or other action is required of Ver�dor in orr
for the Piggy-Bacic Award and tf�is Agreement to be binding upan Vendor. Vendar further agrees that no interlsneatsons
_cha�es to_�hi_s_A�reement_b.y_VeRdor will. be binding__v_n. lVational_ Cogperative, unless. suc� changes_are_agreed to by___._
BuyBoard Admir�istrator in writing.
3. Vendor agrees that it shali ofFer its goods and services to National Coaperative members at the same unit pricing c
same general te�ms and cond's�ions, subjecC to applicable state laws in the s�are of purchase, as required by the Underly�
Award. However, nothing in this Agreement �revents Vendor from affering Natiana� Coaperat;ve members better (i.e., lo�r��
competitive pricing and more Pavorable terms and conditions than those in the Underlying Award.
4. Vendor hereby agrees and confirms thai it wi!I serve those states it has designated on the Stat� Service Designation Fo;
of this Praposal Invitation. Any changes ta the states designated on the 5tate Service Designation Form m�st be approv_
in writing by the BuyBoard Administrator.
S. Vendar agrees ta pay National Cooperative the service fee pro�ided for in the Underlying Award based on the amaunt
purchases generated �ram f�ational Cooperati�e rnembers through the Piggy-Back Award. Vendar shalf remit paym�nt
Nationa! Coopera�i�e o� such schedule as it saecifies (wY�ich s�,all not be more of�en than monthly). Further, upon reque_
Vendor shall provide Nationaf Cooperative with copies of afl purcF�ase arders generated from Na�ior�al Caoperative membe
vendor invoices, and/or such othter documentation regarding those purchase orders as the Cooperative's administrators rr
require in their reasona6le discretior� for purposes of reviewing ancf veritying purchase acti�ity. Vendor further agrees t�-
National Cooperative sha[I have the righ�, upon reasonable written noti�e, to review Vendor's records per�aining to purchas=
rrtade by Nationa! Cooperative members in order to verify the accuracy of s�rvice fees.
6. Vendor agrees thar the Underlying Award, including its General Terms and Co�ditions, are adopted by reference to `
fulfest exten� such provisions can reasonably �pply to t�e pos�-proposal�[ontract award phase. The rights and responsibilit�
that would orciinarify inure to the Texas Coaperati�e pursuant to the Underlying Award shall inure �a Na�ional Cooperat:�
and, conversely, the rigY�ts and responsibilities that woufd ordinarily inure to Vendor in the lJnderlying Award shall inure
Vendor in this Agreement. Vendar recognizes and agrees that Vendor and NationaE Cooperative are the only parties �o t`
Agreement, and that nothing in khis Agreement has appfication to other third parties, �ncluding the Texas Cooperative. In f
event of conflict be�,veen th:s Agreement and the terms of the Underlying Award, r�e terms of this Agreement shali contr
and then onfy to the extent necessary to recon�ile the conflict.
Proposal F^r�� !'OMiM/SVCS v.08.112621
Page 31 of 72
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�'UFCiIA�'MC LCffFFR;:7:1`�
12007 Research Soulevard ° Austin, Texas 78759-2439 � PH: 800-695-Z919 ° FAX: 800-211-5454 • buvboard.com
7. This Agreement shalf be governed and construed in accordance with the laws of the State of Rhode Island and �enue �
any dispute shafl Ise in the federal distriet caurt of Alexandria, Virginia.
S. Ve€�dor acknowledges and �grees that the award of a Piggy-8ack Award is withir� the sole discretion of Natio-
Cooperative, and that this Agreement does nat take effect unless and until NationaE Coaperative awards Vendor a Piggy-B< �
Award and the BuyBoard Administrator notifies �Jendor in writirtg of such Piggy-Back Award as provided for herein.
WHEREF0�2E, by signing below Ve�dor agrees to the foregoing and warrants that it has the authorsty to enter into `
Agreement.
�6ty�i�e, I�ce
Name of Venr�cr
�.:. :. _ - _
5ignature of Autf�orized Company OFfieiai
667-22
Proposal In�ikation Number
Jo�n �Cir�g
Printed I�ame of Authorized Company Official
� �1'1412021
Date
praposal Farms COM:hISVC$ v.08.11.2fl21
Page 32 of 7Z
-�1 � .� �, -
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i2007 Resear�h Boulevard • Austin, Texas 78759-2439 • PH: 8��-695-2919 ' FAX: 800-211-5454 ' buvhoard.com
LOCATI�N%14UTIiOFtIZE� S�ILER LISTINC�S
If you have more than one location/authorized seller that will servic� a Contract awarded under this Praposai Invitatio�
please 3ist each locatianlauthor�zed seller �elaw. If additional sheets are reqs�ired, please dupiicate ti�ss fo� m as necessar
NOTE: Awarded Vendors shal! remain respon5ible for all aspe[t5 of the Cqntract, including processing of P�rchase Order:
and shall be responsible for the pe�ormance of all locations arsd aukhorized sellers under and in accordance witf� the Contrac
If yau are a product manufacturer and wish to designate Desiynat�d Dealers as defined in the Genera/ Terrr
and Condit;"ans ta receive Cooperative member Purchase Orders on your 6ehalf, ynu must complete trf
I�IanUfacturer Oesiqn�red Dealer form.
Vanguard
Aelicia Bayfess
713-$71-8686 K 1002
aelicia@�anguardenvironments.com
I Total office Solution
�� 1
Baytech Su�ply
; � Navajo OfFice Praducts
��„
In#elligent Int�riors
Babby Sterling
David Yabfonski
Jill Albus
Dilfan Greer
25�-716-0028
bo�by@mytotalaffice. com
21 Q-$28-310D
806-382-2235
jai�us@officewiseco.com
972-716-9979
diilon@3ispaces.cam
Proposal Forms CdMM�SVCS v.08.11.2�21
Page 33 0€ 7Z
' �a��r� ,
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?L�r'.CN,i2P!!� CfnEE++a7i4'F.
i2007 Research Boulevard ' Austin, Texas 78759-2439 � f'M: 800-695-2919 ' FAX: 800-Z11-5454 ' bwboard.com
N�ANU�ACiUREFt DEAIL�IZ DE�IGNATI�I�
If Vendor is a manufacturer tha� sells praduc�s through a dea]er network and w€shes to designate a dealer or m�ltiple dea[E
("Designated Realers'� �o receive Cooperati�e member Purchase Orders on Ve�dar's behaff, you must complete this form `
each deaier you wish to designate.
Regard�ess of any Designated Dealers submitted by Vendor, Vendor specifically agrees and aeknawledges that any s�:
designations are for Vendor's convenience only and shall not, if Vendor is awarded a Contract, relieve Vendar of 2
obfigations under the Contract, including payme�t of Cooperati�e service fees on all Purchase Orders submitted to Vendo�
any Designa�ed Dealer. In accorcfance with the Genera! Terms and Conditions, an awarded Vendor shall remain responsi`
and liable for all of its obligations under the ContracE and t�e performar�ce of both Vendor and any of Vendor's Desigrsa�:
Dealers �r�der and in accordance with ti�e Contract and remain subject to ali remedies for default thereunder, sncluding, �
not lirnit�d to suspension and termination oP Vendor's Contract for nonpayment of se�-vice fees.
If awarded, Vendar authorizes t�e Cooperative, in its sole discretion, to I'sst any Vendor �esignated Dealers in the BuyBo�
system and to recei�e P�rchase Orders direc�ly fsam Cooperative members on behalf vf Vendar. To the extent a Vendor v�
Designated Dealers recei�es a Purc�ase Order c�irectly, it s�all be CY�e responsibility af Vendor to apprapriately process s�
Purchase Order in ac�ordance with the Cantract, including but not licnited to Cimely forwarding s�tch Purchase brder *c
Designated Dealer far proc�ssing.
