HomeMy WebLinkAboutContract 62732CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement (“Agreement”) is entered into by and IdentiSys, Inc.
(“Vendor”) and the City of Fort Worth (“City”), a Texas home-rule municipality, individually referred to
as “party” and collectively as the “parties”.
The Cooperative Purchase Agreement includes the following documents which shall be construed in the
order of precedence in which they are listed:
This Cooperative Purchase Agreement;
Exhibit A –Seller’s Quote,
Exhibit B – Cooperative Agency Contract BuyBoard ; and
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. If any provisions of the attached exhibits conflict with the terms herein, are prohibited
by applicable law, conflict with any applicable rule, regulation or ordinance of City, the terms in this
Agreement shall control.
City shall pay Vendor in accordance with the payment terms in Exhibit A and in accordance
with the provisions of this Agreement. Total payment made under this Agreement by City shall not
exceed Thousand Dollars ($0,000.00) annually. 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 ("Effective Date") and expires on January 31, 202 , with renewal
options.
Vendor agrees that City shall, until the expiration of three (3) years after final payment under
this Agreement, or the final conclusion of any audit commenced during the said three years, have
access to and the right to examine at reasonable times any directly pertinent books, documents, papers
and records, including, but not limited to, all electronic records, of Vendor involving transactions
relating to this Agreement at no additional cost to City. Vendor agrees that City shall have
access during normal working hours to all necessary Vendor facilities and shall be provided
adequate and appropriate work space in order to conduct audits in compliance with the provisions of
this section. City shall give Vendor reasonable advance notice of intended audits.
Notices required pursuant to the provisions of this Agreement shall be conclusively determined
to have been delivered when (1) hand-delivered to the other party, its agents, employees, servants or
representatives or (2) received by the other party by United States Mail, registered, return receipt
requested, addressed as follows:
To CITY:
City of Fort Worth
Attn: Valerie Washington
Assistant City Manager
100 Fort Worth Trail
Fort Worth, TX 76102
With copy to Fort Worth City Attorney’s Office at the
same address
To VENDOR:
IdentiSys, Inc.
Lynn Westfall
South/Central Texas Sales Manager
7630 Commerce Way
Eden Prairie, MN, 55344
Email: lynn_westfall@identisys.com
City is a government entity under the laws of the State of Texas and all documents held or
maintained by City are subject to disclosure under the Texas Public Information Act. To the extent the
Agreement requires that City maintain records in violation of the Act, City hereby objects to such
provisions and such provisions are hereby deleted from the Agreement and shall have no force or effect.
In the event there is a request for information marked Confidential or Proprietary, City shall promptly
notify Vendor. It will be the responsibility of Vendor to submit reasons objecting to disclosure. A
determination on whether such reasons are sufficient will not be decided by City, but by the Office of
the Attorney General of the State of Texas or by a court of competent jurisdiction.
The Agreement and the rights and obligations of the parties hereto shall be governed by, and
construed in accordance with the laws of the United States and state of Texas, exclusive of conflicts of
law provisions. Venue for any suit brought under the Agreement shall be in a court of competent
jurisdiction in Tarrant County, Texas. To the extent the Agreement is required to be governed by any
state law other than Texas or venue in Tarrant County, City objects to such terms and any such terms are
hereby deleted from the Agreement and shall have no force or effect.
Nothing herein constitutes a waiver of City’s sovereign immunity. To the extent the Agreement
requires City to waive its rights or immunities as a government entity; such provisions are hereby deleted
and shall have no force or effect.
To the extent the Agreement, in any way, limits the liability of Vendor or requires City to
indemnify or hold Vendor or any third party harmless from damages of any kind or character, City
objects to these terms and any such terms are hereby deleted from the Agreement and shall have no force
or effect.
If Vendor has fewer than 10 employees or this Agreement is for less than $100,000, this section
does not apply. Vendor acknowledges that in accordance with Chapter 2271 of the Texas Government
Code, the City is prohibited from entering into a contract with a company for goods or services unless
the contract contains a written verification from the company that it: (1) does not boycott Israel; and (2)
will not boycott Israel during the term of the contract. The terms “boycott Israel” and “company” has
the meanings ascribed to those terms in Chapter 2271 of the Texas Government Code. By signing this
Agreement, Vendor certifies that Vendor’s signature provides written verification to the City that
Vendor: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the Agreement.
If Vendor has fewer than 10 employees or this Agreement is for less than $100,000, this section
does not apply. Vendor acknowledges that in accordance with Chapter 2276 of the Texas Government
Code, the City is prohibited from entering into a contract for goods or services that has a value of
$100,000 or more that is to be paid wholly or partly from public funds of the City with a company with
10 or more full-time employees unless the contract contains a written verification from the Vendor that
it: (1) does not boycott energy companies; and (2) will not boycott energy companies during the term of
this Agreement. To the extent that Chapter 2276 of the Government Code is applicable to this
Agreement, by signing this Agreement, Vendor certifies that Vendor’s signature provides written
verification to the City that Vendor: (1) does not boycott energy companies; and (2) will not boycott
energy companies during the term of this Agreement.
If Vendor has fewer than 10 employees or this Agreement is for less than $100,000, this section
does not apply. Vendor acknowledges that except as otherwise provided by Chapter 2274 of the Texas
Government Code, the City is prohibited from entering into a contract for goods or services that has a
value of $100,000 or more that is to be paid wholly or partly from public funds of the City with a
company with 10 or more full-time employees unless the contract contains a written verification from
the Vendor that it: (1) does not have a practice, policy, guidance, or directive that discriminates against
a firearm entity or firearm trade association; and (2) will not discriminate during the term of the contract
against a firearm entity or firearm trade association. To the extent that Chapter 2274 of the Government
Code is applicable to this Agreement, by signing this Agreement, Vendor certifies that Vendor’s
signature provides written verification to the City that Vendor: (1) does not have a practice, policy,
guidance, or directive that discriminates against a firearm entity or firearm trade association; and (2) will
not discriminate against a firearm entity or firearm trade association during the term of this Agreement.
(signature page follows)
(remainder of this page intentionally left blank)
The undersigned represents and warrants that he or she has the power and authority to execute
this Agreement and bind the respective party.
CITY OF FORT WORTH:
By: ______________________________
Name: Valerie Washington
Title: Assistant City Manager
Date: _________________________
APPROVAL RECOMMENDED:
By: ______________________________
Name: William F. Rumuly
Title: Municipal Court Services Director
By: ______________________________
Name: Jannette Goodall
Title: City Secretary
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the person
responsible for the monitoring and administration of
this contract, including ensuring all performance and
reporting requirements.
By: ______________________________
Name:
Title:
APPROVED AS TO FORM AND LEGALITY:
By: ______________________________
Name:Title:
Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: N/A
1295 Form: N/A
VENDOR:
IdentiSys, Inc.
By:
Name:
Title: Sales Manager
Date: ________________________
-$ -$
Per BuyBoard contract, standard discount is 20%
If a concern, please contact for accurate delivery as Technology cards need to be programmed before shipping.
Payment Terms: Invoice Due on Receipt with Credit Application Approval, Net30D
TERMS Created:
Quotation Good for at least 30-days
IdentiSys doesn't accept returns on Custom items. It is the customers responsibility to review any programming and/or artwork.
2/3/2025
Shipping not included. Please let us know if a shipping quote is required.
TO ORDER, PLEASE EMAIL PO TO: Attention: Ryan Moe ryan_moe@identisys.com
*This includes a 2% discount for cash payments. If a credit card is used, an additonal charge may apply.
UNIT PRICE TOTAL PRICE
Corporate 1000, Format: H2006617 (msrp: $.35/ea.)200
100 2.82$ 282.00$ IPC-9010 Honeywell Proximity ISO PVC Card V2 (Format# L34NC1), Facility
Code: 199 (msrp: $5.53) (100/per box)
1,052.00$
City of Fort Worth IdentiSys Inc.
1000 Throckmorton 3061 Peyton Brooke Dr.
Fort Worth, TX 76102 Fort Worth, TX 76137
PREPARED FOR:SUBMITTED BY:
Amy McCormick Ryan Moe
Sr. Account Technician District Sales Manager
IdentiSys Quote | City of FW ID Supplies | BuyBoard # 759-25
TECHNOLOGY CARDS & HID/FARGO PRINTER SUPPLIES QUANTITY
TOTAL:
BuyBoard contract # 759-25
49%
Office 817-392-6786 ph: 214-709-3115
Discount %
43%
100%
amy.mccormick@fortworthtexas.gov ryan_moe@identisys.com
2100 iClass Composite Contactless Smart Card, 2k w/ 2 application areas
(msrp: $6.58/ea.) (200/per box)200 3.85$ 770.00$
PREPARED FOR:
Amy McCormick
Sr. Account Technician
City of Fort Worth
1000 Throckmorton
Fort Worth, TX 76102
Office 817-392-6786
amy. mccormick(a�fortworthtexas.qov
�
IdentiSys
�
SUBMITTED BY:
Ryan Moe
District Sales Manager
Identi5ys Inc.
3061 Peyton Brooke Dr.
Fort Worth, TX 76137
ph: 214-709-3115
ryan moeCa�identisys.com
IdentiSys Quote � City of FW ID Supplies � BuyBoard 759-25
New ID Card Badge Printer, Laminator & Supplies QUANTITY Discount % UNIT PRICE TOTAL PRICE
600LE 600dpi Double Sided Retransfer Printer (msrp: $5995) 1 2096 $ 4,796.00 $ 4,796.00
LE10D Double Sided Laminator (msrp: $3499) 1 2096 $ 2,799.00 $ 2,799.00
YMCKK-IDE LE Series Color Ribbon, 750 yield (msrp: $400) 1 2596 $ 300.00 $ 300.00
lmil Clear Patch Laminate, Yield 600 Patches (msrp: $150) 1 2�%6 $ 110.00 $ 110.00
LE Series Retransfer Film (msrp: $145) 1 2796 $ 106.00 $ 106.00
Cleaning Kit (10 Oversize Cleaning Cards, 10 Printhead Cleaning Swabs, & 10 1 2096 $ 68.00 $ 68.00
Cleaning Wipes) (msrp: $85)
Optional: ON-SITE SERVICES, Install, Training, 12-month onsite-includes all
parts, travel, labor and unlimited calls as needed. 1 $ 650.00 $ 650.00
TOTAL: $ 8,829.00
BuyBoard contract # 759-25
Per BuyBoard contract, standard discount is 20%
Quotation Good for at least 30-days
Most items ship within 24-48 hrs. If a concern, please contact for accurate delivery.
Payment Terms: Invoice Due on Receipt with Credit Application Approval, Net30D
Identi5ys doesn't accept returns on Custom items. It is the customers responsibility to review any programming or artwork.
*This includes a 2% discount for cash payments. If a credit card is used, an additonal charge may apply.
PLEASE EMAIL PO TO: IAttention: Ryan Moe
v.02.01.2021
Electronic Delivery
Lynn Westfall
IdentiSys, Inc.
PO Box 1086
Minnetonka, MN 55345
Welcome to BuyBoard!
Re:Proposal Invitation No.
IdentiSys, Inc., Technology: Software and Services
Congratulations, The Local Government Purchasing Cooperative (Cooperative) has awarded your company
a BuyBoard® contract based on the above-referenced Proposal Invitation. The contract is effective for an
initial one-year term of February 1, 2025, through January 31, 2026, and may be subject to two possible one-
year renewals. Please refer to the Proposal Invitation for the contract documents, including the General
Terms and Conditions of the Contract.
To review the items your company has been awarded, please review Proposal Tabulation No. IdentiSys,
Inc. at: www.buyboard.com/vendor. Only items marked as awarded to your company are included in this
contract award, and only those awarded items may be sold through the BuyBoard contract. All sales must
comply with the contract terms and must be at or below the awarded pricing as set forth in the General
Terms and Conditions.
The contract will be posted on the BuyBoard website as an online electronic catalog(s). You are reminded
that, in accordance with the General Terms and Conditions, all purchase orders must be
processed through the BuyBoard. Except as expressly authorized in writing by the Cooperative’s
administrator, you are not authorized to process a purchase order received directly from a Cooperative
member that has not been processed through the BuyBoard or provided to the Cooperative. If you receive
a purchase order directly from a Cooperative member that you have reason to believe has not been received
by the Cooperative or processed through the BuyBoard, you must promptly forward a copy of the purchase
order by email to info@buyboard.com.
A list of Cooperative members is available on the buyboard.com website. Once the contract is active, the
BuyBoard vendor relations staff will be contacting you to assist with the resources available and to provide
any support you may need as an awarded BuyBoard vendor.
On behalf of the Cooperative, we appreciate your interest in the Cooperative and we are looking forward
to your participation in the program. If you have any questions, feel free contact me at bids@buyboard.com.
Sincerely,
Ava Benford, Cooperative Procurement Manager
Texas Association of School Boards, Inc.,
Administrator for The Local Government Purchasing Cooperative
Electronic Delivery
Lynn Westfall
IdentiSys, Inc.
PO Box 1086
Minnetonka, MN 55345
Welcome to BuyBoard!
Re: Proposal Invitation No. 759-25, Technology: Software and Services
Congratulations, The National Purchasing Cooperative (National Cooperative) has awarded your company a BuyBoard®
contract based on the above-referenced Proposal Invitation. The contract is effective for an initial one-year term of February
1, 2025, through January 31, 2026, and may be subject to two possible one-year renewals. Please refer to the Proposal
Invitation for the contract documents, including the National Purchasing Cooperative Vendor Award Agreement and General
Terms and Conditions of the Contract.
To review the items your company has been awarded, please review Proposal Tabulation No. 759-25 at
www.buyboard.com/vendor. Only items marked as awarded to your company are included in this contract award, and only
those awarded items may be sold through the BuyBoard contract. All sales must comply with the contract terms and must
be at or below the awarded pricing as set forth in the General Terms and Conditions.
The contract will be posted on the BuyBoard website as an online electronic catalog(s). You are reminded that, in
accordance with the General Terms and Conditions, all purchase orders from National Cooperative members
must be processed through the BuyBoard. Except as expressly authorized in writing by the Cooperative’s administrator,
you are not authorized to process a purchase order received directly from a National Cooperative member that has not been
processed through the BuyBoard or provided to the Cooperative. If you receive a purchase order directly from a National
Cooperative member that you have reason to believe has not been received by the National Cooperative or processed through
the BuyBoard, you must promptly forward a copy of the purchase order by e-mail to info@buyboard.com
A list of National Cooperative members is available on the buyboard.com website. Once the contract is active, the BuyBoard
vendor relations staff will be contacting you to assist with resources available and provide any support you may need as an
awarded BuyBoard vendor.
On behalf of the National Cooperative, we are looking forward to your participation in the program. If you have any questions,
feel free to contact me at bids@buyboard.com.
