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Weatherford Independent School District

dDistrict 1100 Longhorn Drive, Weatherford, Texas 76086

Business & Operations

NOTICE TO PROPOSERS

BID/PROPOSAL NAME: Professional Development, Assessment, Consultant, Training, Services, Products and Materials

BID PROPOSAL #: Effective Date:

RFP #1024-17 January 16, 2017 –January 15, 2024

NOTICE: This bid form is for additional vendors to be added to the original bid award continuing through 1/15/2024 - Coterminous with original awarded time frame.

Proposals will be publically opened in accordance with Texas Education Code/Law 44.031. However, the proposals will be “under evaluation” until final awards are determined. Proposals will be opened as received.

Proposals must be submitted in sufficient time to be received and time-stamped at the business office at the above location, emailed and received, faxed and received; on or before the published bid date and time shown on this RFP. WISD will not be responsible for delayed mail, courier, hand delivered, faxed or emailed responses. It is the vendor’s responsibility to verify the delivery of proposals. Proposals received after the published time and date will not be considered for the first awarded date, but for subsequent award within the noted time period. Bids/Proposals will be opened as received.

All mailed, courier or hand delivered proposals must be in an envelope and clearly marked on the outside with the company’s name and addressed to:

Weatherford Independent School District Attention: Sharon Landrum 1100 Longhorn Drive Weatherford, TX 76086 RFP: #1024-17 - Professional Development, Assessment, Consultant, Training, Services, Products and Materials

NOTE: This form must be filled out completely and submitted with proposals.

Company Name: Address: City: State: Zip: Officials Name Submitting Proposal (print): Signature of Official: DUNS # Bid Email: Quote Email: Date:

WEATHERFORD INDEPENDENT SCHOOL DISTRICT PROFESSIONAL DEVELOPMENT, ASSESSMENT, CONSULTANT, TRAINING, SERVICES, PRODUCTS AND MATERIALS – SPECIFICATIONS – page 1 RFP #1024-17

SCOPE OF WORK

Weatherford Independent School District (WISD) is requesting proposals from qualified firms and/or professionals interested in contracting with the district to provide Professional Development, Assessment, Consultant, Services, Products and Materials for various areas. These services and materials shall be procured on an “as needed” basis with WISD making the sole determination of need. The services requested should include a wide spectrum of consultation, professional staff development, program improvement, campus level training & events, and other direct type services relating to Pre K – 12 environments and support. This proposal is to begin from the date of award which is tentatively scheduled for January 16, 2017. NOTE: Proposals will be opened as submitted

This proposal will be available for members of the Educational Purchasing Cooperative of North Texas to utilize. There are currently over seventy members made up of districts in Region X and Region XI. A list of current members can be found at the co-op’s website http://www.epcnt.com.

SPECIFIC TERMS AND CONDITIONS

1. This proposal shall be awarded to multiple vendors as determined to be the best value to Weatherford IndependentSchool District. Weatherford Independent School District reserves the right to negotiate with any or all respondentsand accept or reject any and/or all proposals, to waive any formalities and/or irregularities and to award in the bestinterest of the School District.

2. Length of Contract: All responses to this RFP shall be from date of award which is tentatively scheduled forJanuary 16, 2017 between the District and the provider with automatic renewal/continuation through January 15,2024. Additional vendors will be approved and added to the list of awarded vendors during this time period to runcoterminous, based on the long-range needs of the District and not to exceed seven (7) years total.

3. No oral statement of any person shall modify or otherwise change, or affect the terms, conditions, or specificationsstated in the resulting contract.

4. Final evaluation of this proposal will be based on the Texas Educational Code 44.031 (b) per the GeneralConditions. Evaluation of pricing will be based on Unit Price value to be submitted on the “PRICING SHEET”.

Evaluation Criteria Point Value

Purchase Price 40

Reputation of the vendor and vendor’s goods or services 14

Quality of the vendor’s goods or services 15

Extent to which the goods or services meet the district’s needs 10

Vendor’s past relationship with the district 1

Impact of district’s compliance with laws and rules relating to Historically Underutilized Businesses 0

Total long-term cost to the district 10

Principal place of business or number of employees in the State 0

Other relevant factors specifically listed in this RFP 10

Total Points 100

5. Timetable:Release RFPDeadline for Submittal of Proposal Recommendation

November 8, 2016 Continuing through January 15, 2024 Coterminous award time frame 1/16/16 - 1/15/24

6. Communications: Contact between vendors and WISD personnel during the proposal process or evaluationprocess is prohibited. Any attempt by vendors during the proposal process to contact WISD personnel may resultin disqualification. All communication shall go through the Purchasing Department during this competitiveprocess. Any and all questions are to be directed to Sharon Landrum, Director of Purchasing at 817-598-2801 X3019 or [email protected] . No verbal responses will be provided. The deadline for questionsabout this proposal is stated in the timetable and the district will not respond to questions after this time and date.

http://www.epcnt.com/

mailto:[email protected]


Response to questions will be posted in the form of an addendum to this RFP on the WISD Purchasing website as stated in the timeline. The vendors will be responsible for checking the website for any posted addenda.

7. Proposal Submittal: Proposals may be submitted electronically (preferred method) to the PurchasingDepartment’s e-mail address: [email protected] . Faxed (817-598-2917), hand carried, courier or mailedresponses are also acceptable. It is the duty of the responding vendor to verify their response has been receivedand accepted by a member of the WISD Business Office. All mailed, courier or hand delivered responses are to bein an envelope with the following information noted on the outside of the envelope:

WISD RFP #1024-17 Professional Development, Assessment, Consultant, Training, Services, Products and Materials Weatherford ISD – Purchasing Department Attention: Sharon Landrum Director of Purchasing 1100 Longhorn Drive Weatherford, TX 76086

8. Acceptance: WISD reserves the right to accept or reject any or all of the proposals submitted, waive minortechnicalities, and accept the offer most advantageous to the District. Contract, to awarded vendor, will be basedon the determined "Best Value for the District".