The Cooperative reserves the right, in its sole discretion, to refuse add�tion af, or request removal of, any Designated �eai�
and Vendor agrees to imrnediate[y require such Designated Dealer to cease actepting Purchase Orders or otherwise aCc�
on Vendor's behalf under the Contract. Further, the Cooperative administrator shal! be au�horized ta remo�e or suspend a
or all Designated Dealers from the BuyBoard at any time in its sole discretion.
If you wish to designate a dealer to servi�e a contract awarded under this Pro�osal Invitation, please list the Des4gnat-
Dealer below. I� you wish to designate multiple dealers, p[ease duplicate this form as necessary.
�.
besignated aealer Name
Designated Dealer Address
City
Phone Number
Email address
Desigrtated Dealer Contact Person
State Zip
Fax Number
Designated Dea4er Tax iD Nurnber* (*�ttach �1-9p
Proposal Forms CO^^^^`SVCS v.o8.11.2ou
Page 34 of 72
� � ��ard�
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12007 Research Boulevard ' Austir�, Texas 7$759-2439 ' PH: 800-695-2919 • FAX: $OQ-211-5454 ' buvboard_com
PRC3POSAL IN'li'ZTAiYON UESTIONNAIR�
The Cooperati�e wi[I use your responses to the questions �elow in e�aluating your Proposaf and technical and finanr
resou�ces to provide the gaods and pe�form ihe services ("Wark'� under the Buy6oard cantract contemplated by t�is Propoe
Invitation ("Contract`�. Proposers must fully answer eaci� question, numbering your responses to correspond to �
questionslnumbers be{ow. F�oposers snust complete below ar attac� yaur responses to this queslionnaire and submit in e
document with your Proposal. Yae� Pnust subrt9i$ the �uestionnai�e a�td r�spo�ss�s rrva#h ymvu� �r�posai �� "�
Rr�po�a8 �ral� r�ot be cos�s"s�l��e�.
1. List the nurnber of years Pro�oser has f�een in business arsd forrr�er business names (if applicable}. iVote whether y�
company is currently For sale or in�al�ed in any transaction khat would significantly alter its business or result in acquisit'.:.
by anoth2r entity.
n/IitvL�te vvas established ir� � 987, so 34 years in b�si�e��4
11Ve are not �or sa��
2. Describe the resources Pro�vser has to manage staff and successfully perfarm the Work contemplated under t;
_ — _.Contract��tateibe�umber_an�summariz�th��xp�'ience �f_�ompa.n.y_.�?ef_s_v_nne.l_.wh4_.may_be utilized for the Wo�
incfuciing those who will be available to Cooperative members far assistance with project de�e�opment, technical issu�.
and product seEection for Work associated v�rith this Contract.
MityLite has a profesionla safes force. Wit hcustoemr service for post sales support and warranty issues if any.
VUe �a�u��ture �ur furnitu�e er� �hree p[ants on �9or�h �mer�ca�
3. E+A�rlcefione� S�ra$eclb: For your P�aposal to 6e considered, you must submit the Marketing Strategy you will �se ifi'�
Cooperative accepts ail ar part of your Proposal. (Example: Explain how your campany wiU initially rn�orm Coop�rat
mem6ers of your BuyBoard Cantract, and hvc�v you �vill �ontinue to support the BuyBoard far t-he duration of the Contr
term.)At�ach ac€ditional pages if necessary.
M�tyLite has a fully staffed ma�ke#ing team, Email notifications of current
rorr�afiians. And r�ew produc� releases
ProA�sal Porms COMMI��S v.OB.A1,�o21
Page 35 of 72
' �o�r���
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12007 Research Baufevard ' Austin, Texas 78759-2439 ' PH: 800-695-2919 ' FAX; 800-2�1-5454 ° buvk�aard.com
4. Describe Proposer's financial capability to pertorm the Contract. State or describe the firrr�'s financial strength and rati�
�onding capacity, and insurance coverage iirr�its. State whether the firm, or any of the �irrr3's past or present owne
printipa� shareholders or stockho�ders, or officers, have been a debtor party to a bar�Krupfty, re�ei��r<hip, or insa[ver
praceeding i� the last 7 years, and identify any such debtor party by name and relationsf�ip to or posifion wik� your fr:
� i S_ f j,� ��+� i' �� lt�f�r ft' �:: F, ��� _.�:� ;r,� ri f.. `'y i
�- , .� �-v -�.1 -:,_� ; � � L �-�`_ i' ; >�.� ���il � ��' �. -
� _ - . .�. �.�-�— , , �---„�1 L. . _ . ; .� �� ,
M iT�!( tT� l-��iS' n1I'`T ��'�'C-� �� ���lK�!%�.,L, �1���, ��
��',��-- �.� �`����_ _�f�r ��%��_;,!' _��.
5. Does your company have any outstanding financial judgments and/or is it currenkly in default nn any foan or finar,�'
agreement? ff so, provide detailed inforrrtation on the nature af such items and prospects far resolution.
�r /
` � � '; ,r� ;� t � ;� r'! ! � �!�j' 1 �)������.� � � � Lf ._ �:.: ,�c .
b. -List-aEFeontraets� if-any,-in-the-last-lo-years-orrwhieh-Pfaposer-has de€at�lted! failed-to-cc�rtpE�te or-deliver-��e-�,vork,--
that have been termi�ated for any reason. For each such tontract, provide the project name, seope, �alue and date �
the nar�e of the procuring entity. Fully explain the tircumstantes of the default, failure to complete or deliver the w�
or termination.
7. List all litigation or other iegal proceedings (�ncluding arbitration proceedings), if any, in the last 10 years 6rought agai-
your firm, or any of the f�rm's past or present owners, principai shareholders or stockholders, officers, agents
employees, that reEate ta or arise Prom a contract similar to this Contract or the Work contemplated under this Cantrz .
Provide the style of the lawsuit or proceeding (name of parties and caurt or tribuna[ in which fiied), nature of the cla'.
and r�solution or curre�t siatus.
.
PropoSal FOrmS COMMf5VC5 v.fl8.11.2o21
Page 3b of 72
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12007 Research 6oulevard ' Austin, Texas 78759-2439 • PH: 800-695-2919 ° FAX: 80Q-211-5454 • buv6oardTcom
9/EiVD�R ��` I�EST T� SELF�RERORT Bl1Y�OARD PURCFiASE�
The General Terms and Conditians require tha� a!I Purchase Orders generated by or under any ContraCt awarded under t��
Proposal In�itation he processed through the BuyBoard and, except as expressly authorized in writing by the Caoperat�
administrator, Vendors are not autharized to �rocess Purchase Orders receiv�d directly from Caoperative members that ha
not been processed thraugh the BuyBoard or provided ta the Cooperafive. In accordance with this prpvision, Vendor m�
request authorization of khe Cooperati�e administrator to self-repori Cooperati�e member pur�hases if awarded a Cflntr�
under this Proposal In�itatian. By making such a rec{uest, Vendor acfcnowfedges and agrees ti�at self-r�porting is s�ecific,
subje�t Co artd conditioned upo� (1) Vendar's agreem�nt to the Additionai Terms and ConditioRs for BuyBoard Self-R2porti.
which are included in this Proposal Fnvitation and incorporated herein for alE purposes and (2) appraval of this requesfi
writi�g by the Caoperative admsnistrator.
Note: This �orm Is NOT required as part of your proposal. You should sign and return this form OI�L Y if y
wish to request auihorization �o sel� report BuyBoard purchases, Any requesi fio self-repo�t will not be effect��
and Vendor shafl not be authorized to self-report BuyBoard member purchases, unless and �nti1 (1) Vendor is awardec
ConEract under this Praposal In�itation, and (Z} the request fias been approv�d in writing by the Caoperative admi�istra�c
By my signature 6elor�, I hereby request authorization from the Covperati�e administrator �o sElf-re�r
BuyBoard purchases ifmy campany is ac�varded a Contract. I certify that I am authorized 6y the a6ove-nar.�
Vendor to apprave this farm, and I have recei�ed and read the Additional r�rms and Conditions for BuyBo�
Self Reporting included in this Prvposal Invitation and do here6y apprave and agree to such terms G
_....__ _ _ conditian�r��11�l�v�V_en.dot - — — -
�v�rn� o� ��n�oo9t: �8��/�I��, D IICe
Signature off l/ea�dor Aa�t�ao�6zeai &��p��s�ntat�iv�
������� ����: J o� r� K� n g
Tit�O: ��Y. �C�. 1�ic� h�/I�L tlC����
ID���: I o9 7�1 LOZ !