Sincerely,
Ava Benford, Cooperative Procurement Manager
Texas Association of School Boards, Inc.,
Procurement Administrator for the National Purchasing Cooperative
v.02.01.2021
PROPOSAL FORMS COMM/SVCS V.04.23.2024
PROPOSER’S ACCEPTANCE AND AGREEMENT
Proposal Invitation Name
Technology: Software and Services
Proposal Due Date/Opening Date and Time
August 15, 2024, at 4:00 PM
Proposal Invitation Number
759-25
Location of Proposal Opening
Texas Association of School Boards, Inc.
BuyBoard Department
12007 Research Blvd.
Austin, TX 78759
Contract Term
February 1, 2025, through January 31, 2026,
with two possible one-year renewals.
Anticipated Cooperative Board Meeting Date
October 2024
________________________________________________ _______________________________________________
Name of Proposing Company Date
________________________________________________ _______________________________________________
Street Address Signature of Authorized Company Official
________________________________________________ _______________________________________________
City, State, Zip Printed Name of Authorized Company Official
________________________________________________ _______________________________________________
Telephone Number of Authorized Company Official Position or Title of Authorized Company Official
________________________________________________ _______________________________________________
Fax Number of Authorized Company Official Federal ID Number
Page 10 of 67
IdentiSys, Inc.
7630 Commerce Way
Eden Prairie, MN 55344
210-380-7141
N/A
8/8/24
Lynn Westfall
South/Central Texas Sales Manager
41-1938567
PROPOSAL FORMS COMM/SVCS V.04.23.2024
PROPOSAL FORMS PART 1: COMPLIANCE FORMS
INSTRUCTIONS:
Proposer must review and complete all forms in this Proposal Forms Part 1:
Proposal Acknowledgements
Felony Conviction Disclosure
Resident/Nonresident Certification
Debarment Certification
Vendor Employment Certification
No Boycott Verification
No Excluded Nation or Foreign Terrorist Organization Certification
Historically Underutilized Business Certification
Acknowledgement of BuyBoard Technical Requirements
Construction-Related Goods and Services Affirmation
Deviation and Compliance
Vendor Consent for Name Brand Use
Confidential/Proprietary Information
EDGAR Vendor Certification
Compliance Forms Signature Page
An authorized representative of Proposer where indicated
and complete and sign the Compliance Forms Signature Page. Proposer’s failure to fully complete, initial,
and sign forms as required may result in your Proposal being rejected as non-responsive.
PROPOSAL ACKNOWLEDGEMENTS
The proposing company (“you” or “your”) hereby acknowledges and agrees as follows:
1. You have carefully examined and understand all information and documentation associated with this Proposal Invitation,
including the Instructions to Proposers, General Information, General Terms and Conditions, attachments/forms,
appendices, item specifications, and line items (collectively “Requirements”);
2. By your response (“Proposal”) to this Proposal Invitation, you propose to supply the products or services submitted at
the pricing quoted in your Proposal and in strict compliance with the Requirements, unless specific deviations or
exceptions are noted in the Proposal;
3. By your Proposal, you acknowledge and certify all items set forth in the General Terms and Conditions, Section B.12
(Certifications), including all non-collusion certifications and certifications regarding legal, ethical, and other matters set
forth therein.
4. Any and all deviations and exceptions to the Requirements have been noted in your Proposal on the required form and
no others will be claimed;
Initial: _____
Page 11 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
5. If the Cooperative accepts any part of your Proposal and awards you a Contract, you will furnish all awarded products or
services at the pricing quoted and in strict compliance with the Requirements (unless specific deviations or exceptions are
noted on the required form and accepted by the Cooperative), including without limitation the Requirements related
to:
a. conducting business with Cooperative members, including offering pricing to members that is the best you offer
compared to similarly situated customers in similar circumstances;
b. payment of a service fee in the amount specified and as provided for in this Proposal Invitation;
c. the possible award of a piggy-back contract by the National Purchasing Cooperative or nonprofit entity, in which
event you will offer the awarded products and services in accordance with the Requirements; and
d. submitting price sheets or catalogs in the proper format as required by the Cooperative as a prerequisite to
activation of your Contract;
6. You have clearly identified on the included form any information in your Proposal that you believe to be confidential or
proprietary or that you do not consider to be public information subject to public disclosure under the Texas Public
Information Act or similar public information law;
7. The individual submitting this Proposal is duly authorized to enter into the contractual relationship represented by this
Proposal Invitation on your behalf and bind you to the Requirements, and such individual (and any individual signing a
form or Proposal document) is authorized and has the requisite knowledge to provide the information and make the
representations and certifications required in the Requirements;
8. You have carefully reviewed your Proposal, and certify that all information provided is true, complete, and accurate to
the best of your knowledge, and you authorize the Cooperative to take such action as it deems appropriate to verify
such information; and
9. Any misstatement, falsification, or omission in your Proposal, whenever or however discovered, will be grounds for
disqualifying you from consideration for a contract award under this Proposal Invitation, termination of a contract
award, or any other remedy or action provided for in the General Terms and Conditions or by law.
FELONYCONVICTIONDISCLOSURE
Subsection (a) of Section 44.034 of the Texas Education Code (Notification of Criminal History of Contractor)
states: “A person or business entity that enters into a contract with a school district must give advance notice to the district
if the person or an owner or operator has been convicted of a felony. The notice must include a general description of the
conduct resulting in the conviction of a felony.”
Section 44.034 further states in Subsection (b): “A school district may terminate a contract with a person or business
entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or
misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for
services performed before the termination of the contract.”
My company is a publicly-held corporation. (Advance notice requirement does not apply to publicly-held corporation.)
My company is not owned or operated by anyone who has been convicted of a felony.
My company is owned/operated by the following individual(s) who has/have been convicted of a felony:
Name of Felon(s): ___________________________________________________________________________________
Details of Conviction(s): _______________________________________________________________________________
__________________________________________________________________________________________________
Initial: _____
Page 12 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
RESIDENT/NONRESIDENT CERTIFICATION
Chapter 2252, Subchapter A, of the Texas Government Code establishes certain requirements applicable to proposers who
are not Texas residents. Under the statute, a “resident” proposer is a person whose principal place of business is in Texas,
including a contractor whose ultimate parent company or majority owner has its principal place of business in Texas. A
“nonresident” proposer is a person who is not a Texas resident. Please indicate the status of your company as a “resident”
proposer or a “nonresident” proposer under these definitions.
I certify that my company is a Resident Proposer.
I certify that my company is a Nonresident Proposer.
If your company is a Nonresident Proposer, you must provide the following information for your resident state (the state in
which your company’s principal place of business is located):
________________________________________________ _______________________________________________
Company Name Address
________________________________________________ ___________ ________________________________
City State Zip Code
A. Does your resident state require a proposer whose principal place of business is in Texas to under-price proposers
whose resident state is the same as yours by a prescribed amount or percentage to receive a comparable contract?
Yes No
B. What is the prescribed amount or percentage? $_______________ or ______________%
DEBARMENT CERTIFICATION
By signature on the Compliance Forms Signature Page, I certify that neither my company nor an owner or principal of my
company has been debarred, suspended or otherwise made ineligible for participation in Federal Assistance programs under
Executive Order 12549, “Debarment and Suspension,” as described in the Federal Register and Rules and Regulations.
Neither my company nor an owner or principal of my company is currently listed on the government-wide exclusions in
SAM, debarred, suspended, or otherwise excluded by agencies or declared ineligible under any statutory or regulatory
authority. My company agrees to immediately notify the Cooperative and all Cooperative members with pending purchases
or seeking to purchase from my company if my company or an owner or principal is later listed on the government-wide
exclusions in SAM, or is debarred, suspended, or otherwise excluded by agencies or declared ineligible under any statutory
or regulatory authority.
VENDOR EMPLOYMENT CERTIFICATION
Section 44.031(b) of the Texas Education Code establishes certain criteria that a school district must consider when
determining to whom to award a contract. Among the criteria for certain contracts is whether the vendor or the vendor’s
ultimate parent or majority owner (i) has its principal place of business in Texas; or (ii) employs at least 500 people in
Texas. If neither your company nor the ultimate parent company or majority owner has its principal place of business in
Texas, does your company, ultimate parent company, or majority owner employ at least 500 people in Texas?
Yes No
Initial: ______
Page 13 of 67
IdentiSys, Inc.7630 Commerce Way
Eden Prairie MN 55344
X
X
PROPOSAL FORMS COMM/SVCS V.04.23.2024
NO BOYCOTT VERIFICATION
A Texas governmental entity may not enter into a contract with a value of $100,000 or more that is to be paid wholly or partly
from public funds with a company (excluding a sole proprietorship) that has 10 or more full-time employees for goods or
services unless the contract contains a written verification from the company that it: (1) does not boycott Israel and will not
boycott Israel during the term of the contract (TEX. GOV’T CODE Ch. 2271), (2) does not boycott energy companies and will not
boycott energy companies during the term of the contract (TEX.GOV’T CODE Ch. 2276), and (3) does not have a practice, policy,
guidance, or directive that discriminates against a firearm entity or firearm trade association and will not discriminate during
the term of the contract against a firearm entity or firearm trade association (T EX. GOV’T CODE Ch. 2274). Accordingly, this
certification form is included to the extent required by law.
“Boycott Israel” means refusing to deal with, terminating business activities with, or otherwise taking any action that is
intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or
entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business
purposes. TEX. GOV’T CODE §808.001(1).
“Boycott energy company” means, without an ordinary business purpose, refusing to deal with, terminating business
activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial
relations with a company because the company: (A) engages in the exploration, production, utilization, transportation, sale,
or manufacturing of fossil fuel-based energy and does not commit or pledge to meet environmental standards beyond
applicable federal and state law; or (B) does business with a company described by Paragraph (A). T EX. GOV’T CODE
§809.001(1).
“Discriminate against a firearm entity or firearm trade association” means, (A) with respect to the entity or association, to:
(i) refuse to engage in the trade of any goods or services with the entity or association based solely on its status as a
firearm entity or firearm trade association; (ii) refrain from continuing an existing business relationship with the entity or
association based solely on its status as a firearm entity or firearm trade association; or (iii) terminate an existing business
relationship with the entity or association based solely on its status as a firearm entity or firearm trade association; and (B)
does not include: (i) the established policies of a merchant, retail seller, or platform that restrict or prohibit the listing or
selling of ammunition, firearms, or firearm accessories; and (ii) a company’s refusal to engage in the trade of any goods or
services, decision to refrain from continuing an existing business relationship, or decision to terminate an existing business
relationship: (aa) to comply with federal, state, or local law, policy, or regulations or a directive by a regulatory agency; or
(bb) for any traditional business reason that is specific to the customer or potential customer and not based solely on an
entity’s or association’s status as a firearm entity or firearm trade association. T EX. GOV’T CODE §2274.001(3).
By signature on the Compliance Forms Signature Page, to the extent applicable, I certify and verify that Vendor does not
boycott Israel, boycott energy companies, or discriminate against a firearm entity or firearm trade association and will not
do so during the term of any contract awarded under this Proposal Invitation, that this certification is true, complete and
accurate, and that I am authorized by my company to make this certification.
Initial: _____
Page 14 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
NOEXCLUDEDNATIONORFOREIGNTERRORISTORGANIZATIONCERTIFICATION
Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may not enter into a contract with a
company engaged in active business operations with Sudan, Iran, or a foreign terrorist organization – specifically, any company
identified on a list prepared and maintained by the Texas Comptroller under Texas Government Code §§806.051, 807.051, or
2252.153. (A company that the U.S. Government affirmatively declares to be excluded from its federal sanctions regime relating
to Sudan, Iran, or any federal sanctions regime relating to a foreign terrorist organization is not subject to the contract
prohibition.)
By signature on the Compliance Forms Signature Page, I certify and verify that Vendor is not on the Texas Comptroller’s
list identified above; that this certification is true, complete and accurate; and that I am authorized by my company to make
this certification.
HISTORICALLY UNDERUTILIZED BUSINESS CERTIFICATION
A Proposer that has been certified as a Historically Underutilized Business (also known as a Minority/Women Business
Enterprise or “MWBE” and all referred to in this form as a “HUB”) is encouraged to indicate its HUB certification status when
responding to this Proposal Invitation. The BuyBoard website will indicate HUB certifications for awarded Vendors that
properly indicate and document their HUB certification on this form
I certify that my company has been certified as a HUB in the following categories:
Minority Owned Business Women Owned Business
Service-Disabled Veteran Owned Business (veteran defined by 38 U.S.C. §101(2), who has a
service-connected disability as defined by 38 U.S.C. § 101(16), and who has a disability
rating of 20% or more as determined by the U. S. Department of Veterans Affairs or
Department of Defense)
Certification Number: ___________________________________________________
Name of Certifying Agency: _______________________________________________
My company has NOT been certified as a HUB.
ACKNOWLEDGEMENT OF BUYBOARD TECHNICAL REQUIREMENTS
Vendor shall review the BuyBoard Technical Requirements included in this Proposal Invitation. By signature on the
Compliance Forms Signature Page, the undersigned affirms that Proposer has obtained a copy of the BuyBoard Technical
Requirements, has read and understands the requirements, and certifies that Vendor is able to meet and will comply with
those requirements except as follows:
Note: In accordance with the General Terms and Conditions of the Contract, to the extent Vendor is awarded a Contract
under this Proposal Invitation but is unable or unwilling to meet the applicable BuyBoard Technical Requirements, the
information available on the BuyBoard for Vendor’s awarded products or services may be limited, potentially placing Vendor
at a disadvantage and impacting the ability of Cooperative members to search, find, review, and purchase Vendor’s awarded
products and services on the BuyBoard website. Further, to the extent Vendor has acknowledged ability to meet and comply
with the BuyBoard Technical Requirements, any subsequent failure or refusal by Vendor to promptly provide information
upon request to the Cooperative administrator in accordance with those technical requirements may be deemed an event
of default under the Contract. Initial: _____
Page 15 of 67
X
PROPOSAL FORMS COMM/SVCS V.04.23.2024
CONSTRUCTION-RELATED GOODS AND SERVICES AFFIRMATION
The Cooperative issued the BuyBoard Procurement and Construction-Related Goods and Services Advisory for Texas
Members (“Advisory”), which provides information specifically relevant to the procurement of construction-related goods
and services by Texas Cooperative members. The Advisory, available at buyboard.com/Vendor/Resources.aspx, provides
an overview of certain legal requirements that are potentially relevant to a Cooperative member’s procurement of
construction or construction-related goods and services, including those for projects that may involve or require architecture,
engineering or independent testing services. A copy of the Advisory can also be provided upon request. Because many
BuyBoard contracts include goods or installation services that might be considered construction-related, Proposer must
make this Construction Related-Goods and Services Affirmation regardless of type of goods or services associated with this
Proposal Invitation.
A contract awarded under this Proposal Invitation covers only the specific goods and/or services awarded by the
Cooperative. As explained in the Advisory (“Advisory”), Texas law prohibits the procurement of architecture or
engineering services through a purchasing cooperative. This Proposal Invitation and any Contract awarded
thereunder does not include such services. Architecture or engineering services must be procured by a
Cooperative member separately, in accordance with the Professional Services Procurement Act (Chapter
2254 of the Texas Government Code) and other applicable law and local policy.
