06042315 - Page 2 of 5

Date Subject Message

02/02/15 PDF Files All PDF files are Fillable PDF Forms. You have to download the file to your computer, fill out the form, savethe form, and upload the form to the "response attachments" section.

If a signature is required you have to fill out the form, print the form, sign the form, scan the form, andupload the form to the "response attachments" section.

Please review the following and respond where necessary

# Name Note Response

1 Yes - No Disadvantaged/Minority/Women Business Enterprise - NoD/M/WBE (Required by some participating governmentalentities) Vendor certifies that their firm is a D/M/WBE?Vendor must upload proof of certification to the ”ResponseAttachments” D/M/WBE CERTIFICATES section.

2 Yes - No Highly Underutilized Business - HUB (Required by some Noparticipating governmental entities) Vendor certifies thattheir firm is a HUB? Vendor must upload proof ofcertification to the ”Response Attachments” HUBCERTIFICATES section.

3 Yes - No Certification of Residency (Required by the State of NoTexas) Company submitting bid is a Texas residentbidder?

4 Company Residence (City) Vendor's principal place of business is in the city of? Springdale, Arkansas

5 Company Residence (State) Vendor's principal place of business is in the state of? Arkansas

6 Felony Conviction Notice: (Required by the State of Texas) My firm is, as outlined on (No Response Required)PAGE 5 in the Instructions to Bidders document:(Questions 7 - 9)

7 Yes - No A publicly held corporation; therefore, this reporting Norequirement is not applicable?

8 Yes - No Is not owned or operated by anyone who has been Yesconvicted of a felony?

9 Yes - No Is owned or operated by individual(s) who has/have been Noconvicted of a felony? If answer is YES, a detailedexplanation of the name(s) and conviction(s) must beuploaded to the ”Response Attachments” FELONYCONVICTION section.

10 Pricing Information: Pricing information section. (Questions 11 - 14) (No Response Required)

11 Yes - No In addition to the typical unit pricing furnished herein, the YesVendor agrees to furnish all current and future products atprices that are proportionate to Dealer Pricing. If answer isNO, include a statement detailing how pricing for TIPSparticipants would be calculated in the PRICING documentthat is uploaded to the ”Response Attachments” PRICINGsection.

12 Yes - No Pricing submitted includes the 2% TIPS participation fee? Yes

13 Yes - No Vendor agrees to remit to TIPS the required 2% Yesparticipation fee?

14 Yes - No Additional discounts to TIPS members for bulk quantities Yesor scope of work?

06042315 - Page 3 of 5

15 Start Time Average start time after receipt of customer order is ____ 7working days?

16 Years Experience Company years experience in this category? 11

17 Yes - No The Vendor can provide services and/or products to all 50 NoUS States?

18 States Served: If answer is NO to question #17, please list which states Arkansas, Missouri, Kansascan be served. (Example: AR, OK, TX)

19 Company and/or Product Description: This information will appear on the TIPS website in the Professional Cabling Solutions LLCcompany profile section, if awarded a TIPS contract. (Limit specializes in the consultation,750 characters.) design, installation and protection of

fiber, copper and equipment for yourdata, telecommunication and IPsecurity systems. We specialize inSchool Districts.

20 Resellers: Does the vendor have resellers that it will name under this Nocontract? (If applicable, vendor should download theReseller/Dealers spreadsheet from the Attachmentssection, fill out the form and submit the document in the”Response Attachments” RESELLERS section.

21 Primary Contact Name Primary Contact Name Heath Bowerman

22 Primary Contact Title Primary Contact Title Operations Manager

23 Primary Contact Email Primary Contact Email sales@professionalcabling.com

24 Primary Contact Phone Primary Contact Phone - Format (xxx) xxx-xxxx 479-750-0699

25 Primary Contact Fax Primary Contact Fax - Format (xxx) xxx-xxxx 479-750-0689

26 Primary Contact Mobile Primary Contact Mobile- Format (xxx) xxx-xxxx 479-601-2361

27 Secondary Contact Name Secondary Contact Name Heather Bowerman

28 Secondary Contact Title Secondary Contact Title Office Manager

29 Secondary Contact Email Secondary Contact Email heather@professionalcabling.com

30 Secondary Contact Phone Secondary Contact Phone - Format (xxx) xxx-xxxx 479-750-0699

31 Secondary Contact Fax Secondary Contact Fax - Format (xxx) xxx-xxxx 479-750-0689

32 Secondary Contact Mobile Secondary Contact Mobile - Format (xxx) xxx-xxxx

33 2% Contact Name 2% Contact Name Heather Bowerman

34 2% Contact Email 2% Contact Email heather@professionalcabling.com

35 2% Contact Phone 2% Contact Phone - Format (xxx) xxx-xxxx 479-750-0699

36 Purchase Order Contact: This person is responsible for receiving Purchase Orders (No Response Required)from TIPS. (Questions 37 - 39)