9. Contracts shall be put into effect by means of purchase order(s) executed by the District after proposal has beenawarded. Failure to accept purchase orders will disallow your proposal.

10. The District has the right to terminate this contract for convenience, without penalty, if the District fails to appropriatefunds, following delivery to the Vendor of a “Notice of Termination” specifying the extent to which performancehereunder is terminated and the date upon which such termination becomes effective.

11. Transfer of contract by vendor is prohibited.

12. All invoices must be submitted to WISD’s Billing address:

Weatherford ISD Attn: Accounts Payable 1100 Longhorn Drive Weatherford, TX 76086 [email protected]

If your company uses any other billing address, Weatherford ISD will not be responsible for late payments, service charges, etc. WISD’s purchase order number must be referenced on the invoice.

13. The Weatherford Independent School District reserves the right to use and duplicate as often as necessary anymaterial that is submitted by the awarded vendor.

14. Provide WISD with order information on where purchase orders are to be sent:

Company Name

________________________________________ ________________________________________ PO/Street Address Phone Number

________________________________________ ________________________________________ City/State/Zip Code Fax Number

15. Provide WISD with remit information on where payments are to be sent:

Company Name

http://www.lisd.net/apps/pages/index.jsp?uREC_ID=129894&type=d&termREC_ID=&pREC_ID=290831




________________________________________ ________________________________________ PO/Street Address Phone Number

________________________________________ ________________________________________ City/State/Zip Code Fax Number

16. Does your company accept purchase orders by email?

Yes No

If yes, please provide the email address:

17. WISD currently pays all invoices 30 days after receipt of invoice via check through standard USPS.

18. If your company has a catalog, is your company catalog available on a website? _______Yes_______No

If yes, please list your catalog website address: ______________________________________________

19. Provide WISD with contact information: (Name) Main Contact: Phone: Title:Email: Fax:

(Name) Invoicing Contact: Phone: Title: _________________________________ Email: Fax:

20. Please list three references, preferably from school districts, in the DFW area who have used your services withinthe last three years. Additional references may be requested. DO NOT LIST WISD OR WISD EMPLOYEES,FORMER OR CURRENT, AS REFERENCES.

A.School District Contact Person

Address Telephone #

B. School District Contact Person

Address Telephone #

C. School District Contact Person

Address Telephone #

21. INSURANCE: Copies of the successful vendor's liability insurance and workman's compensation certificates arerequired. This certificate does not amend, extend or alter the coverage afforded by the policies below.

Insurance Requirements: Limits:

A. General Liability General Aggregate $1,000,000 Products - Comp/or Agg. $1,000,000

Commercial General Liability Personal & Adv. Injury $1,000,000


Claims Made Occur. Each Occurrence $1,000,000 Owner's & Contractor's Prot. Fire Damage (Any one fire) $ 50,000

Med. Expense (Any one person) $ 5,000

B. Umbrella form - Excess liability

State the limits that your company carries. C. Worker's Compensation Statutory and Each Accident $ 500,000 Employers' Liability Disease - Policy Limit $ 500,000 Disease - Each Employee $ 500,000

The insurance requirements as listed above also applies to any sub-contractor(s) in the event that any that any work is sublet. The contractor is responsible to insure that the sub-contractor(s) meets the minimum insurance requirement limits as by law. 1. Should any of the above described policies be cancelled before the expiration date, therefore the issuing

company will mail thirty (30) days written notice to the certificate holder, Weatherford ISD. 2. The Contractor shall agree to waive all right of subrogation against the District, its officials, employees and

volunteers for losses arising from work performed by contractor for the District. 3. The contractor shall hold the District harmless from and indemnify it against all liability, including attorney's

fees, which may arise from and accrue directly from the performance of the work or any obligation of Contractor or failure of Contractor to perform any work or obligation provided for in this Agreement.

4. The selected bidder will be required to supply an insurance certificate naming Weatherford Independent School District as an additional insured.

**You are required to submit a certificate of insurance for the above insurance requirements with your bid. **

**Item #2, 3, 4 (above) shall be required of the successful vendor/s only.** 22. Vendor accepts full responsibility for adhering to Senate Bill 9 requirements. At no time shall vendor have

unsupervised contact with students. SPECIFICATIONS Weatherford ISD Background: Weatherford ISD currently has 7 elementary campuses, 2 middle school campuses, 1 ninth grade center, 1 high school, and administrative buildings with the possibility of additional campuses to follow. In additional to student instruction, WISD also provides continuing education to approximately 1,000 employees, including teachers, administrators and instructional support and business staff at the school campuses and various school district departments. These areas should also be considered by the bidders for training and staff development consultant services and materials as well. 1. Services: Services should include a wide spectrum of consultation, professional staff development, program

improvement, and other direct type services relating to Pre K – 12 environments and support. a. Professional Development Consulting: Transference of specific knowledge from a professional with wide

knowledge of a specific subject. These services may include providing advice to teachers, staff, students and parents about specific areas/subjects and may include activities to enhance professional career growth for teachers and other educational staff in specific areas.

b. Program Improvement: The process of assisting administrators and other personnel in improving classes/programs in the District. Improvement targets may result from advice from professionals with expertise in the areas needing improvement.

c. Motivational/Keynote Speakers: A person or group of people who makes speeches intended to motivate or inspire an audience.