By signature on the Compliance Forms Signature Page, Proposer affirms that Proposer has obtained a copy of the Advisory,
has read and understands the Advisory, and is authorized by Proposer to make this affirmation. If Proposer sells
construction-related goods or services to a Cooperative member under a Contract awarded under this Proposal Invitation,
Proposer will comply with the Advisory and applicable legal requirements, make a good faith effort to make its Cooperative
member customers or potential Cooperative member customers aware of such requirements, and provide a Cooperative
member with a copy of the Advisory before accepting the member’s Purchase Order or other agreement for construction-
related goods or services.
Initial: ______
Page 16 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
DEVIATION AND COMPLIANCE
If your company intends to deviate from the General Terms and Conditions, Proposal Specifications or other requirements
associated with this Proposal Invitation, you MUST list all such deviations on this form, and provide complete and detailed
information regarding the deviations on this form or an attachment to this form. Prior to completing this form, Vendor
shall review the General Terms and Conditions section B.4 (Deviations from Item Specifications and General
Terms and Conditions). Please note that, as provided in section B.4, certain provisions of the General Terms
and Conditions are NOT subject to deviation, and certain deviations will be deemed rejected without further
action by the Cooperative. Any attempted deviation, whether directly or indirectly, to provisions identified
in this Proposal Invitation as not subject to deviation shall be deemed rejected by the Cooperative and,
unless otherwise withdrawn by Vendor, may result in Vendor’s Proposal being rejected in its entirety.
The Cooperative will consider any deviations in its contract award decision and reserves the right to accept or reject a
proposal based upon any submitted deviation.
In the absence of any deviation identified and described in accordance with the above, your company must fully comply
with the General Terms and Conditions, Proposal Specifications and all other requirements associated with this Proposal
Invitation if awarded a Contract under this Proposal Invitation. A deviation will not be effective unless accepted by the
Cooperative. The Cooperative, by and through the Cooperative administrator, may, in its sole discretion, seek clarification
from and/or communicate with Proposer(s) regarding any submitted deviation, consistent with general procurement
principles of fair competition. The Cooperative reserves the right to accept or reject a Proposal based upon any submitted
deviation.
No; Deviations
Yes; Deviations
List and fully explain any deviations you are submitting:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Initial: _____
Page 17 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
VENDOR CONSENT FOR NAME BRAND USE
BuyBoard members seeking to make purchases using a Contract awarded under this Proposal Invitation may view
information regarding awarded Vendors, including but not limited to product catalogs, pricelists, pricing, and Proposals,
through the BuyBoard website. To improve and enhance the experience of BuyBoard members seeking to procure goods
and services under the Contract utilizing the BuyBoard website, any Vendor logo, product images, and similar brand and
trademark information provided by Vendor for purposes of the Contract (“Vendor Information”) may be posted on the
BuyBoard website.
You acknowledge that, by submitting your Proposal, unless you specifically opt out below, you consent to
use of your company’s Vendor Information on the BuyBoard website if awarded a Contract . You further
acknowledge that whether, where, and when to include the Vendor Information on the BuyBoard website shall be at the
sole discretion of the BuyBoard Administrator. Vendor retains, however, the right of general quality control over the
BuyBoard Administrator’s authorized display of proprietary Vendor Information. Neither the BuyBoard nor its administrator
will be responsible for the use or distribution of Vendor Information by BuyBoard members or any other third party using
the BuyBoard website. This Vendor Consent shall be effective for the full term of the Contract, including renewals, unless
Vendor provides a signed, written notice revoking consent to contractadmin@buyboard.com. BuyBoard shall have up to
thirty days from the date of receipt of a termination or revocation of a Vendor Consent to remove Vendor information from
the BuyBoard website.
This Vendor Consent is subject to the Terms and Conditions of the Contract, including, but not limited to, those terms
pertaining to Disclaimer of Warranty and Limitation of Liability, Indemnification, and Intellectual Property Infringement.
Vendor logo files must be submitted in one of the formats set forth in the BuyBoard Technical Requirements. Proposers
are requested to submit this information with Vendor’s Proposal. (This consent shall not authorize use of your company’s
Vendor Information by BuyBoard if your company is not awarded a Contract.)
OPT OUT:
If your company wishes to opt out of the Vendor Consent for Name Brand Use, you must check the opt out box below.
By checking this box, Vendor hereby declines to provide consent for use of Vendor Information (as defined herein) on
the BuyBoard website. By opting out, Vendor acknowledges and agrees that, if Vendor is awarded a Contract
under this Proposal Invitation, information available on the BuyBoard for Vendor’s awarded products or
services may be limited, potentially placing Vendor at a disadvantage and impacting the ability of
Cooperative members to search, find, review, and purchase Vendor’s awarded products and services on
the BuyBoard website.
Initial: _____
Page 18 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
CONFIDENTIAL/PROPRIETARY INFORMATION
A. Public Disclosure Laws
All Proposals, forms, documentation, catalogs, pricelists, or other materials submitted by Vendor to the Cooperative in
response to this Proposal Invitation, may be subject to the disclosure requirements of the Texas Public Information Act
(Texas Government Code chapter 552.001, ) or similar disclosure law. Proposer must clearly identify on this form
any information in its Proposal (including forms, documentation, or other materials submitted with the Proposal) that
Proposer considers proprietary or confidential. If Proposer fails to properly identify the information, the Cooperative shall
have no obligation to notify Vendor or seek protection of such information from public disclosure should a member of the
public or other third party request access to the information under the Texas Public Information Act or similar disclosure
law. When required by the Texas Public Information Act or other disclosure law, Proposer may be notified of any third-party
request for information in a Proposal that Proposer has identified in this form as proprietary or confidential.
Does your Proposal (including forms, documentation, catalogs, pricelists, or other materials submitted with the Proposal)
contain information which Vendor considers proprietary or confidential?
NO, I certify that none of the information included with this Proposal is considered confidential or proprietary.
YES, I certify that this Proposal contains information considered confidential or proprietary and all such information is
specifically identified on this form.
If you responded “YES”, you must clearly identify below the specific information you consider confidential or proprietary.
List each page number, form number, or other information sufficient to make the information readily identifiable. The
Cooperative and Cooperative administrator shall not be responsible for a Proposer’s failure to clearly identify information
considered confidential or proprietary. Further, by submitting a Proposal, Proposer acknowledges that the Cooperative and
Cooperative administrator will disclose information when required by law, even if such information has been identified
herein as information Vendor considers confidential or proprietary.
Confidential / Proprietary Information:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Initial: _____
Page 19 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
B. Copyright Information
Does your Proposal (including forms, documentation, pricelists, catalogs, or other materials submitted with the Proposal)
contain copyright information?
NO, Proposal (including forms, documentation, pricelists, catalogs, or other materials submitted with the Proposal) does
not contain copyright information.
YES, Proposal (including forms, documentation, pricelists, catalogs, or other materials submitted with the Proposal) does
contain copyright information.
If you responded “YES”, clearly identify below the specific documents or pages containing copyright information.
Copyright Information: ________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
C. Consent to Release Confidential/Proprietary/Copyright Information to BuyBoard Members
BuyBoard members (Cooperative and nonprofit members) seeking to make purchases through the BuyBoard may wish to
view information included in the Proposals of awarded Vendors. If you identified information on this form as confidential,
proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBoard contract
award constitutes your consent to the disclosure of such information to BuyBoard members, including posting of such
information on the secure BuyBoard website for members. Note: Neither the Cooperative nor Cooperative administrator will
be responsible for the use or distribution of information by BuyBoard members or any other party.
D. Consent to Release Proposal Tabulation
Notwithstanding anything in this Confidential/Proprietary Information form to the contrary, by submitting a Proposal, Vendor
consents and agrees that, upon Contract award, the Cooperative may publicly release, including posting on the public
BuyBoard website, a copy of the proposal tabulation and award information for the Contract including Vendor name;
proposed catalog/pricelist name(s); proposed percentage discount(s), hourly labor rate(s), or other specified pricing; and
Vendor award or non-award information.
Initial: ______
Page 20 of 67
X
PROPOSAL FORMS COMM/SVCS V.04.23.2024
EDGAR VENDOR CERTIFICATION
(2 CFR Part 200 and Appendix II)
When a Cooperative member seeks to procure goods and services using funds under a federal grant or contract, specific
federal laws, regulations, and requirements may apply in addition to those under state law. This includes, but is not limited
to, the procurement standards of the Uniform Administrative Requirements, Cost Principles and Audit Requirements for
Federal Awards, 2 CFR 200 (sometimes referred to as the “Uniform Guidance” or new “EDGAR”). All Vendors submitting a
Proposal must complete this EDGAR Certification Form regarding Vendor’s willingness and ability to comply with certain
requirements which be applicable to specific Cooperative member purchases using federal grant funds. Completed
forms will be made available to Cooperative members for their use while considering their purchasing options when using
federal grant funds. Cooperative members may also require Vendors to enter into ancillary agreements, in addition to the
terms and conditions of the BuyBoard contract, to address the member’s specific contractual needs, including contract
requirements for a procurement using federal grants or contracts.
A “NO” response to any of the items may, if applicable, impact the ability of a Cooperative member to purchase
from the Vendor using federal funds.
1. Vendor Violation or Breach of Contract Terms:
Contracts for more than the simplified acquisition threshold, which is the inflation adjusted amount determined by the
Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 USC
1908, must address administrative, contractual, or legal remedies in instances where contractors violate or breach contract
terms, and provide for such sanctions and penalties as appropriate.
Provisions regarding Vendor default are included in the BuyBoard General Terms and Conditions, including Section E.18,
Remedies for Default and Termination of Contract. Any Contract award will be subject to such BuyBoard General Terms
and Conditions, as well as any additional terms and conditions in any Purchase Order or Cooperative member ancillary
contract agreed upon by Vendor and the Cooperative member which must be consistent with and protect the Cooperative
member at least to the same extent as the BuyBoard Terms and Conditions. The remedies under the Contract are in addition
to any other remedies that may be available under law or in equity. By submitting a Proposal, you agree to these Vendor
violation and breach of contract terms.
YES, I agree. NO, I do not agree.
2. Termination for Cause or Convenience:
For any Cooperative member purchase or contract in excess of $10,000 made using federal funds, you agree that the
following term and condition shall apply:
If an alternate provision for termination of a Cooperative member purchase for cause and convenience, including the
manner by which it will be effected and the basis for settlement, is included in the Cooperative member’s Purchase Order
or ancillary agreement agreed to by the Vendor, the Cooperative member’s provision shall control.
YES, I agree. NO, I do not agree. Initial: _____
Page 21 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
3. Equal Employment Opportunity:
Except as otherwise provided under 41 CFR Part 60, all Cooperative member purchases or contracts that meet the definition
of “federally assisted construction contract” in 41 CFR Part 60-1.3 shall be deemed to include the equal opportunity clause
provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, “Equal Employment Opportunity” (30 FR
12319, 12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, “Amending Executive Order
11246 Relating to Equal Employment Opportunity,” and implementing regulations at 41 CFR Part 60, “Office of Federal
Contract Compliance Programs, Equal Employment Opportunity, Department of Labor.”
The equal opportunity clause provided under 41 CFR 60-1.4(b) is hereby incorporated by reference. Vendor agrees that
such provision applies to any Cooperative member purchase or contract that meets the definition of “federally assisted
construction contract” in 41 CFR Part 60-1.3 and Vendor agrees that it shall comply with such provision.
YES, I agree. NO, I do not agree.
4. Davis-Bacon Act:
When required by Federal program legislation, Vendor agrees that, for all Cooperative member prime construction
contracts/purchases in excess of $2,000, Vendor shall comply with the Davis-Bacon Act (40 USC 3141-3144, and 3146-
3148) as supplemented by Department of Labor regulations (29 CFR Part 5, “Labor Standards Provisions Applicable to
Contracts Covering Federally Financed and Assisted Construction”). In accordance with the statute, Vendor is required to
pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determinate made
by the Secretary of Labor. In addition, Vendor shall pay wages not less than once a week.
Current prevailing wage determinations issued by the Department of Labor are available at beta.sam.gov. Vendor agrees
that, for any purchase to which this requirement applies, the award of the purchase to the Vendor is conditioned upon
Vendor’s acceptance of the wage determination.
Vendor further agrees that it shall also comply with the Copeland “Anti-Kickback” Act (40 USC 3145), as supplemented by
Department of Labor regulations (29 CFR Part 3, “Contractors and Subcontractors on Public Building or Public Work Financed
in Whole or in Part by Loans or Grants from the United States”). The Act provides that each contractor or subrecipient must
be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work,
to give up any part of the compensation to which he or she is otherwise entitled.
YES, I agree. NO, I do not agree.
5. Contract Work Hours and Safety Standards Act:
Where applicable, for all Cooperative member contracts or purchases in excess of $100,000 that involve the employment
of mechanics or laborers, Vendor agrees to comply with 40 USC 3702 and 3704, as supplemented by Department of Labor
regulations (29 CFR Part 5). Under 40 USC 3702 of the Act, Vendor is required to compute the wages of every mechanic
and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible
provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours
worked in excess of 40 hours in the work week.
The requirements of 40 USC 3704 are applicable to construction work and provide that no laborer or mechanic must be
required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These
requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or
contracts for transportation or transmission of intelligence.
YES, I agree. NO, I do not agree.
Initial: _____
Page 22 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
6. Right to Inventions Made Under a Contract or Agreement:
If the Cooperative member’s Federal award meets the definition of “funding agreement” under 37 CFR 401.2(a) and the
recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the
substitution of parties, assignment or performance or experimental, developmental, or research work under that “funding
agreement,” the recipient or subrecipient must comply with the requirements of 37 CFR Part 401, “Rights to Inventions
Made by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative
Agreements,” and any implementing regulations issued by the awarding agency.
Vendor agrees to comply with the above requirements when applicable.
YES, I agree. NO, I do not agree.
7. Clean Air Act and Federal Water Pollution Control Act:
Clean Air Act (42 USC 7401-7671q.) and the Federal Water Pollution Control Act (33 USC 1251-1387), as amended –
Contracts and subgrants of amounts in excess of $150,000 must contain a provision that requires the non-Federal award
to agree to comply with all applicable standards, orders, or regulations issued pursuant to the Clean Air Act (42 USC 7401-
7671q.) and the Federal Water Pollution Control Act, as amended (33 USC 1251-1387). Violations must be reported to the
Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA).
When required, Vendor agrees to comply with all applicable standards, orders, or regulations issued pursuant to the Clean
Air Act and the Federal Water Pollution Control Act.
YES, I agree. NO, I do not agree.
8. Debarment and Suspension:
Debarment and Suspension (Executive Orders 12549 and 12689) – A contract award (see 2 CFR 180.220) must not be
made to parties listed on the government-wide exclusions in the System for Award Management (SAM), in accordance with
the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1966 Comp. p. 189) and 12689 (3
CFR Part 1989 Comp. p. 235), “Debarment and Suspension.” SAM Exclusions contains the names of parties debarred,
suspended, or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority
other than Executive Order 12549.