37 Purchase Order Contact Name Purchase Order Contact Name Heath Bowerman

38 Purchase Order Contact Email Purchase Order Contact Email heath@professionalcabling.com

39 Purchase Order Contact Phone Purchase Order Contact Phone - Format (xxx) xxx-xxxx 479-750-0699

40 Company Website Company Website www.professionalcabling.com

06042315 - Page 4 of 5

41 Federal ID Number: Federal ID Number also known as the EmployerIdentification Number.

42 Primary Address Primary Address 255 Moore Ave

43 Primary Address City Primary Address City Hindsville

44 Primary Address State Primary Address State Arkansas

45 Primary Address Zip Primary Address Zip 72738

46 Search Words: Please list search words to be posted in the TIPS Security, IP cameras, IP accessdatabase about your company that TIPS website users control, AXIS, Vivotek, Nuuo, titan,might search. Words may be product names, Hikvision, Exaqvision, Cameras,manufacturers, or other words associated with the NVRs, badges, swipes, motions,category of award. YOU MAY NOT LIST PIRsNON-CATEGORY ITEMS. (Limit 500 words) (Format:product, paper, construction, manufacturer name, etc.)

47 Yes - No Do you wish to be eligible to participate in a TIPS contract Yesin which a TIPS member utilizes federal funds on contractsexceeding $100,000? (Non-Construction) (If YES, vendorshould download the Federal Funds Over $100,000Certification document from the Attachments section, fillout the form and submit the document in the ”ResponseAttachments” FEDERAL FUNDS section.) (Vendor mustalso download the Suspension or Debarment Certificatedocument from the Attachments section, fill out the formand submit the document in the ”Response Attachments”SUSPENSION OR DEBARMENT section.)

ron－Constl・uCtIOnFederaiCertlficiltiollS

ProvISlOnSfbrpurchasewithfbderalfundsH）rCOntraCtSeXCeCding＄100，000

Thcseformsarcfbrnon－COnStruCtioncontracts

／†anyTIPSmembers（granteesandsub－granteeS）purchasegoodsandserviceswithfederalnulds．

Vhenamemberengagesacontractexceeding＄100，000andpaidwithfede一・alfmds再rOVisiollSa一・e

イlggeredby、′ariousCodeofFederalRegulationsreqLllrementS・Prilllarily34CFR80・36n・Omthe

）epartmentofEducationand7CFR3015＆3016をomtheDepartmentofAgricu血rek）1・School

JmlChPl・Ogram・TheremaybeotherFedel－alprogramsHomtimctotimethatal・el10teIlumerated

bovethatmavfmdcertainprq〕eCtSuSlngOutSidevendors・ThesearenotoptlOnalfbl・tlleCOntraetmg

ntityandinol・dertospendthefederal餌ldscertainprovisionandcertificationsmustbeinplaceto

nsurelegalconlPliance．

tlyoucompanywishesLObeeligibletoparticIPateinaTIPScontractinwhichamembel・utilizes

記era皿ndsoncontractsexceeding＄100，000，yOumLlStCOmPletetheft）。oWringfbrmscanp一・〇Vlde

leCertlficationsasrequiredonthesubsequentpages・

）OyoLlWjshLobeeligibletoparticIPateinaTTPScontractiTIWhichamenlbe…tilizesfederalfunds