For a listing of departments and divisions within Weatherford ISD, you may visit www.weatherfordisd.com and from the ribbon click onto “Departments”.

2. Materials: Materials should include items that you or your firm may offer during the term of this proposal to include,

but not be limited to, books, workbooks, training materials, etc.

http://www.weatherfordisd.com/


3. Travel: WISD’s preference is to have all travel and expenses included in the cost of the service. 4. The use of tobacco and alcohol is prohibited on WISD property.

5. You may attach additional information to your proposal to provide details about your services and materials if needed.

WEATHERFORD INDEPENDENT SCHOOL DISTRICT PROFESSIONAL DEVELOPMENT, ASSESSMENT, CONSULTANT, TRAINING, SERVICES, PRODUCTS AND MATERIALS – PRICING SHEET – page 6 RFP#1024-17

PRICING SHEET

Indicate your cost information for subject areas as specified below and add any additional areas under “Other” that you/your firm propose(s) to offer the District. These areas might include, but not be limited to, instructional and instructional support areas not previously listed, including any/all departments operating within Weatherford ISD.

Service Area

Does your Firm provide Professional Development in this area? (Yes) or (No)

Cost per hour Cost per 1/2 day (# of hours = 4)

Cost Per Full day (# of hours = 8)

General Education $ /Hr $ per 1/2 Day $ per Full Day

Career and Technology $ /Hr $ per 1/2 Day $ per Full Day

Counseling/Guidance $ /Hr $ per 1/2 Day $ per Full Day

Fine Arts $ /Hr $ per 1/2 Day $ per Full Day

Language Arts 6-12 $ /Hr $ per 1/2 Day $ per Full Day

Language Arts Pre K-5 $ /Hr $ per 1/2 Day $ per Full Day

Math 6-12 $ /Hr $ per 1/2 Day $ per Full Day

Math Pre K-5 $ /Hr $ per 1/2 Day $ per Full Day

Science 6-12 $ /Hr $ per 1/2 Day $ per Full Day

Science Pre K-5 $ /Hr $ per 1/2 Day $ per Full Day

Social Studies 6-12 $ /Hr $ per 1/2 Day $ per Full Day

Social Studies Pre K-5 $ /Hr $ per 1/2 Day $ per Full Day

Special Education $ /Hr $ per 1/2 Day $ per Full Day

Other:

Motivational/Keynote Speakers

$ /Hr $ per 1/2 Day $ per Full Day

Leadership Development $ /Hr $ per 1/2 Day $ per Full Day

Assessment Services $ /Hr $ per 1/2 Day $ per Full Day










WEATHERFORD INDEPENDENT SCHOOL DISTRICT PROFESSIONAL DEVELOPMENT, ASSESSMENT, CONSULTANT, TRAINING, SERVICES, PRODUCTS AND MATERIALS – PRICING SHEET – page 9 RFP#1024-17

PERCENT-OFF DISCOUNT FOR MATERIALS

The district may require additional unspecified items that you/your firm may offer during the term of this contract (to include, but not be limited to, books, workbooks, training materials, etc.). Please indicate the percentage discount the district may apply to vendor’s published catalog price or to manufacturer’s list price:

________% Discount (If discount is “0%,” a “0” must be entered. A blank space will be considered non-responsive).

TRAVEL EXPENSES: (IT IS REQUESTED ALL TRAVEL AND ADDITIONAL EXPENSES BE INCLUDED IN YOUR SUBMITTED PRICE/QUOTE)

Are travel costs included in the cost of services? _______Yes _______No

If travel costs are not included, please provide cost information for travel:

__________________________________________________________________________________________

__________________________________________________________________________________________

COMPANY BACKGROUND AND STAFF INFORMATION

Please provide the following information:

A. Year present company was established

B. Name of parent company, if any

C. Address of parent company _______________________________________

D. Former company name(s), if any, and year(s) established:

Name Year

Name Year

E. Number of employees in firm locally (Texas) _______________________________________

F. Total number of employees in firm (all locations) _______________________________________

NOTE: If awarded this contract, this RFP will serve as the agreement and each PO will serve as the specific Statement of Work. WISD will utilize the rates above, unless a group discount rate is requested by WISD and offered by the vendor, and include the details (dates, location, program requested, etc.) in the Purchase Order before the service is performed. Do not perform any services without the receipt of a valid WISD Purchase Order.

Educational Purchasing Cooperative of North Texas (EPCNT)

Weatherford ISD encourages vendors to check yes to the EPCNT clause because other schools in Texas

Education Service Center (ESC) Regions 10 and 11 can buy under our awarded procurement under the same

terms. It keeps vendors from having to answer multiple bids for many school districts for the same product(s)

or services, thereby saving the vendors resources. Do not check yes if doing so would be detrimental to

Carrollton Farmers Branch ISD pricing, terms or conditions in your response. Approximately 70 school

districts in the area have formed, through an inter-local agreement, the Educational Purchasing Cooperative of

North Texas (EPCNT). You may learn about EPCNT at http://www.epcnt.com/ Vendor may always offer

lower pricing due to volume of purchase, but may not charge more than the unit costs or listed discounts in the

response. Not all are EPCNT members but possibly could be at a future time. See a list of current member

schools at http://www.epcnt.com/Current_members.htm

If vendor checks yes, the following will apply: Members and participants of the EPCNT, will be eligible, but not obligated, to purchase materials or services

under the contract awarded as a result of this solicitation. All purchases by members and participants other

than the Weatherford ISD will be billed directly to that entity and paid by that entity. Weatherford ISD will

not be responsible for another entity's debts. Each governmental entity will order its own materials/services as

necessary and according their policies.