Vendor certifies that Vendor is not currently listed on the government-wide exclusions in SAM, is not debarred, suspended, or
otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than Executive Order 12549.
Vendor further agrees to immediately notify the Cooperative and all Cooperative members with pending purchases or seeking
to purchase from Vendor if Vendor is later listed on the government-wide exclusions in SAM, or is debarred, suspended, or
otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than Executive Order 12549.
YES, I agree. NO, I do not agree.
9. Byrd Anti-Lobbying Amendment:
Byrd Anti-Lobbying Amendment (31 USC 1352) - Vendors that apply or bid for an award exceeding $100,000 must file the
required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay
any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of
Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any
Federal contract, grant or any other award covered by 31 USC 1352. Each tier must also disclose any lobbying with non-
Federal funds that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to
tier up to the non-Federal award. As applicable, Vendor agrees to file all certifications and disclosures required by, and
otherwise comply with, the Byrd Anti-Lobbying Amendment (31 USC 1352).
YES, I agree. NO, I do not agree.
Initial: _____
Page 23 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
10. Procurement of Recovered Materials:
For Cooperative member purchases utilizing Federal funds, Vendor agrees to comply with Section 6002 of the Solid Waste Disposal
Act, as amended by the Resource Conservation and Recovery Act where applicable and provide such information and certifications
as a Cooperative member may require to confirm estimates and otherwise comply. The requirements of Section 6002 include
procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR Part 247 that contain the
highest percentage of recovered materials practicable, consistent with maintaining a satisfactory level of competition, where the
purchase price of the item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded
$10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery, and
establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines.
YES, I agree. NO, I do not agree.
11. Domestic Preferences for Procurements:
Where appropriate and consistent with law, 2 CFR §200.322 contains certain considerations for domestic preferences for
procurements which may be applicable to Cooperative members using federal funds. When required by a Cooperative
member, Vendor agrees to provide such information or certification as may reasonably be requested by the Cooperative
member regarding Vendor’s products, including whether goods, products, or materials are produced in the United States.
YES, I agree. NO, I do not agree.
12. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment
2 CFR §200.216 prohibits expending federal loan or grant funds to procure or obtain certain telecommunications and video
surveillance services or equipment. To the extent applicable and when required by a Cooperative member, Vendor agrees
to provide such information or certification as may reasonably be requested by the Cooperative member to confirm whether
any telecommunications or video surveillance services or equipment provided by Vendor is covered equipment or covered
services under 2 CFR §200.216.
YES, I agree. NO, I do not agree.
13. Profit as a Separate Element of Price:
For purchases using federal funds in excess of the Simplified Acquisition Threshold, a Cooperative member may be required
to negotiate profit as a separate element of the price. See, 2 CFR 200.324(b). When required by a Cooperative member,
Vendor agrees to provide information and negotiate with the Cooperative member regarding profit as a separate element
of the price for a particular purchase. However, Vendor agrees that the total price, including profit, charged by Vendor to
the Cooperative member shall not exceed the awarded pricing, including any applicable discount, under Vendor’s
Cooperative Contract.
YES, I agree. NO, I do not agree.
14. General Compliance and Cooperation with Cooperative Members:
In addition to the foregoing specific requirements, Vendor agrees, in accepting any Purchase Order from a Cooperative
member, it shall make a good faith effort to work with Cooperative members to provide such information and to satisfy
such requirements as may apply to a particular Cooperative member purchase or purchases including, but not limited to,
applicable recordkeeping and record retention requirements.
YES, I agree.NO, I do not agree.
Initial: _____
Page 24 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
COMPLIANCE FORMS SIGNATURE PAGE
By initialing pages and by signature below, I certify that I have reviewed the following forms; that the information provided
therein is true, complete, and accurate; and that I am authorized by my company to make all certifications, consents,
acknowledgements, and agreements contained herein:
Proposal Acknowledgements
Felony Conviction Disclosure
Debarment Certification
Resident/Nonresident Certification
Vendor Employment Certification
No Boycott Verification
No Excluded Nation or Foreign Terrorist Organization Certification
Historically Underutilized Business Certification
Construction-Related Goods and Services Affirmation
Acknowledgement of BuyBoard Technical Requirements
Deviation and Compliance
Vendor Consent for Name Brand Use
Confidential/Proprietary Information
EDGAR Vendor Certification
__________________________________________
Company Name
__________________________________________
Signature of Authorized Company Official
__________________________________________
Printed Name and Title
__________________________________________
Date
Page 25 of 67
IdentiSys, Inc.
Lynn Westfall - Texas Sales Manager
8/8/24
PROPOSAL FORMS COMM/SVCS V.04.23.2024
PROPOSAL FORMS PART 2: VENDOR INFORMATION FORMS
INSTRUCTIONS:
Proposer must completely and accurately provide all information requested in the following Vendor Information Forms or
your Proposal may be rejected as non-responsive:
Vendor Business Name
Vendor Contact Information
Federal and State/Purchasing Cooperative
Experience
Governmental References
Company Profile
Texas Regional Service Designation
State Service Designation
National Purchasing Cooperative Vendor Award
Agreement
Local/Authorized Seller Listings
Manufacturer Dealer Designation
Proposal Invitation Questionnaire
To the extent any information requested is not applicable to your company, you must so indicate on the form.
VENDOR BUSINESS NAME
By submitting a Proposal, Vendor is seeking to enter into a legal contract with the Cooperative. As such, Vendor must be an
individual or legal business entity capable of entering into a binding contract.
Name of Proposing Company:
_________________________________________________________________________________________________
Type of Business: Individual/Sole Proprietor Corporation Limited Liability Company Partnership
Other (Specify: ________________________)
State of Incorporation (if applicable): ___________________________
Federal Employer Identification Number: ___________________________
Name by which Vendor, if awarded, wishes to be identified on the BuyBoard:
__________________________________________________________________________________________________
Page 26 of 67
IdentiSys, Inc.
Minnesota
41-1938567
IdentiSys, Inc.
Form ���
(Rev. October 2018)
Department of the Treasury
Intemal Revenue Service
Request for Taxpayer
Identification Number and Certification
► Go to www.irs.gov/FormW9 for instructions and the latest information.
Name (as shown on your income tax return). Name is
IdentiSys Incorporated
on tnis une; ao not ieave this line
Give Form to the
requester. Do not
send to the IRS.
2 Business name/disregarded entity name, if different from above
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3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
tollowing seven boxes.
❑ Individual/sole proprietor or
single-member LLC
❑ C Corporation ❑'� S Corporation ❑ Partnership
❑ TrusVestate
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any)
❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any)
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
U Other (see instructions) ►
5 Address (number, street, and apt. or suite no.) See instructions.
7630 Commerce Way
6 City, state, and ZIP code
Eden Prairie, MN 55344
7 List account number(s) here (optional)
Identification Number
(Applies ro accounfs maintained outside the U.S.)
Requester's name and address (optional)
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Si n g �' '
g Si nature of / t
Here U.S. person ►(_ 1��' �` i
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.govlFormW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (fIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
• Form 1099-INT (interest earned or paid)
Date ► _ _ -.
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat. No. 10231X Form W-9 (Rev. 10-2018)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid � Social security number l
backup withholding. For individuals, this is generally your social security number (SSN). However, for a �_ m —�
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later. or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number
Number To Give the Requester for guidelines on whose number to enter. ��
PROPOSAL FORMS COMM/SVCS V.04.23.2024
VENDOR CONTACT INFORMATION
FEDERAL AND STATE/PURCHASING COOPERATIVE EXPERIENCE
The Cooperative strives to provide Cooperative members with the best services and products at the best prices available from
Vendors with the technical resources and ability to serve Cooperative members. Please respond to the following questions.
1. Provide the dollar value of sales to or through purchasing cooperatives at or based on an established catalog or market
price during the previous 12-month period or the last fiscal year: $______________. (The period of the 12-month
period is _________/_________). In the event that a dollar value is not an appropriate measure of the sales, provide
and describe your own measure of the sales of the item(s).
2. By submitting a proposal, you agree that, based on your written discounting policies, the discounts you offer the
Cooperative are equal to or better than the best price you offer other purchasing cooperatives for the same items under
equivalent circumstances.
3. Provide the information requested below for other purchasing cooperatives for which Proposer currently serves, or in the past
has served, as an awarded vendor. Rows should be added to accommodate as many purchasing cooperatives as required.
PURCHASING
GROUP
CURRENT
VENDOR?
(Y/N)
FORMER VENDOR (Y/N)? –
IF YES, LIST YEARS
AS VENDOR
AWARDED
COMMODITY
CATEGORY(IES)
1. Federal General Services Administration
2. T-PASS (State of Texas)
3. OMNIA Partners
4. Sourcewell (NJPA)
5. E&I Cooperative
6. Houston-Galveston Area Council (HGAC)
7. Choice Partners
8. The Interlocal Purchasing System (TIPS)
9. Other
MY COMPANY DOES NOT CURRENTLY HAVE ANY OF THE ABOVE OR SIMILAR TYPE CONTRACTS.
CURRENT BUYBOARD VENDORS
If you are a current BuyBoard vendor in the same contract category as proposed in this Proposal Invitation, indicate the
discount for your current BuyBoard contract and the proposed discount in this Proposal. Explain any difference between your
current and proposed discounts.
Current Discount (%): _________________________ Proposed Discount (%):_______________________
________________________________________________________________________________________
Page 27 of 67
60,000,000
5.31.2023 6.01.2024
N
N
N
N
N
N
N
Y 2010 to present
Photo ID Systems / Security Products
Y DIR 2023 to present Software
20 20
PROPOSAL FORMS COMM/SVCS V.04.23.2024
GOVERNMENTAL REFERENCES
For your Proposal to be considered, you must supply a minimum of five (5) individual governmental entity references. The
Cooperative may contact any and all references provided as part of the Proposal evaluation. Provide the information requested
below, including the existing pricing/discounts you offer each customer. The Cooperative may determine whether
pricing/discounts are fair and reasonable by comparing pricing/discounts stated in your Proposal with the pricing/discounts
you offer other governmental customers. Attach additional pages if necessary.
Quantity/
Entity Name Contact Phone# Email Address Discount Volume
1._______________________________________________________________________________________________
2._______________________________________________________________________________________________
3._______________________________________________________________________________________________
4._______________________________________________________________________________________________
5._______________________________________________________________________________________________
Do you ever modify your written policies or standard governmental sales practices as identified in the above chart to give
better discounts (lower pricing) than indicated? YES NO If YES, please explain:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
COMPANY PROFILE
Information on awarded Cooperative Contracts is available to Cooperative Members on the BuyBoard website. If your
company is awarded a Contract under this Proposal Invitation, please provide a brief company description that you would
like to have included with your company profile on the BuyBoard website.Submit your company profile in a separate
file, in Word format, with your Proposal. (Note: Vendor is solely responsible for any content provided for inclusion on
the BuyBoard website. The Cooperative reserves the right to exclude or remove any content in its sole discretion, with or
without prior notice, including but not limited to any content deemed by the Cooperative to be inappropriate, irrelevant to
the Contract, inaccurate, or misleading.)
Page 28 of 67
Waco ISD, Joseph Jacobs, 254-755-9401, joseph.jacobs@wacoisd.org, 20, $25,000
Northside ISD, James Fountain, 210-397-5667, james.fountain@nisd.net, 20, $25,000
City of San Antonio, Maritza Reyes, 210-207-4158, maritza.reyes@sanantonio.gov, 20, $40,000
Travis County, Alyssa Bauer, 512-854-7846, alyssa.bauer@traviscountytx.gov, 20, $20,000
Univ of Houston-Victoria Elizabeth Corte 361-570-4390 cortee@uhv.edu 20 $10,000
If large volume price discounts are available, we pass them along to the end user.
OUR MISSION
IdentiSys Inc., North America’s largest full-service security, identification, card solutions and presentation products
provider, is committed to serving you with exceptional customer service, an expansive product line, on-site service,
and an unparalleled experience.
VALUE TO OUR CUSTOMERS
IdentiSys represents over 70 key manufacturers in the identification
and security marketplace to meet customer needs in corporate,
education, financial, gaming, government, healthcare, insurance,
loyalty/membership, retail, transportation and other markets.
With sales representatives and factory certified technicians located
in 2 states and the District of Columbia, IdentiSys offers
consultative sales and on-site service to help improve security and
efficiency within your organization. IdentiSys colleagues have over
1200 years combined experience and the industry knowledge to
help ensure the success of your program.
OUR COMPANY
Located in Eden Prairie, Minnesota, IdentiSys provides superior
service and support to customers worldwide, with over 0,000 in
the U.S.
IdentiSys continually focuses on expanding its market reach, with
these key acquisitions across the United States:
Southwest Datacom Systems - Texas (2005)
Gebco of Hawaii, Inc. - Hawaii (2007)
CardSmart Systems, Inc. - Midwest (2008)
Card Solutions Corporation - South Florida (2010)
Inland Business Products - Washington (2011)
Capital Card Systems, Inc. - D.C. Metro and surrounding states
(2012)
Claritus – Identification Division - Nebraska, South Dakota and Iowa (2012)
Mountainland Business Systems – Identification Division - Western States
(2012)
Photo I.D. Systems & Supplies Ohio, Kentucky and Indiana (2014)
LINSTAR New York (2015)
ACS (Automated Card Systems and ACS East (Access Card Solutions)
Pennsylvania, Maryland, Ohio, New Jersey (2017)
ID Connection, a division of IdentiSys, is a distributor of ID products,
selling to resellers worldwide.
SOLUTIONS IN BRIEF
Photo ID systems, cards, supplies & accessories
Access control & CCTV
Card personalization, embossing & fulfillment
Metal plate/tag embossing
Emergency response & accountability
Member, visitor & asset tracking
Campus ONECard
Food service/cafeteria point-of-sale
Positive patient ID
Financial instant issuance
Presentation products
Document finishing & shredders
HEADQUARTERS
7630 Commerce Way
Eden Prairie, MN 55344
FOUNDED
1999
EMPLOYEES
160
OWNERSHIP
Private
OFFICES (SALES &SERVICE)
District of Columbia
Florida
Delaware
Hawaii Idaho
Illinois Iowa
Kentucky Michigan
Minnesota Nebraska
Nevada New York
Ohio
Indiana
Maryland
Montana
New Jersey
Virginia
PROFESSIONAL ORGANIZATIONS
BindRite Dealers Assn.