inCOntraCtSeXCeeding＄100，000？

ⅢeckyOurreSPOnSe？

′ES囲　NO□

雑言二一一肩紐一間圏闘　病団間国四国Lttachtothisp‘ZgeaCurY・enlW9jbrm

’leでtSeCO′ry，letethejbl・lnSbelow

1〕agelof6

！ロL帖c航b時⊂Om申ny，En†e川etaxciass橘胎ntC＝C

Note・F0－85ineieLmemberLLC曜日sc庫朝地ed，cQi′○

□ctner（See晶S間CtのnS号

sAdαess（numbeらS陸e吊ndapLOr刑場ilC．）

㌍55MooreAve ��（ eC∴言 Hindsv 7日t �lie，Arkansas72738 　1 �

Taxpayerldentification NumbermN）

日日■‘当JHi〕Yi白こい■＝〕〕人　用c∴日日ヽト母UViUeO「nUSlmaICn時e nBmegNenOniinel：oaY○【d

b組哩、VithhoidingFcr潮＞（dua－5回sISgeneTalyyourscc融sec面ynumber（SSN）HoweVer，fora

reS俄ntalieniSOteproprktor・OrdsregaTdoden時SeethePar川nstructtonsonpa983．Foro廟

entitIeSiitiSyoL一制Pioyeridei、冊ation冊mber（E岬ifyoudonothavea刷mber，SeeHowtogo†a

nNonpaSe3

Sociei8eCUmynUmbor

□ロー［□剛詰CCU帖morethan。ne時Seetheins剛S・。r両dthechan。噂岬。「璽堅牢雪空雪空≡≡∃gUide周eSOnlVhcsenJInb9日Oent圭子

Ce南fication

Unoerpe欄間esofpe世甲，【C師事hat

1Thenumbersho囲OnthISlormiSmyCOrreCttaxpayor軸riCatiOn…t，er｛oriam剛ngforanumbertobelSSuedtome），酬d

2iarnno（叫ECttobackupwithho鴫becaUSe（a）iamexemptfrombacKuPWItIli、。剛胆（b冊venotOee…Oti楠by－hehtornaIRe剛Je

SerYiCetJRS冊tiamsubjeC仁Obac両面冊oidhgasarcs岨○（ataihretoreporta帖ereStOr帥qendscr（C）仙RShasnolifiedmeけ旭日am

nOIoncerSUbJeCitobac…PW冊Oidi博and

3I三下一台US帥zenorotherUS pers即（de†一nedbebwj，arl0

4lleFATCACCLdeIS）enteredcnthsiorm陸ny））ndhCat町中IatIamexemptfromFATCArepc両ngiscorreCt

Ce捕cati°ninstrucdons・You爪UStCirOSSOu出em2aboVOlfyo］haVebeennctifiedbyheIRS凪yeJarecuTren恒bJeCttCbac両川・lit剛cing

becaJSeyOUhave摘Itoreport紺nterestam棚endson〉OUrtaXreturnForrea－esta帥ansactFCnS・iterT12doesnctappiyFcrmort9age

I南stpaId・aCqUiSi剛0rabandcmentOfsecuredpropehy・CanCe冊onofdebt・COntr面，OnStOanlnOiV軸retH－8mentarTanOeme回RA）飢d

genJeraIiy悌yrTenlsotherthall両restartddividends）yOUarenO白equireO一〇signthece航atorlibu事UrTlLiS巾roVkrc）rOUrCOrreCtTiNSee・he

in気ructiOnSOnPage3

詑⊥遺　し上記イ二毒二人／－ �。。．。。訪高手 � GeneraiInstructions　　　　　　　　　　　　　　　．F。rrTli098〈h �。m川。「騨叫左目。－‘8＿的∪柚i。a �

∴∴∴∴∴「∴∴∴∴∴「∴ �ほCqUis屈。nCはbanccnmとn一〇′S∝雄dPt �“・Oerry） PurposeofForm

柄n…id…icren叫（Fo…持greques一画whoiS鳩qJ栂dtc割eal鴫rmaわn

r鉦′i‾＼画時雨…8・○地nyoc・cor麟‥部的orLCon冊訊0…UmDげriN〉

…iChmSybeyours00ais期間ynuinber（SSNI，ndMduB＝axpa的Iide柄ぐ却On′「Lmb叫丁時ad口的∩鰭XPeyer舶nti他tio…Umber（AT時DremPioyQr

de酬CiItl0nnL，母er一訓〉itOrePOrtOnarlint。rrna－iOnretUrrr母amo面Pilidlo

yOUierOlトしき●帥0両repchabieo…n河曲的∩融Urn Exam函30日nIcrin訓°∩－¢山nsinC血delbuはr帥〇日mile小0言heIo臨叫

