HomeMy WebLinkAboutContract 57360-R1 CSC No.57360-RI
CITY OF FORT WORTH
REQUEST TO EXERCISE RENEWAL OPTION
November 15, 2022
Winston Water Cooler
Attn: John Hutchinson
6626 Oakbrook Blvd.
Dallas,TX 75235-4106
Re: Contract Renewal Notice
Contract No. CSC No.57360(the"Contract")
Renewal Term No. 1: December 1, 2022 to November 30, 2023
The above referenced Contract with the City of Fort Worth expires on November 30,2022
(the "Expiration Date"). Pursuant to the Contract, contract renewals are at the mutual agreement
of the parties. This letter is to inform you that the City is requesting to renew the Contract for an
additional one (1) year period, which will begin immediately after the Expiration Date. All other
terms and conditions of the Contract remain unchanged.
To agree to renew the Contract for an additional one(1)year period,please sign and
return this request to exercise renewal option, along with a copy of your current insurance
certificate,to the address set forth below.
Please log onto PeopleSoft Purchasing at hqp://fortworthtexas.Rov/Durchasing to insure
that your company inforrnation is correct and up-to-date.
If you have any questions concerning this Contract Renewal Notice, please contact me at
the telephone number listed below.
Sincerely,
Megan Fowler
Property Management Department
900 Monroe Street, 4th floor, Suite 402
Fort Worth, Texas 76102
817-392-6645 OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
Contract Renewal Page 1 of 2
CSC No.
ACCEPTED AND AGREED:
CITY OF FORT WORTH CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the
person responsible for the monitoring and
administration of this contract, including
By: Dana Burghdoff(Nov 22,20&714:02 CSTY,?�/ ensuring all performance and reporting
Name: Dana Burghdoff requirements.
Title: Assistant City Manager Ellana Guevara on behalf o-f.41anShuror
By: Eliana Guevara on behalf of Alan Shuror(Nov 17,202210:40 CST)
Name: Alan Shuror
Title: Assistant Director, Property
APPROVAL RECOMMENDED: Management Department
By: Steve Cobke(Nov 18,2022 14:11 CST) APPROVED AS TO FORM AND
Name: Steve Cook LEGALITY:
Title: Director,Property Management
Department ga440ann By:
*Onr 4��
Name:�0*0000—% Jeremy Anato Mensah
o'
Title: Assistant City Attorney I
00to
0'oo-o
a�SEX b
ATrEST- 0000 J
CONTRACT AUTHORIZATION:
By: JannetteS.Goodall(N 22,202216:22CST) M&C: 22-0209
Name: Jannette Goodall Date Approved: 3/29/22
Title: City Secretary
Form 1295 Certification No.: 2022-853485
Winston Waier Cr oler, LTD.
By:
Name: Johngliichinson
Title: l4e- Sales
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
Contract Renewal Page 2 of 2
ICY COUNCIL tRTRT1t,
Create New From This MSC
DATE: 3129/2022 REFERENCE**M&C 22- LOG NAME: 13PCOOP BB 657-21 PLUMBING
O.: 0209 PARTS TD PMD
CODE: P PE: CONSENT PUBLIC NO
FEARING:
SUBJECT. (ALL)Authorize Purchase Agreement with Mark's Plumbing Parts, LLC and Winston
Water Cooler,Ltd. in the Combined Annual Amount of$250,000.00 and Authorize Two
Consecutive One-Year Renewal Options for the Same Annual Amount for Plumbing
Supplies for the Property Management Department Using BuyBoard Cooperative
Contract 657-21
RECOMMENDATION:
It is recommended that the City Council authorize a purchase agreement with Mark's Plumbing Parts,
LLC and Winston Water Cooler, Ltd. in the combined annual amount of$250,000.00 and authorize
two consecutive one-year renewal options for the same annual amount for plumbing supplies for the
Property Management department using BuyBoard cooperative contract 657-21.
DISCUSSION:
In January 2022,the Property Management Department contacted the Purchasing Division to enter
into an agreement with Mark's Plumbing Parts, LLC and Winston Water Cooler, Ltd.under BuyBoard
Contract No.657-21,for plumbing parts,supplies,and repair kits.These will be used to repair and
replace any existing plumbing parts throughout City buildings.
BuyBoard Contract No.657-21 has a term through November 30,2022,The Request for Offer for
BuyBoard Contract No.657-21 was published on January 28, 2021,and responses were opened on
June 17,2021. BuyBoard contracts offer fixed discounts.Staff reviewed the pricing and determined it
to be fair and reasonable.
This amount is budgeted in the Facilities Repair/Maintenance Supplies account.
This Agreement may be renewed for up to two additional one-year terms,in accordance with the terms
of the BuyBoard Contract.Should BuyBoard elect to exercise the renewal option,the City will do the
same.
State law provides that a local government purchasing an item under a cooperative purchase
agreement satisfies any state law requiring that the local government seek competitive bids for
purchase of the item. BuyBoard contracts are competitively bid to increase and simplify the purchasing
power of government entities across the State of Texas.
A M/WBE goal is not assigned when purchasing from an approved purchasing cooperative or public
entity.
This project will serve ALL COUNCIL DISTRICTS.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that funds are available in the current operating budget,as
previously appropriated,in the General Fund to support the approval of the above recommendation
and award of the contract. Prior to any expenditure being incurred,the Property Management
Department has the responsibility to validate the availability of funds.
BQN11
TO
i Fund Department Account l Project I Program Activity Budget i_.._. Reference# Amount l
l.._...__,d_.._ ID Ira Year (Chart€ield 2I [
_. .. .. _... .. _..__ .._ .
FROM
i Fund Department Account Protect[ Program 1 Activity Budget Reference# Amount 1
IL? __.... IDJ _ _j, ..._„__ Year (ChartEieitl_2.._#._
Submitted for City-Manager's Office by_ Reginald Zeno(8517)
Dana Burghdoff(8018)
Originating Department Head:
Anthony Rousseau(8338)
Steve Cooke(5134)
Additional Information Contact: Cynthia Garcia(8285)
Taylor Dean(7648)
ATTACHMENTS
1295Form Marks Plumbing .�jf-Earts.p f (CFW internal)
1295 Form Winston Water Cooler,qdf (CFW Internal)
13P_QQOP BB 657-21 eLULABING FARTS IP PIVID,dLogx (CFW Internal)
FID TABLE Plumbingxlsx (CFW Internal)
SAMS Marks Plumbinq_aaf!s.pjf (CFW Internal)
SAMS Winston Water Cooler Ltd.p.df (CFW Internal)
CSC No. 57360
FORTWORTH
CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement ("Agreement") is entered into by and between Winston
Water Cooler, Ltd ("Vendor") and the City of Fort Worth, ("City"), a Texas home rule municipality.
The Cooperative Purchase Agreement includes the following documents which shall be construed in the
order of precedence in which they are listed:
1. This Cooperative Purchase Agreement;
2. Exhibit A—Seller's Quote, Scope of Services or Purchase Order;
3. Exhibit B—Cooperative Agency Contract BuyBoard 657-21; and
4. Exhibit C—Conflict of Interest Questionnaire
Exhibits A, B, and C, which are attached hereto and incorporated herein, are made a part of this
Agreement for all purposes. Vendor agrees to provide City with the services and goods included in
Exhibit A pursuant to the terms and conditions of this Cooperative Purchase Agreement, including all
exhibits thereto.
City shall pay Vendor in accordance with the fee schedule in Exhibit A and in accordance with
the provisions of this Agreement. Total payment made under this Agreement by City shall be in the
amount of Two Hundred Fifty Thousand Dollars ($250,000.00). Vendor shall not provide any
additional items or services or bill for expenses incurred for City not specified by this Agreement
unless City requests and approves in writing the additional costs for such services. City shall not be
liable for any additional expenses of Vendor not specified by this Agreement unless City first
approves such expenses in writing.
The term of this Agreement is effective beginning on the date signed by the Assistant City
Manager below ("Effective Date") and shall expire on November 30, 2022. The City shall be able to
renew this agreement for two (2) one-year renewal options by written agreement of the parties.
Vendor agrees that City shall,until the expiration of three(3)years after final payment under this
Agreement, or the final conclusion of any audit commenced during the said three years, have access to
and the right to examine at reasonable times any directly pertinent books,documents,papers and records,
including, but not limited to, all electronic records, of Vendor involving transactions relating to this
Agreement at no additional cost to City. Vendor agrees that City shall have access during normal
working hours to all necessary Vendor facilities and shall be provided adequate and appropriate work
space in order to conduct audits in compliance with the provisions of this section. City shall give Vendor
reasonable advance notice of intended audits.
Notices required pursuant to the provisions of this Agreement shall be conclusively determined
to have been delivered when (1) hand-delivered to the other party, its agents, employees, servants or
representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3)
received by the other party by United States Mail, registered, return receipt requested, addressed as
follows:
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
To CITY: To VENDOR:
City of Fort Worth Winston Water Cooler, Ltd.
Attn: Dana Burghdoff, Assistant City Manager John Hutchinson, Inside Sales
200 Texas Street
Fort Worth, TX 76102-6314 Address:
Facsimile: (817) 392-8654 6626 Oakbrook Blvd.
Dallas, TX 75235
With copy to Fort Worth City Attorney's Office
at same address Facsimile: N/A
The undersigned represents and warrants that he or she has the power and authority to execute this
Agreement and bind the respective Vendor.
CITY OF FORT WORTH:
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person responsible
By: Dana Burghdoff(Apr 5,202 :46 CDT) for the monitoring and administration of this contract,
Name: Dana Burghdoff including ensuring all performance and reporting
Title: Assistant City Manager requirements.
Date:
alan H: shuror
APPROVAL RECOMMENDED: By: Alan H.Shuror(Apr 4,202216:14 CDT)
Name: Alan Shuror
SS �Qe Title: Assistant Property Management Director
By: Steve(Apr 4,2202216:19CDT) APPROVED AS TO FORM AND LEGALITY:
Name: Steve Cook
Title: Property Management Director C�
'00R � T
ATTEST: of F 0000rtyaa� By:
�1►0 .�pdd Name: Taylor Paris
Apo
o=d Title: Assistant City Attorney
o
0oo
By; Jannette S.Goodall(Apr 5,2022 16:05 CDT) v �00000 9 ap CONTRACT AUTHORIZATION:
Name: Jannette Goodall a��nExAa� M&C: 22-0209
Title: City Secretary
VENDOR:
Winston
//Water Cooler,Ltd.
By: Q/''& Wt.&4;r. el
ame: John Hutchinson
Title: Inside Sales OFFICIAL RECORD
CITY SECRETARY
Date: 04/04/2022
FT. WORTH, TX
Exhibit A
Winston Water Cooler, Ltd. Information
Contact: Donna Thompson
Address: 6626 Oakbrook Blvd.
Dallas, TX 75235
Phone: (972) 920-3089
Fax: (214) 550-1396
Email: donna@winstonwatercooler.com
By submitting your response, you certify that you are authorized to represent and bind your company.
John Hutchinson jhutchinson@winstonwatercooler.com
Signature Email
Submitted at 413012021 7:30:10 AM
Requested Attachments
BuyBoard Proposal Invitation No.657-21 - Building Maintenance, Repair and 657-21-Build ing-MRO.pdf
Operations Supplies and Equipment
REQUIRED - In PDF format, upload all proposal invitation documents available for download at vendor.buyboard.com
including any additional pages, as necessary. (Please DO NOT password protect uploaded files.)
Catalog/Pricelist WWC cover.pdf
REQUIRED - In PDF format, upload catalog/pricelist in proposal invitation instructions. File size must not exceed
100MB.(Please DO NOT password protect uploaded files.)
Detailed Information and Exceptions Related to Discount and/or Hourly Labor Rate No response
In PDF format, define the services that are proposed to be provided and attach detailed information including
exceptions to pricing or discount percentage, NOTE: IF DETAILED INFORMATION IS NOT SUBMITTED, PROPOSAL
MAY NOT BE CONSIDERED. (Please DO NOT password protect uploaded files.)
IRS Form W-9 Request for Taxpayer Identification Number and Certification W-9 WWC-Mansfield.pdf
REQUIRED - In PDF format, upload W-9 form. (Please DO NOT password protect uploaded files.)