Identification Systems Group (ISG)
Identification Systems Dealers Assn. (ISDA)
National Assn. of Campus Card Users (NACCU)
National Systems Contractors Assn. (NSCA)
Professional Security Alliance (PSA)
Specialty Graphic Imaging Assn. (SGIA)
Security Industry Assn. (SIA)
For more information or to engage an IdentiSys
sales representative:
visit www.identisys.com
email sales@identisys.com
or call 888.437.9783
IdentiSys Inc. Corporate Fact Sheet
PROPOSAL FORMS COMM/SVCS V.04.23.2024
TEXAS REGIONAL SERVICE DESIGNATION
The Cooperative (referred to as “Texas Cooperative” in this form and in the State Service Designation form) offers vendors
the opportunity to service its members throughout the entire State of Texas. In the electronic proposal submission system,
you must indicate if you will service Texas Cooperative members statewide or, if you do not plan to service all Texas
Cooperative members statewide, you indicate the specific regions you will service. If you propose to serve different
regions for different products or services included in your Proposal, you must complete and submit a separate Texas Regional
Service Designation form for each group of products and clearly indicate the products or services to which the designation
applies. (Additional forms can be obtained by contacting bids@buyboard.com
.)
Additionally, if you do not plan to service Texas Cooperative
members (i.e., if you will service only states other than Texas),
Region and Headquarters
1 Edinburg
2 Corpus Christi
3 Victoria
4 Houston
5 Beaumont
6 Huntsville
7 Kilgore
8 Mount Pleasant
9 Wichita Falls
10 Richardson
11 Fort Worth
12 Waco
13 Austin
14 Abilene
15 San Angelo
16 Amarillo
17 Lubbock
18 Midland
19 El Paso
20 San Antonio
Page 29 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
STATE SERVICE DESIGNATION
As set forth in the Proposal Invitation, it is the Cooperative’s intent that other governmental entities in the United States have
the opportunity to purchase goods or services awarded under the Contract, subject to applicable state law, through a piggy-
back award or similar agreement through the National Purchasing Cooperative BuyBoard. If you plan to service the entire
United States or only specific states,
If you serve different states for different products or services included in your Proposal, you must complete and submit a
separate State Service Designation form for each group of products and clearly indicate the products or services to which the
designation applies. (Additional forms can be obtained by contacting bids@buyboard.com
I will service all states in the United States.
I will not service all states in the United States.
Alabama Montana
Alaska Nebraska
Arizona Nevada
Arkansas New Hampshire
California (Public Contract Code 20118 & 20652) New Jersey
Colorado New Mexico
Connecticut New York
Delaware North Carolina
District of Columbia North Dakota
Florida Ohio
Georgia Oklahoma
Hawaii Oregon
Idaho Pennsylvania
Illinois Rhode Island
Indiana South Carolina
Iowa South Dakota
Kansas Tennessee
Kentucky Texas
Louisiana Utah
Maine Vermont
Maryland Virginia
Massachusetts Washington
Michigan West Virginia
Minnesota Wisconsin
Mississippi Wyoming
Missouri
Page 30 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
NATIONAL PURCHASING COOPERATIVE VENDOR AWARD AGREEMENT
In accordance with the Terms and Conditions associated with this Proposal Invitation, a contract awarded under this Proposal
Invitation may be “piggy-backed” by another governmental entity. The National Purchasing Cooperative is an
intergovernmental purchasing cooperative formed by certain school districts outside of Texas to serve its members throughout
the United States. If you agree to be considered for a piggy-back award by the National Purchasing Cooperative, you agree
to the following terms and agree to serve National Purchasing Cooperative members in the states you have indicated on the
State Service Designation form, in your Proposal.
By signing this form, Proposer (referred to in this Agreement as “Vendor”) agrees as follows:
1. Vendor acknowledges that if The Local Government Purchasing Cooperative (“Texas Cooperative”) awards Vendor a
contract under this Proposal Invitation (“Underlying Award”), the National Purchasing Cooperative (“National Cooperative”)
may - but is not required to - “piggy-back” on or re-award all or a portion of that Underlying Award (“Piggy-Back Award”).
By signing this National Cooperative Vendor Award Agreement (“Agreement”), Vendor accepts and agrees to be bound by
any such Piggy-Back Award as provided for herein.
2. In the event National Cooperative awards Vendor a Piggy-Back Award, the National Cooperative Administrator (“BuyBoard
Administrator”) will notify Vendor in writing of such Piggy-Back Award, which award shall commence on the effective date
stated in the Notice and end on the expiration date of the Underlying Award, subject to annual renewals as authorized in
writing by the BuyBoard Administrator. Vendor agrees that no further signature or other action is required of Vendor in order
for the Piggy-Back Award and this Agreement to be binding upon Vendor. Vendor further agrees that no interlineations or
changes to this Agreement by Vendor will be binding on National Cooperative, unless such changes are agreed to by its
BuyBoard Administrator in writing.
3. Vendor agrees that it shall offer its goods and services to National Cooperative members at the same pricing and same
general terms and conditions, subject to applicable state laws in the state of purchase, as required by the Underlying Award.
However, nothing in this Agreement prevents Vendor from offering National Cooperative members better (i.e., lower)
competitive pricing and more favorable terms and conditions than those in the Underlying Award.
4. Vendor hereby agrees and confirms that it will serve those states it has designated on the State Service Designation Form
of this Proposal Invitation. Any changes to the states designated on the State Service Designation Form must be approved
in writing by the BuyBoard Administrator.
5. Vendor agrees to pay National Cooperative the service fee provided for in the Underlying Award based on the amount of
purchases generated from National Cooperative members through the Piggy-Back Award. Vendor shall remit payment to
National Cooperative on such schedule as it specifies (which shall not be more often than monthly). Further, upon request,
Vendor shall provide National Cooperative with copies of all purchase orders generated from National Cooperative members,
vendor invoices, and/or such other documentation regarding those purchase orders as the Cooperative’s administrators may
require in their reasonable discretion for purposes of reviewing and verifying purchase activity. Vendor further agrees that
National Cooperative shall have the right, upon reasonable written notice, to review Vendor’s records pertaining to purchases
made by National Cooperative members in order to verify the accuracy of service fees.
6. Vendor agrees that the Underlying Award, including its General Terms and Conditions, are adopted by reference to the
fullest extent such provisions can reasonably apply to the post-proposal/contract award phase. The rights and responsibilities
that would ordinarily inure to the Texas Cooperative pursuant to the Underlying Award shall inure to National Cooperative;
and, conversely, the rights and responsibilities that would ordinarily inure to Vendor in the Underlying Award shall inure to
Vendor in this Agreement. Vendor recognizes and agrees that Vendor and National Cooperative are the only parties to this
Agreement, and that nothing in this Agreement has application to other third parties, including the Texas Cooperative. In the
event of conflict between this Agreement and the terms of the Underlying Award, the terms of this Agreement shall control,
and then only to the extent necessary to reconcile the conflict.
Page 31 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
7. This Agreement shall be governed and construed in accordance with the laws of the State of Texas and venue for any
dispute shall lie in the federal district court of Travis County, Texas.
8. Vendor acknowledges and agrees that the award of a Piggy-Back Award is within the sole discretion of National
Cooperative, and that this Agreement does not take effect unless and until National Cooperative awards Vendor a Piggy-Back
Award and the BuyBoard Administrator notifies Vendor in writing of such Piggy-Back Award as provided for herein.
WHEREFORE, by signing below Vendor agrees to the foregoing and warrants that it has the authority to enter into this
Agreement.
_______________________________________________ _______________________________________________
Name of Vendor Proposal Invitation Number
_______________________________________________ _______________________________________________
Signature of Authorized Company Official Printed Name of Authorized Company Official
__________________________________
Date
Page 32 of 67
IdentiSys, Inc. 759-25
Lynn Westfall
8/8/24
PROPOSAL FORMS COMM/SVCS V.04.23.2024
LOCATION/AUTHORIZED SELLER LISTINGS
If you have more than one location/authorized seller that will service a Contract awarded under this Proposal Invitation,
please list each location/authorized seller below. If additional sheets are required, please duplicate this form as necessary.
NOTE: Awarded Vendors shall remain responsible for all aspects of the Contract, including processing of Purchase Orders,
and shall be responsible for the performance of all locations and authorized sellers under and in accordance with the Contract.
Location/Authorized
Seller Name Contact Person
Contact Information
(Mailing Address, Phone, Fax, Email)
Page 33 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
MANUFACTURER DEALER DESIGNATION
If Vendor is a manufacturer that sells products through a dealer network and wishes to designate a dealer or multiple dealers
(“Designated Dealers”) to receive Cooperative member Purchase Orders on Vendor’s behalf, you must complete this form for
each dealer you wish to designate.
Regardless of any Designated Dealers submitted by Vendor, Vendor specifically agrees and acknowledges that any such
designations are for Vendor’s convenience only and shall not, if Vendor is awarded a Contract, relieve Vendor of any
obligations under the Contract, including payment of Cooperative service fees on all Purchase Orders submitted to Vendor or
any Designated Dealer. In accordance with the General Terms and Conditions, an awarded Vendor shall remain responsible
and liable for all of its obligations under the Contract and the performance of both Vendor and any of Vendor’s Designated
Dealers under and in accordance with the Contract and remain subject to all remedies for default thereunder, including, but
not limited to suspension and termination of Vendor’s Contract for nonpayment of service fees.
If awarded, Vendor authorizes the Cooperative, in its sole discretion, to list any Vendor Designated Dealers in the BuyBoard
system and to receive Purchase Orders directly from Cooperative members on behalf of Vendor. To the extent a Vendor with
Designated Dealers receives a Purchase Order directly, it shall be the responsibility of Vendor to appropriately process such
Purchase Order in accordance with the Contract, including but not limited to timely forwarding such Purchase Order to a
Designated Dealer for processing.
The Cooperative reserves the right, in its sole discretion, to refuse addition of, or request removal of, any Designated Dealer,
and Vendor agrees to immediately require such Designated Dealer to cease accepting Purchase Orders or otherwise acting
on Vendor’s behalf under the Contract. Further, the Cooperative administrator shall be authorized to remove or suspend any
or all Designated Dealers from the BuyBoard at any time in its sole discretion.
If you wish to designate a dealer to service a contract awarded under this Proposal Invitation, please list the Designated
Dealer below. If you wish to designate multiple dealers, please duplicate this form as necessary.
_______________________________________________ _______________________________________________
Designated Dealer Name Designated Dealer Contact Person
___________________________________________________________________________________________________
Designated Dealer Address
_______________________________________________ __________ ________________________________
City State Zip Code
_______________________________________________ _______________________________________________
Phone Number Fax Number
_______________________________________________ _______________________________________________
Email address Designated Dealer Tax ID Number* (*attach W-9)
Page 34 of 67
PROPOSAL FORMS COMM/SVCS V.04.23.2024
PROPOSAL INVITATION QUESTIONNAIRE
The Cooperative will use your responses to the questions below in evaluating your Proposal and technical and financial
resources to provide the goods and perform the services (“Work”) under the BuyBoard contract contemplated by this Proposal
Invitation (“Contract”). Proposers must fully answer each question, numbering your responses to correspond to the
questions/numbers below. Proposers must complete below or attach your responses to this questionnaire and submit in one
document with your Proposal. You must submit the questionnaire and responses with your Proposal or the
Proposal will not be considered.
1. List the number of years Proposer has been in business and former business names (if applicable). Note whether your
company is currently for sale or involved in any transaction that would significantly alter its business or result in acquisition
by another entity.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2. Describe the resources Proposer has to manage staff and successfully perform the Work contemplated under this
Contract. State the number and summarize the experience of company personnel who may be utilized for the Work,
including those who will be available to Cooperative members for assistance with project development, technical issues,
and product selection for Work associated with this Contract.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
3.Marketing Strategy: For your Proposal to be considered, you must submit the Marketing Strategy you will use if the
Cooperative accepts all or part of your Proposal.
Attach additional pages if necessary.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Page 35 of 67
IdentiSys has been in business for 25 years.
IdentiSys is not for sale for involved n any transaction that would alter its business or
result in an acquisition.
IdentiSys has field technicians reporting directly to Regional Service Managers who report directly
to our EVP of Service. We have complete In-House and Factory Support available.
We have weekly meetings between Sales and Service Departments to make sure all
Customer needs are met. We have over 100 employees serving our Customers daily.
We market to our COOP Members via phone, email and on-site visits. IdentiSys has a
very active website with excellent Google placement. We maintain 5 full time Texas
Sales Reps are supported by Inside Reps and our Corporate Mkt Dept.
IdentiSys does over $60 million in revenue annually.
PROPOSAL FORMS COMM/SVCS V.04.23.2024
4. Describe Proposer’s financial capability to perform the Contract. State or describe the firm’s financial strength and rating,
bonding capacity, and insurance coverage limits. State whether the firm, or any of the firm’s past or present owners,
principal shareholders or stockholders, or officers, have been a debtor party to a bankruptcy, receivership, or insolvency
proceeding in the last 7 years, and identify any such debtor party by name and relationship to or position with your firm.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
5. Does your company have any outstanding financial judgments and/or is it currently in default on any loan or financing
agreement? If so, provide detailed information on the nature of such items and prospects for resolution.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
6. List all contracts, if any, in the last 10 years on which Proposer has defaulted, failed to complete or deliver the work, or
that have been terminated for any reason. For each such contract, provide the project name, scope, value and date and
the name of the procuring entity. Fully explain the circumstances of the default, failure to complete or deliver the work,
or termination.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7. List all litigation or other legal proceedings (including arbitration proceedings), if any, in the last 10 years brought against
your firm, or any of the firm’s past or present owners, principal shareholders or stockholders, officers, agents or
employees, that relate to or arise from a contract similar to this Contract or the Work contemplated under this Contract.
Provide the style of the lawsuit or proceeding (name of parties and court or tribunal in which filed), nature of the claim,
and resolution or current status.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Page 36 of 67
IdentiSys is a private company with revenues in the $60 million range and has been profitable
since being founded in 1999. We go through annual GAAP financial audit and have always obtained
an unqualified opinion. None of its owners or officers have ever been a debtor party to a
bankruptcy, receivership or insolvency proceeding.
No.
N/A
N/A
PROPOSAL FORMS COMM/SVCS V.04.23.2024
PROPOSAL SPECIFICATION SUMMARY
The categories and items specified for this Proposal Invitation are summarized below. For full Proposal
Specifications, you must review and complete the Proposal Specification information in the electronic proposal
submission system in accordance with the Instructions to Proposers (or, if submitting a hard copy Proposal, timely
request and complete the Proposal Specification Form in accordance with the Instructions to Proposers).
__________________________________________________________________________________________________
Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be
considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with
Excel or searchable PDF preferred.
Software or Software as a Product (SaaP) as used herein shall mean software products for which the
purchaser purchases a license for software to be hosted on the client’s computer. (Vendor shall not include in its Proposal
any Software as a Service (SaaS) products where software is licensed on a subscription basis and is centrally hosted by the
software provider. Such items are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility requirements and guidelines
for governmental entities including any applicable World Wide Web Consortium Web Contact Accessibility Guidelines and
applicable state, local, and/or federal law.
Section I: Technology: Software as a Product (SaaP) and Other Related Services
1. Discount (%) off catalog/pricelist for Admission Ticket Tracking Software.
2. Discount (%) off catalog/pricelist for Bill Pay Software and Technology.
3. Discount (%) off catalog/pricelist for Business/Office Software.
4. Discount (%) off catalog/pricelist for Desktop/Web Publishing Software.
5. Discount (%) off catalog/pricelist for Instructional Software.
6. Discount (%) off catalog/pricelist for Specialty Software Products (school transportation routing software and
related products).
