HomeMy WebLinkAboutContract 60487FORT WORTH CSC No. 60487
CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement ("Agreement") is entered into by and between Northern
Imports, dba Work Wear Safety Shoes ("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 — Texas Interlocal Purchasing System (TIPS)
No. 220101; and
4. Exhibit C — Conflict of Interest Questionnaire.
Exhibits A, B, and C which are attached hereto and incorporated herein, are made a part of this
Agreement for all purposes. Vendor agrees to provide City with the services and goods included in
Exhibit A pursuant to the terms and conditions of this Cooperative Purchase Agreement, including all
exhibits thereto.
City shall pay Vendor in accordance with the fee schedule in Exhibit A and in accordance with
the provisions of this Agreement. Total payment made under this Agreement for the firstyear by City
shall not exceed Sixty Thousand Dollars ($60,000.00). 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 expires on March 31, 2024 in line with the COOP Agreement. City
shall be able to renew this agreement for up to one (1) one-year renewal options by written agreement of
the parties, so long as the underlying COOP is renewed. Spend authorization for the renewal shall be as
follows: up to $75,000.00 for the First Renewal.
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.
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
Federal Compliance: Vendor agrees to comply with all federal statutes relating to
nondiscrimination, labor standards, domestic preference and environmental compliance. Additionally, for
work to be performed underthe Agreement or subcontract thereof, including procurement of materials or
leases of equipment, Vendor shall notify each potential subcontractor or supplier of the Vendor's federal
compliance obligations. These may include,but are not limited to: (a) Title VI of the Civil Rights Act of
1964 (P.L. 88-352) which prohibits discrimination onthe basis of race, color or national origin; (b) Title
IX of the Education Amendments of 1972, as amended (20 U.S.C. §§ 1681-1683, and 1685-1686),
which prohibits discrimination on the basis of sex; (c) the Fair Labor Standards Act of 1938 (29 USC
676 et. seq.), (d) Section 504 of the Rehabilitation Act of 1973, as amended (29
U.S.C. § 794), which prohibits discrimination on the basis of handicaps and the Americans with
Disabilities Act of 1990; (e) the Age Discrimination in Employment Act of 1967 (29 USC 621 et. seq.)
and the Age Discrimination Act of 1974, as amended (42 U.S.C. §§ 6101-6107), which prohibits
discrimination on the basis of age; (f) any other nondiscrimination provisions in any specific statute(s)
applicable to any Federal funding for this Agreement; (g) the requirements of any other nondiscrimination
statute(s) which may apply to this Agreement; (h) applicableprovisions of the Davis -Bacon Act under 40
USC § 3141 — 3148, and the Contract Work Hours and Safety Standards Act under 40 USC § 3701 —
3708; (i) applicable provisions of the Rights to Invention Made Under Contract or Agreement Act under
37 CFR Part 401; 0) applicable provisions of the Clean Air Act under 42 USC § 7401— 7671, the Energy
Federal Water Pollution Control Act 33 USC § 1251 — 1387, and the Energy Policy Conservation Act
under 42 USC § 6201; (k) compliance with all Buy America requirements under 23 USC 313 and 23
CFR 635.410, which require a domestic manufacturing process for any steel or iron products; (1)
Compliance with Prohibition on Certain Telecommunications and Video Surveillance Services or
Equipment under 2 CFR §200.216 and §200.471; (m) compliance with federal assistance programs under
Executive Order 12549, Debarment and Suspension, which prohibit participation of debarred or
suspended or otherwise excludedfrom or ineligible vendor or its suppliers using federal funds; (n)
compliance with federal restriction on lobbying expenditures under 2 CFR 200 clauses: (o) consistent
with Domestic preferences for procurements under 2 CFR §200.322, which provide a preference for the
purchase, acquisition, or use of goods, products, or materials produced in the United States as appropriate
and to the greatest extent practicable.
Notices required pursuant to the provisions of this Agreement shall be conclusively determined
to have been delivered when (1) hand -delivered to the other party, its agents, employees, servants or
representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3)
received by the other party by United States Mail, registered, return receipt requested, addressed as
follows:
To CITY:
To VENDOR:
City of Fort Worth Northern Imports, Inc.
Attn: William Johnson, Assistant City Manager Steve Bowman, Vice President of Sales
200 Texas Street 6318 Airport Freeway Suite C
Fort Worth, TX 76102-6314 Fort Worth, TX 76117
Facsimile: (817) 392-8654
Facsimile: (800) 820-0072
With copyto Fort Worth CityAttomey's Office
at same address
The undersigned represents and warrants that he or she has the power and authority to execute this
Agreement and bind the respective Vendor.
CITY OF FORT WORTH:
By:
William Johnson (N v 16, 202310:57 CST)
Name: William Johnson
Title: Assistant City Manager
Date:
APPROVAL RECOMMENDED:
A.
By Lauren Prieur (Nov 15, 2023 10:55 CST)
Name: Lauren Prieur
Title: Director, Public Works and Transportation
ATTEST: 4Foq>^
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V � ➢➢➢nnrea a$a'�'
By:
Name: Jannette S. Goodall
Title: City Secretary
VENDOR:
Northern Imports, Inc.
By: S'
Name: Steve Bowman
Title: Vice -President of Sales
Date: 11 /14/2023
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract, including ensuring all performance
and reporting requirements.
Tien Noreno
By: Tim Moreno (Nov 15, 202310:48 CST)
Name: Timothy Moreno
Title: TPW Superintendent
APPROVED AS TO FORM AND LEGALITY:
By:
Name: Jeremy Anato Mensah
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: N/A
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
EST 1980 Page 1
\WDRKWEAR of EXHIBIT A
S A F E T Y
08/30/23
2023 PRICE Prices reflect '
1 1 discountl
*PRICES AND STYLES MAY VARY DUE TO SUPPLY CHAIN ISSUES*
STYLE # PRICE STYLE H PRICE STYLE # PRICE STYLE H PRICE STYLE # PRICE
10011976 $128.10 1027458 S109.90 26256 $114.80 I804-4330 S252.00 A7896 $183.40
I10016265 S248.50 1027459 $109.90 27111 $166.60 I804-6136 S154.00 A8624 S86.80
I10017420 $211.40 10291 $122.50 3003J $185.50 I804-6292 $126.00 A8625 $86.80
I10020094 $179.90 108010BLK $18.40 3005J $166.60 I809-6110 $101.50 IA8674 $86.80
I10024956 $149.80 108116BLK $52.50 3007J $202.30 I812901-BLK $162.40 IA8675 $86.80
I10024983 S149.80 108136BKGD $95.90 I31261 S24.50 I812901-OAK S162.40 IBOPS6001 $103.60
I10024992 $164.50 108151BLK $79.10 I312951 $175.00 I8398DB $219.10 ICML8360 S195.30
I10033966 $189.70 11011 $122.50 I3630CAROLINA $145.60 I839CBK $219.10 ICMP1258 $193.90
I10033994 $164.50 11170 $92.40 I4052 $233.80 I89085 $54.60 CMW6275 $158.20
I10034673 S119.70 11509 $100.10 I4300J S152.60 I89086 $65.10 CWP1250 S169.40
I10034720 $165.90 12222 $131.60 I4321 $251.30 I90646 $179.90 DD130176 $177.80
I10038398 $149.10 12250 $170.80 I4818J $144.90 AIIQF $124.60 DD130204 $174.30
I10038923 $246.40 12251 S170.80 I4NQUBK $201.60 IA176A $112.70 DD130215 $177.80
I10040319 S116.90 12254 $172.90 I505CAROLINA $274.40 IAIGT9 $118.30 DD130237 $185.50
I10040405 S119.70 12323 $122.50 I518CA $308.00 AIKBW $149.10 DD130301 S194.60
I10042485 $135.10 12420 $127.40 I53531 $249.90 IA28NW S87.50 DD130331 S194.60
I10042550 $189.00 13500 $140.00 I5356HH $144.90 IA29G9 $240.80 DD130363 $146.30
I10043 $87.50 13562 $183.40 I5358HH $158.90 IA2MGD $140.00 DD130366 $205.10
I10044427 $115.50 13571 $135.80 I5391HH $193.90 IA300 $91.00 DD130389 S194.60
I1007024 $184.80 13621 $111.30 I5398HH $182.00 AWY S118.30 DD130394 $205.10
I1007969 $182.70 1435CAROLINA S162.40 I5424HH $168.00 IA41UY $175.00 DD130424 $193.90
I1016166 $224.70 14562 $191.80 I5547CAROLINA $191.80 IA5NU2 $114.10 DD130451 $204.40
I1018023 S198.80 15041 $205.10 I5548CA $172.90 IA5PIA $144.90 IDRD0417 $127.40
I1018079 $141.40 15261 $190.40 I5570CAROLINA $119.00 IA5RRP $118.30 IDRD0418 $149.10
I1021467 $207.20 15581 S135.80 I5679CA $135.10 IA5WHB $149.10 IE03164 $125.30
I1021469 $207.20 165001-019 $87.50 I5SG30002-001 $66.50 IA650 $96.60 IE03184 $130.90
I1023386 S219.80 166001-019 $87.50 I603102 $287.70 IA7111 S102.20 I103564 $125.30
1024186 $216.30 1753J $203.00 I605118 $249.20 I A712 $98.70 I FR40101 $191.10
I1024573 S219.80 1ML047COY S240.80 I605119 $249.20 IA7287 $110.60 IFR40602F S122.50
I1025581 $211.40 IML047RGN $240.80 I630785 $133.00 IA7420 $107.10 IFS2334 $119.00
I1025692 S219.80 1SG0002-001 $65.10 I6301 $243.60 IA7422 $115.50 IFS2650 $114.10
I1025696 $233.80 200166BLK $65.10 I640005 S106.40 IA7472 $116.20 IGB000494 $157.50
I1026357 $168.00 203102 $209.30 I640105 $106.40 IA7547 $131.60 IGB00236 $190.40
I1026369 S168.00 206214 $174.30 I640135 $98.00 IA7573 $147.00 IGB00471 $189.00
I1026486 $172.20 2106HH S122.50 I6921CAROLINA S189.00 IA7590 $161.00 IGG470 S59.50
I1026487 $172.20 2200CAROLINA S100.10 I72301 $217.00 IA7612 $95.20 IGG4700 $59.50
I1026706 $141.40 23250 $176.40 7505 $111.30 IA7625 $74.20 IGG5050 $86.80
I1027080 $166.60 23251 $184.80 I76551BLK $77.70 IA7627 $89.60 IGG6040 $83.30
I1027100 S175.00 23481 S179.90 I77111BLK S72.80 IA7673 $84.70 IGG7100 $60.20
I1027103 S168.00 23560 $184.10 I77200BLK S72.80 IA7675 S84.70 IGG7160 S82.60
STYLE # PRICE STYLE H PRICE STYLE # PRICE STYLE H PRICE STYLE H PRICE
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*PRICES AND
STYLES
MAY
VARY DUE TO SUPPLY
CHAIN ISSUES*
STYLE #
PRICE
STYLE #
PRICE
STYLE #
PRICE
STYLE #
PRICE
IT40500
$151.90
GG8200
$69.30
IP90936
S109.90
RB4166
S130.90
IT40511
$98.00
IA5016
$109.20
IP90976
$114.10
RB417
S146.30
IT40628
$140.70
IA5017
$135.80
P91026
$109.90
R134452
$99.40
IT40629
$139.30
IA5062
$123.90
P91266
$99.40
R134453
$106.40
IT41000
$95.20
IA5092
$137.90
P91331
$122.50
RB452
S99.40
IT43710
$149.10
IA5093
$135.80
P91340
$157.50
RB494
$100.10
IT44323
$136.50
IA5094
$151.90
P91351
$105.00
R138850
$153.30
IT94051
$82.60
IB3501
$15.60
P91361
$131.60
R138874
$151.90
ITD0312
$141.40
1003901
$128.80
P91392
$114.10
R138894
$151.90
ITW3430
$185.50
1005055
$179.90
P91402
$153.30
RK643
$107.10
ITW5008
$219.10
J05241
$144.90
P91415
$170.80
RK6710
$119.00
IVM30226
$105.00
J099511
$119.10
IP91448
$184.10
RKW0385
$170.10
IVM30239
$121.10
J099517
$87.50
IP91480
$100.80
S10001
$90.30
IVM30244F
$103.60
KDOA4TERDBX
$192.50
IP91541
$144.90
IS10002
$91.00
IVM30358
$110.60
KDOA4TGWC59
S118.30
IP91575
S141.40
IS10050
$87.50
IVM30801
$81.50
LIB 1550
$16.10
IP91604
$109.90
IS10060
$81.50
IVM30802F
$87.50
LIB 1551
$16.80
I P91605
$100.80
I S10530
$92.40
I W10180
$131.60
MAS012PBLK
$55.30
I P91672
$79.10
I SF6071
$112.70
I W10633
$109.90
MCAN003
$90.30
R13049
$125.30
ISTG-UH-BK
$164.50
IW10643
$105.00
MCAN006
S104.30
R6055
S95.90
ISTT-UH-BR
$158.90
IW10680
$122.50
MCANM01
$127.40
R131067
$138.60
IT10424
$112.00
W201147
$87.50
MCANSDI
S104.30
IRB113
$59.50
IT10628
$125.30
W201153
$109.90
MIDALLS
$149.10
IRB1130
$59.50
IT11010
$90.30
W201156
$149.10
MIDCLBRWH
$149.10
R131920
S80.50
IT11015
$90.30
W201218
$144.90
MIDSPWROL
$116.20
R13223
$76.30
IT119133
$75.60
W211001
$152.60
MT202
$124.60
R132230
$76.30
IT119134
$75.60
W211128
$166.60
MT2520
$243.60
IRB3225
S127.40
IT20234
$109.20
W221019
$137.20
MT2540
S220.50
R133240
$98.00
IT20235
$109.20
W221020
$144.90
MT2560
$206.50
R63241
$105.00
IT21114
$140.00
W221029
$114.80
MXALWOI
$202.30
IRB3482
$112.00
IT21124
$154.00
W221049
$105.00
MXBAW01
$211.40
R13350
$86.80
IT24610
$141.40
W231024
$114.10
MXBAW02
$210.00
IRB3500
$86.80
IT21210
$135.80
W231025
$127.40
MXBAW03
$211.40
R13383
$112.00
IT28111
$141.40
W231048
$118.30
MXBAW04
$214.90
R64044
$120.40
IT40095
$137.20
IW5009
$140.00
MXBNW01
$211.40
R134049
$125.30
IT40096
$135.80
IW5010
$140.00
MXBNW05
$216.30
R134051
$108.50
IT40104
$135.80
IW5011
$140.00
MXBW001
$216.30
R134120
$95.90
IT40105
$134.40
IWAS012LBLK
S84.70
N460
$52.50
RB4132
$104.30
IT40323
$126.70
IWIDLOGIBLE
$116.20
P51039
$61.60
R64144
$126.00
IT40423
S126.70
WXBAWOI
$203.00
P90565
$142.80
R134154
$93.80
IT40425
$123.90
WZS677BLK
$93.10
STYLE #
PRICE
STYLE #
PRICE
STYLE #
PRICE
STYLE #
PRICE
WORKWEARSAFETY.COM
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TIPS VENDOR AGREEMENT
Between Northern Imports DBA Work Wear Safety Shoes and
(Company Name)
THE INTERLOCAL PURCHASING SYSTEM (TIPS),
a Department of Texas Education Service Center Region 8 for
TIPS RFP 220101 Safety Equipment, Supplies and Services
General Information
The Vendor Agreement ("Agreement") made and entered into by and between The Interlocal Purchasing
System (hereinafter "TIPS") a government cooperative purchasing program authorized by the Region 8
Education Service Center, having its principal place of business at 4845 US Hwy 271 North, Pittsburg, Texas
75686 and the TIPS Vendor. This Agreement consists of the provisions set forth below, including provisions
of all attachments referenced herein. In the event of a conflict between the provisions set forth below and
those contained in any attachment, the provisions set forth shall control unless otherwise agreed by the
parties in writing and by signature and date on the attachment.