Bid Lines
1
Section I: Equipment, Products,and Supplies-Discount(%)off catalog/pricelist for Electrical Supplies, Materials and Equipment.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Page 3 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
Item Attributes
1. State Name of Catalog/Pricelist
No response
2
Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for All Types of Power Generating
Equipment(electric, gas, diesel portable, back up on-site).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
3
Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Various Types of Lamps and
Ballasts (Fluorescent, incandescent, quarts, HID, shatterproof, metal handle, high pressure sodium, ballasts, similar related items).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
Page 4 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
4
Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Various Types of Lighting Fixtures.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
5
Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for All Types of Indoor Signage.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
6
Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for All Types of Solar Supplies and Equipment.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Page 5 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
Item Attributes
1. State Name of Catalog/Pricelist
No response
7
Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Building Supplies and Materials(carpentry,
lumber, drywall, insulation products, concrete products, and similar related items).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
8
Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Doors-All Types and Sizes(metal, wooden, and
similar related items).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
Page 6 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
9
Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Overhead Doors-All Types and Sizes(metal,
wooden, similar related items).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
1
0 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for All Types of Fasteners and Hardware
Products (doors, cabinets, and similar related items).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
Page 7 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
1
1 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Roofing Materials and Supplies(PRODUCTS
ONLY-NO LABOR).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
1
2 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Paint and Paint Related Products,Supplies and
Equipment.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
Page 8 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
1
3 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Parking Lot Striping Equipment,Supplies and
Materials.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
1
4 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Plumbing Supplies, Materials and Equipment.
Total: I10%
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
www.wwesupply.com
Page 9 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
1
5 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Various Types of Toilet Partitions,Sinks,and
Countertops.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
1
6 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for All Types of Energy and Water Monitoring
Products.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
Page 10 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
1
7 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Boiler Equipment and Supplies.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
1
8 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for HVAC Refrigerants and Supplies.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
1
9 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for All Types of Hand Tools and Sets.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Page 11 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
Item Attributes
1. State Name of Catalog/Pricelist
No response
2
U Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Welding Supplies and Equipment.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
2
1 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Commercial Building Glass and Other Glass
Materials and Supplies.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
Page 12 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
2
2 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Building Entryway Awnings,Canopies and
Related Accessories-all types of materials (metal, fabric, and related materials).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
2
3 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Elevator Equipment and Supplies.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
Page 13 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
2
4 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Escalator Equipment and Supplies.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
2
5 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Material Handling and Storage Equipment and
Supplies (forklifts, warehouse storage systems, pallet jacks, similar related items).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
Page 14 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
2
6 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for All Types of Fencing Materials and Supplies.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
2
7 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Pest Control Products and Supplies.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
2
8 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Power Washing Equipment and Materials.
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Page 15 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
Item Attributes
1. State Name of Catalog/Pricelist
No response
2
9 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for Soil/Road Chemical Base Stabilizer Products
(solvents, surfactants, acid oxidizers, and common dispersing agents).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
3
0 Section I: Equipment,Products,and Supplies-Discount(%)off catalog/pricelist for All Other Building Maintenance, Repair and
Operations Products not listed (supplies, materials and equipment).
No Bid
Item Notes: Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
No response
3
1 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of Boiler
Equipment and Products and Related Items -- Not to Exceed Hourly labor rate for Installation/Repair
Service of Equipment and Products.
Quantity: 1 UOM: Hour No Bid
Page 16 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
3
2 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of Power
Generating Equipment, Products and Related Items -- Not to Exceed Hourly labor rate for
Installation/Repair Service of Equipment and Products.
Quantity: 1 UOM: Hour NO Bid
3
3 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of
Commercial Building Glass and Related Items -- Not to Exceed Hourly labor rate for Installation/Repair
Service of Equipment and Products.
Quantity: 1 UOM: Hour No Bid
3
4 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of
Elevator Equipment, Products and Related Items -- Not to Exceed Hourly labor rate for Installation/Repair
Service of Equipment and Products.
Quantity: 1 UOM: Hour NO Bid
3
5 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of
Escalator Equipment, Products and Related Items -- Not to Exceed Hourly labor rate for Installation/Repair
Service of Equipment and Products.
Quantity: 1 UOM: Hour NO Bid
3
6 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of Fencing
Products and Related Items -- Not to Exceed Hourly labor rate for Installation/Repair Service of Equipment
and Products.
Quantity: 1 UOM: Hour No Bid
3
7 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of Toilet
Partitions, Sinks, Countertops and Related Items -- Not to Exceed Hourly labor rate for Installation/Repair
Service of Equipment and Products.
Quantity: 1 UOM: Hour NO Bid
3
8 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of
Overhead Door Equipment, Products and Related Items -- Not to Exceed Hourly labor rate for
Installation/Repair Service of Equipment and Products.
Quantity: 1 UOM: Hour NO Bid
3
9 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of Doors,
Framework, Door Hardware Equipment, Products and Related Items --.Not to Exceed Hourly labor rate
for Installation/Repair Service of Equipment and Products.
Quantity: 1 UOM: Hour NO Bid
Page 17 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
4
U Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of Building
Entryway Awnings, Canopies and Related Equipment, Products and Related Items -- Not to
Exceed Hourly labor rate for Installation/Repair Service of Equipment and Products.
Quantity: 1 UOM: Hour NO Bid
4
1 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of Power
Washing Equipment and/or Services and Related Items -- Not to Exceed Hourly labor rate for
Installation/Repair Service of Equipment and Products.
Quantity: 1 UOM: Hour No Bid
4
2 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of Parking
Lot Striping Equipment and/or Services and Related Items -- Not to Exceed Hourly labor rate for
Installation/Repair Service of Equipment and Products.
Quantity: 1 UOM: Hour No Bid
4
3 Section II: Installation and Repair Service- Hourly Labor Rate for Installation/Repair Service of
Concrete Cutting and Related Items -- Not to Exceed Hourly labor rate for Installation/Repair Service of
Equipment and Products.
Quantity: 1 UOM: Hour NO Bid
Response Total: $0.00
Page 18 of 18 pages Vendor:Winston Water Cooler,Ltd. 657-21
Exhibit B
gVBoardP.O. Box 400,Austin,Texas 78767
800.695.2919 •info@buyboard.com • buyboard.com
October 11, 2021
Sent Via Email: jhutchinson@winstonwatercooler.com
John Hutchinson
Winston Water Cooler, Ltd.
6626 Oakbrook Blvd.
Dallas, TX 75235
Welcome to BuyBoard!
Re: Notice of The Local Government Purchasing Cooperative ContractAward;Proposal Invitation No.
657-21, Building Maintenance, Repair and Operations Supplies and Equipment
Congratulations, The Local Government Purchasing Cooperative (Cooperative) has awarded your company
a BuyBoard® contract based on the above-referenced Proposal Invitation. The contract is effective for an
initial one-year term of December 1, 2021,through November 30, 2022, and may be subject to two possible
one-year renewals. Please refer to the Proposal Invitation for the contract documents, including the General
Terms and Conditions of the Contract.
To review the items your company has been awarded, please review Proposal Tabulation No. 657-21 at:
www.buyboard.com/vendor. Only items marked as awarded to your company are included in this contract
award, and only those awarded items may be sold through the BuyBoard contract. All sales must comply
with the contract terms and must be at or below the awarded pricing as set forth in the General Terms and
Conditions.
The contract will be posted on the BuyBoard website as an online electronic catalog(s). You are reminded
that, in accordance with the General Terms and Conditions, all purchase orders must be
processed through the 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 Cooperative
member that has not been processed through the BuyBoard or provided to the Cooperative. If you receive
a purchase order directly from a Cooperative member that you have reason to believe has not been received
by the Cooperative or processed through the BuyBoard, you must promptly forward a copy of the purchase
order by email to info@buyboard.com.
A list of Cooperative members is available on the buyboard.com website. The BuyBoard vendor relations
staff will be contacting you to assist with the resources available and to provide any support you may need
as an awarded BuyBoard vendor.
On behalf of the Cooperative, we appreciate your interest in the Cooperative and we are looking forward
to your participation in the program. If you have any questions, please contact Cooperative
Procurement Staff at 800-695-2919 (select option "2'�.
Sincerely,
Arturo Salinas
Asst. Division Director, Cooperative Purchasing
Texas Association of School Boards, Inc.,
Administrator for The Local Government Purchasing Cooperative
v.02.01.2021
Endorsed by �7 TASAV TML \Q= ..p?aa
Board®
National School
Nanonar Pmcnasmg coopeianve Endorsed by 'NSBA' Boards Association
October 11, 2021
Sent Via Email: jhutchinson@winstonwatercooler.com
John Hutchinson
Winston Water Cooler, Ltd.
6626 Oakbrook Blvd.
Dallas, TX 75235
Welcome to BuyBoard!
Re: Notice of National Purchasing Cooperative Award; Proposal Invitation No. 657-21, Building Maintenance, Repair and
Operations Supplies and Equipment
Congratulations, The National Purchasing Cooperative (National Cooperative) has awarded your company a BuyBoard@
contract based on the above-referenced Proposal Invitation. The contract is effective for an initial one-year term of December
1, 2021, through November 30, 2022, and may be subject to two possible one-year renewals. Please refer to the Proposal
Invitation for the contract documents, including the National Purchasing Cooperative Vendor Award Agreement and General
Terms and Conditions of the Contract.
To review the items your company has been awarded, please review Proposal Tabulation No. 657-21 at
www.buyboard.com/vendor. Only items marked as awarded to your company are included in this contract award, and only
those awarded items may be sold through the BuyBoard contract. All sales must comply with the contract terms and must
be at or below the awarded pricing as set forth in the General Terms and Conditions.
The contract will be posted on the BuyBoard website as an online electronic catalog(s). You are reminded that, in
accordance with the General Terms and Conditions, all purchase orders from National Cooperative members
must be processed through the 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 National Cooperative member that has not been
processed through the BuyBoard or provided to the Cooperative. If you receive a purchase order directly from a National
Cooperative member that you have reason to believe has not been received by the National Cooperative or processed through
the BuyBoard, you must promptly forward a copy of the purchase order by e-mail to info@buyboard.com
A list of National Cooperative members is available on the buyboard.com website. The BuyBoard vendor relations staff will
be contacting you to assist with resources available and provide any support you may need as an awarded BuyBoard vendor.
On behalf of the National Cooperative,we are looking forward to your participation in the program. If you have any questions,
please contact Cooperative Procurement Staff at 800-695-2919 (select option"2").
Sincerely,
Arturo Salinas, Asst. Division Director, Cooperative Purchasing
Texas Association of School Boards, Inc., Procurement Administrator for the National Purchasing Cooperative
v.02.01.2021
P.O. Box 400,Austin, Texas 78767-0400
800.695.2919•buyboard.com
card
PYRUASING ConPERA VVE
12007 Research Boulevard ' Austin, Texas 78759-2439 • PH: 800-695-2919 ' buyboard.com
PROPOSER'S ACCEPTANCE AND AGREEMENT
Proposal Invitation Name: Building Proposal Due Date/Opening Date and Time:
Maintenance, Repair, and Operations Supplies and June 17, 2021 at 4:00 PM
Equipment
Location of Proposal Opening:
Texas Association of School Boards, Inc.
BuyBoard Department
Proposal Invitation Number: 657-21 12007 Research Blvd.
Austin, TX 78759
Anticipated Cooperative Board Meeting Date:
Contract Term: December 1, 2021 through October 2021
November 30, 2022 with two possible one-year
renewals.
By signature below, the undersigned acknowledges and agrees that you are authorized to submit this
Proposal, including making all acknowledgements, consents, and certifications herein, on behalf of Proposer
and, to the best of your knowledge, the information provided is true, accurate, and complete.
Winston Water Cooler 04/15/2021
Name of Proposing Company Date
Digitally signed by John
615 S. Wisteria st
John Hutchinson Hutchinson
Date:2021.04.15 11:29:57-05'00'
Street Address Signature of Authorized Company Official
Mansfield, TX 76063 John Hutchinson
City, State, Zip Printed Name of Authorized Company Official
817.612.5001 Inside Sales
Telephone Number of Authorized Company Official Position or Title of Authorized Company Official
81 -1348390
Fax Number of Authorized Company Official Federal ID Number
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Board
PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
PROPOSAL FORMS PART 1: COMPLIANCE FORMS
INSTRUCTIONS:
Proposer must review and complete all forms in this Proposal Forms Part 1:
■ Proposal Acknowledgements
■ Felony Conviction Disclosure
■ Resident/Nonresident Certification
■ Debarment Certification
■ Vendor Employment Certification
■ No Israel Boycott Certification
■ No Excluded Nation or Foreign Terrorist Organization Certification
■ Historically Underutilized Business Certification
■ Acknowledgement of BuyBoard Technical Requirements
■ Construction-Related Goods and Services Affirmation
■ Deviation and Compliance
■ Vendor Consent for Name Brand Use
■ Confidential/Proprietary Information
■ EDGAR Vendor Certification
■ Compliance Forms Signature Page
An authorized representative of Proposer must initial in the bottom right corner of each page where indicated
and complete and sign the Compliance Forms Signature Page. Proposer's failure to fully complete, initial,and
sign forms as required may result in your Proposal being rejected as non-responsive.
