Di strict wide Consultant / Speaker Services

RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT DISTRICT WIDE CONSULTANT/SPEAKER RFP #21-038 Sealed bids will be received by the Raymondville Independent School District at 419 FM 3168, RAYMONDVILLE, TEXAS 78580 (956) 689-8175 ext. 4110 for District Wide Consultant/Speaker services. The bid will be received until Monday, April 14, 2025, 3:00 p.m., Central Standard Time (CST). Bids received after this time will not be considered. Interested bidders may obtain specifications and information for bidding at the R.I.S.D. Business Office or at www.raymondvilleisd.org. Please mark your envelope plainly: “District Wide Consultant/Speaker Services, Bid #21-038, due date: Monday, April 14, 2025, at 3:00 p.m.” 1. BID OPENING: Bidders are invited to attend the bid opening at the Business Office on 4th Tuesday of each month, at 3:05 p.m., Central Standard Time (CST) at which time the bids will be opened.

Bidder’s presence is not mandatory. 2. BID SUBMISSION: Bids should be submitted on this form and continued on any attached list(s) of bid items and submitted in a sealed envelope. Each bid shall be placed in a separate envelope, sealed and properly identified with the bid title, bid number and date to be opened. The District will not be held responsible for missing, lost or late mail. Raymondville Independent School District WILL NOT ACCEPT ANY FACSIMILE (FAX) ON SEALED BIDS. 3. TENTATIVE AWARD DATE: Incremental basis, bids received by the 4th Tuesday of each month will be awarded at the following month’s regular board meeting. 4. TERM OF BID: The contract created by this solicitation will be a term contract to be in effect on date of award to August 12, 2025. Note: the District may cancel a contract with a vendor at any time due to performance. 5. QUANTITIES: Raymondville Independent School District reserves the right to increase or decrease the number of units of each item on the basis of the unit price quoted, unless to do so will increase unit bid. In bid, stipulate whether the increase or decrease will affect bid price. The bid prices will remain firm until August 12, 2025 from date of Board Approval, unless otherwise stipulated. 6. ITEM DESCRIPTION: Bidders shall submit complete data on each item contained in the bid. Such data shall show and identify, by manufacture's number, (catalog) or other illustrations, the brand and model on which the bid is based and so marked as to be identified with the bid item. FAILURE TO SUBMIT THE ABOVE INFORMATION WITH SEALED BID WILL DISQUALIFY BID. 7. CASH DISCOUNTS: The Raymondville Independent School District considers cash discounts or discounts for prompt payment when evaluating bids. 8. PURCHASE ORDERS: The District is not responsible for orders placed by individuals, without an appropriate purchase order issued by the Raymondville I.S.D. The District will not make cash advances to the awarded vendors. Payment will be promptly made after all goods have been received and all services have been rendered by the awarded vendors. Page 1 of 9 http://www.raymondvilleisd.org/ RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT DISTRICT WIDE CONSULTANT/SPEAKER RFP #21-038 9. VENDOR REPRESENTATIVE: The successful vendor agrees to send a personal representative with binding authority for the company to the district upon request to make adjustments and/or assist with coordination of all transactions as needed. 10. QUALITY OF PRODUCTS: If applicable, all items must be new, in first class condition, including containers suitable for shipment and storage, unless otherwise indicated on the bid. No Substitutions in standard grades or lesser quality will be accepted. 11. DETERMINING FACTORS FOR AWARD: Bidders net price on bid items, stock availability, and reputation of brand names offered, and reputation and location of the bidder. Information must be made available upon request. 12. PRICING: Bid unit price on quantity specified, extend and show total. In case of errors in extension, unit prices shall govern. 13. SIGNING OF BID: Failure to manually sign bid will disqualify if person signing bid should show title or authority to bind their firm to a contract. 14. TAXES: The district is exempt from Federal Excise Tax, State Tax and Local Taxes. Do not include tax in the bid. If it is determined that tax was included in the bid it will not be included in the tabulation or any awards. Tax exemption certificates will be furnished upon request. 15. OR EQUAL: Any catalog, brand name or manufacturer's reference used in the bid request is descriptive - not restrictive - it is intended to indicate type and quality desired. Bids on brands of like nature and quality will be considered. If bidding on other than reference specifications, bid must show manufacturer, brand, model, etc. of article offered. If brand other than that specified is offered, complete descriptive information of said article must be included with the bid. If bidder takes no exception to specifications of reference data, brand names, models, etc. as specified, must be furnished. 16. SAMPLES: When requested, must be furnished within five working days of the request at no cost to the district. If not destroyed in examination they will be returned to the bidder on request at the vendor's expense. 17. EEOC GUIDELINES: During the performance of this contract, the contractor agrees not to discriminate against any employee or applicant for employment because of race, color, national origin, age, religion, gender, marital or veteran status, or handicapping condition. Page 2 of 9 RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT DISTRICT WIDE CONSULTANT/SPEAKER RFP #21-038 18. AS NEEDED BASIS: Quantities shown are estimates only. They are based on prior yearly usage. Items are to be ordered “as needed” over a period of 1 year. 19. QUESTIONS ON SPECIFICATIONS: All questions regarding bid specifications must be addressed (7) seven days prior to bid submission. 20. The Raymondville Independent School District has the right to reject or rebid if only one bid/proposal is received by “submission date” or extend the submission date by an additional two (2) weeks. 21. RECORDS PERTAINING TO THIS BID: Vendor Must Submit A Public Information Request Form Through Public Information Department At Phone Number (956) 689-8175. 