Do you wish to participate in the EPCNT cooperative as listed above, subject to your exclusions?

YES NO

Signature below certifies authorizes EPCNT participation for this offer by the responding vendor.

Authorized Signature Company Name

Printed Name

Date

http://www.epcnt.com/

http://www.epcnt.com/Current_members.htm

Weatherford I.S.D. - EDGAR CERTIFICATIONS

ADDENDUM FOR AGREEMENT FUNDED BY U.S. FEDERAL GRANT

Weatherford ISD is in the process of ensuring that all policies and procedures involving the expenditure of federal funds are compliant with the new Education Department General Administrative Guidelines (EDGAR). Part of the process involves ensuring that all current vendors agree to comply with EDGAR. You must complete this form and return to Weatherford ISD along with your agreement.

The following certifications and provisions are required and apply when Weatherford ISD expends federal funds for any contract resulting from this procurement process. Pursuant to 2 C.F.R. 200.326, all contracts, including small purchases awarded by the District and the District’s subcontractors shall contain the procurement provisions of Appendix II to Part 200, as applicable REQUIRED CONTRACT PROVISIONS FOR NON-FEDERAL ENTITY CONTRACTS UNDER FEDERAL AWARDS APPENDIX II TO 2 CFR PART 200

(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.

Does Vendor agree? YES __________ Initials of Authorized Representative of Vendor

(B) All contracts in excess of $10,000 must address termination for cause and for convenience by the non-Federal entity

including the manner by which it will be effected and the basis for settlement.


(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.”


(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 sub recipient 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.


(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.


(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 sub recipient 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 sub recipient 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.


(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 sub grants of amounts in excess of $150,000 must contain a provision that requires the non-Federal award to

agree to comply with all applicable standards, orders or regulations issued pursuant to the Clean Air Act (42 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).


(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.


(I) Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award exceeding $100,000 must file

the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to

pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of

Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any

Federal contract, grant or any other award covered by 31 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.


RECORD RETENTION REQUIREMENTS FOR CONTRACTS INVOLVING FEDERAL FUNDS

When federal funds are expended by Weatherford ISD for any contract resulting from this procurement process, 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 sub grantees

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 THE ENERGY POLICY AND CONSERVATION ACT

When Weatherford ISD expends federal funds for any contract resulting from this procurement process, Vendor certifies

that it will comply with the 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 (42 U.S.C 6321 et seq.; 49 C.F.R.

Part 18) Does Vendor agree? YES __________ Initials of Authorized Representative of Vendor

CERTIFICATION OF COMPLAINCE WITH BUY AMERICA PROVISIONS

Vendor certifies that Vendor is in compliance with all applicable provisions of the Buy America Act. Purchases made in

accordance with the Buy America Act must still follow the applicable procurement rules calling for free and open competition


CERTIFICATION OF ACCESS TO RECORDS – 2 C.F.R. § 200.336

Vendor agrees that the Inspector General of the District or any of their duly authorized representatives shall have access to any

books, documents, papers and records of Vendor that are directly pertinent to Vendor’s discharge of its obligations under the

Contract for the purpose of making audits, examinations, excerpts, and transcriptions. The right also includes timely and

reasonable access to Vendor’s personnel for the purpose of interview and discussion relating to such documents.


CERTIFICATION OF APPLICABILITY TO SUBCONTRACTORS

Vendor agrees that all contracts it awards pursuant to the Contract shall be bound by the foregoing terms and conditions.


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.

Vendor’s Name:____________________________________________________________________________

Address --------------------------------------------------------------------------------------------------------------------------------------

City, State, Zip Code:________________________________________________________________________

Phone:_____________________________________________

Printed Name and Title of Authorized Representative:

Email Address:______________________________________________________

Signature of Authorized Representative:______________________________________________

Date:__________________________________

WEATHERFORD INDEPENDENT SCHOOL DISTRICT

CERTIFICATE OF INTERESTED PARTIES - FORM 1 295

Certificate of Interest Parties (Form 1 295 - must be filled out electronically with the Texas Ethics Commission's online filing application, printed out, signed, notarized and submitted with proposals or qualifications to Weatherford ISD.

Weatherford ISD is required to comply with House Bill 1 295, which amended the Texas Government Code by adding Section 2252.908, Disclosure of Interested Parties. Section 2252.908 prohibits Weatherford ISD from entering into a contract resulting from this solicitation with a business entity unless the business entity submits a Disclosure of Interested Parties (Form 1295) to Weatherford ISD at the time the business entity submits the signed contract/proposal/qualifications. The Texas Ethics Commission has adopted rules requiring the business entity to file Form 1 295 electronically with the Texas Ethics Commission.

INTERESTED PARTY - means a person:

a) Who has a controlling interest in a business entity with whom Weatherford ISD contracts; OR b) Who actively participates in facilitating the contract or negotiating the terms of the contract,

including a broker, intermediary, adviser or attorney for the business entity.

BUSINESS ENTITY - means an entity recognized by law through which business in conducted. Including a sole proprietorship, partnership, or corporation.

As a BUSINESS ENTITY, all vendors must electronically complete, print, sign, notarize, and submit Form 1295 with their proposals even if no interest parties exist.