PROPOSAL ACKNOWLEDGEMENTS
The proposing company 'you"or"your' hereby acknowledges and agrees as follows:
1. You have carefully examined and understand all information and documentation associated with this Proposal Invitation,
including the Instructions to Proposers, General Information, General Terms and Conditions, attachments/forms,
appendices, item specifications, and line items (collectively"Requirements';
2. By your response ("Proposal') to this Proposal Invitation, you propose to supply the products or services submitted at
the pricing quoted in your Proposal and in strict compliance with the Requirements, unless specific deviations or
exceptions are noted in the Proposal;
3. By your Proposal, you acknowledge and certify all items set forth in the General Terms and Conditions, Section B.12
(Certifications), including all non-collusion certifications and certifications regarding legal, ethical, and other matters set
forth therein.
4. Any and all deviations and exceptions to the Requirements have been noted in your Proposal on the required form and
no others will be claimed;
Initial• J H
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5. If the Cooperative accepts any part of your Proposal and awards you a Contract, you will furnish all awarded products or
services at the pricing quoted and in strict compliance with the Requirements (unless specific deviations or exceptions
are noted on the required form and accepted by the Cooperative), including without limitation the Requirements related
to:
a. conducting business with Cooperative members, including offering pricing to members that is the best you offer
compared to similarly situated customers in similar circumstances;
b. payment of a service fee in the amount specified and as provided for in this Proposal Invitation;
c. the possible award of a piggy-back contract by the National Purchasing Cooperative or nonprofit entity, in which
event you will offer the awarded products and services in accordance with the Requirements; and
d. submitting price sheets or catalogs in the proper format as required by the Cooperative as a prerequisite to activation
of your Contract;
6. You have clearly identified on the included form any information in your Proposal that you believe to be confidential or
proprietary or that you do not consider to be public information subject to public disclosure under the Texas Public
Information Act or similar public information law;
7. The individual submitting this Proposal is duly authorized to enter into the contractual relationship represented by this
Proposal Invitation on your behalf and bind you to the Requirements, and such individual (and any individual signing a
form or Proposal document) is authorized and has the requisite knowledge to provide the information and make the
representations and certifications required in the Requirements;
8. You have carefully reviewed your Proposal, and certify that all information provided is true, complete, and accurate to
the best of your knowledge, and you authorize the Cooperative to take such action as it deems appropriate to verify such
information; and
9. Any misstatement, falsification, or omission in your Proposal, whenever or however discovered, will be grounds for
disqualifying you from consideration for a contract award under this Proposal Invitation, termination of a contract award,
or any other remedy or action provided for in the General Terms and Conditions or by law.
FELONY CONVICTION DISCLOSURE
Subsection (a) of Section 44.034 of the Texas Education Code (Notification of Criminal History of Contractor)
states: "A person or business entity that enters into a contract with a school district must give advance notice to the district
if the person or an owner or operator has been convicted of a felony. The notice must include a general description of the
conduct resulting in the conviction of a felony."
Section 44.034 further states in Subsection (b): "A school district may terminate a contract with a person or business
entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or
misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for
services performed before the termination of the contract."
Please check (-\/) one of the following:
❑ My company is a publicly-held corporation. (Advance notice requirement does not apply to publicly-held corporation.)
❑■ My company is not owned or operated by anyone who has been convicted of a felony.
❑ My company is owned/operated by the following individual(s) who has/have been convicted of a felony:
Name of Felon(s):
Details of Conviction(s):
Initial: J H
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Board
PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
RESIDENT/NONRESIDENT CERTIFICATION
Chapter 2252, Subchapter A, of the Texas Government Code establishes certain requirements applicable to proposers who
are not Texas residents. Under the statute, a "resident" proposer is a person whose principal place of business is in Texas,
including a contractor whose ultimate parent company or majority owner has its principal place of business in Texas. A
AN nonresident"proposer is a person who is not a Texas resident. Please indicate the status of your company as a "resident"
proposer or a "nonresident" proposer under these definitions.
Please check N) one of the following;
❑■ I certify that my company is a Resident Proposer.
❑ I certify that my company is a Nonresident Proposer.
If your company is a Nonresident Proposer, you must provide the following information for your resident state (the state in
which your company's principal place of business is located):
Company Name Address
City State Zip Code
A. Does your resident state require a proposer whose principal place of business is in Texas to under-price proposers
whose resident state is the same as yours by a prescribed amount or percentage to receive a comparable contract?
❑ Yes ❑ No
B. What is the prescribed amount or percentage? $ or %
DEBARMENT CERTIFICATION
By signature on the Compliance Forms Signature Page, I certify that neither my company nor an owner or principal of my
company has been debarred, suspended or otherwise made ineligible for participation in Federal Assistance programs under
Executive Order 12549, 'Debarment and Suspension," as described in the Federal Register and Rules and Regulations.
Neither my company nor an owner or principal of my company is currently listed on the government-wide exclusions in SAM,
debarred, suspended, or otherwise excluded by agencies or declared ineligible under any statutory or regulatory authority.
My company agrees to immediately notify the Cooperative and all Cooperative members with pending purchases or seeking
to purchase from my company if my company or an owner or principal is later listed on the government-wide exclusions in
SAM, or is debarred, suspended, or otherwise excluded by agencies or declared ineligible under any statutory or regulatory
authority.
VENDOR EMPLOYMENT CERTIFICATION
Section 44.031(b) of the Texas Education Code establishes certain criteria that a school district must consider when
determining to whom to award a contract. Among the criteria for certain contracts is whether the vendor or the vendor's
ultimate parent or majority owner(i) has its principal place of business in Texas; or(ii) employs at least 500 people in Texas.
If neither your company nor the ultimate parent company or majority owner has its principal place of business in Texas, does
your company, ultimate parent company, or majority owner employ at least 500 people in Texas?
Please check N) one of the following:
❑ Yes ❑ No Initial: J H
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NO ISRAEL BOYCOTT CERTIFICATION
A Texas governmental entity may not enter into a contract with a value of $100,000 or more that is to be paid wholly or
partly from public funds with a company (excluding a sole proprietorship) that has 10 or more full-time employees for goods
or services unless the contract contains a written verification from the company that it: (1) does not boycott Israel; and (2)
will not boycott Israel during the term of the contract. (TEX. Gov'T CODE Ch. 2270). Accordingly, this certification form is
included to the extent required by law.
"Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is
intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity
doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business
purposes. TEx. Gov'T CODE §808.001(1).
By signature on the Compliance Forms Signature Page, to the extent applicable, I certify and verify that Vendor does not
boycott Israel and will not boycott Israel during the term of any contract awarded under this Proposal Invitation, that this
certification is true, complete and accurate, and that I am authorized by my company to make this certification.
NO EXCLUDED NATION OR FOREIGN TERRORIST ORGANIZATION CERTIFICATION
Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may not enter into a contract with
a company engaged in active business operations with Sudan, Iran, or a foreign terrorist organization — specifically, any
company identified on a list prepared and maintained by the Texas Comptroller under Texas Government Code §§806.051,
807.051, or 2252.153. (A company that the U.S. Government affirmatively declares to be excluded from its federal sanctions
regime relating to Sudan, Iran, or any federal sanctions regime relating to a foreign terrorist organization is not subject to
the contract prohibition.)
By signature on the Compliance Forms Signature Page, I certify and verify that Vendor is not on the Texas Comptroller's list
identified above; that this certification is true, complete and accurate; and that I am authorized by my company to make this
certification.
HISTORICALLY UNDERUTILIZED BUSINESS CERTIFICATION
A Proposer that has been certified as a Historically Underutilized Business (also known as a Minority/Women Business
Enterprise or"MWBE"and all referred to in this form as a "HUB") is encouraged to indicate its HUB certification status when
responding to this Proposal Invitation. The BuyBoard website will indicate HUB certifications for awarded Vendors that
properly indicate and document their HUB certification on this form. Please check (-/) all that apply:
❑ I certify that my company has been certified as a HUB in the following categories:
❑ Minority Owned Business
❑ women Owned Business
❑ Service-Disabled Veteran Owned Business (veteran defined by 38 U.S.C. §101(2), who has a
service-connected disability as defined by 38 U.S.C. § 101(16), and who has a disability rating
of 20% or more as determined by the U. S. Department of Veterans Affairs or Department of
Defense)
Certification Number: 1472583745500
Name of Certifying Agency: Texas H U B
❑ My company has NOT been certified as a HUB.
Initial: J H
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ACKNOWLEDGEMENT OF BUYBOARD TECHNICAL REQUIREMENTS
Vendor shall review the BuyBoard Technical Requirements included in this Proposal Invitation. By signature on the Compliance
Forms Signature Page, the undersigned affirms that Proposer has obtained a copy of the BuyBoard Technical Requirements,
has read and understands the requirements, and certifies that Vendor is able to meet and will comply with those requirements
except as follows: [List and explain BuyBoard Technical Requirements, if any, to which your company cannot or will not
comply.]
Note: In accordance with the General Terms and Conditions of the Contract, to the extent Vendor is awarded a Contract
under this Proposal Invitation but is unable or unwilling to meet the applicable BuyBoard Technical Requirements, the
information available on the BuyBoard for Vendor's awarded products or services may be limited, potentially placing Vendor
at a disadvantage and impacting the ability of Cooperative members to search, find, review, and purchase Vendor's awarded
products and services on the BuyBoard website. Further, to the extent Vendor has acknowledged ability to meet and comply
with the BuyBoard Technical Requirements, any subsequent failure or refusal by Vendor to promptly provide information
upon request to the Cooperative administrator in accordance with those technical requirements may be deemed an event of
default under the Contract.
CONSTRUCTION-RELATED GOODS AND SERVICES AFFIRMATION
The Cooperative issued the BuyBoard Procurement and Construction-Related Goods and Services Advisory for Texas Members
("Advisory"), which provides information specifically relevant to the procurement of construction-related goods and services
by Texas Cooperative members. The Advisory, available at buyboard.com/Vendor/Resources.aspx, provides an overview of
certain legal requirements that are potentially relevant to a Cooperative member's procurement of construction or
construction-related goods and services, including those for projects that may involve or require architecture, engineering or
independent testing services. A copy of the Advisory can also be provided upon request. Because many BuyBoard contracts
include goods or installation services that might be considered construction-related, Proposer must make this Construction
Related-Goods and Services Affirmation regardless of type of goods or services associated with this Proposal Invitation.
A contract awarded under this Proposal Invitation covers only the specific goods and/or services awarded by the Cooperative.
As explained in the Advisory ("Advisory"), Texas law prohibits the procurement of architecture or engineering
services through a purchasing cooperative. This Proposal Invitation and any Contract awarded thereunder
does not include such services. Architecture or engineering services must be procured by a Cooperative
member separately, in accordance with the Professional Services Procurement Act(Chapter 2254 of the Texas
Government Code) and other applicable law and local policy.
By signature on the Compliance Forms Signature Page, Proposer affirms that Proposer has obtained a copy of the Advisory,
has read and understands the Advisory, and is authorized by Proposer to make this affirmation. If Proposer sells construction-
related goods or services to a Cooperative member under a Contract awarded under this Proposal Invitation, Proposer will
comply with the Advisory and applicable legal requirements, make a good faith effort to make its Cooperative member
customers or potential Cooperative member customers aware of such requirements, and provide a Cooperative member with
a copy of the Advisory before accepting the member's Purchase Order, Member Construction Contract, or other agreement
for construction-related goods or services.
Initial: J H
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DEVIATION AND COMPLIANCE
If your company intends to deviate from the General Terms and Conditions, Proposal Specifications or other requirements
associated with this Proposal Invitation, you MUST list all such deviations on this form, and provide complete and detailed
information regarding the deviations on this form or an attachment to this form. Prior to completing this form, Vendor
shall review the General Terms and Conditions section B.4 (Deviations from Item Specifications and General
Terms and Conditions). Please note that, as provided in section B.4, certain provisions of the General Terms
and Conditions are NOT subject to deviation, and certain deviations will be deemed rejected without further
action by the Cooperative. Any attempted deviation, whether directly or indirectly, to provisions identified in
this Proposal Invitation as not subject to deviation shall be deemed rejected by the Cooperative and, unless
otherwise withdrawn by Vendor, may result in Vendor's Proposal being rejected in its entirety.
The Cooperative will consider any deviations in its contract award decision and reserves the right to accept or reject a proposal
based upon any submitted deviation.
In the absence of any deviation identified and described in accordance with the above, your company must fully comply with
the General Terms and Conditions, Proposal Specifications and all other requirements associated with this Proposal Invitation
if awarded a Contract under this Proposal Invitation. A deviation will not be effective unless accepted by the Cooperative.
The Cooperative, by and through the Cooperative administrator, may, in its sole discretion, seek clarification from and/or
communicate with Proposer(s) regarding any submitted deviation, consistent with general procurement principles of fair
competition. The Cooperative reserves the right to accept or reject a Proposal based upon any submitted deviation.