A Purchase Order ("PO"), Agreement or Contract is the TIPS Member's approval providing the authority to
proceed with the negotiated delivery order under the Agreement. Special terms and conditions as agreed
between the Vendor and TIPS Member should be added as addendums to the Purchase Order, Agreement
or Contract. Items such as certificate of insurance, bonding requirements, small or disadvantaged business
goals are some, but not all, of the possible addendums.
Terms and Conditions
Freight
All quotes to Members shall provide a line item for cost for freight or shipping regardless if there is a charge
or not. If no charge for freight or shipping, indicate by stating "No Charge", "$0", "included in price" or other
similar indication. Otherwise, all shipping, freight or delivery changes shall be passed through to the TIPS
Member at cost with no markup and said charges shall be agreed by the TIPS Member unless alternative
shipping terms are agreed by TIPS as a result of the proposal award.
Warranty Conditions
All new supplies equipment and services shall include manufacturer's minimum standard warranty unless
otherwise agreed to in writing. Vendor shall be legally permitted to sell all products offered for sale to TIPS
Members if the offering is included in the Request for Proposal ("RFP") category. All goods proposed and
sold shall be new unless clearly stated in writing.
Customer Support
The Vendor shall provide timely and accurate customer support for orders to TIPS Members as agreed by
the Parties. Vendors shall respond to such requests within a commercially reasonable time after receipt of
the request. If support and/or training is a line item sold or packaged with a sale, support shall be as agreed
with the TIPS Member.
TIPS Vendor Agreement 06022020_sr Page 1
Agreements
Agreements for purchase will normally be put into effect by means of a contract, agreement, or purchase
order(s) executed by authorized agents of the TIPS Member participating government entities, but other
means of placing an order may be used at the Member's discretion. Vendor accepts and understands that
when a purchase order or similar purchase document is sent from a customer through TIPS to the Vendor,
TIPS is recording the purchase and verifying whether the purchase is within the parameters of the TIPS
Contract only. Vendor agrees that TIPS is not a legal party to the purchase order or similar purchase
document and TIPS is not responsible for identifying fraud, mistakes, or misrepresentations for the specific
order. Vendor agrees that anv purchase order or similar purchase document issued from a customer to
Vendor, even when processed through TIPS, constitutes a legal contract between the customer and Vendor
only. A Vendor that accepts a purchase order or similar purchase document and fulfills an order, even when
processed through TIPS, is representing that the vendor has carefully reviewed the purchase order or similar
purchase document for legalitv, authenticity, and accuracy.
Tax exempt status
Most TIPS Members are tax exempt and the related laws and/or regulations of the controlling jurisdictions)
of the TIPS Member shall apply.
Assignments of Agreements
No assignment of this Agreement may be made without the prior notification of TIPS. Written approval of
TIPS shall not be unreasonably withheld. Payment for delivered goods and services can only be made to the
awarded Vendor, Vendor designated reseller or vendor assigned company.
Disclosures
• Vendor and TIPS affirm that he/she, or any authorized employees or agents, has not given, offered to
give, nor intends to give at any time hereafter any economic opportunity, future employment, gift,
loan, gratuity, special discount, trip, favor or service to a public servant in connection with this
Agreement.
• Vendor shall attach, in writing, a complete description of any and all relationships that might be
considered a conflict of interest in doing business with the TIPS program.
• The Vendor affirms that, to the best of his/her knowledge, the offer has been arrived at
independently, and is submitted without collusion with anyone to obtain information or gain any
favoritism that would in any way limit competition or give an unfair advantage over other vendors in
the award of this Agreement.
Term of Agreement and Renewals
The Agreement with TIPS is for approximately three (3) years with an option for renewal for an additional one
(1) consecutive year. If TIPS offers the renewal extension year, the Vendor will be notified by email to the primary
contact of the awarded Vendor and shall be deemed accepted by the Vendor unless the awarded Vendor notifies
TIPS of its objection to the additional term. TIPS may or may not exercise the available extension(s) provided in
the original solicitation beyond the base three-year term. Whether or not to offer the extension is at the sole
discretion of TIPS.
TIPS Vendor Agreement 06022020_sr Page 2
"Start Date" for Term Calculation Purposes Only: Regardless of actual award/effective date of Contract, for
Agreement "term" calculation purposes only, the Agreement "start date" is the last day of the month that Award
Notifications are anticipated as published in the Solicitation
Example: If the anticipated award date published in the Solicitation is May 22, 2020 but extended negotiations
delay award until June 27, 2020 The end date of the resulting initial "three-year" term Agreement, (which is
subject to an extension(s)) will still be May 31, 2023 in this example.
"Termination Date": The scheduled Agreement "termination date" shall be the last day of the month of the
month of the Original Solicitation's Anticipated Award Date plus three years.
Example: If the original term is approximately three years, and the solicitation provides an anticipated award
date of May 22, 2020, the expiration date of the original three-year term shall be May 31, 2023 in this example.
Extensions: Any extensions of the original term shall begin on the next day after the day the original term
expires.
Example Following the Previous Example: If TIPS offers a one-year extension, the expiration of the extended term
shall be May 31, 2024 in this example.
TIPS may offer to extend Vendor Agreements to the fullest extent the original Solicitation permits.
Automatic Renewal Clauses Incorporated in Awarded Vendor Agreements with TIPS Members Resulting from the
Solicitation and with the Vendor Named in this Agreement.
No Agreement for goods or services with a TIPS Member by the awarded vendor named in this Agreement
that results from the solicitation award named in this Agreement, may incorporate an automatic renewal
clause that exceeds month to month terms with which the TIPS Member must comply. All renewal terms
incorporated in an Agreement by the vendor with the TIPS Member shall only be valid and enforceable when
the vendor receives written confirmation by purchase order, executed Agreement or other written
instruction issued by the TIPS Member for any renewal period. The purpose of this clause is to avoid a TIPS
Member inadvertently renewing an Agreement during a period in which the governing body of the TIPS
Member has not properly appropriated and budgeted the funds to satisfy the Agreement renewal. This term
is not negotiable and any Agreement between a TIPS Member and a TIPS awarded vendor with an automatic
renewal clause that conflicts with these terms is rendered void and unenforceable.
Shipments
The Vendor shall ship, deliver or provide ordered products or services within a commercially reasonable time
after the receipt of the order from the TIPS Member. If a delay in said delivery is anticipated, the Vendor
shall notify TIPS Member as to why delivery is delayed and shall provide an estimated time for completion
of the order. TIPS or the requesting entity may cancel the order if estimated delivery time is not acceptable
or not as agreed by the parties.
Invoices
Each invoice or pay request shall include the TIPS Member's purchase order number or other identifying
designation as provided in the order by the TIPS Member. If applicable, the shipment tracking number or
pertinent information for verification of TIPS Member receipt shall be made available upon request.
Payments
The TIPS Member will make payments directly to the Vendor, the Vendor Assigned Dealer or as agreed by
the Vendor and the TIPS Member after receiving invoice and in compliance with applicable payment
statute(s), whichever is the greater time or as otherwise provided by an agreement of the parties.
TIPS Vendor Agreement 06022020_sr Page 3
Pricing
Price increases will be honored according to the terms of the solicitation. All pricing submitted to TIPS shall
include the participation fee, as provided in the solicitation, to be remitted to TIPS by the Vendor. Vendor
will not show adding the fee to the invoice presented to TIPS Member customer.
Participation Fees and Reporting of Sales to TIPS by Vendor
The Participation Fee that was published as part of the Solicitation and the fee published is the legally effective
fee, along with any fee conditions stated in the Solicitation. Collection of the fees by TIPS is required under
Texas Government Code §791.011 Et seq. Fees are due on all TIPS purchases reported by either Vendor or
Member. Fees are due to TIPS upon payment by the Member to the Vendor, Reseller or Vendor Assigned
Dealer. Vendor, Reseller or Vendor Assigned Dealer agrees that the participation fee is due to TIPS for all
Agreement sales immediately upon receipt of payment including partial payment, from the Member Entity
and must be paid to TIPS at least on a monthly basis, specifically within 31 calendar days of receipt of payment,
if not more frequently, or as otherwise agreed by TIPS in writing and signed by an authorized signatory of TIPS.
Thus, when an awarded Vendor, Reseller or Vendor Assigned Dealer receives any amount of payment, even
partial payment, for a TIPS sale, the legally effective fee for that amount is immediately due to TIPS from the
Vendor and fees due to TIPS should be paid at least on a monthly basis, specifically within 31 calendar days of
receipt of payment, if not more frequently.
Reporting of Sales to TIPS by Vendor
Vendor is required to report all sales under the TIPS contract to TIPS. When a public entity initiates a purchase
with a TIPS Awarded Vendor, if the Member inquires verbally or in writing whether the Vendor holds a TIPS
Contract, it is the duty of the Vendor to verify whether or not the Member is seeking a TIPS purchase. Once
verified, the Vendor must include the TIPS Contract number on any communications and related sales
documents exchanged with the TIPS Member entity. To report sales, the Vendor must login to the TIPS Vendor
Portal online at htti3s://www.tii3s-usa.com/vendors form.cfm and click on the PO's and Payments tab. Pages
3-7 of the Vendor Portal User Guide will walk you through the process of reporting sales to TIPS. Please refer
to the TIPS Accounting FAQ's for more information about reporting sales and if you have further questions,
contact the Accounting Team at accounting@tips-usa.com. The Vendor or vendor assigned dealers are
responsible for keeping record of all sales that go through the TIPS Agreement and submitting same to TIPS.
Failure to render the participation fee to TIPS shall constitute a breach of this agreement with our parent
governmental entity, Texas Education Service Center Region 8, as established by the Texas legislature and shall
be grounds for termination of this agreement and any other agreement held with TIPS and possible legal
action. Any overpayment of participation fees to TIPS by a Vendor will be refunded to the Vendor within ninety
(90) days of receipt of notification if TIPS receives written notification of the overpayment not later than the
expiration of six (6) months from the date of overpayment and TIPS determines that the amount was not
legally due to TIPS pursuant to this agreement and applicable law. It is the Vendor's responsibility to identify
which sales are TIPS Agreement sales and pay the correct participation fee due for TIPS Agreement sales. Any
notification of overpayment received by TIPS after the expiration of six (6) months from the date of
overpayment will be non-refundable. Region 8 ESC and TIPS reserve the right to extend the six (6) month
deadline to notify if approved by the Region 8 ESC Board of Directors. TIPS reserves all rights under the law to
collect the fees due. Please contact TIPS at tips@tips-usa.com or call (866) 839-8477 if you have questions
about paying fees.
Indemnity
The Vendor agrees to indemnify and hold harmless and defend TIPS, TIPS Member(s), officers and employees
from and against all claims and suits by third parties for damages, injuries to persons (including death),
TIPS Vendor Agreement 06022020_sr Page 4
property damages, losses, and expenses including court costs and reasonable attorney's fees, arising out of,
or resulting from, Vendor's performance under this Agreement, including all such causes of action based
upon common, constitutional, or statutory law, or based in whole or in part, upon allegations of negligent
or intentional acts on the part of the Vendor, its officers, employees, agents, subcontractors, licensees, or
invitees. Parties found liable shall pay their proportionate share of damages as agreed by the parties or as
ordered by a court of competent jurisdiction over the case. NO LIMITATION OF LIABILITY FOR DAMAGES
FOR PERSONAL INJURY OR PROPERTY DAMAGE ARE PERMITTED OR AGREED BY TIPS/ESC REGION 8. Per
Texas Education Code §44.032(f), and pursuant to its requirements only, reasonable Attorney's fees are
recoverable by the prevailing party in any dispute resulting in litigation.
State of Texas Franchise Tax
By signature hereon, the Vendor hereby certifies that he/she is not currently delinquent in the payment of
any franchise taxes owed the State of Texas under Chapter 171, Tax Code.
Miscellaneous
The Vendor acknowledges and agrees that continued participation in TIPS is subject to TIPS sole discretion
and that any Vendor may be removed from the participation in the Program at any time with or without
cause. Nothing in the Agreement or in any other communication between TIPS and the Vendor may be
construed as a guarantee that TIPS or TIPS Members will submit any orders at any time. TIPS reserves the
right to request additional proposals for items or services already on Agreement at any time.
Purchase Order Pricing/Product Deviation
If a deviation of pricing/product on a Purchase Order or contract modification occurs between the Vendor
and the TIPS Member, TIPS must be notified within five (5) business days of receipt of change order.
Termination for Convenience of TIPS Agreement Only
TIPS reserves the right to terminate this agreement for cause or no cause for convenience with a thirty (30)
days prior written notice. Termination for convenience is conditionally required under Federal Regulations 2
CFR part 200 if the customer is using federal funds for the procurement. All purchase orders presented to
the Vendor, but not fulfilled by the Vendor, by a TIPS Member prior to the actual termination of this
agreement shall be honored at the option of the TIPS Member. The awarded Vendor may terminate the
agreement with ninety (90) days prior written notice to TIPS 4845 US Hwy North, Pittsburg, Texas 75686.
The vendor will be paid for goods and services delivered prior to the termination provided that the goods
and services were delivered in accordance with the terms and conditions of the terminated agreement.
This termination clause does not affect the sales agreements executed by the Vendor and the TIPS Member
customer pursuant to this agreement. TIPS Members may negotiate a termination for convenience clause
that meets the needs of the transaction based on applicable factors, such as funding sources or other
needs.
TIPS Member Purchasing Procedures
Usually, purchase orders or their equal are issued by participating TIPS Member to the awarded vendor and
should indicate on the order that the purchase is per the applicable TIPS Agreement Number. Orders are
typically emailed to TIPS at tipspo@tips-usa.com.
• Awarded Vendor delivers goods/services directly to the participating member.
• Awarded Vendor invoices the participating TIPS Member directly.
• Awarded Vendor receives payment directly from the participating member.
• Fees are due to TIPS upon payment by the Member to the Vendor. Vendor agrees to pay the
participation fee to TIPS for all Agreement sales upon receipt of payment including partial payment, from
TIPS Vendor Agreement 06022020_sr Page 5
the Member Entity or as otherwise agreed by TIPS in writing and signed by an authorized signatory of TIPS.