( For Cooperative Administratar Use QnlyJ
Appror►ed by BuyBoard Adminisfratpr:
Effecti�e/Start Date €ar SeEf-Reporting:
Proposal Fprms COfdM1511C5 v.48.11.2021
Page 37 of 72
� � � � �
12p07 Research Boufevard • Austin, Texas 78759-2439 • PH: $00-695-2919 ° FAX: $QO-211-5454 • bu_yboard.com
PR�PQSAL SPECIFI�ATIOfV �lJNFMARY
7he categories and i�ems s��ecified for this Pwoposal InuitaCion �re su�nrr�arized belowo Far full Propos :
5pecifications, you must review and compie�e tf�e Proposai Specificatiar� ii�foi�mation i� tF�e eEectronic proposE�..
submissivn sysiem in accordance with the Instruc#ions to Proposers (or, if submitting a hard copy Proposal, Yimel�
request and comp�ete the Propasaf 5pecification Form ir� accordance with tl�e Instr�rcCiortis to Proposers},
��€o�OSd1L INOTE: Vendors shall sUbmit catalag(s)/pricelist{s} with their Proposal response or the Proposal wili noE -
considered. Vendors snall submit cataiog(s)/pricelist(s) with the Proposal in a readily available and readaale electronic �arm<
with �xcel or searc�able PbF preferred. �4v pane� �a�alv4s o� enanufactur�erlver�dar �nre9ssit�.� wi�� �e acce�te�.
Settim€a I: F��na��s�� f�r �9as�rv�ms, �ampus, and Schoo9s
1. Discount {%) off tatalog�price[ist for A�I C�a.ssr��a�t anai �c�amol Ea�rniture.
2. Discount (°/a) off [atalag/pricelist for,��8 A�a���oroaaata Seating Fur�iture.
3. Discount (%) aff catalog/pricelist for A9� �af�:tea�aa/�ieaang i��om �ur�eitusre.
�. Discount (°/o) off catalag/pricelist for AV! Dori�itoay F�arrai$n�r�.
5. Qiscount (%) off catalog�pricelist for A!! 9.u�sr�ry Fa�rnitr.ar�,
6. Discou�t (°/o) off catalog/pricelist for A91 Scierr�€ ���orafory Furnitaare.
7, bisco�nt (%} aff catalog�pricelist for,4B8 Oth�r �c@ucaEi�n ReHate� Furnit�ar� �ead P�oa�uc�s.
sect,oe� aa: F��raitwr� for �e�suness, O��e, a¢�d I�Iark�nP�ee
8� Di�coun� ��lo-)-o�F�a�a4ogfPriceiist €or-e419 O��e �a���ei��r , — _
9. Discount (%) ofF catalog/pricelist for D.l1 PR�dIu�BaP Fur�itea�e (fVeu�).
10. [3iscount (%) off catalag/pricelist for AIP �iad�lar F�srnitc�r� (Refus�9�isPoe��e
11. Discaunt (%) off catalog/pricelist for A�6 �ourtroorn F�rni�a�r�.
12. �iscaunt (%) off catalog�pricelist for A@9 �hu��h ao�d Religp�us Faarnitu�e.
13. Discaunt {%) off cata[og/pricelist for AIQ 9��althe�re ��ara�iture.
14. Discount (%) off cata[og�'pr;celist for AE� Oih�r �3a�s�ness and lAlorlcplac� F�srra��u�e,
Settim� YII: ��aa�a�i�aur� f�� S$ora � 1AlaliS Pane95 artcl A�cessaries
15. Disco�nt (%) off catalog/pricelist for All Filieag Cabi�ro�ts.
16. �iscount (%) off catalog/pricelist for A8! �ocke�� an� �ock�r Products.
17. Discount (%) ofF catalog/pricelist for A�I M1o�eaFsP� Wal1s ancl P2artitioros.
18. Discount (°/a) off cakalog/pr9�elist for i411 Ty�s�s �ff �scoustic Ceiiin�, Vllaltl P��els ae�d �te�ated �7a��roa�s.
19. Discaunt (%) o€f eatalog/pricelist for A[G {1�9@radovn� �reatm�mts.
S�tti�ra YiI: Yn�tta99a�io�e aracl R�paAr �erduc�
20. Fioearly �afsor liata �or Ins�aliation/Repaar S��vice of,411 Types of �urnitur�-- hVot $c� �xceed hourly labor ra:
for Instailation/Repair Service of All Types of Furniture.
21. �er�entage (%) fta$e of �"otae Oa�de� for �nsta9lation of F�ra�iture -- N�t ta Exeeee9 percentage (°/a) �endor r
charge of Total Order Price for Installation nf FuTniture.
-- � r� �p t PR�mdiatc� �er�►iCes
�eetoan �f: �urnota�r� an� � ui rnen
22. �urnit�re a�d Eq�ipme�t Mvv6otg Serrrices - per squara Foot price for f�rniture and equipment tr�oving. Price
incfude alf necessary sUpplies, labor, and related items to complete moving of furnit�re and equipment.
23. R�va�o�a8 aa�� �isposaf of ���s� Ser�ices - per square foat prfce for Ene rema�al and disposal of trash. Price to ir�cl�-
all necessary supplies, labor, and related items to complete rerrsoval and disposal of trash.
Proposal Farms COM�a�SVCS v.08.1f.262I
Page 38 of 72
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12007 Research Baulevard • Austin, Texas 78759-2439 • PH: $00-695-2919 ' FAX: 800-211-5454 ' buv%oard.cr_:m
Secti�ra 1/Y: �ro �sa! FVo. f�3'-22 - Furrai�ure for School, Office. Sci�nce. �ibraey and �orr�eitotv: �/A�UATl�1N I�P�d��
1. Information under 5ection VI is requested and will be used only for purposes of assisfing in the evaluation of Ver�dor .
price competitiveness. Ti�ese oterras ►n�ill no� be indidid[�ally �uvarded, THE FOLLdN1ING EVALUATION ITEMS MUST �3 -
COMPI.ETED FOR E�iE9ER TF�E AS SPE�IF%�D �R ALT��,F9A�E &�RO�Dl9�a Equal alternates rrtay be su6mitted anly
you do nof seil the specifc prod�ct Ifsted. Evaluation items must be fully complet�ci and submi�ted, or the PRQPOSAL W�L
NOT B� CONSIDER�D.
2,1/endors s9�aIR g�robid� A� S�ECYFT�D 00� A�TEFt�IA�E PFtOD41CT pricing based an the fol[owing pricing structure.
[Calc��lated B�iyBoard Price (cataloc�/pr�icelist price less disco��nt proposed = BuyBoard Price)]
3. Vendars that do r�ot oFfer any af tfne evaluation or alt�rnate items listed below s1naVV sut�rvait a v�rritt�� �xr�9��oa�aou� ��
��ca��st �xem�$ioan from this reqt�irement. The Cooperati�e may determine, in its sale discretior�, whether or not to exem::
a Vendor from this repuirement based on all information pro�ided with the Proposal.
24. IErr�Da��ta�a� IIt�e�a �9�0 �, — Spe�if�c4 �u�a�t9, ��d�9� �rod �OP�: Virco — 9000 5eries 4-Leg Stack Chair (#9418);
Qty. 1; Size: 18 in. seat height; Calor: Na�y Blue; Four !eg ehrome; For Classroom Seating.