Please check (-/) one of the following:
❑■ NO; Deviations
❑ Yes; Deviations
List and fully explain any deviations you are submitting:
Initial: J H
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VENDOR CONSENT FOR NAME BRAND USE
BuyBoard members seeking to make purchases using a Contract awarded under this Proposal Invitation may view information
regarding awarded Vendors, including but not limited to product catalogs, pricelists, pricing, and Proposals, through the
BuyBoard website. To improve and enhance the experience of BuyBoard members seeking to procure goods and services
under the Contract utilizing the BuyBoard website, any Vendor logo, product images, and similar brand and trademark
information provided by Vendor for purposes of the Contract("Vendor Information") may be posted on the BuyBoard website.
You acknowledge that, by submitting your Proposal, unless you specifically opt out below, you consent to use
of your company's Vendor Information on the BuyBoard website if awarded a Contract. You further acknowledge
that whether, where, and when to include the Vendor Information on the BuyBoard website shall be at the sole discretion of
the BuyBoard Administrator. Vendor retains, however, the right of general quality control over the BuyBoard Administrator's
authorized display of proprietary Vendor Information. Neither the BuyBoard nor its administrator will be responsible for the
use or distribution of Vendor Information by BuyBoard members or any other third party using the BuyBoard website. This
Vendor Consent shall be effective for the full term of the Contract, including renewals, unless Vendor provides a signed,
written notice revoking consent to contractadmin(.abuyboard.com. BuyBoard shall have up to thirty days from the date of
receipt of a termination or revocation of a Vendor Consent to remove Vendor information from the BuyBoard website.
This Vendor Consent is subject to the Terms and Conditions of the Contract, including, but not limited to, those terms
pertaining to Disclaimer of Warranty and Limitation of Liability, Indemnification, and Intellectual Property Infringement.
Vendor logo files must be submitted in one of the formats set forth in the BuyBoard Technical Requirements. Proposers are
requested to submit this information with Vendor's Proposal. (This consent shall not authorize use of your company's Vendor
Information by BuyBoard if your company is not awarded a Contract.)
OPT OUT:
If your company wishes to opt out of the Vendor Consent for Name Brand Use, you must check the opt out box below. DO
NOTselect this box unless your company is opting out of this Vendor Consent for Name Brand Use.
❑ By checking this box, Vendor hereby declines to provide consent for use of Vendor Information (as defined herein) on
the BuyBoard website. By opting out, Vendor acknowledges and agrees that, if Vendor is awarded a Contract
under this Proposal Invitation, information available on the BuyBoard for Vendor's awarded products or
services may be limited, potentially placing Vendor at a disadvantage and impacting the ability of
Cooperative members to search, find, review, and purchase Vendor's awarded products and services on the
BuyBoard website.
Initial: I H
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PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
CONFIDENTIAL/PROPRIETARY INFORMATION
A. Public Disclosure Laws
All Proposals, forms, documentation, catalogs, pricelists, or other materials submitted by Vendor to the Cooperative in
response to this Proposal Invitation, may be subject to the disclosure requirements of the Texas Public Information Act(Texas
Government Code chapter 552.001, et, seq.) or similar disclosure law. Proposer must clearly identify on this form any
information in its Proposal (including forms, documentation, or other materials submitted with the Proposal) that Proposer
considers proprietary or confidential. If Proposer fails to properly identify the information, the Cooperative shall have no
obligation to notify Vendor or seek protection of such information from public disclosure should a member of the public or
other third party request access to the information under the Texas Public Information Act or similar disclosure law. When
required by the Texas Public Information Act or other disclosure law, Proposer may be notified of any third-party request for
information in a Proposal that Proposer has identified in this form as proprietary or confidential.
Does your Proposal (including forms, documentation, catalogs, pricelists, or other materials submitted with the Proposal)
contain information which Vendor considers proprietary or confidential?
Please check W)one of the following:
❑ NO, I certify that none of the information included with this Proposal is considered confidential or proprietary.
aYES, I certify that this Proposal contains information considered confidential or proprietary and all such information is
specifically identified on this form.
If you responded"YES", you must clearly identify below the specific information you consider confidential or proprietary. List
each page number, form number, or other information sufficient to make the information readily identifiable.The Cooperative
and Cooperative administrator shall not be responsible for a Proposer's failure to clearly identify information considered
confidential or proprietary. Further, by submitting a Proposal, Proposer acknowledges that the Cooperative and Cooperative
administrator will disclose information when required by law, even if such information has been identified herein as
information Vendor considers confidential or proprietary.
Confidential / Proprietary Information:
(Attach additional sheets if needed.)
Initial: J H
Page 18 of 76
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Board
PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
B. Copyright Information
Does your Proposal (including forms, documentation, pricelists, catalogs, or other materials submitted with the Proposal)
contain copyright information?
Please check()/)one of the following:
❑E NO, Proposal (including forms, documentation, pricelists, catalogs, or other materials submitted with the Proposal) does not
contain copyright information.
❑ YES, Proposal (including forms, documentation, pricelists, catalogs, or other materials submitted with the Proposal) does
contain copyright information.
If you responded "YES", clearly identify below the specific documents or pages containing copyright information.
Copyright Information:
(Attach additional sheets if needed.)
C. Consent to Release Confidential/Proprietary/Copyright Information to BuyBoard Members
BuyBoard members (Cooperative and nonprofit members) seeking to make purchases through the BuyBoard may wish to
view information included in the Proposals of awarded Vendors. If you identified information on this form as confidential,
proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBoard contract
award constitutes your consent to the disclosure of such information to BuyBoard members, including posting of such
information on the secure BuyBoard website for members. Note: Neither the Cooperative nor Cooperative administrator will
be responsible for the use or distribution of information by BuyBoard members or any other party.
D.Consent to Release Proposal Tabulation
Notwithstanding anything in this Confidential/Proprietary Information form to the contrary, by submitting a Proposal, Vendor
consents and agrees that, upon Contract award, the Cooperative may publicly release, including posting on the public
BuyBoard website,a copy of the proposal tabulation and award information for the Contract including Vendor name; proposed
catalog/pricelist name(s); proposed percentage discount(s), hourly labor rate(s),or other specified pricing; and Vendor award
or non-award information.
Initial: J H
Page 19 of 76
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Board
PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
EDGAR VENDOR CERTIFICATION
(2 CFR Part 200 and Appendix II)
When a Cooperative member seeks to procure goods and services using funds under a federal grant or contract, specific
federal laws, regulations, and requirements may apply in addition to those under state law. This includes, but is not limited
to, the procurement standards of the Uniform Administrative Requirements, Cost Principles and Audit Requirements for
Federal Awards, 2 CFR 200 (sometimes referred to as the "Uniform Guidance"or new"EDGAR'�. All Vendors submitting a
Proposal must complete this EDGAR Certification Form regarding Vendor's willingness and ability to comply with certain
requirements which may be applicable to specific Cooperative member purchases using federal grant funds. Completed
forms will be made available to Cooperative members for their use while considering their purchasing options when using
federal grant funds. Cooperative members may also require Vendors to enter into ancillary agreements, in addition to the
terms and conditions of the BuyBoard contract, to address the member's specific contractual needs, including contract
requirements for a procurement using federal grants or contracts.
For each of the items below, Vendor should certify Vendor's agreement and ability to comply, where
applicable, by having Vendor's authorized representative check the applicable boxes, initial each page, and
sign the Compliance Forms Signature Page. If you fail to complete any item in this form, the Cooperative will
consider and may list the Vendor's response on the BuyBoard as WO,"the Vendor is unable or unwilling to
comply. A "NO" response to any of the items may, if applicable, impact the ability of a Cooperative member to purchase
from the Vendor using federal funds.
1. Vendor Violation or Breach of Contract Terms:
Contracts for more than the simplified acquisition threshold, which is the inflation adjusted amount determined by the Civilian
Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 USC 1908, must
address administrative, contractual, or legal remedies in instances where contractors violate or breach contract terms, and
provide for such sanctions and penalties as appropriate.
Provisions regarding Vendor default are included in the BuyBoard General Terms and Conditions, including Section E.18,
Remedies for Default and Termination of Contract. Any Contract award will be subject to such BuyBoard General Terms and
Conditions, as well as any additional terms and conditions in any Purchase Order, Member Construction Contract, or
Cooperative member ancillary contract agreed upon by Vendor and the Cooperative member which must be consistent with
and protect the Cooperative member at least to the same extent as the BuyBoard Terms and Conditions. The remedies under
the Contract are in addition to any other remedies that may be available under law or in equity. By submitting a Proposal,
you agree to these Vendor violation and breach of contract terms.
91 YES, I agree. ❑ NO, I do not agree.
2. Termination for Cause or Convenience:
For any Cooperative member purchase or contract in excess of$10,000 made using federal funds,you agree that the following
term and condition shall apply:
The Cooperative member may terminate or cancel any Purchase Order under this Contract at any time, with or without cause,
by providing seven (7) business days advance written notice to the Vendor. If this Agreement is terminated in accordance
with this Paragraph, the Cooperative member shall only be required to pay Vendor for goods or services delivered to the
Cooperative member prior to the termination and not otherwise returned in accordance with Vendors return policy. If the
Cooperative member has paid Vendor for goods or services not yet provided as of the date of termination, Vendor shall
immediately refund such payment(s).
If an alternate provision for termination of a Cooperative member purchase for cause and convenience, including the manner
by which it will be effected and the basis for settlement, is included in the Cooperative member's Purchase Order, Member
Construction Contract, or ancillary agreement agreed to by the Vendor, the Cooperative member's provision shall control.
YES, I agree. ❑ NO, I do not agree. Initial: JH
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Board
PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
3. Equal Employment Opportunity:
Except as otherwise provided under 41 CFR Part 60, all Cooperative member purchases or contracts that meet the definition
of"federally assisted construction contract" in 41 CFR Part 60-1.3 shall be deemed to include the equal opportunity clause
provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246,"Equal Employment Opportunity"(30 FR 12319,
12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, "Amending Executive Order 11246
Relating to Equal Employment Opportunity," and implementing regulations at 41 CFR Part 60, "Office of Federal Contract
Compliance Programs, Equal Employment Opportunity, Department of Labor."
The equal opportunity clause provided under 41 CFR 60-1.4(b) is hereby incorporated by reference. Vendor agrees that such
provision applies to any Cooperative member purchase or contract that meets the definition of"federally assisted construction
contract" in 41 CFR Part 60-1.3 and Vendor agrees that it shall comply with such provision.
4 YES, I agree. ❑ NO, I do not agree.
4. Davis-Bacon Act:
When required by Federal program legislation, Vendor agrees that, for all Cooperative member prime construction
contracts/purchases in excess of$2,000,Vendor shall comply with the Davis-Bacon Act(40 USC 3141-3144, and 3146-3148)
as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts
Covering Federally Financed and Assisted Construction"). In accordance with the statute, Vendor is required to pay wages to
laborers and mechanics at a rate not less than the prevailing wages specified in a wage determinate made by the Secretary
of Labor. In addition, Vendor shall pay wages not less than once a week.
Current prevailing wage determinations issued by the Department of Labor are available at beta.sam.gov. Vendor agrees
that, for any purchase to which this requirement applies, the award of the purchase to the Vendor is conditioned upon
Vendor's acceptance of the wage determination.
Vendor further agrees that it shall also comply with the Copeland "Anti-Kickback" Act (40 USC 3145), as supplemented by
Department of Labor regulations (29 CFR Part 3,"Contractors and Subcontractors on Public Building or Public Work Financed
in Whole or in Part by Loans or Grants from the United States"). The Act provides that each contractor or subrecipient must
be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work,
to give up any part of the compensation to which he or she is otherwise entitled.
A YES, I agree. ❑ NO, I do not agree.
S. Contract Work Hours and Safety Standards Act:
Where applicable, for all Cooperative member contracts or purchases in excess of$100,000 that involve the employment of
mechanics or laborers, Vendor agrees to comply with 40 USC 3702 and 3704, as supplemented by Department of Labor
regulations (29 CFR Part 5). Under 40 USC 3702 of the Act, Vendor is required to compute the wages of every mechanic and
laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided
that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in
excess of 40 hours in the work week.
The requirements of 40 USC 3704 are applicable to construction work and provide that no laborer or mechanic must be
required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These
requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or
contracts for transportation or transmission of intelligence.
YES, I agree. ❑ NO, I do not agree.
Initial: JH
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Board
PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
6. Right to Inventions Made Under a Contract or Agreement:
If the Cooperative member's Federal award meets the definition of "funding agreement" under 37 CFR 401.2(a) and the
recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the
substitution of parties, assignment or performance or experimental, developmental, or research work under that "funding
agreement,"the recipient or subrecipient must comply with the requirements of 37 CFR Part 401,"Rights to Inventions Made
by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements,"
and any implementing regulations issued by the awarding agency.