Proposers must file Form 1 2 9 5 electronically with the Texas Ethics Commission using the online filing application which can be found at:

https://www.ethics.state.tx.us/whatsnew/el f i nfo form 1 295. htm

Proposers must use the filing application on the Texas Ethics Commission's website to enter the required information on Form 1 295. Proposers must print a copy of the completed for which will include a certification of filing containing a unique certification number. The Form 1 295 must be signed by an authorized agent of the business entity, and the form MUST be notarized.

The Completed Form 1 295 with the certification must be filed with Weatherford ISD by attaching the completed form to the vendor's electronic proposal.

Weatherford ISD must acknowledge the receipt of the filed Form 1 295 by notifying the Texas Ethics Commission of the receipt of the filed Form 1 295 no later than the 30th day after the date the contract binds all parties to the contract. After Weatherford ISD acknowledges the Form 1 295, the Texas Ethics Commission will post the completed Form 1 295 to its website within seven business days after receiving notice from Weatherford ISD.

http://www.ethics.state.tx.us/whatsnew/el

http://www.ethics.state.tx.us/whatsnew/el

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.

1 Name of business entity filing form, and the city, state and country of the business ent ity'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.

OFFICE USEONLY

3 Provide the identif ication 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 Nature of Interest (check applicable) Name of Interested Party City,State,Country

(place of business) Controlling Intermedia ry

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

A FFIX NOTARY STA MP I SEAL ABOVE

Sworn to and subscribed before me, by the said _ • ---- -- - _ __• this the _ day of ----- , 20 , to certify which ,witness my hand and a t t e s t to.

Signature officer

ADD ADDITIONAL PAGES AS NECESSAR Y

Form provided by Texas Ethics Commission wWN.ettiics.stato.tx.us Adopted 10i5/2015

WEATHERFORD ISD STANDARD TERMS AND CONDITIONS

Notice that this solicitation is being processed as a Request for Proposal. A RFP is interactive negotiation process therefore

only the identity of the respondent will be revealed at the opening. The following constitute the Standard Terms and

Conditions of the Weatherford ISD. Some of these Standard Terms and Conditions may not be applicable to a specific

bid or proposal. To the extent each of the terms and conditions is applicable, these shall be deemed to be part of the bid

documents or RFP documents. If there are specific terms and conditions contained in the bid documents or RFP

documents which are inconsistent with the Standard Terms and Conditions, the specific terms and conditions in the bid

and RFP documents shall control.

1. Seller of Package Goods: Seller will package goods in accordance with good commercial practice. Each shipping container shall be clearly and permanently packed as follows: (a) Seller's name and address ;(b) Consignee's name, address and purchase order or purchase release number and the supply agreement number if applicable; (c) Container number and total number of containers, e.g., box 1 of 4 boxes; and (d) the number of the container bearing the packing slip. Seller shall bear cost of packaging unless otherwise provided. Goods shall be suitably packed to secure lowest transportation costs and to conform with requirements of common carriers and any applicable specifications. Buyer's count or weight shall be final and conclusive on shipments not accompanied by packing lists.

2. Shipment under Reservation Prohibited: Seller is not authorized to ship the goods under reservation and no tender of a bill of lading will operate as a tender of goods.

3. Title and Risk of Loss: The title and risk of loss of the goods shall not pass to Buyer until Buyer actually receives and takes possession of the goods at the point or points of delivery.

4. Delivery Terms and Transportation Charges: All deliveries shall be freight prepaid FOB destination with bid prices reflecting freight and delivery charges to locations within the District, unless otherwise described in the Special Terms and Conditions of this invitation to bid. Buyer agrees to reimburse Seller for transportation costs in the amount specified in Seller's bid, or actual costs, whichever is lower, if the quoted delivery terms do not include transportation costs, provided Buyer shall have the right to designate what method of transportation shall be used to ship the goods.

5. No Placement of Defective Tender: Every tender or delivery of goods must fully comply with all provisions of this contract as to time of delivery, quality and the like. All delivered equipment, materials or merchandise must be new, unused, and in the manufacturer's original packing unless otherwise specified. If a tender is made which does not fully conform, this shall constitute a breach and Seller shall not have the right to substitute a conforming tender provided, where the time for performance has not yet expired, the Seller may reasonably notify Buyer of his intention to cure and may then make a conforming tender within the contract time but not afterward.

6. Place of Delivery: The District will issue purchase orders during the bid period. No deliveries will be accepted without a corresponding valid purchase order. Delivery must occur within sixty (60) days after receipt of order (ARO) unless otherwise specified on the District purchase order. Failure to deliver awarded merchandise within 60 days will cancel the order. The place of delivery shall be that set forth on the purchase order. Any change thereto shall be effected by modification as provided for in Clause 20, "Modifications," hereof. The terms of this agreement are "no arrival, no sale."

7. Invoices and Payments:

a. Seller shall submit separate invoices, in duplicate, on each purchase order after each delivery. Invoices shall indicate the purchase order number, shall be itemized and transportation charges, if any, shall be listed separately. A copy of the bill of lading, and the freight weigh bill when applicable, shall be attached to the invoice. Mail to: Weatherford Independent School District, Attn: Accounts Payable Department, 1100 Longhorn Dr. Weatherford TX 76086. Payment shall not be due until the above instruments are submitted after delivery. Suppliers should keep both the Purchasing and Accounts Payable Department advised of any changes in your remittance addresses.

b. Buyer's obligation is payable only and solely from funds available for the purpose of the purchase. Lack of funds shall render this contract null and void to the extent funds are not available and any delivered but unpaid for goods will be returned to Seller by Buyer.

c. Do not include Federal Excise, State or City Sales Tax. The District will furnish tax exemption certificate(s), if required.