22. CONTACT WITH BUYER: The Proposer/Bidder should be advised that all end users or Board Member may not communicate with any potential Proposer/Bidder and may only communicate with the designated buyer on any matter related to the proposal /bid. This includes technical questions on the Scope of Work. The buyer will not respond to technical question until first contacting an end user for input and concurrence and then submit an addendum to all potential Proposer/Bidder. A Proposer/Bidder should not contact any end user directly and should refer all questions in writing to the designated buyer. Continued non-compliance of the requirement is ground for rejection of the proposal/bid. 23. ETHICS & CONDUCT: No person shall participate or assume a responsibility in the implementation and execution of this procedure including, but not limited to, the evaluation of proposal/bids and selection of contractors, when such participation of proposals/bid and selection of contractors, when such participation constitutes a conflict of interest as defined by law. 24. CRIMINAL BACKGROUND CHECKS: Respondent agrees by signing and executing this solicitation to provide assurance that all employees, subcontractors and volunteers of the Provider who have contact with students have passed a criminal history background check current within the last year as per defined in Senate Bill 9. 25. WEBSITE DISCLAIMER: All solicitation postings on RISD website are provided as an added public service and are not intended for official use. Every effort has been made to provide specifications that are up to date, but information provided herein may change without notice or further posting. Any information provided here is subject to revision at any time and is reproduced from official documents of the Purchasing Department, 26. FIRM PRICE WITH ESCLATION: Price bid may be increased according to the terms listed: Page 3 of 9 RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT DISTRICT WIDE CONSULTANT/SPEAKER RFP #21-038 1. Based in Consumer Price Index, Producers Price Index, or other index approved by RISD purchasing office. The vendor must submit a written request for price increase to RISD purchasing office within 15 days of the affected price increase. The request must be address to the appropriate assigned to manage the procurement. Note: Vendors shall not delay or stop deliveries pending price change approval. Price increase requests shall be supported by the appropriate index documentation from an independent and industry accepted market report. A price increase from your supplier alone is not sufficient documentation. RISD will respond within 15 calendar days of the request receipt date by 1) granting the request; 2) reassigning the items(s) to another awarded vendor, 3) re-bidding the items(s); or taking any other action deemed in the best interest to RISD. Price decreases will be accepted at any time during the contract period. Title allowable percent increase change shall be calculated as follows: (B-A)/A x 100% = Percent of allowable price increase A= Index from the month of the original bid or the month of the last approval price increase B= Current and/or latest baseline index The resulting percent shall be rounded to the nearest one-hundredth of one percent and shall be the maximum adjustment permitted. The Consumer Price Index (CPI) or Producer Price Index (PPI) used will be for the industry of the specific items listed in the bid. At the sale discretion of RISD, multiple CPI’s or PPI’s may be used for various items in the same bid. The Raymondville Independent School District reserves the right to reject any/or all bids and to make awards as they may appear to be advantageous to the School District, to hold bid for 120 days from submission date without action, and to waive all formalities in bidding. The bidder must indicate “all or none” in the bid if the above-stated condition is not acceptable. Vendor must provide Federal Identification Number and/or Social Security Number in order to be considered as a qualified vendor. The District Wide Consultant/Speaker Services shall be delivered FOB Raymondville Independent School District, Raymondville. Texas 78580. A contract for the District Wide Consultant/Speaker Services will be placed into effect by means of a purchase order issued by the District after tabulation and final approval by the Board of Trustees. Joe A. Lopez Purchasing Coordinator/Fixed Assets Raymondville Independent School District Page 4 of 9 RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT BID SPECIFICATIONS FOR: DISTRICT WIDE CONSULTANT/SPEAKER RFP #21-038 $ hourly rate per service/training $ 1⁄2 day rate per service/training $ full day rate per service/training $ cost for training supplies & materials X number of hour(s)/days(s) $ Total fee for your services/training * $ additional materials not included in consulting services to be purchased by staff * Note: Total fee should include all expenses, i.e., hotel, flight, meals, etc. Type of service/training: Topic: Category/Classification: (please check those that apply) Motivational Instructional Parental Target Audience: (please check those that apply) Students Teachers Administration Parents Consultant Qualifications: (Must Attach Vita, Resume, Background Information) Company/Group Presenter: Signature: TAX ID#/S.S. #: Address: Fax No.: Phone No.: City: State: Zip:  Please include references of the Districts that you provided consulting services. If available, please include TAKS results in the content area of your expertise. Page 5 of 9 RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT DISTRICT WIDE CONSULTANT/SPEAKER RFP #21-038 FELONY CONVICTION NOTICE State of Texas Legislative Senate Bill No.1, Section 44.034, Notification of Criminal History, Subsection (a), 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 of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony. Subsection (b) states "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 the services performed before the termination of contract." THIS NOTICE IS NOT REQUIRED OF A PUBLICLY-HELD CORPORATION I, the undersigned agent for the firm named below, certify that the information concerning notification of felony has been reviewed by me and the following information furnished is true to the best of my knowledge. VENDOR'S NAME: AUTHORIZED COMPANY OFFICIAL'S NAME (PRINTED) a. My firm is a publicly-held corporation; therefore, this reporting requirement is not applicable. Signature of Company: _ b. My firm is neither owned nor operated by anyone who has been convicted of a felony: Signature of Company Official: c. My firm is owned or operated by the following individual(s) who has/have been convicted of a felony: Name: Felon(s): Details of Conviction(s): Signature of Company Official: Note: Please complete and submit this form with your bid or company will be disqualified. Page 6 of 9 RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT DISTRICT WIDE CONSULTANT/SPEAKER RFP #21-038 NON-COLLUSIVE AFFIDAVIT The undersigned bidder, by signing and executing this BID certifies and represents to the Raymondville Independent School District that bidder has not offered, conferred or agreed to confer any pecuniary benefit, as defined by 11.07 (a) (6) of the Texas Penal Code, or any other thing of value, as consideration for the receipt of information or any special treatment or advantage relating to this BID: the bidder also certifies and represents that the bidder has not offered, conferred or agreed to confer any pecuniary benefit or other thing of value as consideration for the recipient's decision, opinion, recommendation, vote or other exercise of discretion concerning this BID: the bidder certifies and represents that bidder has neither coerced nor attempted to influence the exercise of discretion by any offer, trustee, agent or employee of the Raymondville Independent School District concerning this BID on the basis of any consideration not authorized by law; the bidder also certifies and represents that bidder has not received any information not available to other bidders so as to give the undersigned a preferential advantage with respect to this BID; the bidder further certifies and represents that bidder has not violated any state, federal, or local law, regulation or ordinance relating to bribery, improper influence, collusion or the like and that bidder will not in the future offer, confer, or agree to confer any pecuniary benefit of other thing of value of any officer, trustee, agent or employee of the Raymondville Independent School District in return for the person having exercised their person's official discretion, power or duty with respect to this BID; the bidder certifies and represents that it has not now and will not in the future offer, confer, or agree to confer a pecuniary benefit or other thing of value to any officer, trustee, agent, or employee of the Raymondville Independent School District in connection with information regarding this BID, the submission of this BID, the award of this BID or the performance, delivery of sale pursuant to this BID. Signature of Company Official: Date: _ Print Name: Note: Please complete and submit this form with your bid or company will be disqualified. Page 7 of 9 RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT DISTRICT WIDE CONSULTANT/SPEAKER RFP #21-038 AFFIDAVIT State of Texas County of Willacy I, (name) as a Trustee of the Raymondville I.S.D. Board of Trustees make this affidavit and herby on oath of state the following; I, or a person related to me, have a substantial interest, in a business entity, as those terms are defined in Local Government code Sections 171.001-171.002, that would experience a special economic effect distinguishable from it's effect on the public by a vote or decisions of the board or in a real property for which it is reasonably foreseeable that the board's action will have a special economic effect on the value of the property distinguishable form it's effect on the public. ( name and address of Business or description of property). I or name or relative and relationship (have/has a substantial interest in this business entity or real property for the following reason: CHECK ALL THAT APPLY ( ) Ownership of 10 percent or more of the voting stock or shares of the business entity. ( ) Ownership of 10 percent or more the fair market value of the business entity. ( ) Ownership of $5,000 or more of the fair market value of the business entity. ( ) Funds received from the business exceed 10 percent of (my, her, his) gross income for the previous year. ( ) Real property is involved and (I, he, she) (have, has) and equitable or Legal ownership with a fair market value of at least $2,500. Upon filing of this affidavit with the School Board's Secretary, I affirm that I shall abstain from participation in any decision involving this business entity or real property, unless permitted according to Local Government Section 171.006 Signed this day of , 20 Signature of Official Title ACKNOWLEDGEMENT State of Texas County of Willacy BEFORE ME, the undersigned authority, this day personally appeared My commission expires: Page 8 of 9 DPS Computerized Criminal History (CCH) Verification (AGENCY COPY) I , - - - - - - - - - - - - - - , ac kn o wled ge th at a Corn pu ter iz ed Cr in1i.t1.al APPLICANT or EMPLOYEE NAME (Please print) History (CCH) check will be pe1fonned by accessing the Texas Department of Public Safety Secure Website and will be based on name and DOB id e ntifiers I suppl y. (This is not a consent fonn.) Authority for this agency to access an individual's criminal history data may be found in Texas Government Code 411; Subchapterf. Name-b ased information is not an exact search and only fingerprint record searches represent true identification to criminal history, tl1erefore tl1e organization conducting the criminal history check is not allowed to discuss with me fillLCriminal history record informati on obtained using this method. The agency may reque st that I have a fingerprint search petformed to clear any misidentification based on the result of the name and DOB search. Once this process is completed the information on my fingerprint criminal history record may be discussed with me. In order to co mplete the process I must make an appointment witl1 the Finge1print Applicant Services of Texas (FAST) as instructed online at wvlvv.txdps.state.lx.us /Crime Records/Review of Personal Criminal Histo,y or by calling the DPS Program Vendor at 1-888-467-2080, submit a full and complete set of :finge1prrnts, request a copy be sent to ilie agency listed below, and pay a fee of $24.95 to the fingerprinting se1v ices company. (This copy must remain on file by your agency. Required for future DPS Audits) Signature of Applicant or Employee Date Raymondvlile ISD Agency Name (Please print) Ten:yDuran Agency Representative Name (Please print) Signature of Agency Representative Date Rev. 09/20 13 Please: Check and Initial each Applicable Space CCH Report P1inted: YES NO _ _ _ initial Purpose of CCH: Empl _ Vol/Contractor initial Date Printed: initial tDersode - - - _ initial Retain in yonr files RAYMONDVILLE ISD CRIMINAL HISTORY RECORD INFORMATION REQUEST Confidentiai* The Raymond vill e Ind epen den t Sc hool District is required by Texas Education Code Chapter 22, Subchapter C to review the criminal history of applicants, employees, independent contractors, student teachers, and certain volunteers. The information requested below is necessary to obtain criminal