Vendor agrees to comply with the above requirements when applicable.
A YES, I agree. ❑ NO, I do not agree.
7. Clean Air Act and Federal Water Pollution Control Act:
Clean Air Act(42 USC 7401-7671q.)and the Federal Water Pollution Control Act(33 USC 1251-1387), as amended—Contracts
and subgrants of amounts in excess of$150,000 must contain a provision that requires the non-Federal award to agree to
comply with all applicable standards, orders, or regulations issued pursuant to the Clean Air Act (42 USC 7401-7671q.) and
the Federal Water Pollution Control Act, as amended (33 USC 1251-1387). Violations must be reported to the Federal
awarding agency and the Regional Office of the Environmental Protection Agency (EPA).
When required, Vendor agrees to comply with all applicable standards, orders, or regulations issued pursuant to the Clean
Air Act and the Federal Water Pollution Control Act.
11 YES, I agree. ❑ NO, I do not agree.
8. Debarment and Suspension:
Debarment and Suspension (Executive Orders 12549 and 12689) —A contract award (see 2 CFR 180.220) must not be made
to parties listed on the government-wide exclusions in the System for Award Management (SAM), in accordance with the
OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1966 Comp. p. 189) and 12689 (3 CFR
Part 1989 Comp. p. 235),"Debarment and Suspension." SAM Exclusions contains the names of parties debarred, suspended,
or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than
Executive Order 12549.
Vendor certifies that Vendor is not currently listed on the government-wide exclusions in SAM, is not debarred, suspended,
or otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than Executive Order
12549. Vendor further agrees to immediately notify the Cooperative and all Cooperative members with pending purchases or
seeking to purchase from Vendor if Vendor is later listed on the government-wide exclusions in SAM, or is debarred,
suspended, or otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than
Executive Order 12549.
4 YES, I agree. ❑ NO, I do not agree.
9. Byrd Anti-Lobbying Amendment:
Byrd Anti-Lobbying Amendment (31 USC 1352) - Vendors that apply or bid for an award exceeding $100,000 must file the
required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay
any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of
Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal
contract, grant or any other award covered by 31 USC 1352. Each tier must also disclose any lobbying with non-Federal funds
that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the
non-Federal award. As applicable, Vendor agrees to file all certifications and disclosures required by, and otherwise comply
with, the Byrd Anti-Lobbying Amendment (31 USC 1352).
YES, I agree. ❑ NO, I do not agree.
Initial• JH
Page 22 of 76
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Board
PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
10. Procurement of Recovered Materials:
For Cooperative member purchases utilizing Federal funds, Vendor agrees to comply with Section 6002 of the Solid Waste
Disposal Act, as amended by the Resource Conservation and Recovery Act where applicable and provide such information
and certifications as a Cooperative member may require to confirm estimates and otherwise comply. The requirements of
Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR
Part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory
level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the
preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and
resource recovery, and establishing an affirmative procurement program for procurement of recovered materials identified in
the EPA guidelines.
A YES, I agree. ❑ NO, I do not agree.
11. Domestic Preferences for Procurements:
Where appropriate and consistent with law, 2 CFR §200.322 contains certain considerations for domestic preferences for
procurements which may be applicable to Cooperative members using federal funds. When required by a Cooperative
member, Vendor agrees to provide such information or certification as may reasonably be requested by the Cooperative
member regarding Vendor's products, including whether goods, products, or materials are produced in the United States.
4 YES, I agree. ❑ NO, I do not agree.
12. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment
2 CFR §200.216 prohibits expending federal loan or grant funds to procure or obtain certain telecommunications and video
surveillance services or equipment. To the extent applicable and when required by a Cooperative member, Vendor agrees to
provide such information or certification as may reasonably be requested by the Cooperative member to confirm whether
any telecommunications or video surveillance services or equipment provided by Vendor is covered equipment or covered
services under 2 CFR §200.216.
4 YES, I agree. ❑ NO, I do not agree.
13. Profit as a Separate Element of Price:
For purchases using federal funds in excess of the Simplified Acquisition Threshold, a Cooperative member may be required
to negotiate profit as a separate element of the price. See, 2 CFR 200.324(b). When required by a Cooperative member,
Vendor agrees to provide information and negotiate with the Cooperative member regarding profit as a separate element of
the price for a particular purchase. However, Vendor agrees that the total price, including profit, charged by Vendor to the
Cooperative member shall not exceed the awarded pricing, including any applicable discount, under Vendor's Cooperative
Contract.
11 YES, I agree. ❑ NO, I do not agree.
14. General Compliance and Cooperation with Cooperative Members:
In addition to the foregoing specific requirements, Vendor agrees, in accepting any Purchase Order from a Cooperative
member, it shall make a good faith effort to work with Cooperative members to provide such information and to satisfy such
requirements as may apply to a particular Cooperative member purchase or purchases including, but not limited to,applicable
recordkeeping and record retention requirements.
�l YES, I agree. ❑ NO, I do not agree.
Initial: J H
Page 23 of 76
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Board
PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
COMPLIANCE FORMS SIGNATURE PAGE
By initialing pages and by signature below, I certify that I have reviewed the following forms; that the information provided
therein is true, complete, and accurate; and that I am authorized by my company to make all certifications, consents,
acknowledgements, and agreements contained herein:
■ Proposal Acknowledgements
■ Felony Conviction Disclosure
■ Debarment Certification
■ Resident/Nonresident Certification
■ Vendor Employment Certification
■ No Israel Boycott Certification
■ No Excluded Nation or Foreign Terrorist Organization Certification
■ Historically Underutilized Business Certification
■ Construction-Related Goods and Services Affirmation
■ Acknowledgement of BuyBoard Technical Requirements
■ Deviation and Compliance
■ Vendor Consent for Name Brand Use
■ Confidential/Proprietary Information
■ EDGAR Vendor Certification
Winston Water Cooler
Company Name
+lih riSOrl Digitally signed by John Hutchinson
John H U
L Date:2021.04.15 11:46:11-05'00'
Signature of Authorized Company Official
John Hutchinson - Inside Sales
Printed Name and Title
04/15/2021
Date
Page 24 of 76
Proposal Forms CONST.v.03.01.2021
Board
PURUASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
PROPOSAL FORMS PART 2: VENDOR INFORMATION FORMS
INSTRUCTIONS:
Proposer must completely and accurately provide all information requested in the following Vendor Information Forms or
your Proposal may be rejected as non-responsive:
■ Vendor Business Name ■ National Purchasing Cooperative Vendor Award
■ Vendor Contact Information Agreement (vendors serving outside Texas only)
■ Federal and State/Purchasing Cooperative ■ Local/Authorized Seller Listings
Experience ■ Manufacturer Dealer Designation
■ Governmental References ■ Proposal Invitation Questionnaire
■ Company Profile ■ Vendor Request to Self-Report BuyBoard
■ Texas Regional Service Designation Purchases (optional)
■ State Service Designation
To the extent any information requested is not applicable to your company, you must so indicate on the form.
VENDOR BUSINESS NAME
By submitting a Proposal, Vendor is seeking to enter into a legal contract with the Cooperative. As such, Vendor must be an
individual or legal business entity capable of entering into a binding contract.
Name of Proposing Company: Winston Water COOler
(List the legal name of the company seeking to contract with the Cooperative. Do NOT list an assumed name, dba,aka, etc.here. Such information may
be provided below. If you are submitting a joint proposal with another entity to provide the same proposed goods or services,each submitting entity should
complete a separate vendor information form. Separately operating legal business entities, even if affiliated entities, which propose to provide goods or
services separately must submit their own Proposals.)
Please check(v/)one of the following:
Type of Business: ❑ Individual/Sole Proprietor ❑ Corporation ❑ Limited Liability Company M Partnership
❑ Other (Specify: )
State of Incorporation (if applicable):
Federal Employer Identification Number: 81-1348390
(Vendor must include a completed IRS W-9 form with their Proposal)
Name by which Vendor, if awarded,wishes to be identified on the BuyBoard: (Note: Ifdifferentthan the Name of Proposing
Company listed above, only valid trade names(dba,aka, etc.)of the Proposing Company may be used and a copy of your Assumed Name Certiticate(s),if
applicable,must be attached.)
Winston Water Cooler
Page 25 of 76
Proposal Forms CONST.v.03.01.2021
Form W=9 Request for Taxpayer Give Form to the
(Rev.October2018) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service ►Go to www.irs.gov/FormW9 for instructions and the latest information,
1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
WINSTON WATER COOLER OF MANSFIELD, LTD
2 Business name/disregarded entity name,If different from above
41 c4 3 Check appropriate box for federal tax classification of the person whose name is entered online 1.Check only one of the 4 Exemptions(codes apply only to
following seven boxes, certain entities,not individuals;see
a instructions on page 3):
® ❑ Individual/sole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate
C single-member LLC Exempt payee code(if any)
O
0 Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)► P
p Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
c LLC If the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code(if any)
'c S another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that
CL is disregarded from the owner should check the appropriate'box for the tax classification of its owner.
k
❑ Other(see instructions)► (Axoios to accaums nmmwOwdoutslde the US.;
y5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional)
rn 615 S.WISTERIA STREET
6 City,state,and ZIP code
MANSFIELD, TX 76063
7 List account number(s)here(optsonaq
Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals,s,this is generally your social security number(Sater F#or ,other fora � _E] _
resident alien,sole proprietor,or disregarded entity,see the instructions for Part I, later. For other
entities,it is your employer identification number(Ell If you do not have a number,see How to get a
TIN, later. or
Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer Identification number
Number To Give the Requester for guidelines on whose number to enter.
8 1 - 1 3 4 8 3 9 0
• Certification
Under penalties of perjury, I certify that:
1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2.1 am not subject to backup withholding because;(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3. 1 am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,
acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA},and generally,payments
other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part 11, later.
Sign Signature of
Here U.S.person pate► Q
General Instructions •Form 1099-DIV(dividends,including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise •Form 1099-MISC(various types of income,prizes,awards,or gross
noted. proceeds)
Future developments. For the latest information about developments a Form 1099-B(stock or mutual fund sales and certain other
related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.irs.gov/FormW9.
• Farm 1099-5(proceeds from real estate transactions)
Purpose of Form • Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest), 1098-E(student loan interest),
information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number .Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number fIT1N),adoption .Form 1099-A(acquisition or abandonment of secured property)
taxpayer identification number(ATIN),or employer identification number
(El to report on an information return the amount paid to you,or other Use Form W-9 oniy if you are a U.S.person(including a resident
amount reportable on an information return.Examples of information alien),to provide your correct TIN.
returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might
•Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding,
later.
Cat.No.10231 X Form W-g(Rev.10-2018)
card
PYRUASING ConPERA VVE
12007 Research Boulevard • Austin, Texas 78759-2439 - PH: 800-695-2919 ' buyboard.com
VENDOR CONTACT INFORMATION
Proposal/Contract Contact:
Vendor Proposal/Contract Contact Name: John Hutchinson
Vendor Proposal/Contract Contact E-mail Address: jhutchinson@winstonwatercooler.com
Vendor Contact Mailing Address for Proposal/Contract Notices: 615 S. Wisteria St
Company Website: WlnStonwatercooler.com
Purchase Orders Contact Information: All Purchase Orders from Cooperative members will be available through the
Internet. Vendors need Internet access and at least one e-mail address so that notification of new orders can be sent to the
Internet contact when a new purchase order arrives. An information guide will be provided to Vendors to assist them with
retrieving their orders.
Please select options below for receipt of Purchase Orders and provide the requested information:
❑ I will use the internet to receive Purchase Orders at the following address:
Purchase Order E-mail Address: jhutchinson@winstonwatercooler.com
Purchase Order Contact: John hutchinson Phone: 817.612.5001
Alternate Purchase Order E-mail Address:
Alternate Purchase Order Contact: Phone:
❑ Purchase Orders may be received by the Designated Dealer(s) identified on my company's Dealer Designation
form as provided to the Cooperative administrator. I understand that my company shall remain responsible
for the Contract and the performance of all Designated Dealers under and in accordance with the Contract.
Request for Quotes ("RFQ',: Cooperative members will send RFQs to you by e-mail. Please provide e-mail addresses
for the receipt of RFQs:
RFQ E-mail Address: jhutchinson@winstonwatercooler.com
RFQ Contact: john hutchinson Phone: 817.612.5001
Alternate RFQ E-mail Address: zbutter@winstonwatercooler.com
Alternate RFQ Contact: Zane Butter Phone: 214.748.1484
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Proposal Forms CONST.v.03.01.2021
card
PURCHASING CODPERAVVE
12007 Research Boulevard ' Austin, Texas 78759-2439 • PH: 800-695-2919 ' buyboard.com
Invoices: Your company will be billed monthly for the service fee due under a Contract awarded under this Proposal
Invitation. All invoices are available on the BuyBoard website and e-mail notifications will be sent when they
are ready to be retrieved.