8. Gratuities: The buyer may, by written notice to the Seller, cancel this contract without liability to Seller if it is determined by Buyer that gratuities, in the form of entertainment, gifts, or otherwise, were offered or given by the Seller, or any agent, or representative of the Seller, to any officer or employee of the District with a view toward securing a contract or securing favorable treatment with respect to the awarding or amending or the making or any determinations with respect to the performing of such a contract. In the event this contract is canceled by Buyer pursuant to this provision, Buyer shall be entitled, in addition to any other rights and remedies, to recover or withhold the amount of the cost incurred by Seller in providing such gratuities.

9. Special Tools and Test Equipment: If the price stated on the face hereof includes the cost of any special tooling or special test equipment fabricated or required by Seller for the purpose of filling this order, such special tooling equipment and any process sheets related thereto shall become the property of the Buyer and to the extent feasible shall be identified by the Seller as such.

10. Warranty Price:

a. The price to be paid by the Buyer shall be that contained in Seller's bid which Seller warrants to be no higher than Seller's current prices on orders by others for products of the kind and specification covered by this agreement for similar quantities under similar or like conditions and methods of purchase. In the event Seller breaches this warranty, the prices of the items shall be reduced to the Seller's current prices on orders by others, or in the alternative, Buyer may cancel this contract without liability to Seller for breach or Seller's actual expense.

b. The Seller warrants that no person or selling agency has been employed or retained to solicit or secure this contract upon an agreement or understanding for commission, percentage, brokerage, or contingent fee excepting bona fide employees of bona fide established commercial or selling agencies maintained by the Seller for the purpose of securing business. For breach or violation of this warranty, the Buyer shall have the right in addition to any other right or rights to cancel this contract without liability and to deduct from the contract price, or otherwise recover the full amount of such commission, percentage, brokerage or contingent fee.

11. Warranty Products: Seller shall not limit or exclude any implied warranties and any attempt to do so shall render this contract voidable at the option of the Buyer. Seller warrants that the goods furnished will conform to the specifications, drawings and descriptions listed in the bid invitation and to the sample(s) furnished by Seller, if any. In the event of a conflict between the specifications, drawings and descriptions, the specifications shall govern. All equipment items awarded as a result of the bid will be covered by an all parts and labor warranty, including any/all transportation charges, for a minimum period of one (1) year, or as specified in the Special Conditions section of this bid.

12. Safety Warranty: Seller warrants that the product sold to Buyer shall conform to the standards promulgated by the U.S. Department of Labor under the Occupational Safety and Health Act of 1970. In the event the product does not conform to OSHA standards, Buyer may return the product for correction or replacement at the Seller's expense. In the event Seller fails to make the appropriate correction within a reasonable time or 30 days whichever is shorter, correction may be made by the Buyer at Seller's expense.

13. No Warranty by Buyer against Infringements: As part of this contract for sale, Seller agrees to ascertain whether goods manufactured in accordance with the specifications attached to this agreement will give rise to the rightful claim of any third person by way of infringement or the like. Buyer makes no warranty that the production of goods according to the specification will not give rise to such a claim, and in no event shall Buyer be liable to Seller for indemnification in the event that Seller is sued on the grounds of infringement or the like. If Seller is of the opinion that an infringement or the like will result, he will notify Buyer to this effect in writing within two weeks after the signing of this agreement. If Buyer does not receive notice and is subsequently held liable for the infringement or the like, Seller will save Buyer harmless. If Seller in good faith ascertains that production of the goods in accordance with the specifications will result in infringement or the like, this contract shall be null and void except that Buyer will pay Seller the reasonable cost of his search as to infringements.

14. Right of Inspection: Buyer shall have the right to inspect the goods at delivery before accepting them.

15. Cancellation: Buyer shall have the right to cancel for default all or any part of the undelivered portion of this order if Seller breaches any of the terms hereof including warranties of Seller or if the Seller becomes insolvent or commits acts of bankruptcy. Such right of cancellation is in addition to and not in lieu of any other remedies which Buyer may have in law or equity.

16. Termination: The performance of work under this order may be terminated in whole or in part by the Buyer in accordance with this provision. Termination of work hereunder shall be effected by the delivery to the Seller of a "Notice of Termination" specifying the extent to which performance of work under the order is terminated and the date upon which such termination becomes effective. Such right of termination is in addition to and not in lieu of rights of Buyer set forth in Clause 15, herein.

17. Force Majeure: If by reason of Force Majeure, either party hereto shall be rendered unable wholly or in part to carry out its obligations under this Agreement then such party shall give notice and full particulars of Force Majeure in writing to the other party within a reasonable time after occurrence of the event or cause relied upon, and the obligation of the party giving such notice, so far as it is affected by such Force Majeure, shall be suspended during the continuance of the inability then claimed, except as herein provided, but for no longer period, and such party shall endeavor to remove or overcome such inability with all reasonable dispatch. The term Force Majeure as employed herein, shall mean acts of God, landslides, lightning, earthquake, fires, hurricanes, storms, floods, washouts, droughts, acts of war, act of public enemy, orders of any kind of government of the United States or the State of Texas or any civil or military authority, insurrections, riots, epidemics, arrests, restraint of government and people, civil disturbances, explosions, strikes, lockouts, or other industrial disturbances, breakage or accidents to machinery, pipelines or canal, or other causes not reasonably within the control of the party claiming such inability. It is understood and agreed that the settlement of strikes and lockouts shall be entirely within the discretion of the party having the difficulty, and that the above requirement that any Force Majeure shall be remedied with all reasonable dispatch shall not require the settlement of strikes and lockouts by acceding to the demands of the opposing party of parties when such settlement is unfavorable in the judgment of the party having the difficulty.