7. Discount (%) off catalog/pricelist for Archive, Email, Data Migration, and Related Services.
8. Discount (%) off catalog/pricelist for Cloud Storage, Data Center Hosting, and Related Software Services.
9. Discount (%) off catalog/pricelist for Data Analytics/Science and Related Services.
10. Discount (%) off catalog/pricelist for Software Support Maintenance Agreements.
Section II: Training, Installation, and Repair Service
11. Hourly Labor Rate for Installation/Repair Service of Software Products - not to exceed hourly labor rate for
Software Products.
12.Hourly Labor Rate for Staff Development and Training of Software Products - not to exceed hourly labor rate
for Staff Development and Training of Software Products.
Page 37 of 67
IdentiSys, Inc. Information
Contact: Lynn Westfall
Address: 7630 Commerce Way
Eden Prairie, MN 55344
Phone: (210) 522-9986
Fax: (210) 568-6181
Toll Free: (877) 213-8180
Email: lynn_westfall@identisys.com
Web Address: www.identisys.com
By submitting your response, you certify that you are authorized to represent and bind your company.
Lynn Westfall lynn_westfall@identisys.com
Signature Email
Submitted at 8/12/2024 12:12:09 PM (CT)
Requested Attachments
Manufacturer Catalog(s) and/or Product Price list(s)IdentiSys BusinessOfficeSW.pdf
REQUIRED-In Excel or PDF format, upload manufacturer catalog(s)and/or product price list(s) in accordance with
proposal invitation instructions. Vendors shall submit catalog(s)/price list(s) with their Proposal response or Proposal
will not be considered. No paper catalogs or manufacturer/vendor websites will be accepted. File size must not exceed
250MB. (Please DO NOT password protect uploaded files.)
BuyBoard Proposal Invitation No. 759-25, Technology: Software and
Services
Proposal-No-759-25 Software
IdentiSys Response
8.8.24_signed.pdf
REQUIRED-In PDF format, upload all COMPLETED and FILLED in proposal invitation documents available for
download at vendor.buyboard.com including any additional pages, as necessary. NOTICE: DO NOT complete
proposal forms in internet browser. No data will be stored. Download file to computer and complete proposal forms
prior to submitting. (Please DO NOT password protect uploaded files.)
Company Profile identisys-corporate-fact-sheet.pdf
REQUIRED-Information on awarded Cooperative Contracts is available to Cooperative Members on the BuyBoard
website. If your company is awarded a Contract under this Proposal Invitation, please provide a brief company
description that you would like to have included with your company profile on the BuyBoard website. Submit your
company profile in a separate file, in Word format, with your Proposal. (Note: Vendor is solely responsible for any
content provided for inclusion on the BuyBoard website. The Cooperative reserves the right to exclude or remove any
content in its sole discretion, with or without prior notice, including but not limited to any content deemed by the
Cooperative to be inappropriate, irrelevant to the Contract, inaccurate, or misleading.)
IRS Form W-9 Request for Taxpayer Identification Number and
Certification
W-9 IdentiSys 2024.pdf
REQUIRED-In PDF format, upload W-9 form. (Please DO NOT password protect uploaded files.)
Exceptions and/or Detailed Information Related to Discount % and/or
Hourly Labor Rate Proposed
No response
In PDF format and if necessary, vendor shall attach detailed information regarding exceptions to pricing and/or
discount percentage and define the services that are proposed to be provided. NOTE: IF DETAILED INFORMATION IS
NOT SUBMITTED, PROPOSAL MAY NOT BE CONSIDERED. (Please DO NOT password protect uploaded files.)
Vendor: IdentiSys, Inc. 759-25Page 3 of 29 pages
Response Attachments
IdentiSys Specialty SW.pdf
IdentiSys Specialty Software Price Pages
IdentiSys SMA.pdf
IdentiSys Software Maintenance Agreement Price Pages
Bid Attributes
1 Federal Identification Number
Federal Identification Number
41-1938567
2 No Boycott Verification/No Excluded Nation or Foreign Terrorist Organization Certification/Historically
Underutilized Business Certification
No Boycott Verification/No Excluded Nation or Foreign Terrorist Organization Certification/Historically Underutilized
Business Certification
Vendor: IdentiSys, Inc. 759-25Page 4 of 29 pages
3 No Boycott Certification
A Texas governmental entity may not enter into a contract with a value of $100,000 or more that is to be paid wholly
or partly from public funds with a company (excluding a sole proprietorship) that has 10 or more full-time employees
for goods or services unless the contract contains a written verification from the company that it: (1) does not
CODE Ch. 2276), and (3) does not have a practice, policy, guidance, or directive that discriminates against a
firearm entity or firearm trade association and will not discriminate during the term of the contract against a firearm
the extent required by law.
is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a
person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for
activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit
commercial relations with a company because the company: (A) engages in the exploration, production, utilization,
transportation, sale, or manufacturing of fossil fuel-based energy and does not commit or pledge to meet
environmental standards beyond applicable federal and state law; or (B) does business with a company described
association, to: (i) refuse to engage in the trade of any goods or services with the entity or association based solely
on its status as a firearm entity or firearm trade association; (ii) refrain from continuing an existing business
relationship with the entity or association based solely on its status as a firearm entity or firearm trade association;
or (iii) terminate an existing business relationship with the entity or association based solely on its status as a
firearm entity or firearm trade association; and (B) does not include: (i) the established policies of a merchant, retail
seller, or platform that restrict or prohibit the listing or selling of ammunition, firearms, or firearm accessories; and (ii)
business relationship, or decision to terminate an existing business relationship: (aa) to comply with federal, state,
or local law, policy, or regulations or a directive by a regulatory agency; or (bb) for any traditional business reason
By signature on the Compliance Forms Signature Page, to the extent applicable, I certify and verify that Vendor
does not boycott Israel, boycott energy companies, or discriminate against a firearm entity or firearm trade
association and will not do so during the term of any contract awarded under this Proposal Invitation, that this
certification is true, complete and accurate, and that I am authorized by my company to make this certification.
Yes
4 No Excluded Nation or Foreign Terrorist Organization Certification
Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may not enter into a
contract with a company engaged in active business operations with Sudan, Iran, or a foreign terrorist organization
to be excluded from its federal sanctions regime relating to Sudan, Iran, or any federal sanctions regime relating to
a foreign terrorist organization is not subject to the contract prohibition.)
By signature on the Compliance Forms Signature Page, I certify and verify that Vendor is not on the Texas
my company to make this certification.
Yes
Vendor: IdentiSys, Inc. 759-25Page 5 of 29 pages
5 Historically Underutilized Business Certification
A Proposer that has been certified as a Historically Underutilized Business (also known as a Minority/Women
certification status when responding to this Proposal Invitation. The BuyBoard website will indicate HUB certifications
for awarded Vendors that properly indicate and document their HUB certification on this form.
I certify that my company has been certified as a MWBE/HUB in the following categories:(Please check all that
apply)
6 Minority Owned Business
Minority Owned Business
Minority Owned Business
7 Women Owned Business
Women Owned Business
Women Owned Business
8 Service-Disabled Veteran Owned Business
S. Department of Veterans Affairs or Department of Defense)
Service-Disabled Veteran Owned Business
9 Certification Number
Certification Number
No response
10 Name of Certifying Agency
Certifying Agency
No response
11 Non-MWBE/HUB
My company has NOT been certified as a MWBE/HUB
Non-HUB
12 Vendor General Contact Information
Proposal/Contract General Contact Information
13 Vendor Proposal/Contract Contact - First Name
Vendor Proposal/Contract Contact - First Name
Lynn
14 Vendor Proposal/Contract Contact - Last Name
Vendor Proposal/Contract Contact - Last Name
Westfall
15 Vendor Proposal/Contract Contact E-mail Address
Vendor Proposal/Contract Contact E-mail Address
lynn_westfall@identisys.com
Vendor: IdentiSys, Inc. 759-25Page 6 of 29 pages
16 Vendor Proposal/Contract Mailing Address
Vendor Proposal/Contract Mailing Address
PO Box 1086
17 Vendor Proposal/Contact Mailing Address - City
Vendor Proposal/Contact Mailing Address - City
Minnetonka
18 Vendor Proposal/Contact Mailing Address - State
Vendor Proposal/Contact Mailing Address - State (Abbreviate State Name)
MN
19 Vendor Proposal/Contact Mailing Address - Zip Code
Vendor Proposal/Contact Mailing Address - Zip Code
55345
20 Vendor Proposal/Contact Phone Number
Vendor Proposal/Contact Phone Number (xxx-xxx-xxxx)
210-380-7141
21 Vendor Proposal/Contact Extension Number
Vendor Proposal/Contact Extension Number
No response
22 Company Website
Company Website (www.XXXXX.com)
www.identisys.com
23 Purchase Orders Contact Information
All Purchase Orders from Cooperative members will be available through the Internet. Vendors need Internet
access and at least one e-mail address so that notification of new orders can be sent to the Internet contact when a
new purchase order arrives. An information guide will be provided to Vendors to assist them with retrieving their
orders.
Please select options below for receipt of Purchase Orders and provide the requested information:
I will use the internet to receive Purchase Orders at the following address
Yes
24 Purchase Order E-mail Address
Purchase Order E-mail Address
lynn_westfall@identisys.com
25 Purchase Order Contact - First Name
Purchase Order Contact - First Name
Lynn
Vendor: IdentiSys, Inc. 759-25Page 7 of 29 pages
26 Purchase Order Contact - Last Name
Purchase Order Contact - Last Name
Westfall
27 Purchase Order Contact Phone Number
Purchase Order Contact Phone Number (xxx-xxx-xxxx)
210-380-7141
28 Purchase Order Contact Extension Number
Purchase Order Contact Extension Number
No response
29 Alternate Purchase Order E-mail Address
Alternate Purchase Order E-mail Address
andrew_johnson@identisys.com
30 Alternate Purchase Order Contact - First Name
Alternate Purchase Order Contact - First Name
Andrew
31 Alternate Purchase Order Contact - Last Name
Alternate Purchase Order Contact - Last Name
Johnson
32 Alternate Purchase Order Contact Phone Number
Alternate Purchase Order Contact Phone Number (xxx-xxx-xxxx)
952-294-1216
33 Alternate Purchase Order Contact Extension Number
Alternate Purchase Order Contact Extension Number
No response
34 Purchase Orders Contact Information
All Purchase Orders from Cooperative members will be available through the Internet. Vendors need Internet
access and at least one e-mail address so that notification of new orders can be sent to the Internet contact when a
new purchase order arrives. An information guide will be provided to Vendors to assist them with retrieving their
orders.
Please select options below for receipt of Purchase Orders and provide the requested information:
Designation form as provided to the Cooperative administrator. I understand that my company shall remain
responsible for the Contract and the performance of all Designated Dealers under and in accordance with
the Contract.
Yes
35 Request for Quotes (RFQ)
Cooperative members will send RFQs to you by e-mail. Please provide e-mail addresses for the receipt of RFQs:
Vendor: IdentiSys, Inc. 759-25Page 8 of 29 pages
36 Request for Quote (RFQ) E-mail Address
Request for Quote (RFQ) E-mail Address
andrew_johnson@identisys.com
37 Request for Quote (RFQ) Contact - First Name
Request for Quote (RFQ) Contact - First Name
Andrew
38 Request for Quote (RFQ) Contact - Last Name
Request for Quote (RFQ) Contact - Last Name
Johnson
39 Request for Quote (RFQ) Contact Phone Number
Request for Quote (RFQ) Contact Phone Number (xxx-xxx-xxxx)
952-294-1216
40 Request for Quote (RFQ) Contact Extension Number
Request for Quote (RFQ) Contact Extension Number
No response
41 Alternate Request for Quote (RFQ) E-mail Address
Alternate Request for Quote (RFQ) E-mail Address
lynn_westfall@identisys.com
42 Alternate Request for Quote (RFQ) Contact - First Name
Alternate Request for Quote (RFQ) Contact - First Name
Lynn
43 Alternate Request for Quote (RFQ) Contact - Last Name
Alternate Request for Quote (RFQ) Contact - Last Name
Westfall
44 Alternate Request for Quote (RFQ) Contact Phone Number
Alternate Request for Quote (RFQ) Contact Phone Number (xxx-xxx-xxxx)
210-380-7141
45 Alternate Request for Quote (RFQ) Contact Extension Number
Alternate Request for Quote (RFQ) Contact Extension Number
No response
46 Invoices
Your company will be billed monthly for the service fee due under a Contract awarded under this Proposal
Invitation.All invoices are available on the BuyBoard website and e-mail notifications will be sent when
they are ready to be retrieved.
Vendor: IdentiSys, Inc. 759-25Page 9 of 29 pages
47 Invoices
Please choose only one (1) of the following options for receipt of invoices and provide the requested
information:
(a) Service fee invoices and related communications should be provided directly to my company at:
or
(b) In lieu of my company, I request and authorize all service fee invoices to be provided directly to the following
billing agent:
If Vendor authorizes a billing agent to receive and process service fee invoices, in accordance with the General Terms and Conditions of the Contract,
Vendor specifically acknowledges and agrees that nothing in that designation shall relieve Vendor of its responsibilities and obligations under the
Contract including, but not limited to, payment of all service fees under any Contract awarded Vendor.
Service fee invoices and notices direct to company
48 Invoice Company Name
Invoice Company Name
IdentiSys, Inc.
49 Invoice Company Department Name
Invoice Company Department Name
Account Payable
50 Invoice Contact - First Name
Invoice Contact - First Name
Beth
51 Invoice Contact - Last Name
Invoice Contact - Last Name
Willemsen
52 Invoice Mailing Address
Invoice Mailing Address (P.O. Box or Street Address)
PO Box 1086
53 Invoice Mailing Address - City
Invoice Mailing Address - City
Minnetonka
54 Invoice Mailing Address - State
Invoice Mailing Address - State (Abbreviate State Name)
MN
55 Invoice Mailing Address - Zip Code
Invoice Mailing Address (Zip Code)
55345
Vendor: IdentiSys, Inc. 759-25Page 10 of 29 pages
56 Invoice Contact Phone Number
Invoice Contact Phone Number (xxx-xxx-xxxx)
952-294-1227
57 Invoice Contact Extension Number
Invoice Contact Extension Number
No response
58 Invoice Contact Fax Number
Invoice Contact Fax Number (xxx-xxx-xxxx)
No response
59 Invoice Contact E-mail Address
Invoice Contact E-mail
accounts_payable@identisys.com
60 Invoice Contact Alternate E-mail Address
Invoice Contact Alternate E-mail Address
beth_willemsen@identisys.com
61 Billing Agent Company Name
Billing Agent Company Name
No response
62 Billing Agent Department Name
Billing Agent Department Name
No response
63 Billing Agent Contact - First Name
Billing Agent Contact - First Name
No response
64 Billing Agent Contact - Last Name
Billing Agent Contact - Last Name
No response
65 Billing Agent Mailing Address
Billing Agent Mailing Address (P.O. Box or Street Address)
No response
66 Billing Agent Mailing Address - City
Billing Agent Mailing Address - City
No response
67 Billing Agent Mailing Address - State
Billing Agent Mailing Address - State (Abbreviate State Name)
No response
Vendor: IdentiSys, Inc. 759-25Page 11 of 29 pages
68 Billing Agent Mailing Address - Zip Code
Billing Agent Mailing Address - Zip Code
No response
69 Billing Agent Contact Phone Number
Billing Agent Contact Phone Number (xxx-xxx-xxxx)
No response
70 Billing Agent Contact Extension Number
Billing Agent Contact Extension Number
No response
71 Billing Agent Fax Number
Billing Agent Fax Number
No response
72 Billing Agent Contact E-mail Address
Billing Agent Contact E-mail Address
No response
73 Billing Agent Alternative E-mail Address
Billing Agent Alternative E-mail Address
No response
74 Shipping Via
Common Carrier, Company Truck, Prepaid and Add to Invoice, or Other
Common Carrier
75 Payment Terms
Note: Vendor payment terms must comply with the BuyBoard General Terms and Conditions and the Texas Prompt
Payment Act (Texas Government Code Ch. 2251).