Licenses
Awarded Vendor shall maintain, in current status, all federal, state and local licenses, bonds and permits
required for the operation of the business conducted by awarded Vendor. Awarded Vendor shall remain
reasonably fully informed of and in compliance with all ordinances and regulations pertaining to the lawful
provision of goods or services under the Agreement. TIPS and TIPS Members reserves the right to stop work
and/or cancel an order or terminate this or any other sales Agreement of any awarded Vendor whose license(s)
required for performance under this Agreement have expired, lapsed, are suspended or terminated subject
to a 30-day cure period unless prohibited by applicable statue or regulation.
Novation
If awarded Vendor sells or transfers all assets, rights or the entire portion of the assets or rights required to
perform this Agreement, a successor in interest must guarantee to perform all obligations under this
Agreement. A simple change of name agreement will not change the Agreement obligations of awarded
vendor. TIPS will consider Contract Assignments on a case by case basis. TIPS must be notified within five
(5) business days of the transfer of assets or rights.
Site Requirements (only when applicable to service or job)
Cleanup: When performing work on site at a TIPS Member's property, awarded Vendor shall clean up and
remove all debris and rubbish resulting from their work as required or directed by TIPS Member or as
agreed by the parties. Upon completion of work, the premises shall be left in good repair and an orderly,
neat, clean and unobstructed condition.
Preparation: Awarded Vendor shall not begin a project for which TIPS Member has not prepared the site,
unless awarded Vendor does the preparation work at no cost, or until TIPS Member includes the cost of
site preparation in a purchase order. Site preparation includes, but is not limited to: moving furniture,
installing wiring for networks or power, and similar pre -installation requirements.
Registered sex offender restrictions: For work to be performed at schools, awarded Vendor agrees that
no employee of a subcontractor who has been adjudicated to be a registered sex offender will perform
work at any time when students are, or reasonably expected to be, present unless otherwise agreed by
the TIPS Member. Awarded Vendor agrees that a violation of this condition shall be considered a material
breach and may result in the cancellation of the purchase order at the TIPS Member's discretion. Awarded
Vendor must identify any additional costs associated with compliance of this term. If no costs are
specified, compliance with this term will be provided at no additional charge. Safety measures: Awarded
Vendor shall take all reasonable precautions for the safety of employees on the worksite, and shall erect
and properly maintain all necessary safeguards for protection of workers and the public. Awarded Vendor
shall post warning signs against all hazards created by the operation and work in progress. Proper
precautions shall be taken pursuant to state law and standard practices to protect workers, general public
and existing structures from injury or damage.
Safety Measures
Awarded Vendor shall take all reasonable precautions for the safety of employees on the worksite, and shall
erect and properly maintain all necessary safeguards for protection of workers and the public. Awarded
vendor shall post warning signs against all hazards created by the operation and work in progress. Proper
precautions shall be taken pursuant to state law and standard practices to protect workers, general public
and existing structures from injury or damage.
Smoking
TIPS Vendor Agreement 06022020_sr Page 6
Persons working under Agreement shall adhere to the TIPS Member's or local smoking statutes, codes or
policies.
Marketing
Awarded Vendor agrees to allow TIPS to use their name and logo within TIPS website, marketing materials
and advertisement subject to any reasonable restrictions provided to TIPS in the Proposal to the
Solicitation. The Vendor may submit an acceptable use directive for Vendor's names and logos with which
TIPS agrees to comply. Any use of TIPS name and logo or any form of publicity, inclusive of press release,
regarding this Agreement by awarded vendor must have prior approval from TIPS which will not be
unreasonably withheld. Request may be made by email to TIPS@TIPS-USA.COM.
Supplemental Agreements
The TIPS Member entity participating in the TIPS Agreement and awarded Vendor may enter into a separate
Supplemental Agreement or contract to further define the level of service requirements over and above
the minimum defined in this Agreement such as but not limited to, invoice requirements, ordering
requirements, specialized delivery, etc. Any Supplemental Agreement or contract developed as a result of
this Agreement is exclusively between the TIPS Member entity customer and the Vendor. TIPS, its agents,
TIPS Members and employees not a party to the Supplemental Agreement with the TIPS Member customer,
shall not be made party to any claim for breach of such agreement unless named and agreed by the Party
in question in writing in the agreement. If a Vendor submitting a Proposal requires TIPS and/or TIPS
Member to sign an additional agreement, those agreements shall comply with the award made by TIPS to
the Vendor. Supplemental Vendor's Agreement documents may not become part of TIPS' Agreement with
Vendor unless and until an authorized representative of TIPS reviews and approves it. TIPS review and
approval may be at any time during the life of this Vendor Agreement. TIPS permits TIPS Members to
negotiate additional terms and conditions with the Vendor for the provision of goods or services under the
Vendor's TIPS Agreement so long as they do not materially conflict with this Agreement.
Survival Clause
All applicable sales, leases, Supplemental Agreements, contracts, software license agreements, warranties or
service agreements that were entered into between Vendor and TIPS or the TIPS Member Customer under
the terms and conditions of this Agreement shall survive the expiration or termination of this Agreement. All
Orders, Purchase Orders issued or contracts executed by TIPS or a TIPS Member and accepted by the Vendor
prior to the expiration or termination of this agreement, shall survive expiration or termination of the
Agreement, subject to previously agreed terms and conditions agreed by the parties or as otherwise
specified herein relating to termination of this agreement.
Legal obligations
It is the responding Vendor's responsibility to be aware of and comply with all local, state and federal laws
governing the sale of products/services identified in the applicable Solicitation that resulted in this Vendor
Agreement and any awarded Agreement thereof. Applicable laws and regulations must be followed even if
not specifically identified herein.
Audit rights
Due to transparency statutes and public accountability requirements of TIPS and TIPS Members', the
awarded Vendor shall, at their sole expense, maintain appropriate due diligence of all purchases made by
TIPS Member that utilizes this Agreement. TIPS and Region 8 ESC each reserve the right to audit the
accounting of TIPS related purchases for a period of three (3) years from the time such purchases are made.
This audit right shall survive termination of this Agreement for a period of one (1) year from the effective
TIPS Vendor Agreement 06022020_sr Page 7
date of termination. In order to ensure and confirm compliance with this agreement, TIPS shall have
authority to conduct audits of Awarded Vendor's pricing or TIPS transaction documentation with TIPS
Members with 30 days' notice unless the audit is ordered by a Court Order or by a Government Agency with
authority to do so without notice. Notwithstanding the foregoing, in the event that TIPS is made aware of
any pricing being offered to eligible entities that is materially inconsistent with the pricing under this
agreement, TIPS shall have the ability to conduct the audit internally or may engage a third- party auditing
firm to investigate any possible non- compliant conduct or may terminate the Agreement according to the
terms of this Agreement. In the event of an audit, the requested materials shall be reasonably provided in
the time, format and at the location acceptable to Region 8 ESC or TIPS. TIPS agrees not to perform a random
audit the TIPS transaction documentation more than once per calendar year, but reserves the right to audit
forjust cause or as required by any governmental agency or court with regulatory authority over TIPS or the
TIPS Member.
Force Majeure
If by reason of Force Majeure, either party hereto shall be rendered unable wholly or in part to carry out its
obligations under this Agreement then such party shall give notice and full particulars of Force Majeure in
writing to the other party within a reasonable time after occurrence of the event or cause relied upon, and
the obligation of the party giving such notice, so far as it is affected by such Force Majeure, shall be
suspended during the continuance of the inability then claimed, except as hereinafter provided, but for no
longer period, and such party shall endeavor to remove or overcome such inability with all reasonable
dispatch.
Choice of Law
The Agreement between the Vendor and TIPS/ESC Region 8 and any addenda or other additions resulting
from this procurement process, however described, shall be governed by, construed and enforced in
accordance with the laws of the State of Texas, regardless of any conflict of laws principles.
Venue, Jurisdiction and Service of Process
Any Proceeding arising out of or relating to this procurement process or any contract issued by TIPS resulting
from or any contemplated transaction shall be brought in a court of competent jurisdiction in Camp County,
Texas and each of the parties irrevocably submits to the exclusive jurisdiction of said court in any such
proceeding, waives any objection it may now or hereafter have to venue or to convenience of forum, agrees
that all claims in respect of the Proceeding shall be heard and determined only in any such court, and agrees
not to bring any proceeding arising out of or relating to this procurement process or any contract resulting
from or any contemplated transaction in any other court. The parties agree that either or both of them may
file a copy of this paragraph with any court as written evidence of the knowing, voluntary and freely
bargained for agreement between the parties irrevocably to waive any objections to venue or to
convenience of forum. Process in any Proceeding referred to in the first sentence of this Section may be
served on any party anywhere in the world. Venue for any dispute resolution process, other than litigation,
between TIPS and the Vendor shall be located in Camp or Titus County, Texas.
Project Delivery Order Procedures
The TIPS Member having approved and signed an interlocal agreement, or other TIPS Membership
document, may make a request of the awarded Vendor under this Agreement when the TIPS Memberdesires
goods or services awarded to the Vendor. Notification may occur via phone, the web, courier, email, fax, or
in person. Upon notification of a pending request, the awarded Vendor shall acknowledge the TIPS
Member's request as soon as possible, but must make contact with the TIPS Member within two working
days.
TIPS Vendor Agreement 06022020_sr Page 8
Status of TIPS Members as Related to This Agreement
TIPS Members stand in the place of TIPS as related to this agreement and have the same access to the
proposal information and all related documents. TIPS Members have all the same rights under the awarded
Agreement as TIPS.
Vendor's Resellers as Related to This Agreement
Vendor's Named Resellers ("Resellers") under this Agreement shall comply with all terms and conditions of
this agreement and all addenda or incorporated documents. All actions related to sales by Authorized
Vendor's Resellers under this Agreement are the responsibility of the awarded Vendor. If Resellers fail to
report sales to TIPS under your Agreement, the awarded Vendor is responsible for their contractual failures
and shall be billed for the fees. The awarded Vendor may then recover the fees from their named reseller.
Support Requirements
If there is a dispute between the awarded Vendor and TIPS Member, TIPS or its representatives may, at TIPS
sole discretion, assist in conflict resolution if requested by either party. TIPS, or its representatives, reserves
the right to inspect any project and audit the awarded Vendor's TIPS project files, documentation and
correspondence related to the requesting TIPS Member's order. If there are confidentiality requirements by
either party, TIPS shall comply to the extent permitted by law.
Incorporation of Solicitation
The TIPS Solicitation which resulted in this Vendor Agreement, whether a Request for Proposals, the Request
for Competitive Sealed Proposals or Request for Qualifications solicitation, or other, the Vendor's response
to same and all associated documents and forms made part of the solicitation process, including any
addenda, are hereby incorporated by reference into this Agreement as if copied verbatim.
SECTION HEADERS OR TITLES
THE SECTON HEADERS OR TITLES WITHIN THIS DOCUMENT ARE MERELY GUIDES FOR CONVENIENCE AND
ARE NOT FOR CLASSIFICATION OR LIMITING OF THE RESPONSIBILITIES OF THE PARTIES TO THIS DOCUMENT.
STATUTORY REQUIREMENTS
Texas governmental entities are prohibited from doing business with companies that fail to certify to this
condition as required by Texas Government Code Sec. 2270.
By executing this agreement, you certify that you are authorized to bind the undersigned Vendor and that
your company (1) does not boycott Israel; and (2) will not boycott Israel during the term of the Agreement.
You certify that your company is not listed on and does not and will not do business with companies that are
on the Texas Comptroller of Public Accounts list of Designated Foreign Terrorists Organizations per Texas
Gov't Code 2270.0153 found at https://comptroller.texas.gov/purchasing/docs/foreign-terrorist.pdf
You certify that if the certified statements above become untrue at any time during the life of this Agreement
that the Vendor will notify TIPS within three (3) business day of the change by a letter on Vendor's letterhead
from and signed by an authorized representative of the Vendor stating the non-compliance decision and the
TIPS Agreement number and description at:
Attention: General Counsel
TIPS Vendor Agreement 06022020_sr Page 9
ESC Region 8/The Interlocal Purchasing System (TIPS)
4845 Highway 271 North
Pittsburg, TX,75686
And by an email sent to bids@tips-usa.com
Insurance Requirements
The undersigned Vendor agrees to maintain the below minimum insurance requirements for TIPS Contract
Holders:
General Liability
$1,000,000 each Occurrence/Aggregate
Automobile Liability
$300,000 Includes owned, hired & non -owned
Workers' Compensation
Statutory limits for the jurisdiction in which
the Vendor performs under this Agreement.
Umbrella Liability
$1,000,000
When the Vendor or its subcontractors are liable for any damages or claims, the Vendor's policy, when the
Vendor is responsible for the claim, must be primary over any other valid and collectible insurance carried
by the Member. Any immunity available to TIPS or TIPS Members shall not be used as a defense by the
contractor's insurance policy. The coverages and limits are to be considered minimum requirements and in
no way limit the liability of the Vendor(s). Insurance shall be written by a carrier with an A-; VII or better
rating in accordance with current A.M. Best Key Rating Guide. Only deductibles applicable to property
damage are acceptable, unless proof of retention funds to cover said deductibles is provided. "Claims made"
policies will not be accepted. Vendor's required minimum coverage shall not be suspended, voided,
cancelled, non -renewed or reduced in coverage or in limits unless replaced by a policy that provides the
minimum required coverage except after thirty (30) days prior written notice by certified mail, return receipt
requested has been given to TIPS or the TIPS Member if a project or pending delivery of an order is ongoing.
Upon request, certified copies of all insurance policies shall be furnished to the TIPS or the TIPS Member.
Special Terms and Conditions
• Orders: All Vendor orders received from TIPS Members must be emailed to TIPS at tipspo@tips-
usa.com. Should a TIPS Member send an order directlyto the Vendor, it is the Vendor's responsibility
to forward a copy of the order to TIPS at the email above within 3 business days and confirm its
receipt with TIPS.
• Vendor Encouraging Members to bypass TIPS agreement: Encouraging TIPS Members to purchase
directly from the Vendor or through another agreement, when the Member has requested using the
TIPS cooperative Agreement or price, and thereby bypassing the TIPS Agreement is a violation of the
terms and conditions of this Agreement and will result in removal of the Vendor from the TIPS
Program.
• Order Confirmation: All TIPS Member Agreement orders are approved daily by TIPS and sent to the
Vendor. The Vendor should confirm receipt of orders to the TIPS Member (customer) within 3
business days.
• Vendor custom website for TIPS: If Vendor is hosting a custom TIPS website, updated pricing when
effective. TIPS shall be notified when prices change in accordance with the award.
• Back Ordered Products: If product is not expected to ship within the time provided to the TIPS
TIPS Vendor Agreement 06022020_sr Page 10
Member by the Vendor, the Member is to be notified within 3 business days and appropriate action
taken based on customer request.
The TIPS Vendor Agreement Signature Page is inserted here.