．Fo…日時9iNT伸BreSi紺nedorPa，d）

●Fo…1099・〇回d囲encs－nCU的9倍。Se的爪的丸さOrmJ時Iunds）

●「°佃109帥・1ほC〈脚eUSt輝S。11irCOmc師ZeSlBWe－ds．0rgrCSSPr°cceoSI

◆ro両腕一日（5時korm面河10紺es掴CertainO冊子南端CtlC鴫by

i、rGkeIと，）

“FormlO99－S〈prCCeeds五〇m胡座温色・rSngaCtiOns）

●Fc′i正09㌢K時（証nrcarOairdlhird函甲e・、iJOrkta醐C的nsI

UseF。rl浩一9。niy時eL一鵡aUS諦IS升目inC山的garCSi筆画eiierlte

Pr℃－ideYOUrC°rreCiT周

IU。Ud。nOtOlUrTIForn7W－9LoU76reqLJeS（erW航aTN．YCも周／gntbe九℃leC〔

！。backuDuIl謝0悌ng SeeWh8I′S批両州加Qldinヨ？cn【982

By的日日glhe細ed一閃－lcrn。yOu

lCe噂柚（heT周yo…rBeM9－3帥reC時ycuarc周1－時‖or…UmbeT

bbeiSSUed）I

Z Ce函ythatycJarenClsubjcdtooackupw冊抽rg，Or

3棚mex叩p（i〇両「。mbackJPi′′il柚d里日直…reaUSc即時ayEeil

8P弾的eiyOJarOais。C評yinglhataSaUS匹rS°∩，y°UrarLoc油eshGeq・

a一「yPart的「SrliPinCOme†ron、aUS tradeCrbL帥OSS琶〇°はUbec‖°the

W冊oid川gt激8nici・e唱n ar，ner9isharocre杵ec囲YCOr・鵬記dinCOmean。

4Cert中国“ATCA的つ的er厨的。同hsl〇・両1ar、y川北3－in白油you日子。

Ⅸemが五〇←画eFATCArepor（時iSC抑ECtSee′・／傭「ふFATCAie諦i・｛g73r

Pdee2わrル「小さ［川舟m訓iOIl

Cat Ncl0231X F抑IW－9両11220時

Ton－ConstmCtiQn FederalCerLiricatlOnS

Le創IIColnn晶In00

ItlStheproposmgcompany●sdut）′andrcsponsib凧ytohaveknowIcdgcofandberesponsibleforthC

COmPliancewlthallapplicablelaws・rulesandregulationsastheyapplytolhisprocurementproeess州dany

Subsequentaward mevendoragreestocomply，1日allrelevantrcspects．withallFederal，State，andLOCallaWS、

…lesandregulation買elatedtotheperlbmameofservicesorsup函′0rgOOdstoTPSorTHSmembers，

Does、′endoragree？YES上玉＿mtialofAuthorizedCompanyO鮪clal

Non－CollusivcBiddin鍍Ccrtiricate

Bvsubmittmgaproposal…reSPOnSetOaRequestfbrProposalsorotherprocurementdcvICeCOntalningthis

Clause，yOuCCrtiDthatyouareauthorizedLOCeltiかtothefbllov月ng

I）　ThisbidorproposalhasbeeIlindcpcnden時arrivedatwithoutcoliuslOnWi皿an）rOthcrBIdderorwLtll

anyCompetitor，

2）　Thisbldor．proposalhasnotbcenknowlnglydiseloscdandwlllnotbeknowlnglyd－Selosed証Or

tothcopenlngOfbidstOrPrOPOSalsfbrthisproJeCt，tOanyOtherBiddcrlCompeutororpotcntial

COmpetit。「・

3）　NoattemptllaSbeenorwlllbemadetoinduccan〉′OtherpelSOn，PartnCrShiPOTCOrPOJat10ntO

Submitorr10Ltosubmltabldorproposal；

4）　Thepersonslgning皿sbidorproposalcertlfiesthathehas…yin知IllCdhlmSelfregardingthe

accuracyr0川estatementscoTltainedinthiscert血atlOn，mdunderthepenaltiesbelng

applieabletotheB⊥dderaswrellastothcpersonslgmnglnltSbeha廿

Thevendorcomplled、Vith＃1血ough4above？YESj遼InltialofAuthorizedCompanyO締高al

SUSPENSJONORDEBARMENTCERTIFICATE

Non－Federalcntltiesal・ePrOh⊥blted廿omcontractlngWithormakingsub－a、Vardsulldercoヽreredlransactionsto

Partiesthatare…SPendedordebarredorWhoscprlnelr）aisarestlSPCndcd。一・debarred．CovcredL1－allSaCtions

lnClし直pr（〕CLLrelllentlも一・g00dsorsel・、icesequaltoorinexcessofSlOOlOOOOO Contractors1－eCel高g

mdi、／1dualaWu．d高一．＄25・000000日110reandallsLIb－reelPjelltSmuStCert1年hattheorganlZat10mmdits