Net 30
76 Vendor's Internal/Assigned Reference/Quote Number
Vendor's Internal/Assigned Reference/Quote Number
No response
77 State or Attach Return Policy
terms, terms of sale, or other information not specifically related to return requirements and processes included in
Deviation and Compliance Form and accepted by the Cooperative.
IdentiSys will offer returns and replacement for defective items within 30 days.
78 Electronic Payments
Are electronic payments acceptable to your company?
Yes
Vendor: IdentiSys, Inc. 759-25Page 12 of 29 pages
79 Credit Card Payments
Are credit card payments acceptable to your company?
Yes
80 Texas Regional Service Designation
Texas Regional Service Designation - Refer to Form in Proposal Invitation
The
vendors the opportunity to service its members throughout the entire State of Texas. If you do not plan to service all
Texas Cooperative members statewide, you must indicate the specific regions you will service on this form. If you
propose to serve different regions for different products or services included in your Proposal, you must complete
and submit a separate Texas Regional Service Designation form for each group of products and clearly indicate the
products or services to which the designation applies. By designating a region or regions, you are certifying that
you are authorized and willing to provide the proposed products and services in those regions. Designating
regions in which you are either unable or unwilling to provide the specified products and services shall be
grounds for either rejection of your Proposal or, if awarded, termination of your Contract.Additionally, if you
do not plan to service Texas Cooperative members (i.e., if you will service only states other than Texas), you must
so indicate on this form.
81 Company Name
Company Name
IdentiSys, Inc.
82 Texas Regional Service Designation
Select only one of the following options.If you select "I will NOT serve all Regions of Texas", you must then
check the individual Regions you wish to serve.
I will serve all Regions of Texas
83 Region 1
Region 1 - Edinburg
Region 1
84 Region 2
Region 2 - Corpus Christi
Region 2
85 Region 3
Region 3 - Victoria
Region 3
86 Region 4
Region 4 - Houston
Region 4
87 Region 5
Region 5 - Beaumont
Region 5
88 Region 6
Region 6 - Huntsville
Region 6
Vendor: IdentiSys, Inc. 759-25Page 13 of 29 pages
89 Region 7
Region 7 - Kilgore
Region 7
90 Region 8
Region 8 - Mount Pleasant
Region 8
91 Region 9
Region 9 - Wichita Falls
Region 9
92 Region 10
Region 10 - Richardson
Region 10
93 Region 11
Region 11 - Fort Worth
Region 11
94 Region 12
Region 12 - Waco
Region 12
95 Region 13
Region 13 - Austin
Region 13
96 Region 14
Region 14 - Abilene
Region 14
97 Region 15
Region 15 - San Angelo
Region 15
98 Region 16
Region 16 - Amarillo
Region 16
99 Region 17
Region 17 - Lubbock
Region 17
100
Region 18
Region 18 - Midland
Region 18
Vendor: IdentiSys, Inc. 759-25Page 14 of 29 pages
101
Region 19
Region 19 - El Paso
Region 19
102
Region 20
Region 20 - San Antonio
Region 20
103
State Service Designation
State Service Designation - Refer to Form in Proposal Invitation.
As set
States have the opportunity to purchase goods or services awarded under the Contract, subject to applicable state
law, through a piggy-back award or similar agreement through the National Purchasing Cooperative BuyBoard. If
you plan to service the entire United States or only specific states, you must complete this form accordingly. (Note:
If you plan to service Texas Cooperative members, be sure that you complete the Texas Regional Service
Designation form.)In addition to this form, to be considered for a piggy-back award by the National
Purchasing Cooperative, you must have an authorized representative sign the National Purchasing
Cooperative Vendor Award Agreement that follows this form.
If you serve different states for different products or services included in your Proposal, you must complete and
submit a separate State Service Designation form for each group of products and clearly indicate the products or
services to which the designation applies. By designating a state or states, you are certifying that you are
authorized and willing to provide the proposed products and services in those states. Designating states in which
you are either unable or unwilling to provide the specified products and services shall be grounds for either
rejection of your Proposal or, if awarded, termination of your Contract.
104
Company Name
Company Name
IdentiSys, Inc.
105
State Service Designation
Select only one of the following options. If you select "I will NOT serve all States", you must then check
the individual States you wish to serve.
I will serve all states in the United States
106
Alabama
Alabama
Alabama
107
Alaska
Alaska
Alaska
108
Arizona
Arizona
Arizona
109
Arkansas
Arkansas
Arkansas
Vendor: IdentiSys, Inc. 759-25Page 15 of 29 pages
110
California
California (Public Contract Code 20118 & 20652)
California
111
Colorado
Colorado
Colorado
112
Connecticut
Connecticut
Connecticut
113
Delaware
Delaware
Delaware
114
District of Columbia
District of Columbia
District of Columbia
115
Florida
Florida
Florida
116
Georgia
Georgia
Georgia
117
Hawaii
Hawaii
Hawaii
118
Idaho
Idaho
Idaho
119
Illinois
Illinois
Illinois
120
Indiana
Indiana
Indiana
121
Iowa
Iowa
Iowa
Vendor: IdentiSys, Inc. 759-25Page 16 of 29 pages
122
Kansas
Kansas
Kansas
123
Kentucky
Kentucky
Kentucky
124
Louisiana
Louisiana
Louisiana
125
Maine
Maine
Maine
126
Maryland
Maryland
Maryland
127
Massachusetts
Massachusetts
Massachusetts
128
Michigan
Michigan
Michigan
129
Minnesota
Minnesota
Minnesota
130
Mississippi
Mississippi
Mississippi
131
Missouri
Missouri
Missouri
132
Montana
Montana
Montana
133
Nebraska
Nebraska
Nebraska
Vendor: IdentiSys, Inc. 759-25Page 17 of 29 pages
134
Nevada
Nevada
Nevada
135
New Hampshire
New Hampshire
New Hampshire
136
New Jersey
New Jersey
New Jersey
137
New Mexico
New Mexico
New Mexico
138
New York
New York
New York
139
North Carolina
North Carolina
North Carolina
140
North Dakota
North Dakota
North Dakota
141
Ohio
Ohio
Ohio
142
Oklahoma
Oklahoma
Oklahoma
143
Oregon
Oregon
Oregon
144
Pennsylvania
Pennsylvania
Pennsylvania
145
Rhode Island
Rhode Island
Rhode Island
Vendor: IdentiSys, Inc. 759-25Page 18 of 29 pages
146
South Carolina
South Carolina
South Carolina
147
South Dakota
South Dakota
South Dakota
148
Tennessee
Tennessee
Tennessee
149
Texas
Texas
Texas
150
Utah
Utah
Utah
151
Vermont
Vermont
Vermont
152
Virginia
Virginia
Virginia
153
Washington
Washington
Washington
154
West Virginia
West Virginia
West Virginia
155
Wisconsin
Wisconsin
Wisconsin
156
Wyoming
Wyoming
Wyoming
Bid Lines
Vendor: IdentiSys, Inc. 759-25Page 19 of 29 pages
1 Section I:Technology: Software as a Product (SaaP) and Other Related Services
Discount (%) off catalog/price list for Admission Ticket Tracking Software.Catalog/Price list MUST be
included or proposal will not be considered.
No Bid
Item Notes:PROPOSAL NOTE 1: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturer/vendor websites will be accepted.
PROPOSAL NOTE 2: Software or Software as a Product (SaaP) as used herein shall mean software
computer. (Vendor shall not include in its Proposal any Software as a Service (SaaS) products where
software is licensed on a subscription basis and is centrally hosted by the software provider. Such items
are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility
requirements and guidelines for governmental entities including any applicable World Wide Web
Consortium Web Contact Accessibility Guidelines and applicable state, local, and/or federal law.
Vendors proposing multiple manufacturer product lines and/or catalog/price list per line item must
submit the information as follows or proposal may not be considered:
Select "Add Alternate" for each additional manufacturer product line and/or catalog/price list
proposed
list listed
Item Attributes
1. State Name of Manufacturer Catalog or Product Price list Proposed with Discount Percentage
NOTE: Do not reference SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed".
No response
Vendor: IdentiSys, Inc. 759-25Page 20 of 29 pages
2 Section I:Technology: Software as a Product (SaaP) and Other Related Services
Discount (%) off catalog/price list for Bill Pay Software and Technology.Catalog/Price list MUST be included
or proposal will not be considered.
No Bid
Item Notes:PROPOSAL NOTE 1: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturer/vendor websites will be accepted.
PROPOSAL NOTE 2: Software or Software as a Product (SaaP) as used herein shall mean software
computer. (Vendor shall not include in its Proposal any Software as a Service (SaaS) products where
software is licensed on a subscription basis and is centrally hosted by the software provider. Such items
are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility
requirements and guidelines for governmental entities including any applicable World Wide Web
Consortium Web Contact Accessibility Guidelines and applicable state, local, and/or federal law.
Vendors proposing multiple manufacturer product lines and/or catalog/price list per line item must
submit the information as follows or proposal may not be considered:
Select "Add Alternate" for each additional manufacturer product line and/or catalog/price list
proposed
list listed
Item Attributes
1. State Name of Manufacturer Catalog or Product Price list Proposed with Discount Percentage
NOTE: Do not reference SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed".
No response
Vendor: IdentiSys, Inc. 759-25Page 21 of 29 pages
3 Section I:Technology: Software as a Product (SaaP) and Other Related Services
Discount (%) off catalog/price list for Business/Office Software.Catalog/Price list MUST be included or
proposal will not be considered.
Total:20%
Item Notes:PROPOSAL NOTE 1: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturer/vendor websites will be accepted.
PROPOSAL NOTE 2: Software or Software as a Product (SaaP) as used herein shall mean software
computer. (Vendor shall not include in its Proposal any Software as a Service (SaaS) products where
software is licensed on a subscription basis and is centrally hosted by the software provider. Such items
are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility
requirements and guidelines for governmental entities including any applicable World Wide Web
Consortium Web Contact Accessibility Guidelines and applicable state, local, and/or federal law.
Vendors proposing multiple manufacturer product lines and/or catalog/price list per line item must
submit the information as follows or proposal may not be considered:
Select "Add Alternate" for each additional manufacturer product line and/or catalog/price list
proposed
list listed
Item Attributes
1. State Name of Manufacturer Catalog or Product Price list Proposed with Discount Percentage
NOTE: Do not reference SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed".
IdentiSys BusinessOfficeSW
Vendor: IdentiSys, Inc. 759-25Page 22 of 29 pages
4 Section I:Technology: Software as a Product (SaaP) and Other Related Services
Discount (%) off catalog/price list for Desktop/Web Publishing Software.Catalog/Price list MUST be included
or proposal will not be considered.
No Bid
Item Notes:PROPOSAL NOTE 1: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturer/vendor websites will be accepted.
PROPOSAL NOTE 2: Software or Software as a Product (SaaP) as used herein shall mean software
computer. (Vendor shall not include in its Proposal any Software as a Service (SaaS) products where
software is licensed on a subscription basis and is centrally hosted by the software provider. Such items
are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility
requirements and guidelines for governmental entities including any applicable World Wide Web
Consortium Web Contact Accessibility Guidelines and applicable state, local, and/or federal law.
Vendors proposing multiple manufacturer product lines and/or catalog/price list per line item must
submit the information as follows or proposal may not be considered:
Select "Add Alternate" for each additional manufacturer product line and/or catalog/price list
proposed
list listed
Item Attributes
1. State Name of Manufacturer Catalog or Product Price list Proposed with Discount Percentage
NOTE: Do not reference SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed".
No response
Vendor: IdentiSys, Inc. 759-25Page 23 of 29 pages
5 Section I:Technology: Software as a Product (SaaP) and Other Related Services
Discount (%) off catalog/price list for Instructional Software.Catalog/Price list MUST be included or proposal
will not be considered.
No Bid
Item Notes:PROPOSAL NOTE 1: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturer/vendor websites will be accepted.
PROPOSAL NOTE 2: Software or Software as a Product (SaaP) as used herein shall mean software
computer. (Vendor shall not include in its Proposal any Software as a Service (SaaS) products where
software is licensed on a subscription basis and is centrally hosted by the software provider. Such items
are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility
requirements and guidelines for governmental entities including any applicable World Wide Web
Consortium Web Contact Accessibility Guidelines and applicable state, local, and/or federal law.
Vendors proposing multiple manufacturer product lines and/or catalog/price list per line item must
submit the information as follows or proposal may not be considered:
Select "Add Alternate" for each additional manufacturer product line and/or catalog/price list
proposed
list listed
Item Attributes
1. State Name of Manufacturer Catalog or Product Price list Proposed with Discount Percentage
NOTE: Do not reference SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed".
No response
Vendor: IdentiSys, Inc. 759-25Page 24 of 29 pages
6 Section I:Technology: Software as a Product (SaaP) and Other Related Services
Discount (%) off catalog/price list for Specialty Software Products (school transportation routing software and
related products).Catalog/Price list MUST be included or proposal will not be considered.
Total:10%
Item Notes:PROPOSAL NOTE 1: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturer/vendor websites will be accepted.
PROPOSAL NOTE 2: Software or Software as a Product (SaaP) as used herein shall mean software
computer. (Vendor shall not include in its Proposal any Software as a Service (SaaS) products where
software is licensed on a subscription basis and is centrally hosted by the software provider. Such items
are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility
requirements and guidelines for governmental entities including any applicable World Wide Web
Consortium Web Contact Accessibility Guidelines and applicable state, local, and/or federal law.
Vendors proposing multiple manufacturer product lines and/or catalog/price list per line item must
submit the information as follows or proposal may not be considered:
Select "Add Alternate" for each additional manufacturer product line and/or catalog/price list
proposed
list listed
Item Attributes
1. State Name of Manufacturer Catalog or Product Price list Proposed with Discount Percentage
NOTE: Do not reference SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed".