Z5. EdaDu��Bo� Itena No. 2— Sp�ci��ad ���atd, f��a4el, and il�R�: Virco — 9000 5eries Chair and Student �esk Cornba
(#940QBR); Qty. 1; Size: 1$ in. seat height; Color: Navy B[ue/Grey; Laminate top; Four leg chrome; 800krack; For
Classroom Seating.
26. �vale��ti�s� II�em N�. 3� S�Se�if�c� �r�n�, M�s�e➢, anci H90l�: Virco — Cafeteria Table with Round Stopis
(#MT517291212); Qty. 1; 7abie height: Z9”; Seat height: 17'; 1Z raund stoo[s; Table frame; Chrome legs; Chair Color
Navy Bfue; Laminate surFace: Grey; Edge Banding: B�ack.
27.-�ata�a�u�ra ft�-�'n-No� �_��e�i�iea�-��a�c6, �e6, an¢i-U�I�Di�ers�fied-VVoodc�afts--�ciagon 5cience cab
Workstation (#1514KF); Qty. 1; Four drawer base (56" Diameter); So{id 1" epoxy resin top.
z8, �er�6u��i�rn II�e� N�, 5—��esifie¢9 �r�eae�, h�lodeG, �rs�l �9�P�: Hon — Task Chair {#59Q1); Qty. 1; Color: Biue;
Grade 4 fabric; ArmEess; 360 Degree Swivel; �ilt Tension and Lo�k; Black Sase.
29. E�ral¢�a�doea iterrt No. 6—�p��6f�ee� �a�a��, �Rocl�I, �nci 4901M9e Gfoba! — Lateral Fi1e Cabinet (#9342-3F1H); Qry. 1;
5ize: 42" Wide; 3-Drawer, Color: Black; Center pull co�figuratian.
3D. �va����io� II�eeai iVoo 7—��n�si�iesll ���nd, PR�deE, a�ad l���WWo Hon — 10700 Series U-Workstatian (Single €�edesta`
Right Desk H10785R, Bridge H10770, and 5ingle Pedestal Credenza Hk�746L); Qty, i,; Size: Desk-72"W x 35"�, Bridge
47"W, Credenza-72"W x 24"D; Laminate; Color; �lahogany.
Proposal Form5 COMM/SVCS v.O8.11.1d21
Fage 39 of 72
' ��ar�-
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12047 Research Baulevard • Austin, T�xas 78759-2439 � PH: 800-695-2919 ° FAX: 8Qp-211-5454 •#�uvbo,�r�'.com
R� uz��� Fo��� ������z��
{Please check {J} the Following)
❑� Reviewed/Cor�p�eted: 9����oser's Acceptance aaad Agr�em�rat
�EL�P05AL ��irN95 RART 1: ��M�LYA�1lCE FQRF7S
� ReviewedlCompleE�d: �r�p�sa9 Ackuaovvle�c�e�a�¢��s
u Reviewed/Completed: ��9ony ��n�dcfaon Diselosaare
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ReviewedlComp�eted: IR��acieart/N�nr�sialen� C�rta���,�ti�n
Reviewed Com leted: De�s�rra�eaat �ertifaca�ian
Re�iewed/CampEeted: l/enc9�� �ffea�lmyrroen'k ��ataff�ca�iora
Reviewed/Campfeted: �9+s �o}�c��ft V�o�"s�aca�aon
Reviewed/Completed: Ne� Exe�ead�d �Iatior� �r �vr�ige� �err�ris� Oa�g��'azatimeo ��r�ifoc�$uo�
Re�iewed Com I�ted: 7�ist�reca�9y [�sader�t�9iz�d �usiu��ss �ea�e��at��ra
Reviewed/Completed: Aa.ka��wa�dg�ra�a�nt m� 6eay��a�� Teshr�icaB Fteqvia�eenents
Reviewed/Corr�pleted: �v�a�trut���av-��9at�c� ���ds �nd S�rvices 4�rat��tu�ra
0 Reviewed/Com�eted; ��:wuati��a �sad �ara�g��i�ea�e
Q Re�iewed Com leted: llenc�or Co�sea�� for �9ara�e �r�rus9 �Ds�
�Reuievued -Gam let�d; -����de��i�6��rc►�Sa���a�sa����a�io� - _ —
� Reviewecf/Completed: ���A� V�r�d�r ��a�i#acataon
[]. Reviewed/Completed: �o¢�p9iance ��a�¢vas �i�na�a�r� �ag�
�=R�POSAL IFORA95 PA6iT �: VEPlUOR YNFOlth9A7'IOfV �QRIWS
� Reviewed/Compfeterf: Ve�odo� �usines� Nam�
�a.
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Reviewed/Campleted: 192�9tI�Y �oi���� In$�rrs���io�B (completem electronicpropasalsu6m;ssionsystem�
Reviewed/Cornaleted: ��dera! �rod S���e/P�srcha�iee� �oaperatiV� Exp�ri�roce
ReviewedlCompleted: i�csr�ersa¢�ue���l Refie�e�e�s
ReviewedlCom,pleted: �osng�a�oy ��of�9e
ReVleWed.(COmpleted: T�X�� 9S�t�l�P➢�I S��vviC� ��SI�P��$906� (complete rn eledronicproposalsubmission systemJ
R@vl�wed/COmpleted: S$�$�5��'Ni�� �£',Sigpla$iU99 (mmpleteinelectronicproposalsutrmissronsystemJ
Reviewed/Compieted: 8�a�iana! �aarc4�a�ing C�gse�ative Ves�e��r dlu�►arc� Agr�e�ne¢a� �uendors servin9 autsirle rexas on�j.
Re�iewed/Completecl: �.eac�f/Aut��riaed Se09er ���tings
Reviewet!/CorrEpl2ted: 6�anuga�aau��r �ea�er �esigna�ts�ra
Re�iewed/Completed: �s��s�sa9 inrrotati�ra Qu�staor+nair�
Re�iewed/Complet�d: ��neior R�sp�uest to �elff-I�eport �a�y�aaarai Poar�ha��s (option��1
�] Re�iewed/Cornpleted: ProposaV �peci�catoons �iscount (%J off Catalog/Pricelist and/or other required pric,`
information including Cata/oqs/Pricelists (or na brd responseJ must 6e submrtted wrth �he Propcsal ar the Proposal avi// r
6e considered aaatt �ualu�ti�� �t�ans.
Prapcsal Forms COMPIISVCS v.�8.11.i021
Page 40 of 7Z
Mity-Lite Information
Acfdress: 1301 West 40� North
Orem, UT 84Q57
Phone: {800) 795-0678
Fax: (801) 22�-619�
8y submitting yaur response, you certify that you ai'e authorized to represent and bind your company.
JOHN KING
Srgr7ature
Scrbrrlrtted at 70/27/2029 92:42:00 PM
Reauested Attachments
john. king@mityinc.coi�� _
�rn�i!
BuyBoard Proposal Invitation No. 6fi7-22 Furniture for 5chool, Office, Praposal part 1& 2-combined.pdf
Science, L�brary and �ormitary
R�QUIR�D-In PDF format, upload all proposal invitation documents a�aiEable for download at ver�dor buyboard.cam
including any additional pages, as necessary. (Please DO NOT password protect uploaded files.)
Exceptions ar�dlflr Detailed Information Related to Discotant % andlor Wourly Labar Rate Na response
Proposed
Ir� PDF format and if necessary, vendor shall attach detailed information regarding excep#ions to pricing andlor
discount percentage and defit�e the services that are proposed to be pro�ided. NOTE: IF DETAILED INFORMATION IS
NOT SlJBN11T7ED, PROPOSAL MAY NOT BE CON5IDEREL. (Please DO NOT password protect uploaded files.)