PrlnCIPaLsarel10tSuSPCndedol・debarred．

YoLICertlB，thatnosuspensionordisbarmentisinplace、WlllChwollldprccltIde一・eCei、rlngafedera凧Irulded

COntraCtしIndcrtheFederalOMB，A－102，COmmOnrLIles

TlleVendorhasnotbee－ldebarred？YESL包InitialofAuthorizedCompan）′0臨地

Page20re

「011－CorlStrLietionFederaiClertlfications

CertCicafionRegal・‘iingLobbl，ing

ApplieabletoGrilntS，Subgrants・CooperativcAgreements，andContractsExcceding

＄100，000inFedcraJFunds

SubmlSSl‘）一10ftllisceI一肌ationlSaPrereqLllSltelbrmaklngOrenterlnglntOthistrans面onandlSinlPOSedbvsec血1

1352出le31・US・Code・ThlSCeltiHcationi8amaterialI－ePreSentat10nO悔tupon、VhjchrellanC…raSl〕1aced、症en

tlllStrt…SaCtio…TaSllladeorenteredintoAllyPerSOn、Vho制stonletllereqmC。じert誼catlOnS剛besublCCL的a

C期lpena時ofnotlessLhan

＄10、000andnotmorcthanSlOO，000Lbreachsuellfhllure

ThcundeISlgnedcertiEes・tOthebestofhisorherknowledgeandbelIe買hat

（1）NoFcde1－4taPPrOPrlatedfundsha、′ebeenpaldorwillbepaldb）・OrOnbe－1alfoftheunderslgned，tOall）中一細

101両lLlCnelllgOratten1回lgtOinflue－lCeanOfHceroremplo｝′eeOfanyagenc，「，aMcmberofCollgreSS，allOmCe1－Or

e－llPloyceol、congrcss…anemPloyeeofaMcmberofCongressinconnccti。n、AIitl－thea、畑dingofaFedelalcontl項．

tllenlakingofaFcdel－aIgrant巾emakingofaFederalIoan・theenterlnglntOaCOOPerativcag一・eement，andLhe

eXtellSLOTT・COntinuat”n，renCWaLamendme時01・modificationofaFederalcontl・aCt・grant」oan，OrCOOPelative

（2）lfanyfulldsotherthanFederalapp一・OPriatedfLmdshavebcenpaidorwlllbepaldtoanypersonforinLlLIenCingm－

allemptlngtOi－lnuenCean。航el・Oremployeeofan｝′agency，aMembcrof・C0－1greSS，anOmCerOl・elllPloyeeof

COng一一eSSフ0⊥・anemployeeofaMembcl・oL、Congressi】lCOllneCtlOIIWthtllisFederal醐ntOreOOPelatLVCagl・eelll叫

tlleunde⊥・Slglledshallcom函eandsubmitStandardForm－LLI∴・disc⊥osLIreFormtoReportLobb⊥ng，当naccord紬Ce

高tllltSlrlSLruCtions

（3月TlleLInderslgnedsllallrcqulrethatthclanguageoftlliscertincatlOnbeincludedilltheawarddocuncnts宜）1all

COVeI－Cdsubav・mdsexceedmgS100，0001mFederalfmdsatallappropriatetiersandtllatallsLIbI－eelPlentSSrla‖〔e一時