Please choose only one (1) of the following options for receipt of invoices and provide the requested
information:
❑ Service fee invoices and related communications should be provided directly to my company at:
Invoice Mailing address: 6626 OAKBROOK BLVD Department:
City: DALLAS State: TEXAS Zip Code: 75235
Contact Name: S HARO N OW E N S Phone: 214.748.1484
Invoice Fax: Invoice E-mail Address: SOWENS@WINSTONWATERCOOLER.COM
Alternative Invoice E-mail Address: ACCTG@WINSTONWATERCOOLER.COM
❑ In lieu of my company, I request and authorize all service fee invoices to be provided directly to the following billing
agent":
Billing Agent Mailing Address: Department:
City: State: Zip Code:
Billing Agent Contact Name: Phone:
Billing Agent Fax: Billing Agent E-mail Address:
Alternative Billing Agent E-mail Address:
**If Vendor authorizes a billing agent to receive and process service fee invoices, in accordance with the General Terms and
Conditions of the Contract, Vendor specifically acknowledges and agrees that nothing in that designation shall relieve Vendor
of its responsibilities and obligations under the Contract including, but not limited to, payment of all service fees under any
Contract awarded Vendor.
PLEASE PROVIDE THE FOLLOWING INFORMATION:
1. Shipping Via: ❑■ Common Carrier ❑■ Company Truck ❑■ Prepaid and Add to Invoice ❑ Other:
2. Payment Terms: (Note: Vendor payment terms must comply with the BuyBoard General Terms and Conditions and the Texas
Prompt Payment Act(Texas Government Code Ch. 2251).): NET 30
3. Vendor's Internal/Assigned Reference/Quote Number (optional):
4. State or attach your return policy. (Note: Only return requirements and processes will be deemed part of Vendor's return
policy. Any unrelated contract terms, terms of sale, or other information not specifically related to return requirements and
processes included in Vendor's return policy shall not apply to any awarded Contract unless specifically included as a
deviation in the Deviation and Compliance Form and accepted by the Cooperative): RETURNS ARE SUBJECT TO VENDOR APPROVAL AND DEPENDING ON THE
ITEM,MIGHT INCUR A RESTOCK FEE.
5. Are electronic payments acceptable? ❑Yes ❑ No 6. Are credit card payments acceptable? ❑■Yes ❑ No
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PYRUASING CODPERAVVE
12007 Research Boulevard ' Austin, Texas 78759-2439 • PH: 800-695-2919 ' buyboard.com
FEDERAL AND STATE/PURCHASING COOPERATIVE EXPERIENCE
The Cooperative strives to provide Cooperative members with the best services and products at the best prices available from
Vendors with the technical resources and ability to serve Cooperative members. Please respond to the following questions.
1. Provide the dollar value of sales to or through purchasing cooperatives at or based on an established catalog or market
price during the previous 12-month period or the last fiscal year: $o . (The period of the 12-month
period is / ). In the event that a dollar value is not an appropriate measure of the sales, provide
and describe your own measure of the sales of the item(s).
2. By submitting a proposal, you agree that, based on your written discounting policies, the discounts you offer the
Cooperative are equal to or better than the best price you offer other purchasing cooperatives for the same items under
equivalent circumstances.
3. Provide the information requested below for other purchasing cooperatives for which Proposer currently serves, or in
the past has served, as an awarded vendor. Rows should be added to accommodate as many purchasing cooperatives
as required.
CURRENT FORMER VENDOR (Y/N)? — AWARDED
PURCHASING VENDOR? • •D
GROUPD•• ••
1. Federal General Services Administration N
2. T-PASS (state of Texas) N
3. OMNIA Partners N
4. Sourcewell (NJPA) N
5. E&I Cooperative N
6. Houston-Galveston Area Council (HGAC) N
7. Choice Partners N
8. The Interlocal Purchasing System (TIPS) N
9. Other N
0 MY COMPANY DOES NOT CURRENTLY HAVE ANY OF THE ABOVE OR SIMILAR TYPE CONTRACTS.
CURRENT BUYBOARD VENDORS
If you are a current BuyBoard vendor in the same contract category as proposed in this Proposal Invitation, indicate the
discount for your current BuyBoard contract and the proposed discount in this Proposal. Explain any difference between your
current and proposed discounts.
Current Discount (%): Proposed Discount (%):
Explanation: Discounts are given on a job by job basis, depending on product requested.
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PYRUASING ConPERA VVE
12007 Research Boulevard ' Austin, Texas 78759-2439 • PH: 800-695-2919 ' buyboard.com
GOVERNMENTAL REFERENCES
For your Proposal to be considered, you must supply a minimum of five (5) individual governmental entity references. The
Cooperative may contact any and all references provided as part of the Proposal evaluation. Provide the information requested
below, including the existing pricing/discounts you offer each customer. The Cooperative may determine whether
pricing/discounts are fair and reasonable by comparing pricing/discounts stated in your Proposal with the pricing/discounts
you offer other governmental customers. Attach additional pages if necessary.
Quantity/
Entity Name Contact Phone# Email Address Discount Volume
1 UNIVERSITY OF TEXAS ARLINGTON- MATT YOUNG-817.770.5759-MYOUNG@UTA.EDU-VARIES ON THE PRODUCT-$28k/YEAR
2 Castleberry ISD - Jerry Walker- 817.455.8871 - walkerj@castleberryisd.net - varies on the project - $4K/year
3 EAGLE MOUNTAIN ISD-JARED BRYANT-817.832.9475-JBRYANT@EMS-ISD.NET-VARIES ON THE PROJECTS-$83k/YEAR
4 GRAPEVINE COLLEYVILLE ISD-GARY FOREE-817.251.5609-GARY.FOREE@GC ISD.NET-VARIES ON THE PROJECT-$19k/YEAR
5 FORT WORTH ISD-JAMES COHEN -817.675.5629-JAMES.COHEN@FWISD.ORG-VARIES ON THE PROJECT-$153k/YEAR
Do you ever modify your written policies or standard governmental sales practices as identified in the above chart to give
better discounts (lower pricing) than indicated? YES 0 NO ❑ If YES, please explain:
WE WILL BID ORDERS LOWER FOR QUANTITIES FOR THE YEAR OR LARGE PROJECTS
COMPANY PROFILE
Information on awarded Cooperative Contracts is available to Cooperative Members on the BuyBoard website. If your
company is awarded a Contract under this Proposal Invitation, please provide a brief company description that you would
like to have included with your company profile on the BuyBoard website. Submit your company profile in a separate
file, in Word format, with your Proposal. (Note: Vendor is solely responsible for any content provided for inclusion on
the BuyBoard website. The Cooperative reserves the right to exclude or remove any content in its sole discretion, with or
without prior notice, including but not limited to any content deemed by the Cooperative to be inappropriate, irrelevant to
the Contract, inaccurate, or misleading.)
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PYRUASING ConPERA VVE
12007 Research Boulevard ' Austin, Texas 78759-2439 • PH: 800-695-2919 ' buyboard.com
TEXAS REGIONAL SERVICE DESIGNATION
The Cooperative (referred to as "Texas Cooperative" in this form and in the State Service Designation form) offers vendors
the opportunity to service its members throughout the entire State of Texas. If you do not plan to service all Texas Cooperative
members statewide, you must indicate the specific regions you will service on this form. If you propose to serve different
regions for different products or services included in your Proposal, you must complete and submit a separate Texas Regional
Service Designation form for each group of products and clearly indicate the products or services to which the designation
applies. By designating a region or regions, you are certifying that you are authorized and willing to provide
the proposed products and services in those regions. Designating regions in which you are either unable or
unwilling to provide the specified products and services shall be grounds for either rejection of your Proposal
or, if awarded, termination of your Contract. Additionally, if you do not plan to service Texas Cooperative members
(i.e., if you will service only states other than Texas), you must so indicate on this form.
Regional Education Service Centers 0 I will service Texas
Cooperative members
statewide.
-- - � ' ❑ I will not service Texas
Cooperative members
statewide. I will only
service members in the
.. _41 regions checked below:
�• �!' °r, Region and Headquarters
� � ❑ 1 Edinburg
µ I� 1 �' — - _ ❑ 2 Corpus Christi
i w_ - _ ❑ 3 Victoria
1 �� Y:v .l ❑ 4 Houston
-, � ' $' ❑ 5 Beaumont
❑ 6 Huntsville
;'h 4 ❑ 7 Kilgore
❑ 8 Mount Pleasant
e" -yam ❑ 9 Wichita Falls
` ❑ 10 Richardson
a•�.- ❑ 11 Fort Worth
❑ 12 Waco
❑ 13 Austin
❑ 14 Abilene
__ �j ❑ 15 San Angelo
'' r ❑ 16 Amarillo
Winston Water Cooler ❑ 17 Lubbock
❑ 18 Midland
Company Name ❑ 19 El Paso
❑ 20 San Antonio
❑ I will not service members of the
Texas Cooperative.
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URCHASYNG COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
STATE SERVICE DESIGNATION
As set forth in the Proposal Invitation, it is the Cooperative's intent that other governmental entities in the United States have
the opportunity to purchase goods or services awarded under the Contract, subject to applicable state law, through a piggy-
back award or similar agreement through the National Purchasing Cooperative BuyBoard. If you plan to service the entire
United States or only specific states,you must complete this form accordingly. (Note:Ifyou plan to service Texas Cooperative
members, be sure that you complete the Texas Regional Service Designation form.) In addition to this form, to be
considered for a piggy-back award by the National Purchasing Cooperative, you must have an authorized
representative sign the National Purchasing Cooperative Vendor Award Agreement that follows this form.
If you serve different states for different products or services included in your Proposal, you must complete and submit a
separate State Service Designation form for each group of products and clearly indicate the products or services to which the
designation applies. By designating a state or states, you are certifying that you are authorized and willing to
provide the proposed products and services in those states. Designating states in which you are either unable
or unwilling to provide the specified products and services shall be grounds for either rejection of your
Proposal or, if awarded, termination of your Contract.
Please check U all that apply:
❑■ I will service all states in the United States.
❑ I will not service all states in the United States. I will service only the states checked below:
❑ Alabama
❑ Alaska ❑ Nebraska
❑ Arizona ❑ Nevada
❑ Arkansas ❑ New Hampshire
❑ California (Public Contract Code 20118 &20652) ❑ New Jersey
❑ Colorado ❑ New Mexico
❑ Connecticut ❑ New York
❑ Delaware ❑ North Carolina
❑ District of Columbia ❑ North Dakota
❑ Florida ❑ Ohio
❑ Georgia ❑ Oklahoma
❑ Hawaii ❑ Oregon
❑ Idaho ❑ Pennsylvania
❑ Illinois ❑ Rhode Island
❑ Indiana ❑ South Carolina
❑ Iowa ❑ South Dakota
❑ Kansas ❑ Tennessee
❑ Kentucky ❑ Texas
❑ Louisiana ❑ Utah
❑ Maine ❑ Vermont
❑ Maryland ❑ Virginia
❑ Massachusetts ❑ Washington
❑ Michigan ❑ West Virginia
❑ Minnesota ❑ Wisconsin
❑ Mississippi ❑ Wyoming
❑ Missouri
❑ Montana
Proposal Forms CONST.v.03.01.2021
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URCHASYNG COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buvboard.com
NATIONAL PURCHASING COOPERATIVE VENDOR AWARD AGREEMENT
In accordance with the Terms and Conditions associated with this Proposal Invitation, a contract awarded under this Proposal
Invitation may be "piggy-backed" by another governmental entity. The National Purchasing Cooperative is an
intergovernmental purchasing cooperative formed by certain school districts outside of Texas to serve its members throughout
the United States. If you agree to be considered for a piggy-back award by the National Purchasing Cooperative, you agree
to the following terms and agree to serve National Purchasing Cooperative members in the states you have indicated on the
State Service Designation form, in your Proposal.
By signing this form, Proposer (referred to in this Agreement as"Vendor") agrees as follows:
1. Vendor acknowledges that if The Local Government Purchasing Cooperative ("Texas Cooperative") awards Vendor a
contract under this Proposal Invitation ("Underlying Award"), the National Purchasing Cooperative ("National Cooperative")
may - but is not required to - "piggy-back"on or re-award all or a portion of that Underlying Award ("Piggy-Back Award").
By signing this National Cooperative Vendor Award Agreement ("Agreement"), Vendor accepts and agrees to be bound by
any such Piggy-Back Award as provided for herein.