Comp�ny Profiile 2021 MITY Incorporated Presentatiors Oeck.pdf
REQUIRED-Informafian an awarded Cooperative Cai}tracts is available to Cooperati�e Members on tl�s BuyBoard
we�site. If yaur campany is awarded a Contract under this Propasal In�itation, please provide a brief company
description th�at yo� woufd like to have included with your company profile on the BuyBoard website. Submlt your
company profile in a separate file, in Word farmat, with your Pro�asal. (Nate: Venclor is solely responsible far any
content provided for inclusion ar� t��e BuyBoard website. The Cooperati�e reserves the right to excl�de or ren�o�e any
content in its sole discretion, with or withaut prinr notice, including but not limited to any conter�t deemed by the
Cooperati�e io be inappropriate, irrele�ant to the Contract, inaccurate, or rr�isleading.)
CataloglPricelist
BuyBoard 2022 price sheet.xlsx
REQUIRED-In Excel or PDF format, upload catalaglpricelist in proposal ir�vitation instr-uctions. Vendors shall submit
catalog(s)Ipricelist(s) with their Proposal response or Proposal will nat be considered. No paper cakalogs or
manufacturerl�endor websites will be accepted. File size must not exceed 100MB. (Piease DO N�T password protect
«pioaded €iles.)
Examption Letter
No response
Vendors that do not affer any ofi the evaluation andlor alternate items shall submit a written letter providing
explanation requesting exemption from this requirement and iden#ify its specialty product line(s).
!RS Form W-9 Request for Taxpayer ldeniification Number and Certification
REQUIREQ-In PDF format, upload W-9 for�n. (Please DO I�O� password protect uploaded files.)
Bid Atfributes
MityLite W-9 2021.pclf
') � HUBlNo Israel Boycokt CertificationlNo Excluded Nation or Foreign Terrarist Certification
HUBINo Israel Boycott CertifieationlNo Excluded Nation or Foreign Terrorist Certification
Page 3 of 3�1 pages Ve:zdor. Mity-Lite b67-22
2 � No Israel Bayco#t Certification
A Texas governmental entity rnay �ot enter into a contract witli a value of �100,000 or �riore that is to be paid wholly
or partly from public funds with a company (excluclinc� � sole proprietorship) that has 1� or more full-time employees
for goods ar services unless the contract contains a written �erification fi'om the con�pany khat it: (1 } does not
boycatt Israel; and (2) will not boycott Israel during the term of the contract. (TEX. GOV'T CODE Ch. 2270).
Accardingly, this certification forrn is included to the extent requirecf !�y law.
"Boycott IsraeE" n�eans refusing to deal with, terminating business activities with, or otherwise t�king any action th�t
is intended to penalize, inflict ecor�omic harm on, or limit commerciaf relations specifically with Israel, or with a
person o�� entity doin� b�isiness In Israel or In an Israell-controlled territory, but does nat include an action made for
ordinary business �urposes. TEX, GOV'T COQE §8D8.001(1).
By signature an the Corr�plianc� Forms Sign�ture Page, to the extent applicable, I certlfy and verify that Vendar
cloes not bQycokt Israel and will not boycatt Israel during the term of any coniract awarded �mder this Proposal
Invitation, that this certification is h-ue, eomplete and acc�.irate, and fhat I am authorized by my company to make this
certificatior�.
Yes
3 � No Excluded I�ation or �oreign Terrorist Organization Certification
Chapter 2252 of the Texas Government Code pro�ides that a Texas governrnental entity n�ay nat enter into a
cantr�ct with a company engaged in active business operatians with Sudan, Iran, or a foreign terrorist orgai�ization
— specifically, any con�pany identified an a list prepared and maintained by the Texas Comptroller under Texas
Governrr�enf Code §§806.051, 807.051, ar 2252.153. (A cornpany that the U.S. Government affirmati�ely declares
to be exclucfed from its federal sanctions regime rel�ting to Sudan, Iran, or any federal sanctions regime refating to
� foreign terrorist organizat�on is not subject ta the contract prohibition.)
By signature on the Compliance Forms Signature Pa�e, I certify and verify that Vendor is not on the Tex�s
Comptraller's list identified above; that this certif}cation is trtie, complete and acc��rate; �nd that I am a��thorized hy
my cornpany ta n�ake this certification.
Yes
4 � MWB�IHUB Sta#us Certifieation
A Propaser that has been certified as a Historicafly Underutilizec� Business (also known as a MinoritylWamen
Busii�ess Enterprise or "MWB�' ar7d all referred to in this form as a"HUB"} is enco�raged to indicate its HUB
certification status when responding to th�s Propasal Invitation. The BuyBoard websiie will i�dicate HUB certifications
for awarded Vendors that praperly indicat� and document their NUB certification on this form.
I certify that my company has been certified as a MWBEIHIJB in the fallowing categories i6rza5e �r�e�r< arr rrt�r
�����ry�
5 Minority Owned Business
Minarity Owned Business
❑ Mrnorrfy Owned Bcrsir�ess (YesJ
6 � Women Owned Business
Women Owned Business
❑ Wor7�en Qwned Business (Yes)
7 I Service-Disabied Veteran Owned Business
Service-Disab�ed Veteran Owned Business (veteran defineci by 38 IJ.S.C. §101(2), wha has a ser�ice-cannected
disability as cfefin�d by 38 U.S.C. § 101(16), and who has a disability rating of 20% or more as deterttiined by the U.
S Departmen# of Veterans Affairs ar Department of Defense)
❑ Service-Disabled Veferan Owned Busrness {YesJ
Page 4 oF34 pages Vc«dor:lVlity-Lite fifi7-22
8 Certification Number
Certificatior� Number
No res�onse
9 Name of Certifying Agency
Gertifying Agency
Na res�Qnse
'i Non-MWBEIHUB
� My company has NOT been ce�tified as a MWBE/HUB
❑✓ Non-HUB (Yes)
Vendor General Contact Information
Proposal�Contract General Contact In�ormation
2 Vendor ProposallContract Contact Name
Vendor Prap�sal/Contract Contact Nan�e
John King
1 Vendor ProposallContrac# Contact E-mail Address
3 Vendor Proposal/Contract Contact E-mail Address
john.king@mityinc.com
1 Vendar �roposallContract Mailing Address
� -1fer��ar-Pra}�osai-ICorttracHHlaifirrg-#ddress—
13�� West 400 Nor�h
1 Vendor PropasailContact Mailing Address - City
� Vendor PropasallContact Mailing Address - Gity
Orerri
1 Vendor PraposailContact Mailing Address - State
6 Vendor ProposallContact Maifing Adclress - State �Ab�reviate Stafe Name)
UT
1 Vendor PropasailContact Mailfng Address - Zip Code
7 Vencfor Pro�asallCantaet Mailinc� Address - Zlp Code
840567
1 Vendor ProposallGontact Phone Number
� Vendor ProposallContact Phone Number (x�c-�cx-xx�j
800-362-5820
1 Vendor ProposallCo�tac# Extensian Number
9 Vendor �ropasallContact Extenslan N�imber
Na respor�se
Pagc 5 of34 pages Vendo��: Ivaity-Lite 667-2Z
2 Campany Website
� Cnmpany Website �www.xxxxx.com)
www.mityinc.com
2 Purchase Orders Contact Information
� All Purchase �rder5 from Cooperative members will be a�ailable khrough lhe Internet. Vendors need I��temet
access and at least one e-mail address so that notification qf new orders can be sent to the li�ternet contact when a
new purcl�ase order arrives. An information guide will be provided fo Vendors to assist them with retrieving their
orders
Pfease seleci options below for receipt of Purchase Orders and provide the requested information:
. I will use the ir�ternet to recei�e Purchase Orders at the following address
Yes
2� Purchase Order E-maii Address
2 Purchase Order E-mail Address
john.king@mityinc.com
2 I Purchase Order Contact Name
3 Purchase Order Contact Name
John King
2 � Purchase Order Contact Phone Numl�er
P�irchase Order Contact Phone Number (xxx-x�-xxxx)
800-362-5820
Z I P�rchase Order Contact Extension Number
� Purchase Order Contact Extension Number
No res�onse
2 I Al�ernate Purchase Order E-mai! Address
� 1 Alternate Purchase �rder E-mail Address
jeff.scott@mityinc.cam
2 I Alternate Purchase Order Contact Name
7 Alterr�ate Purchase Order Contact Nanie
Je�f Scokt
2 Alternate Purchase Qrder Contact Phone Number
$ Aliernate P��rchase Qrder Cantact Phone Number (xxx-xxx-xxxx}
500-795-0678
2 I Aaternate Purchase Order Contact Extensian Number
� Alternate Purchase Order Contact �xtension Num�er
No r-espanse
Page 6 of 34 pages Vendor. Mity-Lite 667-G?