aIlddlSeloseaccoI－dlnglyi

ー鮭缶些出生＿＿NameO†0－－ga111ZatIOrl

喜一一一一面魂一一一一＿＿

園面圏藷浬国璽市議をニ－ー

Page30で16

Provisionsforpurchascwithfcderalfundsfbrc0－1traCtSCXCCCdin鍍SlOOI000

FcderaiRule（1）Administrntive，eOntraCtual，OrlcgalrcmcdiesininstaIICCSW・hcrc

COntraCtOI・SViolatcorbI・eaCheontractterms・andI）rOVidelbrsuehsl－nCtionsandpcn掴Cs

asmaybeapPrOpriate・（Contr批tSmOrCthanthcsimT71iIicdacquisitionthrcshoid）

Notice：PtlrSuallttOFederalRtlle（1）abo、′e辛hellftderalmds・LreeXPendedby

TIPSMember，TIPSMcmbe口eSerVeSallrlglltSandprivllcgesL1－ldel・tlle

applicablelaWSandreglllati0－15Withrespcctto砧sprocurcmenllnthee、・entof・

breachofcontracLb、reitherparty・

Does、′endoragl・eer）YES＿］4＿＿InILIalofAllthorlZedCompanyO描。1al

FcderaLRule（2）1’crmiIlationforcauseandft，reOnVenicnccbythcgrantceorsubgrantec

ineludingthcmannerb〉’、hiehitwiILbcerrcctcdandtllCbasisMrscttlemcnl，（All

eontractsinexecssofS10，01用）

Pu一”SuanttOl：ederalRule（2）abo、C，V・▼henfedcra同mdsal・eCXPClldedbyTIPS

Member∴HPSMemberrescrvesLherighttotel・minateanyagree－Tlentinexcess（〕r

SlO，000resultlng帥nth⊥SPrOCLlre－TlentPl・OCeSSLb一・eauSCaHerg問ngthe、TClldor

洲aPPrOPrlateOPPOl’tunlt）′alldupto30dayS，tocul・etlleCauSalbl・eaChoftemlS

andcondillOnS・TIP V耀lnberrescrveslherighttotemllllateanyagreemeI－tin

CXCeSSOf＄10・000resulting丘om帖sprocL一rCITle－ltPl・OCeSSfb1－COnVeniencewltl1

30davsnoticeinwl・itlngtOtheaWardedvcndor Anvawardullderthis

P】‾OCuremCntPrOCeSSisnotexclusiveandtlleDistrictrescr、reSthel・ightto

P…Chasegoodsa，ldsel・、rlCCSLiomotherヽ，Cndol・SlThenltislnLhebestllltereStOf

D・）eSVendorag一一cc？YES祐Initial。fA。ut．。riz。dC。11．PanyOfi。i。I

I・le（leImRulc（7）Notiecofaw・ardingagency・rCquirclnentS…｛汗gulal高｝nSPC面ningto

reporting．

PursuanttoFederalRLIle（7）abovc，Whenfederalrundsal・eeXPendedbyTIPS

Member，TIPSMeTTlberreqLIlreSulattheproposercertlBTtllatduriIlgtlletermOf

anawardb、当山eTIPSMemberresLlltlng丑Omthispi－OCL一rementP1－0eeSStllC、Tendor

Willprovldereportsalld〔bcLlmentaLiollreqLllredbyallappllCablela、掴ndstate

andfcderallegulationsuponrcquestb〉′thcTTPSMembcroran）・・relevantstateof

federalagency．

Does、′endoragree？YES424＿IllltialofALlth。．uedC。mPan〉IO織。i。l

FcdcI・aiRule（8）Noliccof“a、Yal・dingagencyrcquirelnCntSaI一‘ll・Cguliltjonsperlajningto

PatCntright wwithI・eSI”ettOanvdiscoveryorimrCntion、▼′hieha．risesoris。C、′0－opedinthc