TIPS Vendor Agreement 06022020_sr Page 11
TIPS Vendor Agreement Signature Form
RFP 220101 Safety Equipment, Supplies and Services
Company Name Northern Imports DBA Work Wear Safety Shoes
Address 6318 Airport Freeway Suite C
City Fort Worth State TX Zip 76117
Phone 817-640-2299 Fax 800-820-0072
Email of Authorized Representative
steve.campbell@workwearboots.com
Name of Authorized Representative Steve Campbell
Title Director of Safety & Wellness / Contract Administrator
Signature of Authorized Representative
Date 1 /24/22
TIPS Authorized Representative Name David Fitts
Title FxPriit- 1 vP lei rPrf-nr
TIPS Authorized Representative Signature 1-, kre-
r
Approved by ESC Region 8 4AA
Date 3/29/2022
NOTICE TO MEMBERS REGARDING ATTRIBUTE RESPONSES
TIPS VENDORS RESPOND TO ATTRIBUTE QUESTIONS AS PART OF TIPS COMPETITIVE
SOLICITATION PROCESS. THE VENDOR'S RESPONSES TO ATTRIBUTE QUESTIONS
ARE INCLUDED HEREIN AS "SUPPLIER RESPONSE." PLEASE BE ADVISED THAT
DEVIATIONS, IF ANY, IN VENDOR'S RESPONSE TO ATTRIBUTE QUESTIONS MAY NOT
REFLECT VENDOR'S FINAL ATTRIBUTE RESPONSE, WHICH IS SUBJECT TO
NEGOTIATIONS PRIOR TO AWARD. PLEASE CONTACT THE TIPS OFFICE AT 866-839-
8477 WITH QUESTIONS OR CONCERNS REGARDING VENDOR ATTRIBUTE RESPONSE
DEVIATIONS. PLEASE KEEP IN MIND THAT TIPS DOES NOT PROVIDE LEGAL
COUNSEL TO MEMBERS. TIPS RECOMMENDS THAT YOU CONSULT YOUR LEGAL
COUNSEL WHEN EXECUTING CONTRACTS WITH OR MAKING PURCHASES FROM
TIPS VENDORS.
220101
Northern Imports
Supplier Response
Event Information
Number: 220101
1k
Title: Safety Equipment, Supplies and Services
Type: Request for Proposal
Issue Date: 1 /6/2022
Deadline: 2/18/2022 03.00 PM (CT)
Notes: IF YOU CURRENTLY HOLD TIPS CONTRACT 190101 SAFETY
EQUIPMENT, SUPPLIES AND SERVICES ("190101"), YOU MUST
RESPOND TO THIS SOLICITATION TO PREVENT LAPSE OF
CONTRACT UNLESS YOU HOLD ANOTHER CURRENT TIPS
CONTRACT THAT COVERS ALL OF YOUR SAFETY OFFERINGS.
THIS AWARDED CONTRACT WILL REPLACE YOUR EXPIRING TIPS
CONTRACT 190101.
IF YOU HOLD ANOTHER TIPS CONTRACT OTHER THAN 190101
WHICH COVERS ALL OF YOUR SAFETY OFFERINGS AND YOU ARE
SATISFIED WITH IT, THERE IS NO NEED TO RESPOND TO THIS
CONTRACT UNLESS YOU PREFER TO HOLD BOTH CONTRACTS.
Contact Information
Address: Region 8 Education Service Center
4845 US Highway 271 North
Page 1 of 30 pages Vendor: Northern Imports 220101
Pittsburg, TX 75686
Phone: +1 (866) 839-8477
Email: bids@tips-usa.com
Page 2 of 30 pages Vendor: Northern Imports 220101
Northern Imports Information
Address:
6318 Airport Freeway
Suite C
For Worth, TX 76117
Phone:
(800) 820-0073
Fax:
(800) 820-0072
Toll Free:
(800) 820-0073
Web Address:
workwearboots.com
By submitting your response, you certify that you are authorized to represent and bind your company.
Steven Joseph Campbell
Signature
Submitted at 211412022 3:55:13 PM
Supplier Note
steve.campbell@workwearboots.com
Email
Northern Imports DBA Work Wear Safety Shoes thanks the TIPS COOP for the business we have conducted wi,
COOP members under the expiring contract. By submitting this Bid for 220101 (Safety Equipment, Supplies an
Services) we seek to renew our contract and strengthen and grow our business with TIPS COOP. Thank you! St
Campbell, Director of Safety & Well Admin
Requested Attachments
Agreement Signature Form 220101 Agreement Signature F
If you have not taken exception or deviation to the agreement language in the solicitation attributes, download the
AGREEMENT SIGNATURE FORM from the "ATTACHMENTS" tab. This PDF document is a fillable form. Download the
document to your computer, fill in the requested company information, print the file, SIGN the form, SCAN the complete
signed AGREEMENT SIGNATURE FORM, and upload here.
If you have taken exception to any of the agreement language and noted the exception in the deviations section of the
attributes for the agreement, complete the AGREEMENT SIGNATURE FORM, but DO NOT SIGN until those deviations
been negotiated and resolved with TIPS management. Upload the unsigned form here, because this is a required doCL
All Other Certificates
220101 Form 1295 Certificate of Interested Pa
All Other Certificates (if applicable) must be scanned and uploaded. If vendor has more than one other certification scc
one document. (PDF Format ONLY)
DO NOT UPLOAD encrypted or password protected files.
Pricing Form 2
220101 Pricing For
The vendor must download the PRICING SPREADSHEET SHEET from the attachment tab, fill in the requested informa
upload the completed spreadsheet.
DO NOT UPLOAD encrypted or password protected files.
Reference Form
220101 —Reference-1
The vendor must download the References spreadsheet from the attachment tab, fill in the requested information and
the completed spreadsheet. DO NOT UPLOAD encrypted or password protected files.
Page 3 of 30 pages Vendor: Northern Imports 220101
Conflict of DISCLOSURE OF CONFLICT OF INTEREST FORM - FILE ONLY IF THERE IS A CONFLICT TO REP
Interest Form
CIQ- ONLY
REQUIRED IF A
CONFLICT
EXISTS PER
THE
INSTRUCTIONS
ONLY REQUIRED IF A CONFLICT EXISTS PER THE INSTRUCTIONS
Conflict of Interest Form for Vendors that are required to submit the form. The Conflict of Interest Form is included in &
documents or can be found at https://www.tips-usa.com/assets/documents/docs/CIQ.pdf.
Proposed Goods and Services 2022 Digital Safety Footwear Catalog Lir
Please upload one or more documents or sheets describing your offerings, line cards, catalogs, links to offerings OR li
to your offerings that illustrate the catalog of proposed lines of goods and or services you carry and offer under this pr
It does not have to be exhaustive but should, at a minimum tell us what you are offering. It could be as simple as a shei
your link to your online catalog of goods and services.
D/M/WBE Certification OPTIONAL No n
D/M/WBE Certification documentation may be scanned and uploaded if you desire to claim your status as one of the id
enterprises. (Disadvantaged Business Enterprise, Minority Business Enterprise and/or Woman Business Enterprise) If
has more than one certification scan into one document. (PDF Format ONLY)
DO NOT UPLOAD encrypted or password protected files.
Warranty Warranty_Northern Imports DBA Work Wear Safety SI
Warranty information (if applicable) must be scanned and uploaded. (PDF Format ONLY)
DO NOT UPLOAD encrypted or password protected files.
Vendor Agreement 220101 Vendor Agreemer
The vendor must download the Vendor Agreement from the attachment tab, fill in the requested information and uploa(
completed agreement.
DO NOT UPLOAD encrypted or password protected files.
Pricing Form 1 220101 Pricing For
The vendor must download the PRICING SPREADSHEET SHEET from the attachment tab, fill in the requested informa
upload the completed spreadsheet.
DO NOT UPLOAD encrypted or password protected files.
Supplementary 2022 Digital Safety Footwear Catalog Lir
Supplementary information may be scanned and uploaded. (Company information, brochures, catalogs, etc.) (PDF Fo
ONLY)
DO NOT UPLOAD encrypted or password protected files.
Logo and Other Company Marks Work Wear Safety Shoes L
If you desire, please upload your company logo to be added to your individual profile page on the TIPS website. If any
particular specifications are required for use of your company logo, please upload that information under the Supplem,
section or another non -required section under the "Response Attachment" tab. Preferred Logo Format: 300 x 225 px -
.eps, .jpeg preferred
Certification of Corporate Offerer Form- COMPLETE ONLY IF OFFERER IS A Certificate of Incorpor,
CORPORATION
COMPLETE AND UPLOAD FORM IN ATTACHMENTS SECTION ONLY IF OFFERER IS A CORPORATION
Disclosure of Lobbying Activities Standard Form LLL Disclosure —of Lobbying_Activities_Standard_Form_LLI
ONLY IF you answered "I HAVE Lobbied per above" to attribute #66, please download and complete and upload the St
Form-LLL, "disclosure Form to Report Lobbying," in the Response attachments section.
Page 4 of 30 pages Vendor: Northern Imports 220101
Confidentiality Claim Form
220101 CONFIDENTIALITY CLAIM FORD
REQUIRED CONFIDENTIALITY FORM. Complete the form according to your company requirements, make any desires
attachments and upload to the appropriate section under "Response Attachments" THIS FORM DETERMINES HOW
ESC8/TIPS RESPONDS TO LEGAL PUBLIC INFORMATION REQUESTS.
Current W-9 Tax Form
W9-2
You are required by TIPS to upload a current W-9 Internal Revenue Service (IRS) Tax Form for your entity. This form w
utilized by TIPS to properly identify your entity.
Response Attachments
21-22 Work Wear ESC Region 8 COI.pdf
Certificate of Insurance
CERTIFICATION BY CORPORATE OFFERER.pdf
CERTIFICATION BY CORPORATE OFFERER
2022 Digital Safety Footwear Catalog Links.docx
2022 Digital Safety Footwear Catalog
2022 TIPS COOP Price List 2022-02-03.pdf
2022 TIPS COOP Price List
Bid Attributes
1 Yes - No
Disadvantaged/Minority/Women Business Enterprise - D/M/WBE/Federal HUBZone (Required by some participating
governmental entities). Vendor certifies that their firm is a D/M/WBE or HUBZone? Vendor must upload proof of certifi
to the "Response Attachments" D/M/WBE CERTIFICATES section.
ENO
2 Yes - No
Historically Underutilized Business - HUB (Required by some participating governmental entities) Vendor certifies that
firm is a HUB as defined by the State of Texas at https://comptroller.texas.gov/purchasing/vendor/hub/.
Proof may be submitted. Vendor must upload proof of certification to the "Response Attachments" HUB CERTIFICATE
section.
Eel
3 Yes - No
The Vendor can provide services and/or products to all 50 US States?
IYes
4 States Served:
If answer is NO to question #3, please list which states can be served. (Example: AR, OK, TX)
No response
Page 5 of 30 pages Vendor: Northern Imports 220101
5 Company and/or Product Description:
This information will appear on the TIPS website in the company profile section, if awarded a TIPS contract. (Limit 75(
characters.)
Work Wear Safety Shoes partners with employers to keep workers safe, productive and happy. For more than 40 ye
we have contracted with Coop members to deliver safety products including: safety footwear, wellness products suct
orthotics and insoles and hosiery. We also offer all types of PPE: Safety glasses, hearing protection, Hi-Vis vests ani
apparel, hard hats, gloves and specialty products. Contact us and we will source and provide a quote for you on alrr
any and all Safety Equipment, Supplies and Services. We conduct workplace wellness and safety assessments and
provide written recommendations for PPE to prevent lost time accidents.
6 Primary Contact Name
Primary Contact Name
Steve Campbell
7 Primary Contact Title
Primary Contact Title
Director of Safety and Wellness
8 Primary Contact Email
Primary Contact Email
steve.campbell@workwearboots.com
9 Primary Contact Phone
Enter 10 digit phone number. (No dashes or extensions)
Example: 8668398477
1 21467533531
1 Primary Contact Fax
U Enter 10 digit phone number. (No dashes or extensions)
Example: 8668398477
1 80082000721
1 Primary Contact Mobile
1 Enter 10 digit phone number. (No dashes or extensions)
Example: 8668398477
1 21467533531
1 Secondary Contact Name
2 Secondary Contact Name
Steve Campbell
1 Secondary Contact Title
3 Secondary Contact Title
Director of Sales
1 Secondary Contact Email
4 Secondary Contact Email
steve.campbell@workwearboots.com
Page 6 of 30 pages Vendor: Northern Imports 220101
1 Secondary Contact Phone
5 Enter 10 digit phone number. (No dashes or extensions)
Example: 8668398477
1 81764022991
1 Secondary Contact Fax
6 Enter 10 digit phone number. (No dashes or extensions)
Example: 8668398477
1 80082000721
1 Secondary Contact Mobile
7 Enter 10 digit phone number. (No dashes or extensions)
Example: 8668398477
1 81772665261
1 Admin Fee Contact Name
8 Admin Fee Contact Name. This person is responsible for paying the admin fee to TIPS.
Daniel Hicks
1 Admin Fee Contact Email
9 Admin Fee Contact Email
daniel.hicks@workwearboots.com
2 Admin Fee Contact Phone
U Enter 10 digit phone number. (No dashes or extensions)
Example: 8668398477
1 81764022991
2 Purchase Order Contact Name
1 Purchase Order Contact Name. This person is responsible for receiving Purchase Orders from TIPS.
Steve Campbell
2 Purchase Order Contact Email
2 Purchase Order Contact Email
steve.campbell@workwearboots.com
2 Purchase Order Contact Phone
3 Enter 10 digit phone number. (No dashes or extensions)
Example: 8668398477
1 21467533531
2 Company Website
4 Company Website (Format - www.company.com)
www.workwearboots.com
Page 7 of 30 pages Vendor: Northern Imports 220101
2 Entity D/B/A's and Assumed Names
5 Please identify all of your entity's assumed names and D/B/A's. Please note that you will be identified publicly by the
name under which you responded to this solicitation unless you organize otherwise with TIPS after award.
Northern Imports dba Work Wear Safety Shoes
2 Primary Address
6 Primary Address
6318 AIRPORT FREEWAY, SUITE C
2 Primary Address City
7 Primary Address City
FORT WORTH
2 Primary Address State
8 Primary Address State (2 Digit Abbreviation)
ITX
2 Primary Address Zip
9 Primary Address Zip
176117
3
0
3
1
Search Words:
Please list search words to be posted in the TIPS database about your company that TIPS website users might searc
Words may be product names, manufacturers, or other words associated with the category of award. YOU MAY NOT
NON -CATEGORY ITEMS. (Limit 500 words) (Format: product, paper, construction, manufacturer name, etc.)
safety shoes, safety boots, work boots, steel toe, composite toe, protective footwear, rubber boots, ASTM F2413-18,
electrical hazard, PR puncture resistant, MT metatarsal guard, SD static dissipative, CD conductive, slip resistant, ur
footwear, hard hats, hard hat lights, ear plugs, safety glasses, back braces, knee braces, gloves, protective sleeves,
vests, Hi Vis, respirators, masks, visors, PPE,
Do you want TIPS Members to be able to spend Federal grant funds with you if awarded? Is it your intent
able to sell to our members regardless of the fund source, whether it be local, state or federal?
Most of our members receive Federal Government grants or other funding and they make up a significant portion of
budgets. The Members need to know if your company is willing to sell to them when they spend federal budget funds
their purchase. There are attributes that follow that include provisions from the federal regulations in 2 CFR part 200
Your answers will determine if your award will be designated as eligible for TIPS Members to utilize federal funds with
company.
Do you want TIPS Members to be able to spend Federal funds, at the Member's discretion, with you?