2. In the event National Cooperative awards Vendor a Piggy-Back Award, the National Cooperative Administrator("BuyBoard
Administrator's will notify Vendor in writing of such Piggy-Back Award, which award shall commence on the effective date
stated in the Notice and end on the expiration date of the Underlying Award, subject to annual renewals as authorized in
writing by the BuyBoard Administrator. Vendor agrees that no further signature or other action is required of Vendor in order
for the Piggy-Back Award and this Agreement to be binding upon Vendor. Vendor further agrees that no interlineations or
changes to this Agreement by Vendor will be binding on National Cooperative, unless such changes are agreed to by its
BuyBoard Administrator in writing.
3. Vendor agrees that it shall offer its goods and services to National Cooperative members at the same unit pricing and
same general terms and conditions, subject to applicable state laws in the state of purchase, as required by the Underlying
Award. However, nothing in this Agreement prevents Vendor from offering National Cooperative members better(i.e., lower)
competitive pricing and more favorable terms and conditions than those in the Underlying Award.
4. Vendor hereby agrees and confirms that it will serve those states it has designated on the State Service Designation Form
of this Proposal Invitation. Any changes to the states designated on the State Service Designation Form must be approved
in writing by the BuyBoard Administrator.
5. Vendor agrees to pay National Cooperative the service fee provided for in the Underlying Award based on the amount of
purchases generated from National Cooperative members through the Piggy-Back Award. Vendor shall remit payment to
National Cooperative on such schedule as it specifies (which shall not be more often than monthly). Further, upon request,
Vendor shall provide National Cooperative with copies of all purchase orders generated from National Cooperative members,
vendor invoices, and/or such other documentation regarding those purchase orders as the Cooperative's administrators may
require in their reasonable discretion for purposes of reviewing and verifying purchase activity. Vendor further agrees that
National Cooperative shall have the right, upon reasonable written notice, to review Vendor's records pertaining to purchases
made by National Cooperative members in order to verify the accuracy of service fees.
6. Vendor agrees that the Underlying Award, including its General Terms and Conditions, are adopted by reference to the
fullest extent such provisions can reasonably apply to the post-proposal/contract award phase. The rights and responsibilities
that would ordinarily inure to the Texas Cooperative pursuant to the Underlying Award shall inure to National Cooperative;
and, conversely, the rights and responsibilities that would ordinarily inure to Vendor in the Underlying Award shall inure to
Vendor in this Agreement. Vendor recognizes and agrees that Vendor and National Cooperative are the only parties to this
Agreement, and that nothing in this Agreement has application to other third parties, including the Texas Cooperative. In the
event of conflict between this Agreement and the terms of the Underlying Award, the terms of this Agreement shall control,
and then only to the extent necessary to reconcile the conflict.
Proposal Forms CONST.v.03.01.2021
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URCHASYNG COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
7. This Agreement shall be governed and construed in accordance with the laws of the State of Rhode Island and venue for
any dispute shall lie in the federal district court of Alexandria, Virginia.
8. Vendor acknowledges and agrees that the award of a Piggy-Back Award is within the sole discretion of National
Cooperative, and that this Agreement does not take effect unless and until National Cooperative awards Vendor a Piggy-Back
Award and the BuyBoard Administrator notifies Vendor in writing of such Piggy-Back Award as provided for herein.
WHEREFORE, by signing below Vendor agrees to the foregoing and warrants that it has the authority to enter into this
Agreement.
Winston Water Cooler 657-21
Name of Vendor Proposal Invitation Number
John Hutchinson Date: l021.04d 612:4008-05'00'by John John Hutchinson
Date:2021.04.16 12:40:08-05'00'
Signature of Authorized Company Official Printed Name of Authorized Company Official
04/16/2021
Date
Proposal Forms CONST.v.03.01.2021
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URCHASINO CODPERATWE
12007 Research Boulevard ' Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 ' buyboard.com
LOCATION / AUTHORIZED SELLER LISTINGS
If you have more than one location/authorized seller that will service a Contract awarded under this Proposal Invitation,
please list each location/authorized seller below. If additional sheets are required, please duplicate this form as necessary.
NOTE: Awarded Vendors shall remain responsible for all aspects of the Contract, including processing of Purchase Orders,
and shall be responsible for the performance of all locations and authorized sellers under and in accordance with the Contract.
If you are a product manufacturer and wish to designate Designated Dealers as defined in the General Terms
and Conditions to receive Cooperative member Purchase Orders on your behalf, you must complete the
Manufacturer Designated Dealer form,
Location/Authorized Contact Information
Seller Name Contact Person (Mailing Address, Phone,
Proposal Forms CONST.v.03.01.2021
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URCHASYNG COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
MANUFACTURER DEALER DESIGNATION
If Vendor is a manufacturer that sells products through a dealer network and wishes to designate a dealer or multiple dealers
('Designated Dealers' to receive Cooperative member Purchase Orders on Vendor's behalf, you must complete this form for
each dealer you wish to designate.
Regardless of any Designated Dealers submitted by Vendor, Vendor specifically agrees and acknowledges that any such
designations are for Vendor's convenience only and shall not, if Vendor is awarded a Contract, relieve Vendor of any
obligations under the Contract, including payment of Cooperative service fees on all Purchase Orders submitted to Vendor or
any Designated Dealer. In accordance with the General Terms and Conditions, an awarded Vendor shall remain responsible
and liable for all of its obligations under the Contract and the performance of both Vendor and any of Vendor's Designated
Dealers under and in accordance with the Contract and remain subject to all remedies for default thereunder, including, but
not limited to suspension and termination of Vendor's Contract for nonpayment of service fees.
If awarded, Vendor authorizes the Cooperative, in its sole discretion, to list any Vendor Designated Dealers in the BuyBoard
system and to receive Purchase Orders directly from Cooperative members on behalf of Vendor. To the extent a Vendor with
Designated Dealers receives a Purchase Order directly, it shall be the responsibility of Vendor to appropriately process such
Purchase Order in accordance with the Contract, including but not limited to timely forwarding such Purchase Order to a
Designated Dealer for processing.
The Cooperative reserves the right, in its sole discretion, to refuse addition of, or request removal of, any Designated Dealer,
and Vendor agrees to immediately require such Designated Dealer to cease accepting Purchase Orders or otherwise acting
on Vendor's behalf under the Contract. Further, the Cooperative administrator shall be authorized to remove or suspend any
or all Designated Dealers from the BuyBoard at any time in its sole discretion.
If you wish to designate a dealer to service a contract awarded under this Proposal Invitation, please list the Designated
Dealer below. If you wish to designate multiple dealers, please duplicate this form as necessary.
Designated Dealer Name Designated Dealer Contact Person
Designated Dealer Address
City State Zip
Phone Number Fax Number
Email address Designated Dealer Tax ID Number* (*attach W-9)
Proposal Forms CONST.v.03.01.2021
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URCHASINGCOOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buvboard.com
PROPOSAL INVITATION QUESTIONNAIRE
The Cooperative will use your responses to the questions below in evaluating your Proposal and technical and financial
resources to provide the goods and perform the services("Work") under the BuyBoard contract contemplated by this Proposal
Invitation ("Contract'). Proposers must fully answer each question, numbering your responses to correspond to the
questions/numbers below. Proposers must complete below or attach your responses to this questionnaire and submit in one
document with your Proposal. You must submit the questionnaire and responses with your Proposal or the
Proposal will not be considered.
1. List the number of years Proposer has been in business and former business names (if applicable). Note whether your
company is currently for sale or involved in any transaction that would significantly alter its business or result in acquisition
by another entity.
2Q+
2. Describe Vendor's direct experience (not as a subcontractor) performing the Work proposed under this Contract. Include
a brief description of the projects you have completed for Texas governmental entities in the last 5 years, and include
for each the project name, scope, value, and date, and the name of the procuring government entity and entity contact
person. Identify the contracts that best represent Vendor's capabilities relative to this Contract.
We were awarded a 21 water cooler order from Missouri Western State University through buy board last year.
We continually are awarded commercial water heaters through Fort Worth ISD through our Benbrook Branch.
We have a ton of success with many Independent School Districts,in which we have good relationships with and they like our company's employees,such as Grapevine/Colleyville ISD
3. Describe the resources Proposer has to manage staff and successfully perform the Work contemplated under this
Contract. State the number and summarize the experience of company personnel who may be utilized for the Work,
including those who will be available to Cooperative members for assistance with project development, technical issues,
and product selection for Work associated with this Contract.
We have over 20 branches in the state of Texas alone with a sales force of 3 people at minimum in each branch.Not to mention,DCs in Las Vegas and Phoenix to cover the western United States.
All of our branch managers and inside staff members have years of project management experience on commercial and residential new construction jobs.As well service and repair sales experience.
Proposal Forms CONST.v.03.01.2021
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URCHASYNG COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
4. The Contract does not include architectural or engineering services, which must be procured separately, outside of the
Cooperative, in accordance with Chapter 2254 of the Texas Government Code (Professional Services Procurement Act)
or other applicable law (for entities outside of Texas). If you are performing Work under the Contract on a project that
requires the services of an architect or professional engineer, how will you work with a Cooperative member and its
designated architect or engineer with respect to services that must be procured outside the Contract?
Our company does not perform work. We only supply equipment, pipe, valves, fittings, etc for projects.
5. Describe the tasks and functions that can be completed by Vendor in-house without the use of a subcontractor or other
third party.
This falls outside the realm of our capabilities as a vendor.
6. Marketing Strategy: For your Proposal to be considered, you must submit the Marketing Strategy you will use if the
Cooperative accepts all or part of your Proposal. (Example: Explain how your company will initially inform Cooperative
members of your BuyBoard Contract, and how you will continue to support the BuyBoard for the duration of the Contract
term.)Attach additional pages if necessary.
We've found in the past that buyboard customers reach out to us more often than not.
We have continued relationships with buyboard users and strong relationships built on continued excellence in customer service and prompt attention to their needs.
7. Describe Proposer's financial capability to perform the Contract. State or describe the firm's financial strength and rating,
bonding capacity, and insurance coverage limits. State whether the firm, or any of the firm's past or present owners,
principal shareholders or stockholders, or officers, have been a debtor party to a bankruptcy, receivership, or insolvency
proceeding in the last 7 years, and identify any such debtor party by name and relationship to or position with your firm.
Our company has been in excellent standing with financial institutions for over 10 years and we never have issues,given the amount of business over the past 6+years on buyboard holding up our end of products requested.
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PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
8. Does your company have any outstanding financial judgments and/or is it currently in default on any loan or financing
agreement? If so, provide detailed information on the nature of such items and prospects for resolution.
N/A
9. List all contracts, if any, in the last 10 years on which Proposer has defaulted, failed to complete or deliver the work, or
that have been terminated for any reason. Include any contract for which the surety was notified of a potential claim in
regard to a payment or performance bond. For each such contract, provide the project name, scope, value and date and
the name of the procuring entity. Fully explain the circumstances of the default, notice to surety, failure to complete or
deliver the work, or termination.
N/A
10. List all litigation or other legal proceedings (including arbitration proceedings and/or claims filed with a surety in regard
to a payment or performance bond), if any, in the last 10 years brought against your firm, or any of the firm's past or
present owners, principal shareholders or stockholders, officers, agents or employees, that relate to or arise from a
contract similar to this Contract or the Work contemplated under this Contract. Provide the style of the lawsuit or
proceeding (name of parties and court or tribunal in which filed), nature of the claim, and resolution or current status.
N/A
11. Describe in detail the quality control system Vendor will use, including third party auditing certification, to support the
long-term performance and structural strength of the products to be used in a project under the Contract.
N/A
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PURCHASING COOPERATIVE
12007 Research Boulevard • Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
12. If the Work will require Vendor to tender performance or payment bonds, provide the name of the bonding company or
surety that will issue such bonds.
N/A
13. Describe in detail all documented safety issues, if any, that have involved Vendor in the last three years related to the
type of work contemplated under this Contract. Provide a three-year history of your firm's workers compensation
experience modifier.
N/A
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URCHASIKa CODPERATWE
12007 Research Boulevard ' Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 ' buyboard.com
VENDOR REQUEST TO SELF-REPORT BUYBOARD PURCHASES
The General Terms and Conditions require that all Purchase Orders generated by or under any Contract awarded under this
Proposal Invitation be processed through the BuyBoard and, except as expressly authorized in writing by the Cooperative
administrator, Vendors are not authorized to process Purchase Orders received directly from Cooperative members that have
not been processed through the BuyBoard or provided to the Cooperative. In accordance with this provision, Vendor may
request authorization of the Cooperative administrator to self-report Cooperative member purchases if awarded a Contract
under this Proposal Invitation. By making such a request, Vendor acknowledges and agrees that self-reporting is specifically
subject to and conditioned upon (1) Vendor's agreement to the Additional Terms and Conditions for BuyBoard Self-Reporting
which are included in this Proposal Invitation and incorporated herein for all purposes and (2) approval of this request in
writing by the Cooperative administrator.