3 Purchase Orders Contact Infarmatioi�
� All Purchase Orders from Cooperative members wiil be available through the Internet. Vendors need fnternet
access and at leasf one e-mail address so that notification of new arders can be ser�t to the Internet cantact when a
new p��rchase order arri�es. An information guide wil! he provided to Vendors to assist them with retrie�ing their
orders.
Please select o�tions below for receipt of Purchase Orders and �ra�ide the requested information:
• Purci�ase Orclers may be received f�y the D�signated beaier(s) identified on my coi�pany's Dealer
D�signatlon form as provided to the Coaperative administrator I ui�derstand that my campany shall remain
responsible for the Contract and the performance af all Qesignated ❑ealers under and in accordance with
the Contract.
Yes
3 I Req��est for Quotes {a€oeRFQa€j
� � Coaperative members wilf send RFQs to you by e-rr�ail, Please provide e-mail addresses for the receipt of �FQs;
3 Request for Quote (RFQ) �-mail Address
2 Request for Quote (RFQ} E-mai! Adcires5
john.king@miiyinc.cam
3 Request for Quote (RFQy Cor�tact Name
� Requ�st for Quote (RFQ) Contac� Name
John King
3 Request for Quote (RFQ) Cor�tact Phone Number
4 Request for Quote (RFQ) Contaet Phone iVumber t�ax-�cx-��
80a-362-5820
3 Request for Quote (RFQ) Contact Extension Number
� Request for Quote (RFQ} Contact Exfension Number
No response
6 Alternate Request for Quote (R�'Q} E-mafl Address
Altemate Request for Quate (RFQ} E-mail Address
Na respot�se
3 Alternate Request for Quate (RFQ) Contact Name
7 Alternate Request for Quate (RFQ) Cantact Name
No response
3 Alternate Request for Quote (RFQ) Cantact Phone Number
$ A�ternate Request for Q�ate {RFQ) Contact Phone Number (xxx-xxx-xxxx)
No response
3 Alter�ate Request for Quote (RFQ) Coniact Extension Nurnber
9 Alternate Request for Quofe (R�Q) Cantact Extension Number
No response
Page 7 of 3�} pages Vendor: M{ry-Lite 667-23
4 Invoices
� Your com�any will be bilied monthly for the service fee d�ie �mder a Contract awarded under this F'roposal
Invitakion. All in�oices are a�ailable on the BuyBoard websi#e and e-mail notificatians wiil be sent when
they are ready to be retrieved.
� Invoices
� Please choose onlv one f1) of the following options for receipt of invoices and provide �he requested
infarmatian;
(a) Service fee invoices and related communications should be provided directly to my company at:
or
(b} In lieu of my company, I request and authorize all ser�ice fee invaices to be provided directiy tQ the fol�owing
billing agent:
;T Vendor authorizes a hillrng agent Cn recerve ar7d process sarvice fee rnvorces, rr� accnrdar7ce with tlTe Ger+eral Terms and Cor�oitrons of the Contrar_;.
Vendor specifically acknnwledges and agrees thal nothrng in that des7gnalion sliaf! ralieve Ver+dor nr its res�onsit�ilifles and oblryt�trot�.; �u�der 'rha
Cor�tract including, bu! ��ot lrrr�rted to. payrT�er�f of �11 servrce fees im�f�r �ny �;r�i�frar. f awarded Vencfor:
Service Fea involces and notices direct to company
4 Invo�ce Company Name
� In�oice Compar�y Name
MityLite
4 � In�oice Company Department Name
nvoi�e -nrr�pa��rDepartme�t-fV�n�e
-- - - ---- -- - — — -- --- - - - -
Accaunts Payable
4 � ln�oice Cor�tact Name
4 Invoice Contact Name
John King
4 Invoice Mailing Address
$ Invoice Mailing Address (P.O. Box or Street Address)
1301 West 400 Nort}�
4 In�oice Mailing Address - City
� Invoice Mai�ing Address - City
Orem
4 #nvoice Mailing Address - State
� Invoice Mailing Address - State (Ahbreviate State Name)
UT
4 In�oice Mailing Address - Zip Code
g In�oice Mailing Address (�ip Code)
54057
Page 8 of i4 pages Vendor: Mity-Lite b67-2?
4 Invoice Contact Phone Number
9 Invoice Contact Phone Number (xxx-xxx-xxxx)
8Q0-362-582D
5 I lnvoice Confiact Extension Num�er
� In�oice Contact Extension N��mber
No response
5 In�oice Contact Fax Number
� Invoice Contact Fax Number (xxx-xxx-xxxx)
No respot�se
5 � In�oice Contact �-maif Address
� �nvoice Contact E-maii
john.king@mityinc.com
5 I Invoice Cantact Alternate E-mail Address
� Invoiee Cor�tact Altarnate E-rmail Address
No t�espof7se
� Billing Agent Company Name
Bilhing Agent Company Name
No response
� r�ining Hgenz uepartment Name
� Billing Agent Department Name
No r-esponse
5 Billing Agent Contact Name
6 Bl�ling Agent Contact Name
No respor�se
5 Biiling Agent Mailing Address
7 Billing Age��t Mailing Address (P.O. Box or Street Address)
No r'ss�at�se
5 Bilfing Agent Mailing Address - City
8 Billing Agent Mailing Ad�lress - City
No response
5 Bil�ing Agent Mailing Address - State
� Billing Agent Maifing Address - State (Abbreviate State Name)
No response
6 Billing Agent Mailing Address - Zip Code
� Billing Agent Mailing Address - Zip Cade
No response
Page R of 34 pages Vendor: N[iry-Gite 667-�2
6 Billing Agent Contact Phone N�mber
� Bilfing Agent Contact Phone Nun�t�er (xxx-xxx-xxxx)
Na respotlse
6 Bilfing Agent Contact Extension Numbe�r
Z Billing Agent Cantact Extension Nur��ber
Na response
fi Billing Agent Fax Number
� Billing Agent Fax N�imber
Na respa��s�
6 Billing Agent Cantact E-mail Address
4 Billing Agent Contact �-mail Address
No respot�se
� Billing Agent Alternati�e E-mail Address
� Billing Agent Alternati�e E-mail Address
No resporrse
6 Shipping Via
6 Common Carrier, Company �r�tck, Prepaid and Add to �nvoice, or Other
Prepaid and Add to Invoice
6 Pay�-Terms -- — - -- - — --
7 Note: Venclor paymenf teirns �ncrst comply with the B�ryBo�rd Ge�7eral Terms and Conditions anci the Texas Prompt
Payment Act (Texas Goverrlrrler�t Code Ch. 2259}.
Net 3Q
6 Vendor's InternallAssigr�ed ReferencelQuate Number
� Vendor's in#ernal/Assigned ReferencelQuate Number
No respoi�se
6 Siat� or Aitach Return Policy
� Noie: Only return requirements and pracesses will be deemed part of Venc�or's return palicy. Any unreiated contract
terms, terms of sale, or ofher information not specificaily reiated to reCum requirements and processes includ�d in
Vendor's retur� policy shall not apply ta any awarded Conkract unless specifically included as a deviation in the
Deviation ancf Compllance Form and accepted by the Caoperative.
No respanse
7 �lectronic Payments
� Are electroni� payments acceptable to your company?