IYes
Page 8 of 30 pages Vendor: Northern Imports 220101
3
2
Yes - No
Certification of Residency (Required by the State of Texas) The vendor's ultimate parent company or majority owner:
(A) has its principal place of business in Texas;
(B) employs at least 500 persons in Texas?
This question is required as a data gathering function for information to our members making purchases with awarde
vendors. It does not affect scoring with TIPS.
Yes
3 Company Residence (City)
3 Vendor's principal place of business is in the city of?
Fort Worth
3 Company Residence (State)
4 Vendor's principal place of business is in the state of?
Texas
3
5
Discount Offered - CAUTION READ CAREFULLY BECAUSE VENDORS FREQUENTLY MAKE MISTAKES i
THIS ATTRIBUTE QUESTION
Remember this is a MINIMUM discount percentage. So, be sure that the discount percentage inserted here can be a
to ANY OFFERING OF GOODS OR SERVICES THROUGHOUT THE LIFE OF THE CONTRACT.
CAUTION: BE CERTAIN YOU CAN HONOR THIS MINIMUM DISCOUNT PERCENTAGE ON ANY OFFERED SERVICE C
GOOD NOW OR DURING THE LIFE OF THE CONTRACT.
What is the MINIMUM percentage discount off of any item or service you offer to TIPS Members that is in your regula
catalog (as defined in the solicitation specifications document), website, store or shelf pricing or when adding new go
services to your offerings during the life of the contract? The resulting price of any goods or services Catalog list pric
after this discount is applied is a ceiling on your pricing and not a floor because, in order to be more competitive in th
individual circumstance, you may offer a larger discount depending on the items or services purchased and the quar
time of sale. Please note that any specific greater discount offered for a particular product, brand, or service listed it
Vendor's proposal will control and Vendor will be required to honor that greater specific discount, in excess of the min
discount, for that particular product, brand, or service for the life of the contract.
Must answer with a number between 0% and 100%.
1 30% 1
Page 9 of 30 pages Vendor: Northern Imports 220101
3 MINIMUM Discount Term
6 Does the vendor agree to at least offer, for the life of the Agreement, the Minimum Discount Percentage off list or cat
proposed by Vendor in response to the Attribute entitled "Discount Offered - CAUTION READ CAREFULLY BECAUSE
VENDORS FREQUENTLY MAKE MISTAKES ON THIS ATTRIBUTE QUESTION"? TIPS will utilize this response to sati
Long Term Cost scoring evaluation criteria. A "YES" answer will be awarded the maximum 10 points for this criterion
the 100 total points and a "NO" answer is awarded 0 points.
YES
3 Yes - No
7 If awarded on this TIPS Contract, for the duration of the Contract, Vendor agrees to provide, upon request, their ther
current catalog pricing, as defined in the solicitation and below, to TIPS upon request for any goods and services off(
Vendor's TIPS Contract.
"Catalog" means the available list of tangible personal property or services, in the most current listing, regardless of
during the life of the contract, that takes the form of a catalog, price list, schedule, shelf price or other form that:
A. is regularly maintained by the manufacturer or Vendor of an item; and
B. is either published or otherwise available for inspection by a customerduring the purchase process;
C. to which the minimum discount proposed by the proposing Vendor maybe applied.
YES
3 TIPS Administration Fee
8 By submitting a proposal, I agree that all pricing submitted to TIPS shall include the Administration Fee, as designate
the solicitation or as otherwise agreed in writing which shall be remitted to TIPS by the Vendor, or the vendor's name(
resellers, and as agreed to in the Vendor Agreement. I agree that the fee shall not and will not be added by the Vend
separate line item on a TIPS member invoice, quote, proposal or any other written communications with the TIPS mer
3 Yes - No
9 Vendor agrees to remit to TIPS the required administration fee or, if resellers are named, Vendor agrees to guarante,
fee remittance by or for the reseller named by the vendor?
TIPS/ESC Region 8 is required by Texas Government Code § 791 to be compensated for its work and thus, failure to
shall render your response void and it will not be considered.
Agreed
4 TIPS Administration Fee Paid by Vendor - Not Charged to Customer
U Vendor understands and agrees that it owes TIPS a TIPS Administration Fee (published in the RFP/RCSP docum
every TIPS sale made under an awarded TIPS Contract. Vendor further understands and agrees that Vendor shall
pricing with this proposal which includes and accounts for the TIPS Administration Fee and shall never separately
the TIPS Member Customer the TIPS fee or add the TIPS Administration Fee line item to an invoice or similar pu
document. Submission of this proposal is Vendor's certification that Vendor agrees to this mandatory term.
4 Additional Discounts?
Do you offer additional discounts to TIPS members for large order quantities or large scope of work?
IYes
4 Years in Business as Proposing Company
2 Years in business as proposing company?
1 421
Page 10 of 30 pages Vendor: Northern Imports 220101
4 Resellers:
3 Does the vendor have resellers that it will name under this contract? Resellers are defined as other companies that s
your products under an agreement with you, the awarded vendor of TIPS.
EXAMPLE: BIGmart is a reseller of ACME brand televisions. If ACME were a TIPS awarded vendor, then ACME would
BIGmart as a reseller.
(If applicable, Vendor should add all Authorized Resellers within the TIPS Vendor Portal upon award).
INo I
4 Right of Refusal
4 The proposing vendor has the right not to sell under the awarded agreement with a TIPS member at vendor's discret
unless required by law.
4 NON -COLLUSIVE BIDDING CERTIFICATE
5 By submission of this bid or proposal, the Bidder certifies that:
1) This bid or proposal has been independently arrived at without collusion with any other Bidder or with any Compet
2) This bid or proposal has not been knowingly disclosed and will not be knowingly disclosed, prior to the opening of
or proposals for this project, to any other Bidder, Competitor or potential competitor:
3) No attempt has been or will be made to induce any other person, partnership or corporation to submit or not to sul
bid or proposal;
4) The person signing this bid or proposal certifies that he has fully informed himself regarding the accuracy of the
statements contained in this certification, and under the penalties being applicable to the Bidder as well as to the per
signing in its behalf.
Not a negotiable term. Failure to agree will render your proposal non -responsive and it will not be considered.
4 CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ - Do you have any CONFLICT OF INTEREST T1
6 REPORT OR DISCLOSE under this statutory requirement?
Do you have any CONFLICT OF INTEREST TO REPORT OR DISCLOSE under this statutory requirement? YES or N
If you have a conflict of interest as described in this form or the Local Government Code Chapter 176, cited therein -
are required to complete and file with TIPS.
The Form CIQ is one of the attachments to this solicitation.
There is an optional upload for this form provided if you have a conflict and must file the form
INo I
4 Filing of Form CIQ
7 If yes (above), have you filed a form CIQ by uploading the form to this RFP as directed above?
Yes I
Page 11 of 30 pages Vendor: Northern Imports 220101
4 Regulatory Standing
8 1 certify to TIPS for the proposal attached that my company is in good standing with all governmental agencies Feder
state that regulate any part of our business operations. If not, please explain in the next attribute question.
IYes
4 Regulatory Standing
9 Regulatory Standing explanation of no answer on previous question.
No response
5 Antitrust Certification Statements (Tex. Government Code § 2155.005)
0 By submission of this bid or proposal, the Bidder certifies that:
I affirm under penalty of perjury of the laws of the State of Texas that:
(1) 1 am duly authorized to execute this contract on my own behalf or on behalf of the company, corporation, firm,
partnership or individual (Company) listed below;
(2) In connection with this bid, neither I nor any representative of the Company has violated any provision of the TexE
Enterprise and Antitrust Act, Tex. Bus. & Comm. Code Chapter 15;
(3) In connection with this bid, neither I nor any representative of the Company has violated any federal antitrust law;
(4) Neither I nor any representative of the Company has directly or indirectly communicated any of the contents of thi
to a competitor of the Company or any other company, corporation, firm, partnership or individual engaged in the sar
of business as the Company.
Page 12 of 30 pages Vendor: Northern Imports 220101
5
1
Suspension or Debarment Instructions
Instructions for Certification:
1. By answering yes to the next Attribute question below, the vendor and prospective lower tier participant is providin,
certification set out herein in accordance with these instructions.
2. The certification in this clause is a material representation of fact upon which reliance was placed when this transa
was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous
certification in addition to other remedies available to the federal government, the department or agency with which ti
transaction originated may pursue available remedies, including suspension and / or debarment.
3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is
submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitte
has become erroneous by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participar
"person," "primary covered transaction," "principal," "proposal" and "voluntarily excluded," as used in this clause, hav
meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may cc
the person to which this proposal is submitted for assistance in obtaining a copy of those regulations.
5. The prospective lower tier participant agrees by submitting this form that, should the proposed covered transactioi
entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspe
declared ineligible or voluntarily excluded from participation in this covered transaction, unless authorized by the
department or agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this form that it will include this clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -Lower Tier Covered Transactio
without modification in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier cover
transaction that it is not debarred, suspended, ineligible or voluntarily excluded from the covered transaction, unless
knows that the certification is erroneous. A participant may decide the method and frequency by which it determines i
eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to r
in good faith the certification required by this clause. The knowledge and information of a participant is not required t
exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transactioi
knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible or voluntz
excluded from participation in this transaction, in addition to other remedies available to the federal government, the
department or agency with which this transaction originated may pursue available remedies, including suspension ar
debarment.
5 Suspension or Debarment Certification
2 By answering yes, you certify that no federal suspension or debarment is in place, which would preclude receiving a
federally funded contract as described above.
Yes I
Page 13 of 30 pages Vendor: Northern Imports 220101
Non -Discrimination Statement and Certification
5
3
5
4
In accordance with Federal civil rights law, all U.S. Departments, including the U.S. Department of Agriculture (USDA)
rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or
administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, g
identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, incomE
derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any
program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filin(
deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large
audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (20
2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program
information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, fot
online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA
provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 6;
9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assista
Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442;
email: program.intake@usda.gov.
(Title VI of the Education Amendments of 1972; Section 504 of the Rehabilitation Act of 1973; the Age Discrimination
1975; Title 7 CFR Parts 15, 15a, and 15b; the Americans with Disabilities Act; and FNS Instruction 113-1, Civil Rights
Compliance and Enforcement — Nutrition Programs and Activities)
All U.S. Departments, including the USDA are equal opportunity provider, employer, and lender.
Not a negotiable term. Failure to agree by answering YES will render your proposal non -responsive and it will not be
considered. I certify that in the performance of a contract with TIPS or its members, that our company will conform to
foregoing anti -discrimination statement and comply with the cited and all other applicable laws and regulations.
❑ Yes, I certify (Yes)
2 CFR PART 200 Contract Provisions Explanation
Required Federal contract provisions of Federal Regulations for Contracts for contracts with ESC Region 8 and TIPS
Members:
The following provisions are required to be in place and agreed if the procurement is funded in any part with federal
The ESC Region 8 and TIPS Members are the subgrantee or Subrecipient by definition. Most of the provisions are Ic
in 2 CFR PART 200 - Appendix II to Part 200—Contract Provisions for Non -Federal Entity Contracts Under Federal A
at 2 CFR PART 200. Others are included within 2 CFR part 200 et al.
In addition to other provisions required by the Federal agency or non -Federal entity, all contracts made by the non-F
entity under the Federal award must contain provisions covering the following, as applicable.
Page 14 of 30 pages Vendor: Northern Imports 220101
2 CFR PART 200 Contracts
5
5
5
6
5
7
Contracts for more than the simplified acquisition threshold currently set at $250,000, which is the inflation adjusted
determined by the Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) a:
authorized by 41 U.S.C. 1908, must address administrative, contractual, or legal remedies in instances where contra(
violate or breach contract terms, and provide for such sanctions and penalties as appropriate.
Notice: Pursuant to the above, when federal funds are expended by ESC Region 8 and TIPS Members, ESC Region
TIPS Members reserves all rights and privileges under the applicable laws and regulations with respect to this procur
in the event of breach of contract by either party.
Does vendor agree?
Yes
2 CFR PART 200 Termination
Termination for cause and for convenience by the grantee or subgrantee including the manner by which it will be effe
and the basis for settlement. (All contracts in excess of $10,000)
Pursuant to the above, when federal funds are expended by ESC Region 8 and TIPS Members, ESC Region 8 and T
Members reserves the right to terminate any agreement in excess
of $10,000 resulting from this procurement process for cause after giving the vendor an appropriate opportunity and
30 days, to cure the causal breach of terms and conditions. ESC Region 8 and
TIPS Members reserves the right to terminate any agreement in excess of $10,000 resulting from this procurement p
for convenience with 30 days notice in writing to the awarded vendor. The vendor
would be compensated for work performed and goods procured as of the termination date if for convenience of the E
Region 8 and TIPS Members. Any award under this procurement process is not exclusive and the ESC Region 8 and
reserves the right to purchase goods and services from other vendors when it is in the best interest of the ESC Regi(
and TIPS.
Does vendor agree?
Yes
2 CFR PART 200 Clean Air Act
Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as ame
Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non -Federal a,
agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 U.S.0
7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387). Violations must be reporter
Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA).
Pursuant to the Clean Air Act, et al above, when federal funds are expended by ESC Region 8 and TIPS Member
Region 8 and TIPS Members requires that the proposer certify that during the term of
an award by the ESC Region 8 and TIPS Members resulting from this procurement process the vendor agrees to
with all of the above regulations, including all of the terms listed and referenced therein.
Does vendor agree?
Yes
Page 15 of 30 pages Vendor: Northern Imports 220101
5 2 CFR PART 200 Byrd Anti -Lobbying Amendment
8 Byrd Anti -Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award exceeding $100,000 m
the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated fui
pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a mer
Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining a
Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each tier must also disclose any lobbying witl
Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from
tier up to the non -Federal award.
Pursuant to the above, when federal funds are expended by ESC Region 8 and TIPS Members, ESC Region 8 and T
Members requires the proposer certify that during the term and during the life of any contract with ESC Region 8 and
Members resulting from this procurement process the vendor certifies to the terms included or referenced herein.
Does vendor agree?
Yes
5 2 CFR PART 200 Federal Rule
9 Compliance with all applicable standards, orders, or requirements issued under section 306 of the Clean Air Act (42 l
1857(h)), section 508 of the Clean Water Act (33 U.S.C. 1368), Executive Order 11738, and Environmental Protectioi
Agency regulations (40 CFR part 15). (Contracts, subcontracts, and subgrants of amounts in excess of $250,000)
Pursuant to the above, when federal funds are expended by ESC Region 8 and TIPS Members, ESC Region 8 and T
Members requires the proposer certify that in performance of the contracts, subcontracts, and subgrants of amounts
excess of $250,000, the vendor will be in compliance with all applicable standards, orders, or requirements issued ur
section 306 of the Clean Air Act (42 U.S.C. 1857(h)), section 508 of the Clean Water Act (33 U.S.C. 1368), Executive
11738, and Environmental Protection Agency regulations (40 CFR part 15).
Does vendor certify that it is in compliance with the Clean Air Act?
Yes
6 2 CFR PART 200 Procurement of Recovered Materials
0 A non -Federal entity that is a state agency or agency of a political subdivision of a state and its contractors must corr
with section 6002 of the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. Th
requirements of Section 6002 include procuring only items designated in guidelines of the Environmental Protection i
(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
quantity acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in
manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for
procurement of recovered materials identified in the EPA guidelines.