。OurSeOrorundei・SuCheoIltraCt．

I〕鴨e40f6

聖蓮哩吐哩畦型畦畦畦吐型趣PLlrSuanttoFedcralRule（8）above直enfederalfundsareexpendedby′TIPS

Membcr，TIPSMelllbershauaddressanyrequlrementsandl・egulat10nSPertamng

tOpatentrightswidlrespecttoan｝・discoveryorinve－ltionwllicllarlSeSOris

developedjntIleCOurSeOforundersuchcontractmthecontractdoctImentalld

absentlanguagetotheconLraryorlfthecontractsilentonthesu勘tlleDIStl－ict

retains拙rlgIltS庇reto．

Doesvendoragl’ee？YES也＿InitlalofALltl．。riz。dC。ml，ally。士航

Feder油uic（9）Awar。jngagencyrcquirementsandrcgulatjonspcrtniningfoeop幽liS

PursLIallttOFederalRulc（9）aboveJVheTmdera…ndsareexpendedbyrrTPS

MemberTIPSMemberrequIreStheproposercerti8両latduringthetel・mofall

aWardbytheTIPSMbmbcrresultl1－gLbrthispI－OCul・emelltPrOCeSSthel，endorlVlll

Su】・一enderuponrequcsLanyeop）′1・lghledmateria－sowl－ledby′thel、IPSMembel・but

usedjntheavlmdedcontractperfbrmanceし1－1les油herv，lSeagI－eedillaWitten

doeumntbvthepal・ties・rTTPSMembe‥eservesthellglltStOalldatacreatedor

P一一OVidedtotJIC、rendo血thcpurposeof、contractpelhmaneeresultlllgforthm

PrOCLlrenlen申OeeSSandthc、・endol・W用言皿endersuc～ldatauponrcquestutl」ess

（庇r高eagrcedinLtWrlLtendocume1時′tllePartleS・meco血actlSSilelltOl－

rlOtdispositil／COntJleSL喧ct】mtte一・dataol・Copyrlg－1tSTTPSMelllbel・retalll判

rIg1両inthed的dc、Telopedorgatlleredd…gtheco山一aCtterm

Does、パHldor型C？YES塑I－litlalofAuth。riz。dC。mp。n，。fh。，。⊥

Fcdcramulc（10）Acecssbythcgrantc時subgrante時Fcdcralgrantorag”DCythc

ComptrollerGeneraiofthcUnitedStat臓㍉Oranyol・theirdttIYauth。rizcdrcpI・CSCntatiYCS

tOan｝・books，doeumcnts仰CrS，andrceordsofthccontract（小冊larCdircctIy

Pertinenttothatspccmecontractfbrlhcpurposeofmilkingaudit・cmmimtioI時C申S，

andtr州Seriptions．

Pu一一SLIanttoFederalRule（9）abo、′e同lenfderalfLmdsa一一eeXPe－1dcdbyTIPS

Member・11rPSMembcrre岬eSttlePrOPOSerCe噂thatdLIrillgtheLel・mund

aHertlletLWa▲・dedtemofanawardbytheTTPSMemherICSu一tlngI01・thlS

PrOCLlrelnentproccssthevendol・willgl損ntaCCeSSbvtllegraIltee・tlleSt一bgl－allteC．

tlleFedcralgrantoragenc〉′証。omptrollerGeneraloftheUnltedSt蒔Oran）・

OfthelrdulVaLlthol・izedreprcsentati、・eStOanvboolくS・document岬PerS，and

recol・dsofthecontl－aetOl・、VhLCllaredil・ectl〉′Pellille－lttO吐spcelflcc0両actfor

tllCPuIPOSeOfmalく1－1gaし直exalllinat叫eXCel・PtS・andLl・aIISC甲OnS

Doesvendoragl’ee？YES＿室生＿Initla冊AutllOrizedCompanyOm。i。l

Page50「6

坦畦迫撃一也rpurehasc、Vithftdera一＿ftt＿n〔一sfbrc（｝＿！iI・辿SCXCCCdingS10°．000

FederaLRule（11）Rctentiono‘・allrequiredrceol・dsforthrccyc…，rSanergrantccsol・

SubgranteesmakcfinaII）aymCntSandallo皿erpendingmattcrsareclosed．

PursuallttOFedel・a血le（ll）above，When融eralIilndsareexpelldedbyTIPS

Membcr，TIPSMembe一・reqm・eStheproposercertilytha川eawardedverldor

retainofallrequired一・eCOrdsfOrthree｝・CarSa允ergranteesorsubgrallteeSIn症

fillalpa｝▼melltSandaIlotlle岬ndlngmItterSareCloscd．

Does、′endoragree？YES」4二Inltial。fAuth。rlZ。dC。lllPany。肝。，。I

FcdcraJRulc（12）C…Piianeew旧la肌IPPlicatHcst州dal・ds，OI・ders，Orrequi…lentsisslICd

unfIcrscction3060mleCIeanAirAct（42U・S・C・1857（h）），SCClion5080ftheCIcmWatcr

Aet（33U・S・C・1368），ExecutivcOrdcrl1738，andE血・On－IlentmrotectionAgcney

rCgulations（40CFRpart15）・（Conlracts，Subcontrac両一ldsubgrilntSOl・amountsiIICXCCSS

OfS100，000）

Pul・StlallttOFedel・alRulc（12）above・∵Whenftderal…saleeXPendedbyTIPS

Membe直IPSMemberrequlres血ep一一OPOSei－Cel・tllythtLthlPerfot・manceoftlle

COn血ts珂bcontracts・andsubgrantsofamountsmexcessofm0，000，the

Vendorw】11belnCOmpliaIICeWithallapplieablestandal・ds，01・。ers，01・

l”eqLlirenlentSISSuedL一ndersectlOn3060rtheC－eanAlrAct（42LJS・C1857（11）），

SeCtion5080唖CleanWaterAct（33U・SC1368），ExeeutivcOrderl1738，alld

Ernriro⊥lJlleIltaIProtectionAgency・regLIlatiollS（40CFRpart15）