history record information. Please print. Name -------------------------------- Last First Middle Socia l Security Number _ _ _ _ _ _ _ _ _ Date of birth ----------- Driver's License _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ State and Number Mailing Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Street City State Zip Sex: D Male D Female Ethnicity: □Black □· w hite/Other I understand that the informatio n I am providing about age, sex, and ethnicity will not be used to determine eligibility for employment but will be used solely for the purpose of obtaining criminal history record information. Signature Date This form will be removed from the application and filed separately in the HR office. RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT VENDOR CERTIFICATIONS CERTIFICATION OF COMPLIANCE WITH TEXAS FAMILY CODE Pursuant to Texas Family Code, Section 231.006, a child support obligor who is more than thirty (30) days delinquent in paying child support or a business entity in which the child support obligor is a sole proprietor, partner, shareholder, or owner with an ownership interest of at least twenty-five percent (25%) is not eligible to receive payments from State funds under a contract to provide property, materials, or services until all arrearages have been paid; the obligor is in compliance with a written repayment agreement or court order as to the existing delinquency; or a court of continuing jurisdiction over the child support order has granted the obligor an exemption as part of a court-supervised effort to improve earnings and child support payments. The undersigned proposer certifies that he or she, as the proposing individual, or the proposing business entity named in this contract, bid or application, is not ineligible under Section 231.006 of the Texas Family Code, to receive the specified grant, loan or payment, and acknowledges that a contract resulting from this solicitation may be terminated and payment may be withheld if the certification provided herein is found to be inaccurate. NOTE: Owners not owning at least twenty-five percent (25%) of the business entity submitting this proposal need not execute this certification and acknowledgement. REQUIRED CONTRACT PROVISIONS FOR NON-FEDERAL ENTITY CONTRACTS UNDER FEDERAL AWARDS – APPENDIX II TO 2 CFR PART 200 The following provisions are required and apply when federal funds are expended by RISD, and/or its cooperative members, for any contract resulting from this procurement process. (A) Contracts for more than the simplified acquisition threshold currently set at $150,000, which is the inflation adjusted amount determined by the Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 U.S.C. 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. Pursuant to Federal Rule (A) above, when federal funds are expended by RISD, and/or its cooperative members, RISD, and/or its cooperative members, reserves all rights and privileges under the applicable laws and regulations with respect to this procurement in the event of breach of contract by either party. Does vendor agree? YES Initials of Authorized Representative of vendor (B) Termination for cause and for convenience by the grantee or subgrantee including the manner by which it will be effected and the basis for settlement. (All contracts in excess of $10,000) Pursuant to Federal Rule (B) above, when federal funds are expended by RISD, and/or its cooperative members, RISD, and/or its cooperative members, reserves the right to immediately terminate any agreement in excess of $10,000 resulting from this procurement process in the event of a breach or default of the agreement by Vendor, in the event vendor fails to: (1) meet schedules, deadlines, and/or delivery dates within the time specified in the procurement solicitation, contract, and/or a purchase order; (2) make any payments owed; or (3) otherwise perform in accordance with the contract and/or the procurement solicitation. RISD, and/or its cooperative members, also reserves the right to terminate the contract immediately, with written notice to vendor, for convenience, if RISD, and/or its cooperative members, believes, in its sole discretion that it is in the best interest of RISD, and/or its cooperative members, to do so. The vendor will be compensated for work performed and accepted and goods accepted by RISD, and/or its cooperative members, as of the termination date if the contract is terminated for convenience of RISD, and/or its cooperative members. Any award under this procurement process is not exclusive and RISD, and/or its cooperative members, reserves the right to purchase goods and services from other vendors when it is in the best interest of RISD, and/or its cooperative members. Does vendor agree? YES Initials of Authorized Representative of vendor (C) Equal Employment Opportunity. Except as otherwise provided under 41 CFR Part 60, all contracts that meet the definition of ―federally assisted construction contract‖ in 41 CFR Part 60- 1.3 must 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.‖ Pursuant to Federal Rule (C) above, when federal funds are expended on any federally assisted construction contract, the equal opportunity clause is incorporated by reference herein. Does vendor agree to abide by the above? YES Initials of Authorized Representative of vendor (D) Davis-Bacon Act, as amended (40 U.S.C. 3141-3148). When required by Federal program legislation, all prime construction contracts in excess of $2,000 awarded by non-Federal entities must include a provision for compliance with the Davis-Bacon Act (40 U.S.C. 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, contractors must be required to pay wages to laborers and mechanics at a rate not less than the prevailing wages specified in a wage determination made by the Secretary of Labor. In addition, contractors must be required to pay wages not less than once a week. The non-Federal entity must place a copy of the current prevailing wage determination issued by the Department of Labor in each solicitation. The decision to award a contract or subcontract must be conditioned upon the acceptance of the wage determination. The non- Federal entity must report all suspected or reported violations to the Federal awarding agency. The contracts must also include a provision for compliance with the Copeland ―Anti-Kickback‖ Act (40 U.S.C. 