Does vendor certify that it is in compliance with the Solid Waste Disposal Act as described above?
Yes
Page 16 of 30 pages Vendor: Northern Imports 220101
2 CFR PART 200 Rights to Inventions
6
1
6
2
6
3
If the Federal award meets the definition of "funding agreement' under 37 CFR §401.2 (a) and the recipient or subr(
wishes to enter into a contract with a small business firm or nonprofit organization regarding the substitution of I
assignment or performance of experimental, developmental, or research work under that "funding agreement," the rE
or subrecipient must comply with the requirements of 37 CFR Part 401, "Rights to Inventions Made by No
Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements," a
implementing regulations issued by the awarding agency.
Pursuant to the above, when the foregoing applies to ESC Region 8 and TIPS Members, Vendor certifies that dur
term of an award resulting from this procurement process, Vendor agrees to comply with all applicable requiremi
referenced in the Federal rule above.
Does vendor agree?
IYes
2 CFR PART 200 Domestic Preferences for Procurements
As appropriate and to the extent consistent with law, the non -Federal entity should, to the greatest extent practicabl(
a Federal award, provide a preference for the purchase, acquisition, or use of goods, products, or materials prods
the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured product:
requirements of this section must be included in all subawards including all contracts and purchase orders for \
products under this award. For purposes of 2 CFR Part 200.322, "Produced in the United States" means, for iron ar
products, that all manufacturing processes, from the initial melting stag through the application of coatings, occurrel
United States. Moreover, for purposes of 2 CFR Part 200.322, "Manufactured products" means items and const
materials composed in whole or in part of non-ferrous metals such as aluminum, plastics and polymer -based produc
as polyvinyl chloride pipe, aggregates such as concrete, glass, including optical fiber, and lumber.
Pursuant to the above, when federal funds are expended by ESC Region 8 and TIPS Members, Vendor certifies tha
greatest extent practicable Vendor will provide a preference for the purchase, acquisition, or use of goods, prodt
materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufi
products).
Does vendor agree?
IYes
2 CFR PART 200 Ban on Foreign Telecommunications
Federal grant funds may not be used to purchase equipment, services, or systems that use "covered telecommunic
equipment or services as a substantial or essential component of any system, or as critical technology as part
system. "Covered telecommunications" means purchases from Huawei Technologies Company or ZTE Corporation
subsidiary or affiliate of such entities), and video surveillance and telecommunications equipment produced by
Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company
subsidiary or affiliate of such entities).
Pursuant to the above, when federal funds are expended by ESC Region 8 and TIPS Members, Vendor certifi
Vendor will not purchase equipment, services, or systems that use "covered telecommunications", as defined by
§200.216 equipment or services as a substantial or essential component of any system, or as critical technology as
any system.
Does vendor agree?
IYes
Page 17 of 30 pages Vendor: Northern Imports 220101
2 CFR PART 200 Contract Cost & Price
6
4
6
5
6
6
For contracts more than the simplified acquisition threshold currently set at $250,000, a TIPS Member may, in vE
circumstances, be required to negotiate profit as a separate element of the price pursuant to 2 C.F.R. 200.324(b).
those circumstances, Vendor agrees to provide information and negotiate with the TIPS Member regarding pro
separate element of the price. However, Vendor certifies that the total price charged by the Vendor shall not excf
Vendor's TIPS pricing and pricing terms proposed.
Does Vendor Agree?
Yes
FEMA Fund Certifications
Submission of this proposal is Vendor's certification that Vendor agrees to this term. Vendor certifies that IF and
Vendor accepts a TIPS purchase paid for in full or part with FEMA funds, Vendor certifies that:
(1) Vendor agrees to provide the TIPS Member, the FEMA Administrator, the Comptroller General of the United Sty
any of their authorized representatives access to and rights to reproduce any books, documents, papers, and rec
the Contractor which are directly pertinent to this contract for the purposes of making audits, examinations, excerp
transcriptions. The Vendor agrees to provide the FEMA Administrator or an authorized representatives acc
construction or other work sites pertaining to the work being completed under the contract. Vendor acknowledg
agrees that no language in this contract or the contract with the TIPS Member is intended to prohibit audits or i
reviews by the FEMA Administrator or the Comptroller General of the United States.
(2) The Vendor shall not use the Department of Homeland Security's seal(s), logos, crests, or reproductions of t
likenesses of DHS agency officials without specific FEMA pre -approval.
(3) The Vendor will comply with all applicable Federal law, regulations, executive orders, FEMA policies, procedure
directives.
(4) The Federal Government is not a party to this contract and is not subject to any obligations or liabilities to tl-
Federal entity, contractor, or any other party pertaining to any matter resulting from the contract.
(5) The Vendor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements)
to the Vendor's actions pertaining to this contract.
Certification of Compliance with the Energy Policy and Conservation Act
When appropriate and to the extent consistent with the law, Vendor certifies that it will comply with the Energy Pol
Conservation Act (42 U.S.C. 6321 et seq; 49 C.F.R. Part 18) and any mandatory standards and policies relating to
efficiency which are contained in applicable state energy conservation plans issued in compliance with the Act.
Does Vendor agree?
IYes
Page 18 of 30 pages Vendor: Northern Imports 220101
6
7
Certification Regarding Lobbying
Applicable to Grants, Subgrants, Cooperative Agreements, and Contracts Exceeding $100,000 in Federal Funds
Submission of this certification is a prerequisite for making or entering into this transaction and is imposed by section
Title 31, U.S. Code. This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Any person who fails to file the required certification shall be subject to a civil I
of not less than $10,000 and not more than $100,000 for each such failure.
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person 1
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or eml
of congress, or an employee of a Member of Congress in connection with the awarding of a Federal contract, the ma
a Federal grant, the making of a Federal loan, the entering into a cooperative agreement, and the extension, contint,
renewal, amendment, or modification of a Federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing of
attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of cong
or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the under
shall complete and submit Standard Form-LLL, "disclosure Form to Report Lobbying," in accordance with its instructi
(3) The undersigned shall require that the language of this certification be included in the award documents for all cc
subawards exceeding $100,000 in Federal funds at all appropriate tiers and that all subrecipients shall certify and di;
accordingly.
I HAVE NOT Lobbied per above I
6 If you answered "I HAVE lobbied" to the above Attribute Question
8 If you answered "I HAVE lobbied" to the above Attribute question, you must download the Lobbying Report "Standard
LLL, disclosure Form to Report Lobbying" which includes instruction on completing the form, complete and submit it i
Response Attachments section as a report of the lobbying activities you performed or paid others to perform.
6
9
Subcontracting with Small and Minority Businesses, Women's Business Enterprises, and Labor Surplus
Firms.
Do you ever anticipate the possibility of subcontracting any of your work under this award if you are successful?
IF NO, DO NOT ANSWER THE NEXT ATTRIBUTE QUESTION.. IF YES, and ONLY IF YES, you must answer the next
question YES if you want a TIPS Member to be authorized to spend Federal Grant Funds for Procurement.
NO
Page 19 of 30 pages Vendor: Northern Imports 220101
7
0
7
1
ONLY IF YES TO THE PREVIOUS QUESTION OR if you ever do subcontract any part of your performanc
under the TIPS Agreement, do you agree to comply with the following federal requirements?
ONLY IF YES TO THE PREVIOUS QUESTION OR if you ever do subcontract any part of your performance under the
Agreement,
do you agree to comply with the following federal requirements?
Federal Regulation 2 CFR §200.321 Contracting with small and minority businesses, women's business enterprises,
labor surplus area firms. (a)The non -Federal entity must take all necessary affirmative steps to assure that minority
businesses, women's business enterprises, and labor surplus area firms are used when possible.
(b) Affirmative steps must include:
(1) Placing qualified small and minority businesses and women's business enterprises on solicitation lists;
(2) Assuring that small and minority businesses, and women's business enterprises are solicited whenever they are
potential sources;
(3) Dividing total requirements, when economically feasible, into smaller tasks or quantities to permit maximum partici
by small and minority businesses, and women's business enterprises;
(4) Establishing delivery schedules, where the requirement permits, which encourage participation by small and mino
businesses, and women's business enterprises;
(5) Using the services and assistance, as appropriate, of such organizations as the Small Business Administration ar
Minority Business Development Agency of the Department of Commerce ; and
(6) Requiring the prime contractor, if subcontracts are to be let, to take the affirmative steps listed in paragraphs(1) t
(5) of this section.
No response
Indemnification
The ESC Region 8 and TIPS is a Texas Political Subdivision and a local governmental entity; therefore, is prohibited 1
indemnifying third parties pursuant to the Texas Constitution (Article 3, Section 52) except as specifically provided by
as
ordered by a court of competent jurisdiction. A provision in a contract to indemnify or hold a party harmless is a prom
pay for
any expenses the indemnified party incurs, if a specified event occurs, such as breaching the terms of the contract o
negligently
performing duties under the contract. Article III, Section 49 of the Texas Constitution states that "no debt shall be cre,
or on
behalf of the State ... " The Attorney General has counseled that a contractually imposed obligation of indemnity cre�
"debt" in
the constitutional sense. Tex. Att'y Gen. Op. No. MW-475 (1982). Contract clauses which require the System or institi
to
indemnify must be deleted or qualified with "to the extent permitted by the Constitution and Laws of the State of Texa
Liquidated
damages, attorney's fees, waiver of vendor's liability, and waiver of statutes of limitations clauses should also be dele
qualified
with "to the extent permitted by the Constitution and laws of State of Texas."
Not a negotiable term. Failure to agree will render your proposal non -responsive and it will not be considered. Do yoi
agree
to these terms?
❑ Yes, I Agree (Yes)
Page 20 of 30 pages Vendor: Northern Imports 220101
7 Remedies
2 The parties shall be entitled to exercise any right or remedy available to it either at law or in equity, subject to the chc
law, venue
and service of process clauses limitations agreed herein. Nothing in this agreement shall commit the TIPS to an arbit
resolution
of any disagreement under any circumstances. Any Claim arising out of or related to the Contract, except for those
specifically waived
under the terms of the Contract, may, after denial of the Board of Directors, be subject to mediation at the request of
party. Any
issues not resolved hereunder MAY be referred to non -binding mediation to be conducted by a mutually agreed upoi
mediator as a
prerequisite to the filing of any lawsuit over such issue(s). The parties shall share the mediator's fee and any associE
filing fee
equally. Mediation shall be held in Camp or Titus County, Texas. Agreements reached in mediation shall be reduced 1
writing, and
will be subject to the approval by the District's Board of Directors, signed by the Parties if approved by the Board of
Directors, and, if
signed, shall thereafter be enforceable as provided by the laws of the State of Texas.
Do you agree to these terms?
Yes, I Agree I
7 Remedies Explanation of No Answer
3 I No response
7 Choice of Law
4 The agreement between the Vendor and TIPS/ESC Region 8 and any addenda or other additions resulting from this
procurement process, however described, shall be governed by, construed and enforced in accordance with the law:
State of Texas, regardless of any conflict of laws principles.
THIS DOES NOT APPLY to a vendor's agreement entered into with a TIPS Member, as the Member may be located c
Texas.
Do you agree to these terms?
Agreed I
7 Venue, Jurisdiction and Service of Process
5 An proceeding, involving Region 8 ESC or TIPS, arising out of or relating to this procurement process or an contra
Y p 9, 9 9� 9 9 p p Y
issued by TIPS resulting from or any contemplated transaction shall be brought in a court of competent jurisdiction in
County, Texas and each of the parties irrevocably submits to the exclusive jurisdiction of said court in any such proce
waives any objection it may now or hereafter have to venue or to convenience of forum, agrees that all claims in rest
the Proceeding shall be heard and determined only in any such court, and agrees not to bring any proceeding arisin
of or relating to this procurement process or any contract resulting from or any contemplated transaction in any othe
The parties agree that either or both of them may file a copy of this paragraph with any court as written evidence of t
knowing, voluntary and freely bargained for agreement between the parties irrevocably to waive any objections to ve
to convenience of forum. Process in any Proceeding referred to in the first sentence of this Section may be served of
party anywhere in the world. Any dispute resolution process other than litigation shall have venue in Camp County or
County Texas.
Do you agree to these terms?
Agreed I
Page 21 of 30 pages Vendor: Northern Imports 220101
Infringement(s)
7
6
The successful vendor will be expected to indemnify and hold harmless the TIPS and its employees, officers, agents,
representatives, contractors, assignees and designees from any and all third party claims and judgments involving
infringement of patent, copyright, trade secrets, trade or service marks, and any other intellectual or intangible prope
rights attributed to or claims based on the Vendor's proposal or Vendor's performance of contracts awarded and app
Do you agree to these terms?
Yes, I Agree
7 Infringement(s) Explanation of No Answer
7 No response
7
8
7
9
Contract Governance
Any contract made or entered into by the TIPS is subject to and is to be governed by Section 271.151 et seq, Tex Lo
Code. Otherwise, TIPS does not waive its governmental immunities from suit or liability except to the extent expressly
by other applicable laws in clear and unambiguous language.
❑ Yes, I Agree (Yes)
Payment Terms and Funding Out Clause
Payment Terms:
TIPS or TIPS Members shall not be liable for interest or late payment fees on past -due balances at a rate higher thar
permitted by the laws or regulations of the jurisdiction of the TIPS Member.
Funding Out Clause:
Vendor agrees to abide by the laws and regulations, including Texas Local Government Code § 271.903, or any state
or regulatory limitations of the jurisdiction of any TIPS Member which governs contracts entered into by the Vendor ai
TIPS or a TIPS Member that requires all contracts approved by TIPS or a TIPS Member are subject to the budgeting
appropriation of currently available funds by the entity or its governing body.
See statute(s) for specifics or consult your legal counsel.
Not a negotiable term. Failure to agree will render your proposal non -responsive and it will not be considered.
Do you agree to these terms?
0 Yes, I Agree (Yes)
Page 22 of 30 pages Vendor: Northern Imports 220101
8 Insurance and Fingerprint Requirements Information
U Insurance
If applicable and your staff will be on TIPS member premises for delivery, training or installation etc. and/or with an
automobile, you must carry automobile insurance as required by law. You may be asked to
provide proof of insurance.
Finaerarint
It is possible that a vendor may be subject to Chapter 22 of the Texas Education Code. The Texas Education Code, C
22, Section 22.0834 & 22.08341. Statutory language may be found at: http://www.statutes.Iegis.state.tx.us/
If the vendor has staff that meet both of these criterion:
(1) will have continuing duties related to the contracted services; and
(2) has or will have direct contact with students
Then you have "covered" employees for purposes of completing the attached form.
TIPS recommends all vendors consult their legal counsel for guidance in compliance with this law. If you have questic
how to comply, see below. If you have questions on compliance with this code section, contact the Texas Department
Public Safety Non -Criminal Justice Unit, Access and Dissemination Bureau, FAST -FACT at
NCJU@txdps.state.tx.us and you should send an email identifying you as a contractor to a Texas Independent Schoo
District or ESC Region 8 and TIPS. Texas DPS phone number is (512) 424-2474.