DocsYendL）ragree？YES＿姦二・・lItia冊ALltl．。，iz。dC。mpan，′。軸

Federall油（1卵Iandatorystnndardsand囲ciesrcliltillg両一一ergyCmeicnc〉′lYhithare

eOntainedinthestateenergtCOmcrvatiol両nissucdineoII埴ilCCWitJ亜Energ）r

PoIfcJTandComcrvzLfionAet（1・ub・L・9硝3，89StaL871）．

PursL－anttoFederalRule（13）above，W・henfderal岨sa一・eexpendcdb〉mS

Member・TIPSMemberrequlresproposercerti帥Iatdu一一iIlgtlletermofaIlaWaId

bvtlleTIPSMembe一・resuItlngIbrthisprocurementproeesstlle、iCndorW▼lIlbeln

COlllPllanCe、油mmdato一・yStandardsandpolicleSrelamlgtOenerg〉e鯖clenCy

WhicharecontalnedinthestatecllergyCOnSCrVationplanissucd－llCO】一lPliance

WitlltheEnergyPoJicyalldConservat－OnAet（PubL94－163，89SLat．871）．

DoesV′end‘）ragree9YES一重i－Illltja冊ALItllOr⊥ZedColllPanyO前clal

Pagc60f6

SUSPENS10NORDEBARMENTCERTIFICATE

Non－Federale－ltitiesareprohibitcdfromcontractlngW油ormakingstIb－aWardsundel・COVered

transactiollStOPartleSthatareSuSPCndedordebarredorWhoseprlnCIPalsarcsuspendedor

deban・ed．Co、）eredtransactlOnSineludeplOCulementfbrgoodsorservICCSCql－altoorinexees8

〔rtl＄100，00000ContractOrSreCei＼TingindividualaWardslbrS25・000iOOormoreandallsub－

recll〕lelltSmuStCertifVthattllCOrgallizatiollallditsprlnCIPalsarenotmSPendedol－debalred・

YouceItiEvthatl10SuSPellSionordisbamlelltisinplacc∵WhlChwouldpreeludereeeiVlllga

fcdcralLv請ndedcontractundertlleFederalOMB，A－102，COlnmOnrules

IllfbrmatlOIlmaVbcfbLmdat地坪：凧、机Y．Sall準0、両ldexh仙

IIasthevendorbeendeban－edIt）rmPartlC⊥PationinFedera上fLmdscontraets？

NOi上皇InitialofAt一tllOrlZ．edCompanyOfHclal

YES InitialofAutllOrizedCompanyOmclal

c。m勘10軸al：〟ぐ獄　を／、最！子、叫J m

compmy′：　佳左：言出止血′J主点十六I・こ，止し

CONTRACT Signature Form

The undersigned hereby proposes and agrees to furnish goods and/or services in compliancewith the terms, specifications and conditions at the prices quoted unless noted in writing. Theundersigned further certifies that he or she is an authorized agent of the company and hasauthority to negotiate and contract for the company named below.

Company Name: -"TV JV'.̂ i c^<~\ L*-'̂ ' ̂ <\* orO

Mailing Address; 2^S \\pi>(^ Mi/*L

City:

State:

Zip: __ ,

Telephone Number: _LJ7.P)- "?SQ - Cfc ̂ *\

Fax Number: L/7q - 7SQ- D^^°l _

Email Address: S^\^ fS: tVcr^'>^i-o-^rA Cc^Jj\\c\ CQrsr\d Signature: C^L/> fl. l

HPrinted Name:

Position: O fV r^-f .' 0 ,-j :x \\- r^ At - f ___

This contract is for 3 total TERM of one year with the option of two additional years. Vendors shallhonor the participation fee for any sales mode based on the TIPS contract. Failure to pay the fee willbe grounds for termination of contract and will affect the award of future contracts.

TIPS Authorized Signature Date

Approved by Region VII! ESC Date

References

** Must have at least 3 References. References must be School, City, County, University, State Agency or Other Government.

Organization City State Contact Name Contact Phone

Farmington School Farmington AR Jody Hendrix Technology Coordinator 479-266-1869

Prairie Grove School District Prairie Grove AR Shawn Witt: D. of Technology 479-846-4265

Springdale School District Springdale AR Eric Hatch: D. of Technology 479-751-8771

Huntsville School District Huntsville AR Allen Carney: System Admin 479-738-2011

HIS LICENSE MUST BE CONSPICUOUSLY DISPLAYED IN PLACE OF BUSINES ASP-121

^tate of NUMBER

E 2 0 1 1 0 0 4 6 LICENSE

This is to Certify that PROFESSIONAL CABLING SOLUTIONS

is duly licensed to transact business in the state of Arkansas as an(a) Class E -ALARM SYSTEMS COMPANY, This license is renewable as provided in A. CA,

17-40-101 Et Seq.

NOT TRANSFERABLE

ADMINt