Note: This form is NOT required as part of your proposal. You should sign and return this form ONLY if you
wish to request authorization to self-report BuyBoard purchases. Any request to self-report will not be effective,
and Vendor shall not be authorized to self-report BuyBoard member purchases, unless and until (1) Vendor is awarded a
Contract under this Proposal Invitation, and (2) the request has been approved in writing by the Cooperative administrator.
By my signature below, I hereby request authorization from the Cooperative administrator to self-report
BuyBoard purchases if my company is awarded a Contract. I certify that I am authorized by the above-named
Vendor to approve this form, and I have received and read the Additional Terms and Conditions for BuyBoard
Self-Reporting included in this Proposal Invitation and do hereby approve and agree to such terms and
conditions on behalf of Vendor,
NAME OF VENDOR: Winston Water Cooler
John Hutchinson Digitally signed by John Hutchinson
Date:2021.04.27 07:21:10-05'00'
Signature of Vendor Authorized Representative
Printed Name: John Hutchinson
Title: Inside Sales Manager
Date: 04/27/21
(For Cooperative Administrator Use Only)
Approved by BuyBoard Administrator:
Effective/Start Date for Self-Reporting:
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URCHASINO CODPERATWE
12007 Research Boulevard ' Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 ' buyboard.com
PROPOSAL SPECIFICATION SUMMARY
The categories and items specified for this Proposal Invitation are summarized below. For full Proposal
Specifications, you must review and complete the Proposal Specification information in the electronic proposal
submission system in accordance with the Instructions to Proposers (or, if submitting a hard copy Proposal, timely
request and complete the Proposal Specification Form in accordance with the Instructions to Proposers).
Section I: Equipment, Products, and Supplies
1 . Discount (%) off catalog/pricelist for Electrical Supplies, Materials and Equipment.
2 . Discount (%) off catalog/pricelist for All Types of Power Generating Equipment (electric, gas, diesel portable, back
up on-site).
3 . Discount (%) off catalog/pricelist for Various Types of Lamps and Ballasts (fluorescent, incandescent, quartz, HID,
shatterproof, metal halide, high pressure sodium, ballasts, similar related items).
4. Discount (%) off catalog/pricelist for Various Types of Lighting Fixtures.
5. Discount (%) off catalog/pricelist for All Types of Indoor Signage.
6. Discount (%) off catalog/pricelist for All Types of Solar Supplies and Equipment.
7. Discount(%) off catalog/pricelist for Building Supplies and Materials(carpentry, lumber, drywall, insulation products,
concrete products, and similar related items).
8. Discount (%) off catalog/pricelist for Doors-All Types and Sizes (metal, wooden, and similar related items).
9. Discount (%) off catalog/pricelist for Overhead Doors-All Types and Sizes (metal, wooden, similar related items).
10. Discount (%) off catalog/pricelist for All Types of Fasteners and Hardware Products (doors, cabinets, and similar
related items).
11. Discount (%) off catalog/pricelist for Roofing Materials and Supplies (PRODUCTS ONLY-NO LABOR).
12. Discount (%) off catalog/pricelist for Paint and Paint Related Products, Supplies and Equipment.
13. Discount (%) off catalog/pricelist for Parking Lot Striping Equipment, Supplies and Materials.
14. Discount (%) off catalog/pricelist for Plumbing Supplies, Materials and Equipment.
15. Discount (%) off catalog/pricelist for Various Types of Toilet Partitions, Sinks, and Countertops.
16. Discount (%) off catalog/pricelist for All Types of Energy and Water Monitoring Products.
17. Discount (%) off catalog/pricelist for Boiler Equipment and Supplies.
18. Discount (%) off catalog/pricelist for HVAC Refrigerants and Supplies.
19. Discount (%) off catalog/pricelist for All Types of Hand Tools and Sets.
20. Discount (%) off catalog/pricelist for Welding Supplies and Equipment.
21. Discount (%) off catalog/pricelist for Commercial Building Glass and Other Glass Materials and Supplies.
22. Discount (%) off catalog/pricelist for Building Entryway Awnings, Canopies and Related Accessories - all types
of material (metal, fabric, and related materials).
23. Discount (%) off catalog/pricelist for Elevator Equipment and Supplies.
24. Discount (%) off catalog/pricelist for Escalator Equipment and Supplies.
25. Discount(%) off catalog/pricelist for Material Handling and Storage Equipment and Supplies(forklifts, warehouse
storage systems, pallet jacks, similar related items).
26. Discount (%) off catalog/pricelist for All Types of Fencing Materials and Supplies.
27. Discount (%) off catalog/pricelist for Pest Control Products and Supplies.
28. Discount (%) off catalog/pricelist for Power Washing Equipment and Materials.
29. Discount (%) off catalog/pricelist for Soil/Road Chemical Base Stabilizer Products (solvents, surfactants, acid
oxidizers, and common dispersing agents).
30. Discount(%) off catalog/pricelist for All Other Building Maintenance, Repair and Operations Products not listed
(supplies, materials and equipment).
Proposal Forms CONST.v.03.01.2021
Page 41 of 76
oard�
V
URCHASINO CODPERAME
12007 Research Boulevard ' Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 ' buyboard.com
Section II: Installation and Repair Service
31. Hourly Labor Rate for Installation/Repair Service of Boiler Equipment and Products and Related Items --
Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products.
32. Hourly Labor Rate for Installation/Repair Service of Power Generating Equipment, Products and Related
Items -- Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products.
33. Hourly Labor Rate for Installation/Repair Service of Commercial Building Glass and Related Items -- Not
to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products.
34. Hourly Labor Rate for Installation/Repair Service of Elevator Equipment, Products and Related Items Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products.
35. Hourly Labor Rate for Installation/Repair Service of Escalator Equipment, Products and Related Items Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products.
36. Hourly Labor Rate for Installation/Repair Service of Fencing Products and Related Items -- Not to Exceed
hourly labor rate for Installation/Repair Service of Equipment and Products.
37. Hourly Labor Rate for Installation/Repair Service of Toilet Partitions, Sinks, Countertops and Related
Items -- Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products.
38. Hourly Labor Rate for Installation/Repair Service of Overhead Door Equipment, Products and Related
Items -- Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products.
39. Hourly Labor Rate for Installation/Repair Service of Doors, Framework, Door Hardware Equipment,
Products and Related Items -- Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and
Products.
40. Hourly Labor Rate for Installation/Repair Service of Building Entryway Awnings, Canopies and Related
Equipment, Products and Related Items -- Not to Exceed hourly labor rate for Installation/Repair Service of
Equipment and Products.
41. Hourly Labor Rate for Installation/Repair Service of Power Washing Equipment and/or Services and
Related Items -- Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products.
42. Hourly Labor Rate for Installation/Repair Service of Parking Lot Striping Equipment and/or Services and
Related Items -- Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products.
43. Hourly Labor Rate for Installation/Repair Service of Concrete Cutting and Related Items -- Not to Exceed
hourly labor rate for Installation/Repair Service of Equipment and Products.
Proposal Forms CONST.v.03.01.2021
Page 42 of 76
oard�
F
URCHASINO CODPERATWE
12007 Research Boulevard ' Austin,Texas 78759-2439 • PH: 800-695-2919 ' FAX: 800-211-5454 • buyboard.com
REQUIRED FORMS CHECKLIST
(Please check(,/)the following)
0 Reviewed/Completed: Proposer's Acceptance and Agreement
PROPOSAL FORMS PART 1: COMPLIANCE FORMS
0 Reviewed/Completed: Proposal Acknowledgements
0 Reviewed/Completed: Felony Conviction Disclosure
0 Reviewed/Completed: Resident/Nonresident Certification
0 Reviewed/Completed: Debarment Certification
0 Reviewed/Completed: Vendor Employment Certification
0 Reviewed/Completed: No Israel Boycott Certification
7 Reviewed/Completed: No Excluded Nation or Foreign Terrorist Organization Certification
0 Reviewed/Completed: Historically Underutilized Business Certification
7 Reviewed/Completed: Acknowledgement of BuyBoard Technical Requirements
0 Reviewed/Completed: Construction-Related Goods and Services Affirmation
7 Reviewed/Completed: Deviation and Compliance
0 Reviewed/Completed: Vendor Consent for Name Brand Use
7 Reviewed/Completed: Confidential/Proprietary Information
0 Reviewed/Completed: EDGAR Vendor Certification
0 Reviewed/Completed: Compliance Forms Signature Page
PROPOSAL FORMS PART 2:VENDOR INFORMATION FORMS
Reviewed/Completed: Vendor Business Name
0 Reviewed/Completed: Vendor Contact Information
0 Reviewed/Completed: Federal and State/Purchasing Cooperative Experience
7 Reviewed/Completed: Governmental References
0 Reviewed/Completed: Company Profile
7 Reviewed/Completed: Texas Regional Service Designation
0 Reviewed/Completed: State Service Designation
7 Reviewed/Completed: National Purchasing Cooperative Vendor Award Agreement(vendors serving outside Texas only)
0 Reviewed/Completed: Local/Authorized Seller Listings
7 Reviewed/Completed: Manufacturer Dealer Designation
0 Reviewed/Completed: Proposal Invitation Questionnaire
7 Reviewed/Completed: Vendor Request to Self-Report BuyBoard Purchases (optional)
0 Reviewed/Completed: Proposal Specifications Discount (%) off Catalog/Pricelist and/or other required pricing
information including Catalogs/Pricelists (or no bid response) must be submitted with the Proposal or the Proposal will not
be considered.
Proposal Forms CONST.v.03.01.2021
Page 43 of 76
Exhibit C
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received
has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the
vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local governmental entity not later
than the 7th business day after the date the vendor becomes aware of facts that require the statement to be
filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code.An
offense under this section is a misdemeanor.
!J Name of vendor who has a business relationship with local governmental entity.
2
❑ Check this box if you are filing an update to a previously filed questionnaire.(The law requires that you file an updated
completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which
you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information is being disclosed.
N/A
Name of Officer
4j Describe each employment or other business relationship with the local government officer, or a family member of the
officer,as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.
Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form
CIO as necessary.
A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income,
other than investment income, from the vendor?
Yes F-1 No
B. Is the vendor receiving or likely to receive taxable income,other than investment income,from or at the direction
of the local government officer or a family member of the officer AND the taxable income is not received from the
local governmental entity?
F1 Yes F1 No
IJ Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or
other business entity with respect to which the local government officer serves as an officer or director, or holds an
ownership interest of one percent or more.
6
❑ Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts
as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).
7
��� 03/22/2022
Sig ure of vendor doing business with the governmental entity Date
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
A complete copy of Chapter 176 of the Local Government Code maybe found at http://www.statutes.legis.state.tx.us/
Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.
Local Government Code§176.0010-a):"Business relationship"means a connection between two or more parties
based on commercial activity of one of the parties. The term does not include a connection based on:
(A) a transaction that is subject to rate or fee regulation by a federal,state,or local governmental entity or an
agency of a federal,state,or local governmental entity;
(B) a transaction conducted at a price and subject to terms available to the public; or
(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and
that is subject to regular examination by, and reporting to,that agency.
Local Government Code§176.003(a)(2)(A)and(B):
(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
(2) the vendor:
(A) has an employment or other business relationship with the local government officer or a
family member of the officer that results in the officer or family member receiving taxable
income, other than investment income, that exceeds $2,500 during the 12-month period
preceding the date that the officer becomes aware that
(i) a contract between the local governmental entity and vendor has been executed;
or
(ii) the local governmental entity is considering entering into a contract with the
vendor;
(B) has given to the local government officer or a family member of the officer one or more gifts
that have an aggregate value of more than$100 in the 12-month period preceding the date the
officer becomes aware that:
(i) a contract between the local governmental entity and vendor has been executed; or
(ii) the local governmental entity is considering entering into a contract with the vendor.
Local Government Code§ 176.006(a)and (a-1)
(a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship
with a local governmental entity and:
(1) has an employment or other business relationship with a local government officer of that local
governmental entity,or a family member of the officer,described by Section 176.003(a)(2)(A);
(2) has given a local government officer of that local governmental entity, or a family member of the
officer,one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B),excluding any
gift described by Section 176.003(a-1);or
(3) has a family relationship with a local government officer of that local governmental entity.
(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator
not later than the seventh business day after the later of:
(1) the date that the vendor:
(A) begins discussions or negotiations to enter into a contract with the local governmental
entity; or
(B) submits to the local governmental entity an application,response to a request for proposals
or bids, correspondence, or another writing related to a potential contract with the local
governmental entity;or
(2) the date the vendor becomes aware:
(A) of an employment or other business relationship with a local government officer, or a
family member of the officer,described by Subsection (a);
(B) that the vendor has given one or more gifts described by Subsection (a);or
(C) of a family relationship with a local government officer.
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021