See form in the next attribute to complete entitled:
Texas Education Code Chapter 22 Contractor Certification for Contractor Employees
Page 23 of 30 pages Vendor: Northern Imports 220101
8 Texas Education Code Chapter 22 Contractor Certification for Contractor Employees
1 Introduction: Texas Education Code Chapter 22 requires entities that contract with school districts to provide serviceE
obtain criminal history record information regarding covered employees. Contractors must certify to the district that tr
have complied. Covered employees with disqualifying criminal histories are prohibited from serving at a school distric
Definitions: Covered employees: Employees of a contractor or subcontractor who have or will have continuing duties
related to the service to be performed at the District and have or will have direct contact with students. The District wi
the final arbiter of what constitutes direct contact with students. Disqualifying criminal history: Any conviction or other
criminal history information designated by the District, or one of the following offenses, if at the time of the offense, th
victim was under 18 or enrolled in a public school:
(a) a felony offense under Title 5, Texas Penal Code; (b) an offense for which a defendant is required to register as 2
offender under Chapter 62, Texas Code of Criminal Procedure; or (c) an equivalent offense under federal law or the
another state.
I certify that:
NONE (Section A) of the employees of Contractor and any subcontractors are covered employees, as defined abov
this box is checked, I further certify that Contractor has taken precautions or imposed conditions to ensure that the
employees of Contractor and any subcontractor will not become covered employees. Contractor will maintain these
precautions or conditions throughout the time the contracted services are provided.
SOME (Section B) or all of the employees of Contractor and any subcontractor are covered employees. If this box i,,
checked, I further certify that:
(1) Contractor has obtained all required criminal history record information regarding its covered employees. None o-
covered employees has a disqualifying criminal history.
(2) If Contractor receives information that a covered employee subsequently has a reported criminal history, Contract
immediately remove the covered employee from contract duties and notify the District in writing within 3 business day
(3) Upon request, Contractor will provide the District with the name and any other requested information of covered
employees so that the District may obtain criminal history record information on the covered employees.
(4) If the District objects to the assignment of a covered employee on the basis of the covered employee's criminal hi
record information, Contractor agrees to discontinue using that covered employee to provide services at the District.
Noncompliance or misrepresentation regarding this certification may be grounds for contract termination.
None I
8 Texas Business and Commerce Code § 272 Requirements as of 9-1-2017
2 SB 807 prohibits construction contracts to have provisions requiring the contract to be subject to the laws of another
to be required to litigate the contract in another state, or to require arbitration in another state. A contract with such
provisions is voidable. Under this new statute, a "construction contract" includes contracts, subcontracts, or agreeme
with (among others) architects, engineers, contractors, construction managers, equipment lessors, or materials supp
"Construction contracts" are for the design, construction, alteration, renovation, remodeling, or repair of any building
improvement to real property, or for furnishing materials or equipment for the project. The term also includes moving,
demolition, or excavation. BY RESPONDING TO THIS SOLICITATION, AND WHEN APPLICABLE, THE PROPOSER A(
TO COMPLY WITH THE TEXAS BUSINESS AND COMMERCE CODE § 272 WHEN EXECUTING CONTRACTS WITH 1
MEMBERS THAT ARE TEXAS GOVERNMENT ENTITIES.
Page 24 of 30 pages Vendor: Northern Imports 220101
8
3
Texas Government Code 2270 & 2271 Verification Form
Texas Government Code 2270 & 2271 Verification Form
8
4
If (a) Vendor is not a sole proprietorship; (b) Vendor has ten (10) or more full-time employees; and (c) this Agreemer
value of $100,000 or more, the following certification shall apply; otherwise, this certification is not required. Purs
Chapter 2271 of the Texas Government Code, the Vendor hereby certifies and verifies that neither the Vendor, r
affiliate, subsidiary, or parent company of the Vendor, if any (the "Vendor Companies"), boycotts Israel, and the '
agrees that the Vendor and Vendor Companies will not boycott Israel during the term of this Agreement. For purpi
this Agreement, the term "boycott" shall mean and include refusing to deal with, terminating business activities
otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations with Is
with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action m
ordinary business purposes.
Our entity further certifies that it is is not listed on and we do not do business with companies prohibited by
Government Code 2270 or that are on the Texas Comptroller of Public Accounts list of Designated Foreign Te
Organizations per Texas Gov't Code 2270.0153 found at https://comptroller.texas.gov/purchasing/docs/foreign-terror
I swear and affirm that the above is true and correct.
YES
Logos and other company marks
Please upload your company logo to be added to your individual profile page on the TIPS website. If any particular
specifications are required for use of your company logo, please upload that information under the "Logo and Other
Company Marks" section under the "Response Attachment" tab. Preferred Logo Format: 300 x 225 px - .png, .eps, Jj
preferred
Potential uses of company logo:
* Your Vendor Profile Page of TIPS website
* Potentially on TIPS website scroll bar for Top Performing Vendors
* TIPS Quarterly eNewsletter sent to TIPS Members
* Co -branding Flyers and or email blasts to our TIPS Members (Permission and approval will be obtained before publ
8 Solicitation Deviation/Compliance
5 Does the vendor agree with the General Conditions Standard Terms and
Conditions or Item Specifications listed in this proposal invitation?
IYes
Page 25 of 30 pages Vendor: Northern Imports 220101
Solicitation Exceptions/Deviations Explanation
8
6
If the bidder intends to deviate from the General Conditions Standard Terms and Conditions or Item Specifications lis
this proposal invitation, all such deviations must be listed on this attribute, with complete and detailed conditions and
information included or attached.
TIPS will consider any deviations in its proposal award decisions, and TIPS reserves the right to accept or reject any
based upon any deviations indicated below or in any attachments or inclusions.
In the absence of any deviation entry on this attribute, the proposer assures TIPS of their full compliance with the StZ
Terms and Conditions, Item Specifications, and all other information contained in this Solicitation.
No response
8 Agreement Deviation/Compliance
7 Does the vendor agree with the language in the Vendor Agreement?
IYes
I
a
9
0
Agreement Exceptions/Deviations Explanation
If the proposing Vendor desires to deviate form the Vendor Agreement language, all such deviations must be listed o
attribute, with complete and detailed conditions and information included. TIPS will consider any deviations in its prop
award decisions, and TIPS reserves the right to accept or reject any proposal based upon any deviations indicated b
In the absence of any deviation entry on this attribute, the proposer assures TIPS of their full compliance with the Vei
Agreement.
No response
Felony Conviction Notice
Texas Education Code, Section 44.034, Notification of Criminal History, Subsection (a), states "a person or business
that enters into a contract with a school district must give advance notice to the district if the person or an owner or
operator of the business entity has been convicted of a felony. The notice must include a general description of the c
resulting in the conviction of a felony." Subsection (b) states "a school district may terminate a contract with a person
business entity if the district determines that the person or business entity failed to give notice as required by Subsec
(a) or misrepresented the conduct resulting in the conviction. The district must compensate the person or business e
for services performed before the termination of the contract." (c) This section does not apply to a publicly held corps
The person completing this proposal certifies that they are authorized to provide the answer to this question.
Select A., B. or C.
A. My firm is a publicly held corporation; therefore, this reporting requirement is not applicable.
OR B.My firm is not owned nor operated by anyone who has been convicted of a felony, OR
C. My firm is owned or operated by the following individual(s) who has/have been convicted of a felony. (if you answe
below, you are required to provide information in the next attribute.
B. Firm not owned nor operated by felon; per above I
If you answered C. My Firm is owned or operated by a felon to the previous question, you are REQUIRE[
ANSWER THE FOLLOWING QUESTIONS.
If you answered C. My Firm is owned or operated by a felon to the previous question, you must provide the following
information.
1. Name of Felon(s)
2. The named person's role in the firm, and
3. Details of Conviction(s).
No response
Page 26 of 30 pages Vendor: Northern Imports 220101
Required Confidentiality Claim Form
9
1
9
2
9
3
9
4
9
5
Required Confidentiality Claim Form
This completed form is required by TIPS. By submitting a response to this solicitation you agree to download from the
"Attachments" section, complete according to the instructions on the form, then upload the completed form, with any
confidential attachments, if applicable, to the "Response Attachments" section titled "Confidentiality Form" in order to
provide to TIPS the completed form titled, "CONFIDENTIALITY CLAIM FORM". THIS REQUIRED PROCESS IS THE O
WAY TO DEEM PROPOSAL DOCUMENTATION CONFIDENTIAL ANY OTHER CONFIDENTIAL DESIGNATION WILL BE
DISREGARDED UNLESS THE DOCUMENT IS IDENTIFIED BY AND ATTACHED TO THE REQUIRED FORM. By comp
this process, you provide us with the information we require to comply with the open record laws of the State of TexaE
they may apply to your proposal submission. If you do not provide the form with your proposal, an award will not be r
your proposal is qualified for an award, until TIPS has an accurate, completed form from you.
Read the form carefully before completing and if you have any questions, email bids@tips-usa.com.
Member Access to Vendor Proposal
Notwithstanding any other information provided in this solicitation or Vendor designation of certain documenta
confidential or proprietary, Vendor's acceptance of this TIPS Contract constitutes Vendor's consent to the disclo
Vendor's comprehensive proposal, including any information deemed confidential or proprietary, to TIPS Member
proposing Vendor agrees that TIPS shall not be responsible or liable for any use or distribution of informa
documentation by TIPS Members or any other party. By submitting this proposal, Vendor certifies the foregoing.
Choice of Law clauses with TIPS Members
If the vendor is awarded a contract with TIPS under this solicitation, the vendor agrees to make any Choice of Law cl�
in any contract or agreement entered into between the awarded vendor and with a TIPS member entity to read as foll
"Choice of law shall be the laws of the state where the customer resides" or words to that effect.
Agreed
Venue of dispute resolution with a TIPS Member
In the event of litigation or use of any dispute resolution model when resolving disputes with a TIPS member entity as
result of a transaction between the vendor and TIPS or the TIPS member entity, the Venue for any litigation or other
upon model shall be in the state and county where the customer resides unless otherwise agreed by the parties at th
the dispute resolution model is decided by the parties.
Agreed
Automatic renewal of contracts or agreements with TIPS or a TIPS member entity
This clause DOES NOT prohibit multiyear contracts or agreements with TIPS member entities.
Because TIPS and TIPS members are governmental entities subject to laws that control appropriations of funds durii
their fiscal years for contracts and agreements to provide goods and services, does the Vendor agree to limit any au,
renewal clauses of a contract or agreement executed as a result of this TIPS solicitation award to not longer than "mc
month" and at the TIPS contracted rate.
Agreed
Indemnity Limitation with TIPS Members
Texas and other states restrict by law or state Constitution the ability of a governmental entity to indemnify others. TIF
requires that any contract entered into between a vendor and TIPS or a TIPS Member as a result of an award under
Solicitation limit the requirement that the Customer indemnify the Vendor by either eliminating any such indemnity
requirement clauses in any agreements, contracts or other binding documents OR by prefacing all indemnity clauses
required of TIPS or the TIPS Member entity with the following: "To the extent permitted by the laws or the Constitution
state where the customer resides, ".
Aareement is a reauired condition to award of a contract resultina from this Solicitation.
Agreed
Page 27 of 30 pages Vendor: Northern Imports 220101
9 Arbitration Clauses
7 Except for certain circumstances, TIPS forbids a mandatory arbitration clause in any contract or agreement entered i
between the awarded vendor with TIPS or a TIPS member entity. Does the vendor agree to exclude any arbitration
requirement in any contracts or agreement entered into between TIPS or a TIPS member entity through an awarded
contract with TIPS?
Agreed 1
9 Required Vendor Sales Reporting
8 By responding to this Solicitation, you agree to report to TIPS all sales made under any awarded Agreement with
TIPS. Vendor is required to report all sales under the TIPS contract to TIPS. If the TIPS Member entity requesting a p
from the awarded Vendor requests the TIPS contract, Vendor must include the TIPS Contract number on any
communications with the TIPS Member entity. If awarded, you will be provided access to the Vendor Portal. To report
login to the TIPS Vendor Portal and click on the PO's and Payments tab. Pages 3-7 of the Vendor Portal User Guide
walk you through the process of reporting sales to TIPS. Please refer to the TIPS Accountina FAQ's for more informa
about reporting sales and if you have further questions, contact the Accounting Team at accountino(a)tios-usa.com. l
Vendor or vendor assigned dealers are responsible for keeping record of all sales that go through the TIPS AgreemE
submitting same to TIPS.
9 Upload of Current W-9 Required
9 Please note that you are required by TIPS to upload a current W-9 Internal Revenue Service (IRS) Tax Form for your
entity. This form will be utilized by TIPS to properly identify your entity.
1 CERTIFICATION REGARDING BOYCOTTING CERTAIN ENERGY COMPANIES (Texas law as of Septemb,
0 2021)
By submitting a proposal to this Solicitation, you certify that you agree, when it is applicable, to the follom
required by Texas law as of September 1, 2021:
If (a) company is not a sole proprietorship; (b) company has ten (10) or more full-time employees; and (c) this contra
a value of $100,000 or more that is to be paid wholly or partly from public funds, the following certification shall apply
otherwise, this certification is not required. Pursuant to Tex. Gov't Code Ch. 2274 of SB 13 (87th session), the compa
hereby certifies and verifies that the company, or any wholly owned subsidiary, majority -owned subsidiary, parent con
or affiliate of these entities or business associations, if any, does not boycott energy companies and will not boycott E
companies during the term of the contract. For purposes of this contract, the term "company" shall mean an organize
association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability
company, that exists to make a profit. The term "boycott energy company" shall mean "without an ordinary business
purpose, refusing to deal with, terminating business activities with, or otherwise taking any action intended to penaliz(
economic harm on, or limit commercial relations with a company because the company (a) engages in the exploratior
production, utilization, transportation, sale, or manufacturing of fossil fuel -based energy and does not commit or pled
meet environmental standards beyond applicable federal and state law, or (b) does business with a company describ
paragraph (a)." See Tex. Gov't Code § 809.001(1).
Page 28 of 30 pages Vendor: Northern Imports 220101
1 CERTIFICATION PROHIBITING DISCRIMINATION AGAINST FIREARM AND AMMUNITION INDUSTRIES ('
0 law as of September 1, 2021)
1
By submitting a proposal to this Solicitation, you certify that you agree, when it is applicable, to the follom
required by Texas law as of September 1, 2021:
If (a) company is not a sole proprietorship; (b) company has at least ten (10) full-time employees; (c) this contract ha
value of at least $100,000 that is paid wholly or partly from public funds; (d) the contract is not excepted under Tex. C
Code § 2274.003 of SB 19 (87th leg.); and (e) governmental entity has determined that company is not a sole-sourc(
provider or governmental entity has not received any bids from a company that is able to provide this written verificat
the following certification shall apply; otherwise, this certification is not required. Pursuant to Tex. Gov't Code Ch. 227
SB 19 (87th session), the company hereby certifies and verifies that the company, or association, corporation, partne
joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned sub
majority -owned subsidiary parent company, or affiliate of these entities or associations, that exists to make a profit, d,
have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association a
not discriminate during the term of this contract against a firearm entity or firearm trade association. For purposes of
contract, "discriminate against a firearm entity or firearm trade association" shall mean, with respect to the entity or
association, to: "(1) refuse to engage in the trade of any goods or services with the entity or association based solely
status as a firearm entity or firearm trade association; (2) refrain from continuing an existing business relationship wit
entity or association based solely on its status as a firearm entity or firearm trade association; or (3) terminate an exi;
business relationship with the entity or association based solely on its status as a firearm entity or firearm trade
association. See Tex. Gov't Code § 2274.001(3) of SB 19. "Discrimination against a firearm entity or firearm trade
association" does not include: "(1) the established policies of a merchant, retail seller, or platform that restrict or prol-
listing or selling of ammunition, firearms, or firearm accessories; and (2) a company's refusal to engage in the trade c
goods or services, decision to refrain from continuing an existing business relationship, or decision to terminate an e;
business relationship to comply with federal, state, or local law, policy, or regulations or a directive by a regulatory ag
or for any traditional business reason that is specific to the customer or potential customer and not based solely on e
entity's or association's status as a firearm entity or firearm trade association." See Tex. Gov't Code § 2274.001(3) e
19.