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. The non-Federal entity must report all suspected or reported violations to the Federal awarding agency. Pursuant to Federal Rule (D) above, when federal funds are expended by RISD, and/or its cooperative members, during the term of an award for all contracts and subgrants for construction or repair, the vendor will be in compliance with all applicable Davis-Bacon Act provisions. Does vendor agree? YES Initials of Authorized Representative of vendor (E) Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where applicable, all contracts awarded by the non-Federal entity in excess of $100,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be 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 U.S.C. 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. Pursuant to Federal Rule (E) above, when federal funds are expended by RISD, and/or its cooperative members, the vendor certifies that during the term of an award for all contracts by RISD, and/or its cooperative members, resulting from this procurement process, the vendor will be in compliance with all applicable provisions of the Contract Work Hours and Safety Standards Act. Does vendor agree? YES Initials of Authorized Representative of vendor (F) Rights to Inventions Made Under a Contract or Agreement. If the 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 of 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. Pursuant to Federal Rule (F) above, when federal funds are expended by RISD, and/or its cooperative members, the vendor certifies that during the term of an award for all contracts by RISD, and/or its cooperative members, resulting from this procurement process, the vendor agrees to comply with all applicable requirements as referenced in Federal Rule (F) above. Does vendor agree? YES Initials of Authorized Representative of vendor (G) Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution Control Act (33 U.S.C. 1251-1387), as amended—Contracts and subgrants of amounts in excess of $50,000 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 U.S.C. 7401-7671q) and the Federal Water Pollution Control Act as amended (33 U.S.C. 1251- 1387). Violations must be reported to the Federal awarding agency and the Regional Office of the Environmental Protection Agency (EPA). Pursuant to Federal Rule (G) above, when federal funds are expended by RISD, and/or its cooperative members, the vendor certifies that during the term of an award for all contracts by RISD, and/or its cooperative members, resulting from this procurement process, the vendor agrees to comply with all applicable requirements as referenced in Federal Rule (G) above. Does vendor agree? YES Initials of Authorized Representative of vendor (H) 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 1986 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. Pursuant to Federal Rule (H) above, when federal funds are expended by RISD, and/or its cooperative members, the vendor certifies that during the term of an award for all contracts by RISD, and/or its cooperative members, resulting from this procurement process, the vendor certifies that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation by any federal department or agency. Does vendor agree? YES Initials of Authorized Representative of vendor (I) Byrd Anti-Lobbying Amendment (31 U.S.C. 1352) – All Contractors that apply or bid for an award exceeding $100,000 must file the required Lobbying 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 U.S.C. 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. Pursuant to Federal Rule (I) above, when federal funds are expended by RISD, and/or its cooperative members, the vendor certifies that during the term and after the awarded term of an award for all contracts by RISD, and/or its cooperative members, resulting from this procurement process, the vendor certifies that it is in compliance with all applicable provisions of the Byrd Anti-Lobbying Amendment (31 U.S.C. 1352). The undersigned further certifies that: (1) No Federal appropriated funds have been paid or will be paid for on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of congress, or an employee of a Member of Congress in connection with the awarding of a Federal contract, the making of a Federal grant, the making of a Federal loan, the entering into a cooperative agreement, and the extension, continuation, renewal, amendment, or modification of a Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of congress, or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying”, in accordance with its instructions: https://www.whitehouse.gov/sites/default/files/omb/grants/sflllin.pdf, (3) The undersigned shall require that the language of this certification be included in the award documents for all covered sub-awards exceeding $50,000 in Federal funds at all appropriate tiers and that all subrecipients shall certify and disclose accordingly. Does vendor agree? YES Initials of Authorized Representative of vendor EMPLOYMENT VERIFICATION FAR 22.18 As applicable, and as a condition for the award of any Federal contract at $50,000 or greater, Vendor certifies that vendor is enrolled in, and is currently participating in, E-Verify or any other equivalent electronic verification of work authorization program operated by the U.S. Department of Homeland Security and does not knowingly employ any person who is an unauthorized alien in conjunction with the contracted services. A breach in compliance with immigration laws and regulations shall be deemed a material breach of the contract and may be subject to penalties up to and including termination of the contract. Does vendor agree? YES Initials of Authorized Representative of vendor https://www.whitehouse.gov/sites/default/files/omb/grants/sflllin.pdf RECORD RETENTION REQUIREMENTS FOR CONTRACTS PAID FOR WITH FEDERAL FUNDS – 2 CFR § 200.333 When federal funds are expended by RISD, and/or its cooperative members, for any contract resulting from this procurement process, the vendor certifies that it will comply with the record retention requirements detailed in 2 CFR § 200.333. The vendor further certifies that vendor will retain all records as required by 2 CFR § 200.333 for a period of three years after grantees or subgrantees submit final expenditure reports or quarterly or annual financial reports, as applicable, and all other pending matters are closed. Does vendor agree? YES Initials of Authorized Representative of vendor CERTIFICATION OF COMPLIANCE WITH EPA REGULATIONS APPLICABLE TO GRANTS, SUBGRANTS, COOPERATIVE AGREEMENTS, AND CONTRACTS IN EXCESS OF $50,000 OF FEDERAL FUNDS When federal funds are expended by RISD, and/or its cooperative members, for any contract resulting from this procurement process in excess of $50,000, the vendor certifies that the vendor is in compliance with all applicable standards, orders, regulations, and/or requirements issued pursuant to the Clean Air Act of 1970, as amended (42 U.S.C. 1857(h)), Section 508 of the Clean Water Act, as amended (33 U.S.C. 1368), Executive Order 117389 and Environmental Protection Agency Regulation, 40 CFR Part 15. Does vendor agree? YES Initials of Authorized Representative of vendor CERTIFICATION OF COMPLIANCE WITH THE ENERGY POLICY AND CONSERVATION ACT When federal funds are expended by RISD, or its cooperative members, for any contract resulting from this procurement process, the vendor certifies that the vendor will be in compliance with mandatory standards and policies relating to energy efficiency which are contained in the state energy conservation plan issued in compliance with the Energy Policy and Conservation Act (Pub. L. 94-163, 89 Stat. 871). Does vendor agree? YES Initials of Authorized Representative of vendor CERTIFICATION OF COMPLIANCE WITH BUY AMERICAN PROVISIONS Vendor certifies that vendor is in compliance with all applicable provisions of the Buy American Act. Purchases made in accordance with the Buy American Act must still follow the applicable procurement rules calling for free and open competition. Does vendor agree? YES Initials of Authorized Representative of vendor CERTIFICATION OF NON-COLLUSION STATEMENT Vendor certifies that this company, corporation, firm, partnership or individual has not prepared this proposal in collusion with any other proposer, and that the contents of this proposal as to prices, terms or conditions of said proposal have not been communicated by the undersigned nor by any employee or agent to any other person engaged in this type of business prior to the official opening of this proposal. Does vendor agree? YES Initials of Authorized Representative of vendor Vendor agrees to comply with all federal, state, and local laws, rules, regulations and ordinances, as applicable. It is further acknowledged that vendor certifies compliance with all provisions, laws, acts, regulations, etc. as specifically noted above. Corporate/Company Name: Authorized Signature: Printed Name: Title: Date: Address: City, State, Zip Code: Phone #: Fax #: Email Address: Corporate/Company Website: DUNS #: CAGE #: RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT CONFLICT OF INTEREST QUESTIONNAIRE – FORM CIQ CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity Acomplete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form. Local Government Code§ 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public; or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency. Local Government Code§ 176.003(a)(2)(A) and (B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code§ 176.00G(a) and (a-1) (a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity; or (B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a); (B) that the vendor has given one or more gifts described by Subsection (a); or (C) of a family relationship with a local government officer. Form provided by Texas Etl1ics Commission www.ethics.state.tx.us Revised 11/30/2015 http://www.statutes.legis.state.tx.us/ http://www.statutes.legis.state.tx.us/ http://www.ethics.state.tx.us/ RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT CERTIFICATE OF INTERESTED PARTIES – FORM 1295 Definitions and Instructions for Completing Form 1295 Raymondville Independent School District is required to comply with House Bill 1295, which amended the Texas Government Code by adding Section 2252.908, Disclosure of Interested Parties. Section 2252.908 prohibits RISD, or its cooperative members, from entering into a contract resulting from this RFP with a business entity unless the business entity submits a Disclosure of Interested Parties – Form 1295 to RISD at the time the business entity submits the signed contract. The Texas Ethics Commission has adopted rules requiring the business entity to file Form 1295 electronically with the Texas Ethics Commission. As a “business entity,” all vendors must electronically complete, print, sign, notarize and submit Form 1295 with their proposals or contracts even if no interested parties exist. Proposers must file Certificate of Interested Parties – Form 1295 with the Texas Ethics Commission using the following online application: https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm  Proposers must use the filing application on the Texas Ethics Commission’s website (see link above) to enter the required information on Form 1295.  Proposers must print a copy of the completed form, which will include a certification of filing containing a unique certification number.  The Form 1295 must be printed and then signed by an authorized agent of the business entity, and the form must be notarized.  The completed Form 1295 with the certification of filing must be filed with Raymondville Independent School District by including a copy of the completed/notarized form with the proposal response.  RISD must acknowledge the receipt of the filed Form 1295 by notifying the Texas Ethics Commission of the receipt of the filed Form 1295 no later than the 30 th day after the date the contract binds all parties to the contract.  After RISD acknowledges the Form 1295, the Texas Ethics Commission will post the completed Form 1295 to its website within seven (7) business days after receiving notice from RISD. Instructions to Vendors: 1. Read these instructions, 2. Go to the Ethics Commission Website https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm, 3. Register and complete Form 1295 online - include the proposal number and the contract/RFP name, 4. Print a copy of the submitted Form 1295 and have it notarized - it will have a certification # in the top right corner, 5. Include a copy of the completed, signed and notarized Form 1295 with the proposal response. Definitions:  Interested Party: a person who: 1) has controlling interest in a business entity with whom RISD and/or its cooperative members contracts; or 2) actively participates in facilitating the contract or negotiating the terms of the contract, including a broker, intermediary, adviser, or attorney for the business entity.  Controlling Interest means: 1) an ownership interest or participating interest in a business entity by virtue of units, percentage, shares, stock, or otherwise that exceeds 10 percent; 2) membership on the board of directors or other governing body of a business entity of which the board or other governing body is composed of not more than 10 members; or 3) service as an officer of a business entity that has four or fewer officers, or service as one of the four officers most highly compensated by a business entity that has more than four officers.  Intermediary: a person who actively participates in the facilitation of the contract or negotiation the contract, including a broker, advisor, attorney, or representative of or agent for the business entity who: a) receives compensation from the business entity for the person’s participation; b) communicates directly with the governmental entity or state agency on behalf of the business entity regarding the contract; and c) is not an employee of the business entity.  Business Entity: includes an entity through which business is conducted with a governmental entity or state agency, regardless of whether the entity is a for-profit or nonprofit entity. Resources: Form 1295 Frequently Asked Questions:  https://www.ethics.state.tx.us/whatsnew/FAQ_Form1295.html Instructional Video – First Time Business User:  https://www.ethics.state.tx.us/filinginfo/videos/Form1295/FirstLogin-Business/Form1295Login-Business.html Instructional Video – How to Create a Certificate:  https://www.ethics.state.tx.us/filinginfo/videos/Form1295/CreateCertificate/CreateCertificate.html https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm https://www.ethics.state.tx.us/whatsnew/FAQ_Form1295.html https://www.ethics.state.tx.us/filinginfo/videos/Form1295/FirstLogin-Business/Form1295Login-Business.html https://www.ethics.state.tx.us/filinginfo/videos/Form1295/CreateCertificate/CreateCertificate.html CERTIFICATE OF INTERESTED PARTIES FORM 1295 Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the goods or services to be provided under the contract. 4 Name of Interested Party City, State, Country (place of business) Nature of Interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct. Signature of authorized agent of contracting business entity AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said , this the day of , 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath ADD ADDITIONAL PAGES AS NECESSARY Form provided by Texas Ethics Commission www.ethics.state.tx.us Adopted 10/5/2015 http://www.ethics.state.tx.us/ Form W-9 (Rev. January 2011) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Name (as shown on your income tax return) Business name/disregarded entity name, if different from above Check appropriate box for federal tax classification (required): Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶ Exempt payee Other (see instructions) ▶ Address (number, street, and apt. or suite no.) Requester’s name and address (optional) City, state, and ZIP code List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Social security number – – Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 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). 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 on page 4. General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners’ share of effectively connected income. Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners’ share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No. 10231X Form W-9 (Rev. 1-2011) Sign Here Signature of U.S. person ▶ Date ▶ P ri n t o r ty p e S e e S p e c if ic I n s tr u c ti o n s o n p a g e 2 . Employer identification number – Form W-9 (Rev. 1-2011) The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: • The U.S. owner of a disregarded entity and not the entity, • The U.S. grantor or other owner of a grantor trust and not the trust, and • The U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person, do not use Form W-9. Instead, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8. What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, 2. You do not certify your TIN when required (see the Part II instructions on page 3 for details), 3. The IRS tells the requester that you furnished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Page 2 Certain payees and payments are exempt from backup withholding. See the instructions below and the separate Instructions for the Requester of Form W-9. Also see Special rules for partnerships on page 1. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Name If you are an individual, you must generally enter the name shown on your income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name. If the account is in joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the form. Sole proprietor. Enter your individual name as shown on your income tax return on the “Name” line. You may enter your business, trade, or “doing business as (DBA)” name on the “Business name/disregarded entity name” line. Partnership, C Corporation, or S Corporation. Enter the entity's name on the “Name” line and any business, trade, or “doing business as (DBA) name” on the “Business name/disregarded entity name” line. Disregarded entity. Enter the owner's name on the “Name” line. The name of the entity entered on the “Name” line should never be a disregarded entity. The name on the “Name” line must be the name shown on the income tax return on which the income will be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a domestic owner, the domestic owner's name is required to be provided on the “Name” line. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the “Business name/disregarded entity name” line. If the owner of the disregarded entity is a foreign person, you must complete an appropriate Form W-8. Note. Check the appropriate box for the federal tax classification of the person whose name is entered on the “Name” line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, Trust/estate). Limited Liability Company (LLC). If the person identified on the “Name” line is an LLC, check the “Limited liability company” box only and enter the appropriate code for the tax classification in the space provided. If you are an LLC that is treated as a partnership for federal tax purposes, enter “P” for partnership. If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter “C” for C corporation or “S” for S corporation. If you are an LLC that is disregarded as an entity separate from its owner under Regulation section 301.7701-3 (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be identified on the “Name” line) is another LLC that is not disregarded for federal tax purposes. If the LLC is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner identified on the “Name” line. Form W-9 (Rev. 1-2011) Other entities. Enter your business name as shown on required federal Part I. Taxpayer Identification Number (TIN) Page 3 tax documents on the “Name” line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the “Business name/ disregarded entity name” line. Exempt Payee If you are exempt from backup withholding, enter your name as described above and check the appropriate box for your status, then check the “Exempt payee” box in the line following the “Business name/ disregarded entity name,” sign and date the form. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding. The following payees are exempt from backup withholding: 1. An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2), 2. The United States or any of its agencies or instrumentalities, 3. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities, 4. A foreign government or any of its political subdivisions, agencies, or instrumentalities, or 5. An international organization or any of its agencies or instrumentalities. Other payees that may be exempt from backup withholding include: 6. A corporation, 7. A foreign central bank of issue, 8. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States, 9. A futures commission merchant registered with the Commodity Futures Trading Commission, 10. A real estate investment trust, 11. An entity registered at all times during the tax year under the Investment Company Act of 1940, 12. A common trust fund operated by a bank under section 584(a), 13. A financial institution, 14. A middleman known in the investment community as a nominee or custodian, or 15. A trust exempt from tax under section 664 or described in section 4947. The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 15. IF the payment is for . . . THEN the payment is exempt for . . . Interest and dividend payments All exempt payees except for 9 Broker transactions Exempt payees 1 through 5 and 7 through 13. Also, C corporations. Barter exchange transactions and patronage dividends Exempt payees 1 through 5 Payments over $600 required to be reported and direct sales over $5,000 1 Generally, exempt payees 1 through 7 2 1 See Form 1099-MISC, Miscellaneous Income, and its instructions. 2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency. Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single-member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on page 2), enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN. Note. See the chart on page 4 for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at www.ssa.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676). If you are asked to complete Form W-9 but do not have a TIN, write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note. Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8. Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, below, and items 4 and 5 on page 4 indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on the “Name” line must sign. Exempt payees, see Exempt Payee on page 3. Signature requirements. Complete the certification as indicated in items 1 through 3, below, and items 4 and 5 on page 4. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. http://www.ssa.gov/ http://www.irs.gov/businesses Form W-9 (Rev. 1-2011) Page 4 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: Give name and SSN of: 1. Individual The individual 2. Two or more individuals (joint account) The actual owner of the account or, if combined funds, the first individual on the account 1 3. Custodian account of a minor (Uniform Gift to Minors Act) The minor 2 4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law The grantor-trustee 1 The actual owner 1 5. Sole proprietorship or disregarded entity owned by an individual The owner 3 6. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulation section 1.671-4(b)(2)(i)(A)) The grantor* For this type of account: Give name and EIN of: 7. Disregarded entity not owned by an individual The owner 8. A valid trust, estate, or pension trust Legal entity 4 9. Corporation or LLC electing corporate status on Form 8832 or Form 2553 The corporation 10. Association, club, religious, charitable, educational, or other tax-exempt organization The organization 11. Partnership or multi-member LLC The partnership 12. A broker or registered nominee The broker or nominee 13. Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments The public entity 14. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation section 1.671-4(b)(2)(i)(B)) The trust 1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished. 2 Circle the minor’s name and furnish the minor’s SSN. 3 You must show your individual name and you may also enter your business or “DBA” name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN. 4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships on page 1. *Note. Grantor also must provide a Form W-9 to trustee of trust. Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance. Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059. Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at: spam@uce.gov or contact them at www.ftc.gov/idtheft or 1-877-IDTHEFT (1-877-438-4338). Visit IRS.gov to learn more about identity theft and how to reduce your risk. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information. mailto:phishing@irs.gov mailto:spam@uce.gov http://www.ftc.gov/idtheft RAYMONDVILLE INDEPENDENT SCHOOL DISTRICT PURCHASING DEPARTMENT DISTRICT WIDE CONSULTANT/SPEAKER RFP #21-038 ACKNOWLEDGEMENT FORM PLEASE MAKE SURE THAT YOU HAVE DONE THE FOLLOWING: 1. YOU MUST COMPLETE AND RETURN THE 2 CFR PART 200, CONFLICT OF INTEREST QUESTIONNAIRE, CERTIFICATE OF INTERESTED PARTIES FORM 1295, CRIMINAL HISTORY INFORMATION REQUEST, THE DPS COMPUTERIZED CRIMINAL HISTORY (CCH) VERIFICATION, FELONY CONVICTION NOTICE AND THE TWO (2) AFFIDAVITS YES NO 2. YOU MUST INCLUDE INSURANCE WITH THE BID (IF REQUIRED) YES NO 3. YOU MUST INCLUDE ANY SAMPLES THAT ARE REQUIRED YES NO 4. YOU MUST INCLUDE ANY STATE CERTIFICATE OR LICENSE YES NO WITH THE BID (IF REQUIRED) 5. YOU MUST VERIFY UNIT PRICE TO TOTAL PRICE YES NO 6. YOU MUST INCLUDE A W-9 IRS FORM YES NO (Downloadable at www.raymondvilleisd.org) 7. IF YOUR COMPANY IS NOT BIDDING ON THIS BID/PROPOSAL, PLEASE STATE THE REASON. Deviations from specifications if any: I have read all the specifications and general bid requirements and do hereby certify that all items submitted meet all specifications, conditions, and instructions of said bid. The signature below confirms that our company will enter into a binding contract with Raymondville I.S.D. for item(s) awarded to our company. Company Name: Agent Name: Print Name: Authorized Signature: Address: City: ST: Zip Code: Telephone: ( ) Fax: ( ) E-mail: Federal Id#: and/or Social Security #: Address for Purchasing Order Address for Payment: Note: Please complete and submit this form with your bid or company will be disqualified. Page 9 of 9