18. Assignment Delegation: No right or interest in this contract shall be assigned or delegation of any obligation made by Seller without the written permission of the Buyer. Any attempted assignment or delegation by Seller shall be wholly void and totally ineffective for all purposes unless made in conformity with this paragraph.

19. Waiver: No claim or right arising out of a breach of this contract can be discharged in whole or in part by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by consideration and is in writing signed by the aggrieved.

20. Modifications: This contract can be modified or rescinded only by a writing signed by both of the parties or their duly authorized agents.

21. Interpretation Parole Evidence: This writing is intended by the parties as a final expression of their agreement and is intended also as a complete and exclusive statement of the terms of their agreement. No course of prior dealings between the parties and no usage of the trade shall be relevant to supplement or explain any term used in this agreement. Acceptance or acquiescence in a course of performance rendered under this agreement shall not be relevant to determine the meaning of this agreement even though the accepting or acquiescing party has knowledge of the performance and opportunity for objection. Whenever a term defined by the Uniform Commercial Code is used in this agreement, the definition contained in the Code is to control.

22. Applicable Law: This agreement shall be governed by the Uniform Commercial Code. Wherever the term "Uniform Commercial Code" is used, it shall be construed as meaning the Uniform Commercial Code as adopted in the State of Texas as effective and in force on the date of this agreement.

23. Advertising: Seller shall not advertise or publish, without Buyer's prior consent, the fact that Buyer has entered into this contract, except to the extent necessary to comply with proper requests for information from an authorized representative of the federal, state or local government.

24. Right to Assurance: Whenever one party to this contract in good faith has reason to question the other party's intent to perform he may demand that the other party give written assurance of his intent to perform. In the event that a demand is made and no assurance is given within five (5) days, the demanding party may treat this failure as an anticipatory repudiation of the contract.

25. Venue: Both parties agree that venue for any litigation arising from this contract shall lie in Parker County, Texas.

26. Prohibition against Personal Interest in Contracts:

a. Any board member which has any substantial interest, either direct or indirect, in any business entity seeking to contract with the district, shall before any vote or decision on any matter involving the business entity, file an affidavit stating the nature and extent of interest and shall abstain from any participation in the matter. This is not required if the vote or decision will not have any special effect on the entity other than its effect on the public. However, if a majority of the governing body are also required to file, and do file similar affidavits, then the member is not required to abstain from further participation.

b. No employee of the District will have a direct financial interest in any contract with the District, nor will an employee have

a direct financial interest in the sale to the District of any land, equipment, supplies and materials, or services. Any violation of this policy will render the contract involved void, unless such contract or sale is approved by the Board of Trustees after full disclosure.

27. Bid Responses:

a. Bidders are encouraged to submit bids on any or all items or services their firms can provide. The award will be made to the lowest responsible bidder who submits a responsible bid, as per bid specifications, which is the most advantageous to the District. All prices are to be your lowest and best net price, F.O.B. Destination, on each item. The unit price for each item offered is to include all applicable discounts. In case of error in extension, unit price will govern.

b. A specific statement of delivery after receipt of order (ARO), for each item must be made a part of this bid, and will be a significant determinant in the award for an item where price differences exist if requested on the bid form.

c. Bids will not be accepted and tabulated unless the Vendor Identification portion of the bid form is completely filled out and contains an original signature, in ink, by an authorized representative of the company. Each bid form response shall be typewritten or handwritten in ink. By the signature affixed to the bid form, the bidder thereby certifies that neither the bidder nor the firm, corporation, partnership or institution represented by the bidder, or anyone acting for such firm, corporation, or institution has violated the antitrust laws of this State, codified in Section 15:01 et.seq. Texas Business and Commerce Code, or the antitrust laws, nor communicated directly or indirectly the bid made to any competitor or any other person engaged in such line of business. Unsigned bids will be considered a NO BID.

28. Estimated Quantities: It is specifically understood and agreed that the quantities shown on the bid form are estimates, based on projected use, and are for bid purposes only. The District has no commitment to the vendor to purchase a specific quantity until a Purchase Order is issued. Any increase in quantities will be paid for at the quoted bid price, unless required by law to be rebid. It is further understood that the supplier will not have any claim against the District for the purchase of quantities less than the estimated amount.

29. Product Standards: When a brand name and identification numbers are shown on the bid form, they indicate an acceptable standard, the features of which must be considered when bidding equals. This brand name is used only to establish a quality level, and basic features required. Bids on equivalent or better items are encouraged, but must be accompanied with appropriate information for evaluation purposes. Failure to include such information will disqualify the bid on that item. If bidding on other than reference specifications, bid must identify manufacturer, brand, model, etc., of the article being offered. If other than brand(s) specified is offered, complete descriptive information in literature form of each article being bid must be included with the bid. If bidder takes no exception to specifications of reference data, he will be required to furnish brand names, models, etc., as specified.

30. Product Samples and Demonstrations: Samples and/or demonstrations for evaluation purposes must be provided, at no cost

or obligation to the District, within ten (10) days of request unless specified otherwise in the Special Terms and Conditions

attached to this bid invitation. Samples, if not destroyed in examination, will be returned to the bidder on request, at the bidder's

expense. Each sample, when requested, should be marked "Product Sample" and include bidder's name, address, phone

number, Bid Number and item number.