1 CERTIFICATION REGARDING CERTAIN FOREIGN -OWNED COMPANIES IN CONNECTION WITH CRITIC]
0 INFRASTRUCTURE (Texas law as of September 1, 2021)
2
By submitting a proposal to this Solicitation, you certify that you agree to the following required by Texas
as of September 1, 2021:
Proposing Company is prohibited from entering into a contract or other agreement relating to critical infrastructure th
would grant to the company direct or remote access to or control of critical infrastructure in this state, excluding acce
specifically allowed by the Proposing Company for product warranty and support purposes. Company, certifies that t
it nor its parent company nor any affiliate of company or its parent company, is (1) owned by or the majority of stock i
other ownership interest of the company is held or controlled by individuals who are citizens of China, Iran, North Kor
Russia, or a designated country; (2) a company or other entity, including governmental entity, that is owned or contrc
citizens of or is directly controlled by the government of China, Iran, North Korea, Russia, or a designated country; of
headquartered in China, Iran, North Korea, Russia, or a designated country. For purposes of this contract, "critical
infrastructure" means "a communication infrastructure system, cybersecurity system, electric grid, hazardous waste
treatment system, or water treatment facility." See Tex. Gov't Code § 2274.0101(2) of SB 1226 (87th leg.). The coml
verifies and certifies that company will not grant direct or remote access to or control of critical infrastructure, except
product warranty and support purposes, to prohibited individuals, companies, or entities, including governmental enti
owned, controlled, or headquartered in China, Iran, North Korea, Russia, or a designated country, as determined by
Governor.
1 Acknowledgement
0 By submitting this proposal, Vendor certifies that it has read, examined, and understands all portions of this soli)
3
including but not limited to all attribute questions, attachments, solicitation documents, bid notes, and the
Agreement(s). Vendor certifies that, if found to be necessary by the proposing vendor, vendor has sought the ac
counsel in understanding all portions of the solicitation.
Page 29 of 30 pages Vendor: Northern Imports 220101
Page 30 of 30 pages Vendor: Northern Imports 220101
CERTIFICATION BY CORPORATE OFFERER
COMPLETE ONLY IF OFFERER IS A CORPORATION,
THE FOLLOWING CERTIFICATE SHOULD BE EXECUTED AND INCLUDED AS PART OF
PROPOSAL FORM/PROPOSAL FORM.
OFFERER: Northern Imports DBA Work Wear Safety Shoes
(Name of Corporation)
kC► `VO'►.r 1 j certify that I am the Secretary of the Corporation
I, (Name of Corporate Secretary)
named as OFFERER herein above; that
Steve Campbell
(Name of person who completed proposal document)
who signed the foregoing proposal on behalf of the corporation offerer is the authorized person that is
acting as
Director of Safety and Wellness/Contract Administrator
(Title/Position of person signing proposal/offer document within the corporation)
of the said Corporation; that said proposal/offer was duly signed for and in behalf of said corporation by
authority of its governing body, and is within the scope of its corporate powers.
CORPORATE SEAL if available
GNATURE
21r/2 z
DATE
TIPS RFP # 220101
Reauired Confidential Information Status Form
Northern Imports DBA Work Wear Safety Shoes
Name of company
Steve Campbell
Printed Name and Title of Authorized Company Officer declaring below the confidential status of material
6318 Airport Freeway Suite C Fort Worth TX 76182 817-640-2299
Address City State ZIP Phone
ALL VENDORS MUST COMPLETE THE ABOVE SECTION
CONFIDENTIAL INFORMATION SUBMITTED IN RESPONSE TO COMPETITIVE PROCUREMENT REQUESTS OF EDUCATION SERVICE CENTER REGION 8 AND TIPS
(ESC8) IS GOVERNED BY TEXAS GOVERN M ENT CODE, CHAPTER 552
If you consider any portion of your proposal to be confidential and not subject to public disclosure pursuant to Chapter 552 Texas Gov't Code or other law(s),
you must attach a copy of all claimed confidential materials to this COMPLETED form, name the combined PDF documents "CONFIDENTIAL", and upload
the combined, confidential documents with your proposal submission. If a document is not attached, it will not be considered confidential. The copy uploaded
will be the sole indicator of which material in your proposal, if any, you deem confidential in the event TIPS/ESC 8 receives a Public Information Request. If ESC
8 receives a request, any responsive documentation not deemed confidential by you in this manner will be automatically released. For documents deemed
confidential by you in this manner, ESC8 and TIPS will follow procedures of controlling statute(s) regarding any claim of confidentiality and shall not be liable
for any release of information required by law, including Attorney General determination. Notwithstanding any other information provided in this solicitation
or Vendor designation of certain documentation as confidential or proprietary, Vendor's acceptance of this TIPS Vendor Agreement constitutes Vendor's
consent to the disclosure of Vendor's comprehensive proposal, including any information deemed confidential or proprietary, to TIPS Members. The proposing
Vendor agrees that TIPS shall not be responsible or liable for any use or distribution of information or documentation by TIPS Members or any other party.
ALL VENDORS MUST COMPLETE ONE OF THE TWO OPTIONS BELOW
OPTION 1:
DO CLAIM parts of my proposal to be confidential and DO NOTdesire to expressly waive a claim of confidentiality of
all information contained within our response to the solicitation. The attached contains material from our proposal that I
classify and deem confidential under Texas Gov't Code Sec. 552 or other law(s) and I invoke my statutory rights to
confidential treatment of the enclosed materials.
IF CLAIMING PARTS OF YOUR PROPOSAL CONFIDENTIAL, YOU MUST ATTACH THE SHEETS TO THIS FORM AND LIST THE
NUMBER OT TOTAL PAGES THAT ARE CONFIDENTIAL.
ATTACHED ARE COPIES OF References PAGES OF CLAIMED CONFIDENTIAL MATERIAL FROM OUR PROPOSAL THAT
WE DEEM TO BE NOT PUBLIC INFORMATION AND WILL DEFEND THAT CLAIM TO THE TEXAS ATTORNEY GENERAL IF REQUESTED
WHEN A PUBLIC INFORMATION REQUEST IS MADE FOR OUR PROPOSAL.
Signature ` &4,z ra a& Date 1 /24/22
----- OR
OPTION 2:
1 DO NOT CLAIM any of my proposal to be confidential, complete the section below.
Exoress Waiver: I desire to expressly waive any claim of confidentiality as to any and all information contained within our
response to the competitive procurement process (e.g. RFP, CSP, Bid, RFQ, etc.) by completing the following and submitting
this sheet with our response to Education Service Center Region 8 and TIPS.
Signature
Date
Confidentiality Claim Form Rev 102920215R
044f Z]�Xas
SECRETARY OF STATE
CERTIFICATE OF INCORPORATION
OF
NORTHERN IMPORTS, INC.
526729
The undersigned, as Secretary of State of the State of Texas, hereby certifies that
Articles of Incorporation for the above corporation duly signed and verified pursuant
the the provisions of the Texas Business Corporation Act, have been received in this
office and are found to conform to law.
ACCORDINGLY the undersigned, as such Secretary of State, and by virtue of
the authority vested in him by law, hereby issues this Certificate of Incorporation .and
attaches hereto a copy of the Articles of InJorporation-
Dated duly 28, lcy$O
Secretary of State
WORKW AR
S A F E T Y S H O E S �
12 MONTH LIMITED WARRANTY AGAINST DEFECTS "Llml
Recommended Work Wear Safety Shoes ("Work Wear") footwear products are warranted against defects in workmanship and materials. If within 12 months of purchase, a
defect occurs in a recommended Work Wear footwear product as the result of normal use; Work Wear will repair the defect or exchange the product. The amount of the credit
will be determined in Work Wear's sole judgment.
If a recommended product defect occurs as the result of normal use within 6 months after purchase, Work Wear will repair the defect or issue a store credit for the purchase
price. If a recommended product defect occurs as the result of normal use after 6 months of purchase, Work Wear may, at its option, issue a fair and reasonable credit up to
but not exceeding 50% that can be applied to the purchase of Work Wear footwear products. Recommended product failures caused by excessive or abusive wear conditions
do not qualify for exchange or purchase credit. This warranty is available only to the original purchaser and is not transferable. No adjustment will be given without the original
receipt of purchase. You must return your recommended footwear product to a Work Wear Safety Shoes Superstore or Mobile Stores
DISCLAIMER: The limited warranty relating to recommended Work Wear footwear products is in lieu of any other express warranty. No agent, employee or representative of
Work Wear has any authority to bind Work Wear to any affirmation, representation or warranty concerning recommended Work Wear branded footwear products, except as
stated herein. Work Wear shall not be liable for any consequential or incidental damages.
This limited product warranty gives you specific legal rights, and you may also have other rights that vary from state to state. Any implied warranties shall be effective for a
period not exceeding 12 months from the date of purchase. Some states do not allow manufacturers to impose time limitations on certain implied warranties, so the above
limitation may not apply to you.
30-DAY COMFORT GUARANTEE rE.
Footwear with a 30 day comfort guarantee is provided by the original manufacturer. If during the first 30 days, you are not satisfied with the comfort of your guaranteed
footwear, Work Wear will exchange the purchase, no questions asked. No adjustment will be given without the original receipt within 30 days of purchase. You may return
your footwear to any of our Work Wear locations; Stores, Mobile Stores or customer service department. Limit one exchange per customer.
30 day comfort guarantee is provided by the original manufacturer for featured memory foam insoles.
100% CUSTOMER SATISFACTION IS OUR COMMITMENT
v►sa aS�wER ItPaY SUPPORTING 4rHIREHEROESUSP" WORKWEARBOOTS.COM 1800-820-0073 �OItK H0
EXHIBIT C
CONFLICT OF INTEREST DISCLOSURE REQUIREMENT
Pursuant to Chapter 176 of the Local Government Code, any person or agent of a person who contracts or
seeks to contract for the sale or purchase of property, goods, or services with a local governmental entity
(i.e. The City of Fort Worth) must disclose in the Questionnaire Forms CIQ ("Questionnaire") the person's
affiliation or business relationship that might cause a conflict of interest with the local governmental entity.
By law, the Questionnaire must be filed with the Fort Worth City Secretary no later than seven days after
the date the person begins contract discussions or negotiations with the City, or submits an application or
response to a request for proposals or bids, correspondence, or another writing related to potential
agreement with the City. Updated Questionnaires must be filed in conformance with Chapter 176.
A copy of the Questionnaires Form CIQ is enclosed with submittal documents. The form is also available at
http://www.ethics.state.tx.us/forms/CIQ.pdf.
If you have any questions about compliance, please consult your own legal counsel. Compliance is the
individual responsibility of each person or agent of a person who is subject to the filing requirement. An
offense under Chapter 176 is a Class C misdemeanor.
NOTE: If you are not aware of a Conflict of Interest in any business relationship that you might have
with the City, state Contractor name in the # 1, use N/A in each of the areas on the form. However, a
signature is required in the #7 box in all cases.
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, n41h Leg., Regular Session. OFFICE USE ONLY
This questionnaire is being filed in accordance with Ghapter 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 liled with the records administrator of the local governmental entity not later
than the 7th business day after the date the vendor becomes aware of fads that require the stalemerrt to be
filed. Sop Section 176-006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Loral Govemment Code- An
oilanse under this section is a misdemeanor.
J Name of vendor who has a business relationship with local governmental entity.
N/A
J
X Check th is box ifyou are filing an update to a previously fi led q uastionnaito. (The law requires that you file an updated
c, mpleted questionnaire with the appropriate f ling auth&ity not later than the 7th business day after the date on which
you became aware that the originally f led questionnai•e was incomplete OF inaccurate.)
J Name of local gov$rnment officerabout whom the information is being disclosed.
N/A
Name of Off cer
J Describe each employment or other business relationship with the local government officen or a family member of the
officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local govemrnertoff icer.
Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form
CIC 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 =No
B- Is the vendor receiving or I ikely to receive tax&blri income, other than investment income. from or at the d-i w-tion
of the local gay emmont officer or a family member of the officer AND the taxable income is not received from the
local governmental entity?
Yes =No
Describeeach employment or business relationship that thevendor 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.
J
ElCheck 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).
sh2-�w
11 /14/2023
tignature or vendor ❑ping business wrtr. Me govermrremaal antrty Ja:e
Form provided by Texas Ethics Cornr^issior www.athics.stata_Ix_us Revised 111=1
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
A complete copy of Chapter 176 of the Local 0overnment Code may be found at http:;,'s+wwws[ar.uies_legis_state.tx_us!
Docs; LG,'htrw LCL 176.htm. For easy reference, below are some of the sections cited on this form.
Local Government Code & 17&001f1-a): "Business relationship" means a connection between two or more parties
based on con-n--- rciai activity of one of the parties. The term does not include a connection based on:
(A) a Iran saction that is s ubject 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 Gave m me nt Cade ti i T6.003(a)(2)(A) and (B):
(a) A local government officer shall file a conflicts disclosure statement with respect to avendor if:
(2) thevendor:
(A) has an employment or other business relationship with the local government officer or a
family member of the officer that results in tha officer or family member receiving taxable
income, other than irrrestment income, that exceeds $2.500 during the 12-month period
preceding the date that the officer becomes aware that
(i) acontract between the local governmental entity and vendor has been executed;
or
(ii) the local governmental entity is considering entering into a contract with the
(B) has given to the local government officer or a family mem ber of the off icer 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
(i i) the local gave rnmental entity is considering entering into a contract with the vendor_
Local Government Code 4176.006#a1 and fa-1]
(a) Avendor shall fide a completed conflict of interest questionnaire if the vendor has a business relationship
with a local governmental entity and:
(1) has an emp Ioyment or other busi ness relationship with a I ocal government officer of th at local
governmental entity, or a fam ily member of the off ioer, descri bed by Section 176.003(a)(2) (A)'
(2) has given a local government officer of that focal governmental entity, or a family member of the
officer. one or more giftswith the aggregate value specified by Section 17-6.003(a)(2)(B), excluding any
gift described by Section 176.003(a-1); or
(3) has a family relationship with a Ioeal government officer of that local governmental entity-
(a- I ) 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 arequest 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 ven dor has g iven one or more g ifts described by Subsection (a)' or
(C) of a family relationship with a local government officer_
Farm provided by Texas Ethics Commission www.ethics.state.Ix.us Revered 1110021