Yes
7 Credit Card Payments
� Are credit card payments acceptable to your company7
Yes
Page 10 of34 pages Vendur: Mity-Lite 567-ZZ
7� Texas Regivnal Service DesignatEon
2 Texas Regional Service �esignation - Refer to Form in Proposal Invitation
The Coo�erative (referred to as "Texas Cooperati�e" in this form and in the Stat� Service Designatian form) affers
vendars the opportunity to service its members throughout the sntire State of Texas. ft you do no# plan to service all
Texas Cooperative mernbers statewide, you rr�tust indicate the specific regions you will ser�ice on this form. If yo�i
propose to serve different regions for differenf products or services ir�ciuded in ya�ir Proposal, you must ca�r�pl�fe
and submif a separate Texas Regional Service Designation forrr� for eacl� group of products and c�early indicate the
products or services to which the designation applies. By designafing a region ar regions, you are certifying that
yotr are acrthorized and wi!ling to provide #he proppsed products and services in those regions. Designafing
regions in which you are either unable or unwilling fo provide fhe specified praducts and services shall be
grounds for either rejection of your Proposal or, if awarded, terminatian of your Contract. Additfonally, it you
do not plan to service Texas Coaperative men�bers (i.e., if you will se�vice only stat�s otl�er than Texas), you m�ist
so indicate on t�is form.
7 Company Narne
3 Corr�pany Name
M itytite
7 Texas Regionai Ser�ice Designation
4 Select only orse ofi the faliowing options. If yau select "I will NOT ser�e all Regivns of Texas", you must then
check the individual Regions you wish ta ser�e.
All Regio�ts
7 Region 1
� Region 1 - Edinb��rg
❑ Region 1 (1)
7 Region 2
6 Region 2- Carpus Christl
❑ Regran 2 (2)
7 Region 3
� Region 3 - Victoria
❑ Regror� 3 (3)
7 R�g�on 4
$ Region 4 - Houston
❑ Region 4 (4}
7 Region 5
� Region 5 - Beau�r�ant
❑ Regian 5 {5J
8 Region 6
� Region 6 - N�mtsville
❑ Regior� 6 (6)
� Region 7
� Region 7 - Kilgore
❑ Regior� 7 (7)
Page l l of 34 papes Vzndor: Mity-Litc bfi7-2Z
8 Region S
Z Rec�ion $ - Maunt Pleasant
❑ Region 8 (&)
S Region 9
3 Region 9- Wichita Fafls
0 Rec�ror� 9 (9)
$ Region 1U
4 Region 10 - Richardsan
❑ R�gion 10 (10}
$ Region 11
� Region 11 - Fort Workh
❑ Regron 71 (91)
8 Regian 12
� Regian 12 - Waco
❑ Region 7 2 (12)
8 Region 13
7 Region 13 - Austin
❑ Regra� 93 (93)
8 Region 14
$- Regiari-t� = Abilene--
❑ Region 14 (14)
$ Region 15
9 Reglon 15 - San Angelo
❑ Regian 15 (15J
9 Regior� 16
� Region 16 - Amariilo
❑ Regian 96 (16)
9 Region 17
� Region 17 - Lubback
❑ ReginR 17 { 9 7)
9 Region 1$
� Region 18 - Midland
❑ Region 18 (18)
9 Region 19
3 Region 19 - EI Paso
❑ Regian 79 (19)
Page i 2 of 34 pages Vendar. Mity-Lite 6fi7-22
9 Region 20
4 Region 2Q - San Antonio
❑ Region 20 {20)
9 � State Ser�ice Designatian
� State Service �esignation - Refer ta Form in Proposal Invitation.
As s�t forth in ti�e Proposal Invitation, it is tha Cooperative's intent that other governmental entities in ti�e Uniked
States ha�e the opporfunity to purchase goods or services awarded under the Contract, subject to applicable state
I�v+r, through a piggy-back award or similar agreemenf t}�rough khe Natiorsal Purchasing Coaperati�e BuySoard. If
you plan to service the eniir� llnited States or only specific states, you must complete this form according�y. (Note:
!f yocr plan to serviee Texas Cooperafive members. be scrre tflat yotr complete fhe Texas Regior�al Service
17esic�natian forn�.) !n addition to this �'orm, to b� corrsidered for a prggy-back award by ihe Nationa!
Purchasing Cooperative, yau must have an autharized representative srgn the National Purchasing
Cooperative Vendor Award Agreement that fo!lows this form.
lf you serve different states for differe��t products or services included in your Praposal, you must comple#e and
submit a separate State Service Designatian form for each gra�p of praducts and clearfy indicaie the products or
services to which the designation applies. By designating a stafe or states, you are certrfying that you ar�
�ufhorrzed ar�d wi!ling to �r'ovide fhe proposed pr�odcrcts and servrces in those stafes. Designatir�g states rn wl�ich
you are either crnable ar ur�willrng to provide the specified �rodcrcts and set�vrces sha11 be gt'o�rnds for either
iejeciion af yoclr Propas�l or, if aw�rded, ter�mination of yocrr Cnr�fr�acf
9 Company EVame
6 Con�pany Name
MityLite
9 � State Service Designa#ion
5elect oniy one of #he following optians. !f you se�ect "f will NOT serve all States", you must then check
the individual States you wish to serve.
All States
9 AFabama
8 A€aba+na
❑ Alabam� (AL}
9 Alaska
� Alaska
❑ Alaska (AK)
1 Arizona
� Arizona
❑ Rrrzona (AZ)
� Arkansas
� Arkansas
❑ Arkansas (AR)
1 California
� California (Public Contract Cade 20118 & 20652)
2
❑ Califori�ra (CA)
Page i3 of 34 pages Venrinr: Mity-Lite 667-�?
1 Colorado
� Colorado
3
❑ Colorado (CO}
1 Connecticut
� Connecticut
4
❑ Conrrecticut {CT)
1 D�laware
� Delaware
❑ Delaware {DE)
1 District of Columbia
� �istrict ofi Columbia
6
❑ Distrrcf of Calc�mbra {DC)
1 Florida
� Florida
7
❑ Flor�ida (FL)
1 Georgia
8 Georgia
❑ Georgia (GA)
1 Hawa i i
� Hawan — ----
� -__ --- — -- —
❑ Hawaii (HI)
1 ldaha
� Idaho
❑ ldaho (1Dj
1 Illinais
� Iliinois
1
❑ 1llit7ois (lL)
1 Indiana
2 Indiana
❑ lr�diana ("!N)
1 lowa
3 lowa
❑ lowa (lA)
') Kansa�
4 Kansas
❑ Kansas (KS�
Page l�1 of 3�4 pages Vendor: Mity-Lite 667-2?