IdentiSys Specialty SW
Vendor: IdentiSys, Inc. 759-25Page 25 of 29 pages
7 Section I:Technology: Software as a Product (SaaP) and Other Related Services
Discount (%) off catalog/price list for Archive, Email, Data Migration, and Related Services. Catalog/Price list
MUST be included or proposal will not be considered.
No Bid
Item Notes:PROPOSAL NOTE 1: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturer/vendor websites will be accepted.
PROPOSAL NOTE 2: Software or Software as a Product (SaaP) as used herein shall mean software
computer. (Vendor shall not include in its Proposal any Software as a Service (SaaS) products where
software is licensed on a subscription basis and is centrally hosted by the software provider. Such items
are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility
requirements and guidelines for governmental entities including any applicable World Wide Web
Consortium Web Contact Accessibility Guidelines and applicable state, local, and/or federal law.
Vendors proposing multiple manufacturer product lines and/or catalog/price list per line item must
submit the information as follows or proposal may not be considered:
Select "Add Alternate" for each additional manufacturer product line and/or catalog/price list
proposed
list listed
Item Attributes
1. State Name of Manufacturer Catalog or Product Price list Proposed with Discount Percentage
NOTE: Do not reference SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed".
No response
Vendor: IdentiSys, Inc. 759-25Page 26 of 29 pages
8 Section I:Technology: Software as a Product (SaaP) and Other Related Services
Discount (%) off catalog/price list for Cloud Storage, Data Center Hosting, and Related Software
Services.Catalog/Price list MUST be included or proposal will not be considered.
No Bid
Item Notes:PROPOSAL NOTE 1: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturer/vendor websites will be accepted.
PROPOSAL NOTE 2: Software or Software as a Product (SaaP) as used herein shall mean software
computer. (Vendor shall not include in its Proposal any Software as a Service (SaaS) products where
software is licensed on a subscription basis and is centrally hosted by the software provider. Such items
are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility
requirements and guidelines for governmental entities including any applicable World Wide Web
Consortium Web Contact Accessibility Guidelines and applicable state, local, and/or federal law.
Vendors proposing multiple manufacturer product lines and/or catalog/price list per line item must
submit the information as follows or proposal may not be considered:
Select "Add Alternate" for each additional manufacturer product line and/or catalog/price list
proposed
list listed
Item Attributes
1. State Name of Manufacturer Catalog or Product Price list Proposed with Discount Percentage
NOTE: Do not reference SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed".
No response
Vendor: IdentiSys, Inc. 759-25Page 27 of 29 pages
9 Section I:Technology: Software as a Product (SaaP) and Other Related Services
Discount (%) off catalog/price list for Data Analytics/Science and Related Services. Catalog/Price list MUST
be included or proposal will not be considered.
No Bid
Item Notes:PROPOSAL NOTE 1: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturer/vendor websites will be accepted.
PROPOSAL NOTE 2: Software or Software as a Product (SaaP) as used herein shall mean software
computer. (Vendor shall not include in its Proposal any Software as a Service (SaaS) products where
software is licensed on a subscription basis and is centrally hosted by the software provider. Such items
are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility
requirements and guidelines for governmental entities including any applicable World Wide Web
Consortium Web Contact Accessibility Guidelines and applicable state, local, and/or federal law.
Vendors proposing multiple manufacturer product lines and/or catalog/price list per line item must
submit the information as follows or proposal may not be considered:
Select "Add Alternate" for each additional manufacturer product line and/or catalog/price list
proposed
list listed
Item Attributes
1. State Name of Manufacturer Catalog or Product Price list Proposed with Discount Percentage
NOTE: Do not reference SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed".
No response
Vendor: IdentiSys, Inc. 759-25Page 28 of 29 pages
10 Section I:Technology: Software as a Product (SaaP) and Other Related Services
Discount (%) off catalog/price list for Software Support Maintenance Agreements. Catalog/Price list MUST
be included or proposal will not be considered.
Total:8%
Item Notes:PROPOSAL NOTE 1: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the
Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a
readily available and readable electronic format, with Excel or searchable PDF preferred. No paper
catalogs or manufacturer/vendor websites will be accepted.
PROPOSAL NOTE 2: Software or Software as a Product (SaaP) as used herein shall mean software
computer. (Vendor shall not include in its Proposal any Software as a Service (SaaS) products where
software is licensed on a subscription basis and is centrally hosted by the software provider. Such items
are included in a separate BuyBoard contract.)
It is expected that software and/or hardware proposed will conform to applicable accessibility
requirements and guidelines for governmental entities including any applicable World Wide Web
Consortium Web Contact Accessibility Guidelines and applicable state, local, and/or federal law.
Vendors proposing multiple manufacturer product lines and/or catalog/price list per line item must
submit the information as follows or proposal may not be considered:
Select "Add Alternate" for each additional manufacturer product line and/or catalog/price list
proposed
list listed
Item Attributes
1. State Name of Manufacturer Catalog or Product Price list Proposed with Discount Percentage
NOTE: Do not reference SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed".
IdentiSys SMA
11 Section II: Training, Installation and Repair Service
Hourly Labor Rate for Installation/Repair Service of Software Products - Not to Exceed hourly labor rate
for Installation/Repair Service of Equipment and Products.
Quantity:1 UOM:Hourly Labor Rate Price:$195.00 Total:$195.00
12 Section II: Training, Installation and Repair Service
Hourly Labor Rate for Installation/Repair Service of Staff Development and Training of Software
Products - Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products.
Quantity:1 UOM:Hourly Labor Rate Price:$195.00 Total:$195.00
Response Total: $390.00
Vendor: IdentiSys, Inc. 759-25Page 29 of 29 pages
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.
���IFLI�T �F I�JTERE�T C�iJE�TIDNNAIRE F�RM �I{�
For vendor �oing b�sir�ess witl� lo�al �overnmer�tal entity
This quesiionnai�e eeflecas ehanges made io the I�w by N.B_ 23� eaih ieg., Regu€ar Session. OFRGEUSEONLY
�is �uestiannaire s�eirM� �iled in acc�ardance w'iFs � hapier 1: fi. Local Govemment Code, 5y a vendar who �.3� R�-,x.�ea
has a�usrness relasianshi� as dafined by �eclian 17fi_04�(1-a] with a bca4 gonrernm�nRal entity ar�d the
vender meet� requiremertts un�ar Sacdory 1: b.00b[a].
Gj� larrr 1Fe��s quesnona�ir�a �nus1 he Eiled wiIFE ;he recads adminislrawr oi the laca� gaverren�enlaF eaitr� nal Ia:Qr
ihan ;he 7th business day after the da9e she vendar heoames aware of fads t�as reyuira the sla9ement io- hs
iiled. SeeSsction 176_4o6{a-t}, Lacfl� Gwemment C,ade.
A vendor �ammiL arr a.ffense rf the va[sdar 3sr•rmingJ� �diolale= SecSior� 1�6.�06. iac31 �wernmer.l �a�e. Ar.
ot'erse �xider ihis �ian is a misdemea�oF.
� F�ame af vendor who has a buainess rela�ionship wi#h locnl governmenC�l enkity_
2
� Check th is bax it you aie fili ng sn updal� to a p�viousty fi led q ues4onnai re, (�a law raquiFes 1�s[ yau i�le an updatesk
c�mpleted questionr�aife wii:� t'�e aporopriute i li�rg auth�rity r�ot .ater ��a� ��re 7ih busi�ess day after th� �ata or� ,vhich
y�u beca=ne anvare that tha �rgin�lly i�led quastienraiFe wys �n�ompleta oe I�'1�OCUS3t3.1
� Hame of lacal gnvernmen� ofliaer a6out whem rhe i nforma#ian is being disclosed.
Name of Oi�>cer
� flescribe each amploymern or ather business relationship wi#h the local govemmern afficer, or a farnily member of lhe
vfficer.asdescrl6edbySeczior�]T8.003{aj(2j(Aj, lUsodascribea�familyralaiionshipwithlhelocalgrnremmanSalficer_
Complete subparts A and B toraach ernployment or business �elationshi� described_ A4tach additional pages ta this F�rrn
CIO as n2�essary,
A. Is i�e I�;,al gan,�e�nrr�er�t officeF ar s fami�y TernveF �f i�e ofricer receiving �r I•ke?y t� �eca;ve taxa� a>ncome.
athar than i-�rrestment ie�c�me. #om the vandor?
� �25 � i*�0
�. Is thaveno�r receMir�gor likesyia recsi,,�a taxa��e ncome. othert:�a.� irn��stment i��oma. from ar at thad.raction
�f 1€te locsl gaver.tme�tt officeR o� a fami'y member af L�e �Ffice= ANG ±'re taxr�hle in�ome is �01 re�ivad fram the
Ixal ganre•rmenta�l antiry'
� �2 5 � i*� 0
5 �escriha each employment or busin�ss relationship th st the vendor nam�ed In Section 1 maintains with a corporatian ar
olhar business entity vrith �esp�cl ro which the local government �#ioer serves as an otficer ar director, ar ho-lds an
ownership irt�rest o1 ane percent ar more.
�
❑ Gheck i'� s b�x if ��a ve�da' �7as g�ven the I�cal g;veFnmant oii�er or a famiy .me-nCeF oi [he aN>ceF o�re or mora ai`�s
as d9SCf'b9C I'1 :2CCI�]'1 1 rF. �'3i.a;f2;(6:�, axc•ucir�; g:Ft� de�cribed n 5ec:o-n 1+G.4D3ra-11.
7
�� 3 ��
�ynal�re o ve r :� . �usine�s •��e - r �.7vemr�n�a erqiky _ia�e
Farm F�rovidedby Texas E;hi� Comm;ssior. v�wr�+.sthi�s..�tate.�.s.u: :�e,�ise� -;'2p2•
�ONFLI�� �F Ih�TERE�T QUE�TI��JNAIRE
For v�ndor doir�g bu�irpess wit� local ga�vernmen�al �ntity
A cam�lete copy o� Cfi�apter � 7� of E.#�e Loc a� ;avernment �od� may �e fo�n� at h4tp:,:�l+uww. s�a€��es_�eg�s_state.tx _t�s�'
Docs;'L�� htm� L� 176.fii[�n. F�r easy referer�ce, b��aw are so�ne �f the sec��ons ciked an t�is form.
Local �avemEnent Cad� � 176.001{1=a1: "B�siness re�at�ansfi�ip�� rneans a connection beiweer� twa or rnore pa�ties
based cn cammercia; activit}� of o�re af the parties. The ter{n does not ir�clude a connection ba�se-� on_
(A1 a r��n�action that is subject to rate or fee regulation by a�e�era�, s�aEe, �r iaca� �overnme�t�al entity oi an
agency �f a federa�, sta;e, or 2ccal grnrernmenta� e�rtity;
{B) a trans�v[icn conducted at � pric� and s�bjecE to terr�s ava�lable to �he pubiic; or
(�} a pu rch ass or lease of �ac�ds or servi� es trom a person t*�at is ch a;tere� by a state or fes�eral agency and
that is s��ject tc regula; exarninaticn by, and repar[ing ta. :ha; age?�cy.
�aea1 Governrnent Code � 176.0�3ta1{21iA1 and iB1:
; a; A;c�a� g�rernment o�fic8! sha:i file a canfli�tsdisclasu�e s€atementw� respecE to ave��o� i€:
(2} t�evendor:
iAl has an er�p3oymentoratherbusaness relationshipwi�the local government o�r�cerar a
farriih{ fnembe� of the afticer that resui�s �n the officar �r #arni#y mernber recei�ing tax�ble
ir�come, o�#�er than irnrestr�er�f income. that excee�s ��.wOQ durin� the 1�-manth period
p�ecedi!�g the daEe that t#�e atficer becomes aware that
�;i:� a oon[�acF �eiween the loc�l grnrernrner+.ka; entity a��v�ndor has been executed;
�r
�ii) t�re loca1 govern�nantal entityr +s considering en�ering �nko � cantracE w�th the
+.��dor:
(�} h�S OIY�fI C� Cfi1$ IOC81 �0�5F�fllff3$f5[OffIC2f Or8 f�ff11�'f ffl�f;lb2f Of E�3$ O�IC�f Of32 Of f.IOF���if[S
tha[ have an aggreg�te va �ue of more than $140 in the 12-month per�ad pr�ce-� ing t�se dat� [h 8
officerbecarrres aware �at:
(ij a ca�;Eract beiween the local governrne�;Eal entityr and vendoi ;�as beer� execut8d; �r
[ii) �he icval �c�vernrnental en[s;}r �s considering enteri;�g into � contract with tl�e ver,dar_
Laeal Ga�+ernrrten# Cod� tt 176.�06ia1 an� ia-11
; a; A uend�r sl7all'i'e a vompleted ccnflict af interest q�estionr�aire if the vendor h�s a�usiness relatia�s#�ip
Wli��d �OCB� L�01r�f!1r19�:ia� �fltl�'f ��?d"
(1 } tras an ernployrr�ent ar ather b�siness relatianship with a I� a1 �overnmett officer af that l�cal
�a+rernmental a�t�ty, arafarni#y rnembero�the �fficer, �escribedbySec�i�n 176_�03;aj�,�j(Ai;
(2} has givers a�cr�al grnr8rnment offi�e� o� kh�[ loca� grnrernrraentai e�sEityr. ar a�amdy member of the
af�cer. one ar mar8 grftswith the a�grecate v�lue s�ecified �y Section 17�.043{aj��j(B�, exc�udino arr�
gittde�ribe�by�ection �76.0O3(a-,1;ot
�;31 has a fafnih� relationshi� with a lacal governrner�; affice� o[ that local governrnenta� entity_
�a-3) Thecom�let8dcanflict�fir,kerestques[i�nr�airemusEbefiledwiththeappro�riaterecordsa�rn3nistratoi
r±oR later than the seventh busi�,ess �ay afier t�e 3ater of=
�; I�� tt�e date tt�at the vendor
(Aj bes�ins disvussions ar negotiatior�s ta e�ker �nto a contract with [�e lacal g�v�r�rr�ental
e�tity; of
( 6� subm i#s to the I aca3 gorernrrienkal entity an �ppiicaEi on, respo�se to a req�es[ for prapasals
or bids, corresporderce, or another writing re�ated to a potential cont�acE with �i�e �ocal
s�OV$'lr�ffl2^F�I E�'1C�i}r; 0{
i�] k�e �at� the ver,�or become� aware:
(Aj o� an �mployment oT other �usir�ess re�ak��nsn;� with a lacal government off:cer, ar a
farnih� mernbe� �f the �fficer, �escribed by SubsBctio� (a�=
(B1 tha[!hev�ndafhasgiv�r���eormoregifts�escribedby�ubsectio�a(a��a�
(C) ofafafn�lyrelatior�shi�wi[i�alocalgaver�mentotr:cer_
Formpraro�dedbyTexasE`I11�wC61'I"'S5;6T wmr.ethics.state.;x.us �evised il'r��2•
Signature:
Email: