RFQ 2021-03 Air Disinfecting Systems

1 662 South President Street Jackson, MS 39201 Contact Information Project Administrator: Mr. Joseph Albright Telephone: (601) 968-4519 Email: jalbright@jackson.k12.ms.us RFQ Issue Date: August 09, 2021 Submission Deadline and Time: September 02, 2021 @ 10:00 A.M. (Local Prevailing Time) RFQ 2021-03 Name of Proposal: Air Disinfecting Systems PLACE COVER PAGE (16) IN THE FRONT OF PROPOSAL. INSERT PAGE NUMBERS WHEN SUBMITTING ELECTRONIC PROPOSALS VIA EMAIL. SUBMIT RFQ DOCUMENTS IN THE ORIGINAL FORMAT ALONG WITH OTHER SUPPORTING DOCUMENTS ATTACHED TO PROPOSAL AND EMAIL TO jpsrfp@jackson.k12.ms.us Proposals shall be submitted to the Business Office of the Jackson Public School District located at 662 South President Street, Jackson, MS 39201. Sealed proposals shall be delivered to the listed address at any time prior to, but not later than, 10:00 a.m. CST on

September 02, 2021. Proposals received after this time will not be accepted (in the event of hand delivery) or will be returned unopened to the proposer and the proposal will be automatically disqualified from the process. The district is not liable for any costs incurred by proposers in replying to this RFQ. Ree PUBLIC SCHOOLS TTranisforming lives thratigh | lives through excellent education mailto:jalbright@jackson.k12.ms.us mailto:jpsrfp@jackson.k12.ms.us 2 PROPOSAL FORM Board of Trustees Jackson Public School District Jackson, Mississippi Ladies and Gentlemen: I/We, propose to furnish and deliver all items and/or to perform all services according to all sections of this RFQ document (Proposal Form, Instructions and Conditions, detailed written Specifications, and Addendum if applicable) and in the quantities at the indicated prices, as called for in the document(s). All quantities indicated have been checked very closely, and both unit price and total price (where requested) have been submitted with the understanding that we shall be responsible for making complete and satisfactory delivery accordingly, within the time frame agenda (if applicable). All items contained in this RFQ shall be as specified or JPSD approved equal. For any item(s) proposed which is other than as specified, a complete and detailed cut and description for each item(s) must accompany the RFQ, if the item(s) is to be considered. Please carefully read each section of this RFQ. Acceptance of Proposals: The Jackson Public School District reserves the right to: Have sole discretion to waive minor irregularities in proposals. A minor irregularity is a variation from the proposal that does not affect the proposal, or gives one Offeror an advantage or benefit not enjoyed by other Offerors, or adversely impacts the interests of the school district. Accept the "lowest and best" RFQ which in their judgment assures JPSD the product(s) or service(s) having the best performance and the highest level of function, quality and value. Not accept the lowest priced proposal. Proposals that do not comply with the requirements stated within this RFQ or which are submitted after the deadline are subject to disqualification. Request additional information or conduct discussions with one or more respondents after the RFQ deadline, to secure a final selection to award RFQ should such action be in the best interest of JPSD. See Page Five (5) for further instructions I/WE UNDERSTAND AND AGREE THAT NEITHER THE AWARD OF THIS RFQ TO ME/US BY THE DISTRICT'S BOARD OF TRUSTEES NOR RECEIPT BY ME/US OF A NOTICE OF ACCEPTANCE OF THIS RFQ SHALL CONSTITUTE THE MAKING OF A CONTRACT BETWEEN JPSD AND ME/US, WHICH SHALL BE CONDITIONED UPON THE EXECUTION BY BOTH JPSD AND ME/US OF A FORMAL, WRITTEN AGREEMENT. RESPECTFULLY SUBMITTED, COMPANY __________________________________________________________________________________ ADDRESS __________________________________________________________________________________ __________________________________________________________________________________ PHONE ______________________________________ FAX _______________________________________ E-MAIL ADDRESS __________________________________________________________________________________ SIGNED __________________________________________________________________________________ PRINT NAME __________________________________________________________________________________ TITLE __________________________________________________________________________________ DATE ___________________________________________________________________________________ CIRCLE THE OPERATING STATUS OF YOUR BUSINESS AS INDICATED: WOMAN OWNED NON-MINORITY MINORITY 3 Post Office Box 2338 - Jackson, Mississippi 39225-2338 Telephone: 601-960-8799 Fax: 601-960-8967 Email: bjones@jackson.k12.ms.us REQUEST TO ADD VENDOR To be completed by JPS School/Location: School/Department Requesting Vendor Addition ______________________________________ To Be Completed by Vendor: Please complete all sections and return by fax or email. Will your company accept purchase orders? _____Yes _____No Note: An original JPS purchase order is required for all material purchases. Do not accept any order without a purchase order. Are you an employee of the Jackson Public School District? ____Yes or ____No Product Line ___________________________________________________________ PARENT COMPANY NAME: ______________________________________________ Doing Business As (dba) NAME: ___________________________________________ Order Address: _________________________________________________________ City: __________________________ State: ____________ Zip: _______________ Physical Address: ________________________________________________________ City: __________________________ State: ____________ Zip: _______________ REMITTANCE ADDRESS: Vendor Name: __________________________________________________________ Address: _______________________________________________________________ City: ___________________________ State: ______________ Zip: _________ Contact Person: _________________________________________________________ Phone: (_____) _____________________ Fax (_____) __________________ Email Address: __________________________________________________________ Parent Company Tax ID#___________________________________________________ D/B/A Federal Tax ID/Social Security #: _______________________________________ Select One This information will be used to track purchases from minority vendors. Minority Code: _____Woman & Minority _____Minority _____Non-Minority _____Woman Select One Type of Entity _____Individual/Sole Proprietor _____Corporation _____Partnership _____Other ___________ ****JPS accepts no responsibility for orders filled without a valid purchase order**** Submitted By: Signature Date FOR INTERNAL USE ONLY Vendor Number: _____________________ 1099: _____Yes _____No Completed By: _______________________ Date: __________________ Companys W-9 must accompany this form for IRS purposes. Revised 11-08-18 bj JACKSON PUBLIC SCHOOLS Transforming lives through excellent education mailto:bjones@jackson.k12.ms.us 4 The Board of Trustees of the Jackson Public School District (hereafter referred to as "JPSD") is soliciting sealed, written formal RFQ proposals from qualified vendors (hereafter referred to as "Vendor") for the purchase of furniture, equipment, supplies, materials, labor or services as outlined in the following specifications. Sealed RFQs shall be received by JPSD, in the Business Office of the Jackson Public Schools, 662 South President Street, Jackson, Mississippi, until the time specified on the RFQ Opening Schedule (front page of the formal RFQ document), at which time all RFQs shall be publicly opened and read aloud. Neither dating of the RFQ form nor placing the RFQ in the mail by this date shall meet legal requirements; the formal RFQ document must be received in the Business Office of the Jackson Public School District on or before the date and time stated. JPSD reserves the right to reject any and all RFQs received and to waive any and all informalities. Vendors are encouraged to very carefully read all sections of this RFQ document prior to submitting an RFQ proposal. It is the basic philosophy of JPSD to extend to all responsible Vendors equal consideration and the assurance of unbiased judgment in determining whether their product or service meets specifications and the educational needs of the school district. JPSD shall fairly evaluate all formal RFQ proposals submitted and base all decisions on the "lowest and best" RFQ concept, purchasing only those products and/or services which meet the specifications as written. All decisions rendered shall strive to achieve the greatest value from every tax dollar expended. JPSD shall make no discrimination based on race, color, creed, religion, or national origin, in either the product evaluation process or in transacting business with Vendors or Vendor representatives. The advertising and publishing of this RFQ has met all legal requirements (Mississippi Code of 1972, Annotated, 31-7-13), hence the requirement to offer public notice of the intent of JPSD to solicit RFQs via this RFQ document has been satisfied. This document is to serve as an invitation to all qualified vendors to extend to JPSD, an offer, for the sale of all products and/or services specified herein. It is the purpose of this RFQ document to clearly define "open" and "competitive" product or service RFQ specifications. All items on this RFQ are to be as specified or JPSD approved equal. Addendum: Vendor shall acknowledge the receipt of all addendums that may have been during the course of this RFQ. If specified in the text of the addendum, in addition to acknowledging receipt of the addenda below, the addenda may require additional information required for the RFQ (e.g., pricing), in which case the Addendum shall not only be acknowledged below but shall be completed and attached to the RFQ at the time the RFQ proposal is submitted. Receipt of the following Addendum issued during the course of this formal RFQ is hereby acknowledged: Addendum Number Date Addendum Number Date Addendum Number Date It is acknowledged that this RFQ proposal consists of the following sections: PROPOSAL FORM, INSTRUCTIONS AND CONDITIONS, SPECIFICATIONS and any ADDENDUM (if applicable). Net Prices In all cases, prices quoted are to be net including all applicable discounts. A separate price shall be offered for each item and not in combination with other items (unless the grouping of items is otherwise allowed as defined in the specifications). Unit price shall prevail in case of a conflict between unit and total price (extension); written price shall prevail in case of a conflict between written and enumerated pricing. Vendors are instructed to round off all unit pricing and extensions to the nearest whole cent; i.e., round the pricing to two places to the right of the decimal point only. The JPSD mainframe computer database is designed to accept only pricing which is stated in this manner. All items for which pricing is submitted which is other than two places to the right of the decimal shall be accepted; however, all digits beyond a whole cent (more than two places to the right of the decimal) shall be ignored in the RFQ analysis process and the unit price indicated on the purchase order shall be to the nearest whole cent for each item involved. 5 Payment and Invoicing Unless otherwise indicated in the detailed specifications of this RFQ document; JPSD shall make remittance in a single lump sum payment following satisfactory delivery of all items listed on the purchase order or following satisfactory performance (final inspection) of all services as specified in the contract. JPSD remits by "completed purchase order" only; remittance shall not be made upon receipt of partial shipments or performance, or the receipt of invoicing for same, but only after all items included on the purchase order or contained in the contract are delivered and/or satisfied. It is mutually understood that invoices submitted against Multi-Year or Open Purchase Orders, remittances are processed based on the contracted scheduled agreement prior to the purchase order being generated. Only Multi-Year and Open Purchase Orders have multiple invoices received for remittance for payment. Professional Services, materials and other such services; invoices are submitted for payment in intervals following satisfactory delivery of ALL services and /or performance of ALL services indicated in the contracted agreement between said vendor and JPSD for that time period, following inspection if applicable. Default and Delays Upon failure of the Vendor to deliver all of the items ordered or to render service, within the time set or allowed, the successful Vendor shall be considered in default, in which case JPSD reserves the right to terminate the purchase order or contract and to purchase similar supplies, services, or furniture and equipment, on the open market or secure the manufacture, delivery, and installation thereof by contract or otherwise. The Vendor shall be charged with any cost occasioned by JPSD whether said cost is the same as originally accepted or any excess cost. Damage to School Property Any damage or loss to JPSD property as a result of any action by the Vendor in the delivery, execution or performance of any item or service stated in these specifications shall be repaired or replaced to the satisfaction of designated JPSD personnel, at the Vendor's cost, within a reasonable time. Guarantee Each Vendor, by presenting an RFQ under these specifications, binds himself to make positive that all goods are fully up to the standards set by the specifications. Should it be discovered within a reasonable period of time from the date of purchase order or contract that such goods or services are not up to standard, JPSD shall have the right to have such goods or services replaced by others conforming to the standard requirements and the entire expense be borne by the Vendor. The Vendor shall agree to guarantee and warrant all equipment provided as a result of this RFQ for a period equal to the stated guaranty/warranty in the specifications. All such warranties shall provide the coverage as indicated in the specifications. Acceptance and Award of RFQ Proposals The Vendor's RFQ proposal, once submitted and accepted as a valid RFQ by JPSD, shall be deemed by both parties to constitute a legal and binding offer on the part of the Vendor to sell to JPSD as per the terms of the RFQ specifications, all products and/or services contained therein. RFQ proposals are subject to acceptance by JPSD at any time within ninety (90) calendar days following the RFQ opening date. Consequently, all price quotations shall be effective for a minimum of ninety (90) calendar days and a maximum period as indicated in the specifications. All RFQs must be valid for the effective dates stated in the specification, if applicable. Award of contract shall be made to the responsible Vendor whose RFQ, conforming to the specifications, is deemed to be the most advantageous to JPSD, price and all other factors considered. The Vendor acknowledges the right of JPSD to reject the RFQ, in part or in total, if the Vendor fails to submit the data required in the specifications, or if the RFQ is in any way incomplete or irregular. Under no circumstances may a Vendor deliver, install, or perform any service as specified in these specifications without written authorization from JPSD (i.e., a duly issued purchase order or signed contract). All formal RFQ proposals shall be approved by the Board of Trustees prior to the award of the RFQ. The Vendor shall be issued a purchase order document, which shall be deemed acceptance of the RFQ proposal offer made by the Vendor, for all items and/or services approved by the Board of Trustees and awarded as a result of this RFQ. However, if in the opinion of JPSD a contract document is required to 6 authorize the award of the RFQ, Vendor agrees to sign and execute all such contract documents as required in the written specifications. NOTE: If Vendor policy requires that JPSD sign Vendor contract documents, a sample of all such documents shall be included with the RFQ proposal and shall become a part of the Vendor's RFQ proposal. All awards are based on the availability of funding. In the event of a reduction of funds, this award can be rescinded at any time. Grievance Procedure JPSD has adopted a Vendor Grievance Procedure to address and resolve any Vendor grievances or disputes resulting from or arising out of JPSDs RFQ process. If Vendor disagrees with any aspect of the RFQ process, Vendor shall adhere to the following procedure. Vendor shall submit a letter or written statement of protest to the Purchasing Agent, with a copy to the Superintendent, identifying the RFQ, including RFQ number, title, opening date and, if applicable, the item number(s) at issue, and explaining, in detail, the nature of and/or reason(s) for the protest. No verbal protest shall be acknowledged by JPSD. Vendor protests must be received by the Purchasing Agent not later than five (5) business days prior to the date of the Board meeting at which the Board is to act upon the RFQ that is the subject of the protest. A review committee, appointed by the Superintendent, shall evaluate the protest and render a decision expeditiously. The decision of the review committee shall be based on evidence presented by the Vendor, the Purchasing Agent and other appropriate parties, to be determined in the discretion of the committee. In the sole discretion of the committee, the committee may conduct a hearing on Vendors protest. The decision of the review committee shall be submitted to the Superintendent for approval. The protesting Vendor shall be informed, in writing, of the Superintendents decision not later than two (2) business days prior to the date of the Board meeting at which the Board is to act upon the RFQ that is the subject of the protest. The Superintendents decision shall be final unless Vendor appeals such decision to the Board of Trustees. If Vendors wishes to appeal the Superintendents decision, Vendor shall deliver its appeal, in writing, to the Office of the Superintendent not later than 12:00 p.m. on the date of the Board meeting at which the Board is to act upon the RFQ that is the subject of the appeal. Appeals shall be presented to the Board at the meeting at which the Board acts upon the RFQ that is the subject of the appeal and Vendor, upon written request, will be granted up to five (5) minutes to appear and present to the Board at such meeting its protest and/or appeal. After the Board takes final action upon an RFQ, no appeals or protests will be acknowledged by JPSD. The decision of the Board shall be final, subject to Vendor's right to pursue a legal remedy. Submission of RFQ Proposals Instructions if not emailed to the email address listed: Responses, once completed, should be placed in an opaque, sealed envelope On the outside of the envelope, list the companys name/address, RFQ number, title, opening date and addressee information as they appear in the RFQ proposal in order that the response may be accurately delivered and registered upon receipt. A designated official who is a legal representative of the Company must list required signatures where noted prior to submitting sealed proposal. Failure to comply with the above submittal instructions will cause proposals not to be registered or cataloged to appropriate file or received timely. The original documents must be displayed in front of all copies submitted by interested parties. Please submit Original RFQ Documents in the Format Outlined along Six (6) Copies and any Documentation submitted with Proposal when Mailed or Hand Delivered to: Any proposal not received by the stated submission deadline/time will not be considered and/or opened. The proposal will be returned to the vendor at the vendors expense. The District accepts no liability for late submissions due to the actions of the United States Postal Service, Federal Express, United Parcel Service or any other delivery methods. 7 Page (16): Cover page is to be placed on the very front of the vendors submitted proposal. In the event that this page is not displayed when the opening of proposal occurs; it will not be acknowledged or allowed to be presented. Place this page on the very front of the submitted documents. This applies to all submitted proposals whether mailed, hand delivery or electronically emailed. Please submit proposal when mailed or hand delivered to: Jackson Public School District Business Office Attn: Bettie Jones 662 S. President Street Jackson, MS 39201 Or Proposals may be submitted via email to: jpsrfp@jackson.k12.ms.us. No copies are warranted if emailed electronically. Please follow the proposal submittal instructions. PLACE COVER PAGE (16) IN THE FRONT OF PROPOSAL. INSERT PAGE NUMBERS WHEN SUBMITTING ELECTRONIC PROPOSALS VIA EMAIL. SUBMIT RFQ DOCUMENTS IN THE ORIGINAL FORMAT ALONG WITH OTHER SUPPORTING DOCUMENTS ATTACHED TO PROPOSAL AND EMAIL TO jpsrfp@jackson.k12.ms.us Please follow the proposal submittal instructions. mailto:jpsrfp@jackson.k12.ms.us mailto:jpsrfp@jackson.k12.ms.us 8 Proposal Cover Page VENDOR INFORMATION Name and Title _______________________________________________________________________ Company Name________________________________________________Date___________________ SUBMISSION COVER SHEET AND CONFIGURATION SUMMARY By my signature below, I hereby represent that I am authorized to and do bind the offeror to the provisions of the attached proposal. The undersigned offers and agrees to perform the specified personal and professional services in accordance with provisions set forth in the Request for Proposals. Furthermore, the undersigned fully understands and assures compliance with the Conditions of Solicitation and Standard Terms and Conditions contained in the RFQ. The undersigned is fully aware of the evaluation criteria to be utilized in vendor selection for approval. I further certify that ___________________________ is an authorized dealer in good standing of the products/services included in the proposal submitted in response to the RFQ. ______________________________ ______________________ Authorized Signature Date ______________________________ Printed Signature ------------------------------------------------------------------------------------------------------------------------ ------------------ ----------- CONFIGURATION SUMMARY Vendor must provide a summary of the main component of services offered in this proposal using 100 words or less. For all questions regarding RFQ, please see contact information below. Jackson Public School District 101 Dennis Holloway Drive, Jackson, MS 39203 Contact Information: Mr. Joseph Albright Telephone: 601-968-4519 Email: jalbright@jackson.k12.ms.us 9 Proposal for Air Disinfecting Systems Purpose: JPSD is seeking qualified vendors locally and throughout the states that can provide top of- the-line Air Disinfecting Systems that provide a holistic approach to air disinfection through a combination of installed and portable systems to meet the health needs of our school district. We ask that each proposal submitted in response to this request list their qualifications, type of equipment and technology or chemical used and services to disinfect our school building and many various buildings, buses and all vehicles. It is our intent to keep our students, teachers and staff safe from any pathogen sources, including Coronavirus, that could cause harm in any way. Specifications for Air Disinfecting Systems: Jackson Public School District (JPSD) is requesting proposals for a combination of air disinfecting systems that are installed in the HVAC system, either as the HVAC system itself is installed or after the system is installed. Additionally, JPSD seeks air disinfecting systems that can be placed as required in individual rooms and are portable so they can be moved from room to room. These systems would be supported by the same technology as the installed systems. Efficacy of pathogen kill for COVID, influenza, MRSA, Legionella, and various bacteria will be demonstrated through the results of third-party independent testing. Systems must be completely safe in occupied rooms and facilities, without production of secondary toxins or chemicals such as but not all inclusive of ozone or formaldehyde. Systems must be capable of demonstrating effective kill of pathogens in the true definition of disinfecting and not sanitizing. Building Based: System requirement is for a combination of kill of airborne pathogens for the disinfecting of air and the overall improvement of indoor air quality as well as destruction of the biofilm that grows on HVAC components, thereby increasing useful life and efficiency of the systems. As an addition to the HVAC installed systems, but not as a substitution for the HVAC installed systems, portable and installed classroom air disinfecting and purification systems may be proposed. Such systems would combine the same efficacy in pathogen kill as the HVAC installed systems with a high efficiency filtration system not only killing the pathogens but removing them from the air. As with the HVAC installed systems, third party independent testing must be provided to demonstrate not only the efficacy of the pathogen kill feature but also the elimination of particulate from the air. Vehicle Based: A vehicle mounted system specifically for, but not limited to buses, providing the same pathogen kill and air purification also is being sought and so proposals are invited to a vehicle-based system. This system should run on vehicle supplied power and have similar efficacy in both pathogen kill and air purification as the classroom version. The system should have the capability to compensate for the multiple and continuing air changes that would be experienced through the pick-up and discharge of passengers, without significant degradation in the efficacy of either pathogen kill or air purification. This system would be primarily to support our bus fleet which consists of approximately 260 buses, including 45 Pac for our scholars with disabilities and a combination of 64, 72, and 74 Pac buses for the remainder of our scholars. 10 Selection Criteria: Because of the length and design of the ducting for building-based HVAC systems, a combination of solutions may be selected based on the following criteria: Cost of systems and maintenance over a five (5) year cycle (cost proposal should be developed and presented on this basis) Efficacy as demonstrated through independent, third-party testing Ease of installation and maintenance Ability to kill pathogens in ductwork, classrooms, and HVAC components Aging characteristics of system (Does the system lose efficacy at end of life? What is average system life cycle?) Lack of production of ancillary toxins or hazardous chemicals, by-products, etc. Effect of system functioning on textiles, metals, and other materials. Vehicle-based systems will be evaluated on the following criteria: Cost of system and maintenance over a five (5) year cycle (cost proposal should be developed and presented on this basis) Efficacy in killing not only Coronavirus, but also at a minimum influenza, MRSA, SARS, Rhinovirus, and Norovirus as verified by independent, third-party testing Lack of production of ancillary toxins or hazardous chemicals, by-products, etc. Effect of system functioning on textiles, metals, and other materials Ease of installation and maintenance Experience: Vendor shall provide a list of three (3) projects of similar type, size and complexity. State project (customer) name, description of work, dollar value, public entity, yes or no, and date using the format below. Projects listed must have been performed within the last five (2) years. Please include additional information with proposal if available. Project 1: Project 2: Project 3: 11 References: Proposal shall provide three (3) references letters from company owners or management personnel. REFERENCE #1 Company Name Project Name Contact Person Name Title Email Phone REFERENCE #2 Company Name Project Name Contact Person Name Title Email Phone REFERENCE #3 Company Name Project Name Contact Person Name Title Email Phone 12 Certifications: Employees certifications pertaining to work are to be included in submittal. COSTING FORMAT Costing should be based on each type of equipment offered with a standard installation cost identified. The standard installation cost should be based on what would be required to install the specific piece of equipment at least 90% of the time. As an example, if the Vendor offers a drop-in ceiling style product, the removal of a standard ceiling panel, the wiring into an existing circuit, testing with a remote device or wiring to an existing switch should all be without major modifications to existing electrical circuits or ceiling grids. For transportation assets, the installation should be a straightforward mounting of the brackets and system and wiring into an available electrical block on the console or the installation into the circuits controlled by the ignition switch such that the system is not operational when the ignition is turned off. No major modifications to the electrical panel or specially fabricated attachments for the system would be required for a standard installation. Costing can be provided as a listing by equipment type or a catalogue or any similar format. Cost Analysis Summary Description of Equipment Used to perform Work Disinfectant Technology or Chemical Used Cost $ $ $ Total $ 13 ASSURANCES AND SIGNATURE FORM In submitting this application, I certify that: 1. The organization will comply with applicable federal, state, and local policies and procedures. 2. Services will be provided under the supervision of highly qualified teachers and/or administrators.* 3. The organization will maintain professionalism and confidentiality. 4. The organization is fiscally sound and will be able to complete services to the local educational agency. 5. The organization will ensure that the services provided are aligned the Mississippi Curriculum Frameworks and scientifically research based practices.* 6. The organization will comply with applicable federal, state, and local health, safety, and civil rights laws. 7. Provisions that subject all individuals employed by or otherwise associated with the approved provider, including volunteers, support staff, etc., who have direct contact with students, to the fingerprint and criminal history record check contained in law, including, Education Laws 305(30), 1125(3), 1604(39), 1604(40), 1709(39), 1709(40), 1804(9), 1804(10), 1950(4)(11), 1950(4)(mm), 2503 (18), 2503(19), 2554(25), 2554(26, 2590-h (20), 2854(3)(a-2), 2854(3)(a-3), and 3035. 8. All services will be secular, neutral, and non-ideological. 9. The organization will provide the local educational agency with information regarding implementation of proposal initiatives in increasing achievement, in a format, and to the extent practicable, a language or other mode of communication such that district personnel, parents / legal guardians, and community members can understand.* The undersigned hereby certifies that I am an individual authorized to act on behalf of the organization in submitting this application and assurances. I certify that all of the information provided herein is true and accurate, to the best of my knowledge. I understand that the discovery of deliberately misrepresented information contained herein may constitute grounds for denying the applicants request for approval. Name of Organization Printed Name of Authorized Representative Signature of Authorized Representative Date Signed *For Educational/Instructional proposals 14 INDEPENDENT CONTRACTOR DEBARMENT VERIFICATION FORM (Please print clearly or type) **Appropriate signatures shall certify statements below. FEDERAL DEBARMENT CERTIFICATION: CONTRACTOR hereby certifies that at the execution of a contract with the Jackson Public School District (JPS) that the CONTRACTOR is not on the list for federal debarment on www.sam.gov System for Award Management. STATE OF MISSISSIPPI REGISTRATION: CONTRACTOR hereby certifies that at the execution of a contract with the Jackson Public School District (JPS) that the CONTRACTOR is not on the list for debarment on www.sos.ms.gov for doing business with the State of Mississippi or with any Mississippi State Agency. PARTNERSHIP DEBARMENT CERTIFICATION: CONTRACTOR hereby certify that all entities who are in partnership through this contract or grant with the Jackson Public School District (JPS) (subcontractors, subrecipients, et al.) are not on the federal debarment list on www.sam.gov System for Award Management or the State of Mississippi debarment list. Proof of documentation of partnership verification with SAM shall be kept on file and the debarment status shall be checked prior to submission of every contract/subgrant and modification to JPS. ________________________________________ ________________________ Original Signature of Contractor or Authorized Official Date Subgrantees/Contractors Name Authorized Officials Name Complete Address Contact Number Are you currently registered to do business in the State of Mississippi? (Yes or No) If yes, attach supporting documentation of registration status. If, no please register and provide documentation of registration status. (State/Other fund requirement) JACKSON PUBLIC SCHOOLS Transforming lives through excellent education http://www.sam.gov/ http://www.sos.ms.gov/ 15 INDEPENDENT CONTRACTOR DEBARMENT VERIFICATION FORM* (Please print clearly or type) **Appropriate signatures shall certify statements below. FEDERAL DEBARMENT CERTIFICATION: CONTRACTOR hereby certifies that at the execution of a contract with the Jackson Public School District (JPS), that the CONTRACTOR is not on the list for federal debarment on www.sam.gov System for Award Management. STATE OF MISSISSIPPI REGISTRATION: CONTRACTOR hereby certifies that at the execution of a contract with the Jackson Public School District (JPS) that the CONTRACTOR is not on the list for debarment on www.sos.ms.gov for doing business with the State of Mississippi or with any Mississippi State Agency. PARTNERSHIP DEBARMENT CERTIFICATION: CONTRACTOR hereby certifies that all entities who are in partnership through this contract or grant with the Jackson Public School District (JPS) (subcontractors, subrecipients, et al.) are not on the federal debarment list on www.sam.gov System for Award Management or the State of Mississippi debarment list. Proof of documentation of partnership verification with SAM shall be kept on file and the debarment status shall be checked prior to submission of every contract/subgrant and modification to JPS. _________________________________________________ __________________________________ Original Signature of Contractor or Authorized Official Date Subgrantees/Contractors Name Authorized Officials Name Complete Address Contact Number Are you currently registered with www.sam.gov (Yes or No) If yes, attach supporting documentation and DUNS number must be Active with open access. (Federal fund requirement) Are you currently registered to do business in the State of Mississippi? (Yes or No) If yes, attach supporting documentation of registration status. If not, please register and provide documentation of registration status. (Federal and State/Other fund requirement) JACKSON PUBLIC SCHOOLS Transforming lives through excellent education http://www.sam.gov/ http://www.sos.ms.gov/ http://www.sam.gov/ 16 Jackson Public School District 662 South President Street Jackson, MS 39201 RFQ Proposal #_________ RFQ Title ________________________________________________________________ ________________________________________________________________________ Submission Deadline Date and Time: __________________________________________ Participating Vendor Name__________________________________________________ Address_________________________________________________________________ Hand written Signature_____________________________________________________ Addendums Acknowledge Yes_________ or No_________ Combined Proposal Total Cost _______________________ This cover page is to be placed on the very front of the vendors submitted proposal. In the event that this page is not displayed when the deadline opening date occurs; it will not be acknowledged or allowed to be presented. Place this page on the very front of the submitted documents. This applies to all submitted proposals weather mailed, hand delivery or electronically emailed. Lo! JACKSON PUBLIC SCHOOLS