1 Kent�cky
� Kent�tcky
5
❑ Ket�ti�cky (KY)
1 Lo�aisiana
� Louisiana
❑ Lo�rrsiana (LA)
1 Main�
� Maine
❑ Mar��e (ME)
'i Maryland
� Marylar�d
8
❑ Maryland (ME}
'1 Massachusetts
gNlassachusetts
❑ M�ssacht�setts {MA)
1 Michigan
2 Michigan
0
❑ Mrcf�igarl (MIJ
1 Minnesota
— � -Mmr�s�ta
❑ Mr�7nesota (MNJ
1 Mississippi
� Miss�ssippi
2
❑ Mrssrssippi (MS}
1 Missouri
3 Missauri
❑ Missacrrr (MO}
1 Montana
� Montana
❑ Montar�a (MT)
1 Nebraska
2 Ne�raska
5
❑ Nebraska (NEJ
1 Nevada
� Nevada
❑ Nevada (NV)
Page l5 of34 pnges Ve��dor: Mity-Lirc 667-22
1 New Hampshire
� New Hampshire
7
❑ New Hampsl�ire {IVHJ
1 New Jersey
� N�w Jersey
$
❑ New Jer-sey (!VJ)
1 New Mexico
� New Mexico
❑ New Mexica (NM}
1 New York
3 New York
0
❑ Ne+w York (NY)
1 North Caralina
3 North Carolina
1
❑ North Cai�olrna (NG}
1 Narth Dakota
� North Dakota
2
❑ Narth Dakota (ND)
1 I Ohio
❑ Ohro (OH)
1 Oklahoma
� Oklahoma
4
❑ Oklahoma (OK)
1 Oregon
� Oregon
❑ Oregora {OR)
't Pennsylvania
� Pennsylvania
6
❑ Penr�sylvania {PA)
1 Rhode Island
3 Rhode IsEand
7
❑ F2hocle lslar�d (Rl)
1 5outh Carolina
3 South Carolina
$
❑ Socrth Carolina (SC}
Page 16 oF3=4 ��ages Vccidor: �lity-Lite 667-22
1 South Dakota
3 South �akota
9
❑ Sai�th Qalcota (5�}
1 Tennessee
0 Tenn�ssee
❑ T���nessee (TN)
1 Texas
� 7exas
❑ %x�s (TX)
1 !J#ah
4 ut�n
2
❑ Uta1� (UT)
1 Vermont
3 Vermont
❑ Vermor�t (VT)
1 Virg�nia
� Virginia
❑ Virgir�ia (VA)
1 Washington
� -Wa�s-�in�on
❑ Washii�gton (WA)
1 West Virginia
6 West Virginia
❑ West Virginra (WV}
1 Wisconsin
7 Wisconsin
❑ Wisconsin (Wl)
1 Wyorning
4 Wyoming
8
❑ Wyorning (WY}
Bid Lines
Page 17 af 34 papes Vci�dor: iVliry-Lite 6b7-2?
Exhibit C
CONFLICT 4F INTEREST QUESTIONNAIRE F4RM CIQ
Far �enclor doing business with local go�ernmental entity
This questionnaire reflects changes made to the Eaw by H.B. 23, 84th Leg., Reguiar Session, dFFiCEl15EONLY
This questiannaire is being filed in accordance with Chapter 176. Local Government Code, by a vendor who pate Received
has a business relatianship as deflned by Section 176.001(1-a) wi#h a local governmentaf entily and the
vendor meets requirements �nder 5ection 176.a06(a).
By law this questionnaire musi be fifed with the records adminisirator of the local governmenta! entity no1 later
than the 7th business day af#er the cfate the vendor becomes aware of facts that require the statement to be
filed. 5ee 5ection 176.OD6(a-t �, Local Government Gode.
A vendor commits aEi offense if the vendor knowingly Uiofates Sectian 176.00fi, Loca! Govemmenf Gode. An
offense under this section is a misdemeanor.
� Name of vendor wha has a business re[aiionship witF� local go�ernmental entity.
,� f ' ` � �-�.�r� , l �1 ��, .
2
❑ Check this box if you are filing an update ta a previously filed questionnaire. (The law requires that you file an updated
comp�eted questionnaire with the appropriate filing autharity not later than the 7th business day after the daie on which
you became aware that the originafly fiEed questionnaire was incomplete or inaccurate.)
3 Name af lacal go�ernment otficer about whom the inforrr�ation is being disclosed.
� // ji
�� r
Name af Officer
4 Describ� each employmenf or other business rela�ionship with the local go�ernment officer, ar a family member of the
afficer, as described by Section 176.d03(a)(2)(A). Also describe any tamily rela#ionship with the lacal government officer.
Complete subparts A and B for each employment ar business relationship clescribed. Attach additional pages ta this Form
—Gl.(2_asne.cessar_y--- - - - -- - -- -- --- -- - -- - . — - - - - -.. _ _ .. - -
A. Is the locai gpvernment officer or a family member of the officer receiving ar like{y to receive taxak�le income,
oiher than investment income, from the �endor?
� Yes � No
B. Is the �endar receiving or likely to rece€ve taxahie income, other than In�estmeRt income, from ar at the direction
of the lacal governmenf oificer ar a family member of the afficer AND the taxable incorne is not received from the
local govarnmental entlty?
� Yes ,,l No
r ,.
$ Describe each empioyinent or business relationship that the �endor named in 5ection 1 maintains with a corporation or
other business entity with respect to which the local gavernment officer ser�es as an officer or director, or halds an
ownership interest of one percent or mare.
6
❑ Check this box if the vendor has given the local governmenf officer or a family member of the officer one or mare gifts
as described in Sectlon 176.OD3(a}(2){B}, excluding gifts described m Secfion 176.003(a-1 j.
7 _�� _ �� �,�' ' �" j / '` ',• /,
c- - �� -- ..� � %1-- j f �.. Cf �� % a�� ��-
Signature of vendor doing b slness with`th�g6erRmental entity / Dafe /
Form provided 6y Texas Ethics Cornmission www.ethics.state.tx.us Revised 1/1/2621
CONFLICT OF INTEREST QUESTiONNAIRE
For �endor doing business with local go�ernmental entity
A camplete copy of Chapter 176 of the Local Government Code may be found at http:/lwww.statutes.legis.state.tx.usl
Docs/LGIhtmILG.176.htrn. For easy reference, below are some af the sections cited an tY�is form.
�ocal Ga�ernment Code ��76.001(1-a): "Business relationshtrp" means a connection between two or more parties
based on commercial activity af one of the parties. The term cloes not include a connection based on:
(A) a transaction that is sub}ect to rate or fee regulatian by a federal, s#ate, or local governmental entity or an
agency of a federal, state, or focal governmental entity;
(B) a transactian conducted at a price and subject to terms available to the public; or
(C) a purchase ar lease of goods or services from a person that is chartered by a state or federal agency and
that is subject ta regular examination by, and reparting to, that agency.
Local Go�ernment Code § 176.003(a)(2){A) and {B):
(a) A local go�ernment officer shall file a conflicts disclosure statement with respect ta a �endor if:
(2) the venc�or:
(A) has an employment or other business relationship with the loca� government officer ar a
family member of the officer that results in the officer or family member receiving taxable
incame, other than investment income, that exceeds $2,500 during khe 12-month period
preceding the date that the officer becomes aware that
(i) a contract between th� locaf governmental entity and �endor has been executed;
or
(ii) the local governmental entity is considering entering into a contract with the
vendor;
that ha�e an aggregate value of more than $10D in the 12-mor�th period preceding the dats the
officer becomes aware that:
(i) a contract between the local governmental entity and �endor has been executed; or
(ii) the local go�ernmental entity is considering entering into a contract with the vendor.
Local Government Cocle � 176.OU6(a) and {a-1)
(a) A vendor shall file a cot�pleted conflict of interest questionnaire i# the �endar has a business relatianship
wiih a locai go�ernmental entity and:
(1) has an employment or ather business relafionship with a local government officer of that focaf
governmental entity, or a family memk�er of the officer, described by Section 176.003(a)(2)(A);
(2) has gi�en a loca� go�ernment officer of that local governrr�enta! entity, or a family mernber of ths
officer, one or m�re gifts with the aggregate �alue specified by Section � 76.003(a)(2)(B), excluding any
gift described by Section 176.003(a-1); or
(3) has a family relationship with a lacal government afficer of tha# local go�ernmental eniity.
(a-1) The completed conflict af intsrest questionnaire must be f led with the appropriate records administrator
not later than the seventh business day after the later of:
(1) the date that the �endor:
(A) begins discussions or negatiations ta e�nter into a contract with the local go�ernmenta!
entity; or
(B) submits to the ]ocal governmental entity an application, response to a request for praposals
�r bids, correspondence, or another writing related to a potential cantract with the local
governmental entity; or
(2} the date the vendor becomes aware:
(A) of an employment or other business relationship with a local go�ernment officer, or a
family member of tF�e officer, described by Subsection (a);
(B) that the vendor has given one or more gifts described hy Subsectian (a); or
(C) of a family relationship with a local go�ernment officer.
Form pravided by Texas Elhics Commission www.ethics,state.tx.us Revised 1/1/2021