31. Awarding Bids: The District in accordance with Section 44.031(B) of the Public Education Code may consider the following or

combination of the following in the awarding of bids and proposals

1. Purchase Price

2. Reputation of the vendor and the vendor’s goods or services

3. The quality of the vendor’s goods or services

4. The extent to which the goods or services meet the district needs

5. The vendor’s past relationship with district

6. The impact on the ability of the district to comply with laws and rules relating to historically underutilized businesses

7. The total long-term cost to the district to acquire the vendor’s goods or services and any other relevant factor specifically listed in the request for bids or proposals

32. Right to Re-bid: The District reserves the right to re-bid any item contained in this bid invitation, when fair market value of the item(s) is reduced by a factor of ten (10) percent.

33. Price Per Unit: Unit prices are to be based on the unit of measure requested on the bid form provided such as each, pound, serving, pair, gross, foot, pint, gallon or ounce. Failure to do so will disqualify the bid on that time. All charges, including

delivery charges must be included in the bid price.

34. Term of Contract: Bid prices must prevail for a period of one year from the date of award unless stated otherwise in theSpecifications and/or Special Terms and Conditions.

35. Non-appropriations Clause: This agreement is subject to the appropriation of funds by the District in its budget adopted forany fiscal year for the specific purpose of making payments pursuant to this Agreement for that fiscal year. The obligation ofthe District pursuant to this agreement in any fiscal year for which this Agreement is in effect shall constitute a current expenseof the district for that fiscal year only, and shall not constitute an indebtedness of the District of any monies other than thoselawfully appropriated in any fiscal year. In the event of non-appropriation of funds in any fiscal year to make payments pursuantto this Agreement, this Agreement may be terminated.

36. Extensions: The District reserves the option to renew this contract for an additional period(s) if service is satisfactory of oneyear and if escalation does not exceed five (5) percent per year, or if price reductions are offered; and the renewal is agreedto in writing by both parties.

37. Failure to Honor Bid Prices: Any vendor failing to honor a bid submitted or delivering items not meeting specifications may beremoved from the bid list for a period of two (2) years. Items delivered not as specified on the award will be the responsibilityof the vendor to recover and credit to the District at no expense to the District.

38. Failure to Respond to Bid Invitation: Failure to participate in two (2) successive bid invitations will constitute grounds to removea vendor from the bid list.

39. Bid Withdrawal: Any request to withdraw a bid prior to the scheduled time may be done in the system, if not then it must besubmitted in writing to the Director of Purchasing.

40. Requests for Interpretation and Clarification: If any bidder is in doubt as to the meaning of any part of this bid document, hemay submit to the Director of Purchasing a written request for an interpretation thereof at least seventy-two (72) hours prior tothe hour for opening of bids, unless indicated in the proposal specifications. The person submitting the request will beresponsible for its prompt delivery. An interpretation of the proposed documents will be made only by addendum thereto dulyissued, and a copy of such addendum will be mailed or delivered to each company receiving a set of the bid documents. TheDistrict will not be responsible for any other explanation or interpretations of the proposed documents.

41. Failure to Meet All Terms and Conditions: Failure to meet all Standard Terms and Conditions will constitute grounds forinvalidating the bid(s).

42. Material Safety Data Sheets (MSDS): The District requires product verification in the form of MSDS reports for all items forwhich the MSDS are available. MSDS shall be submitted at the time of the bid opening and with each delivery of thosematerials. MSDS shall be submitted for any product offered as an alternate to the Specifications.

44. Penalties for Non-Performance: If at any time, the contractor fails to fulfill or abide by the terms, conditions, or specificationsof the contract, the District reserves the right to:

a. Purchase on the open market and charge the contractor the difference between contract and actual purchase price,or

b. Deduce such charges from existing invoice totals due at the time, or

c. Cancel the contract within thirty (30) days written notification of intent.

45. Bidder Qualification: All bidders shall be required to prove their qualifications concerning the following criteria:

a. Financial capabilities

b. Bonding status

c. Contractual history (references)

d. Ability to fulfill and abide by the terms and specifications

e. Quality and stability of product and sources.

46. Felony Conviction Notice/Debarment and Suspension: Texas Education Code requires that “a person or business entity thatenters into a contract with a school district must give advance notice to the district if the person or an owner or operator of thebusiness entity has been convicted of a felony. The notice must include a general description of the conduct resulting in theconviction of a felony.” In addition, the District cannot enter into a contract with any company that has been debarred orsuspended under the terms of Executive Order 12549, “Debarment and Suspension.” Certification that the contractor has notbeen debarred or suspended must likewise appear in the Felony Conviction/Debarment Notice. All bidders are required to

complete this form, regardless of status.

47. Insurance Requirements: The proposer shall maintain at all times during the performance of the services under this contract,insurance through companies and agencies approved by WISD, in the amounts, and containing provisions satisfactory toWISD. The successful proposer(s) will be required to supply proof of insurance in accordance with the following schedule priorto the start of the project. WISD requires that proposer’s insurance be placed only with companies that have achieved at leastan “A” rating with A.M. Best and the certificate of insurance in a form as filed with and approved by the Texas Department ofInsurance. The District reserves the right to require higher limits of coverage depending on the size, scope, and nature of acontract. The District also reserves the right to require proof of insurance compliance related to General Liability and WorkersCompensation. Weatherford ISD must be named as an additional insured. The Certificate of Insurance shall provide that theinsurance company may not cancel or nonrenewal or materially alter the insurance until after (30) days written notice has beenreceived by WISD’s representative.

Proposer must demonstrate to Weatherford Independent School District that they can secure required insurance, issued by a company licensed and “authorized carrier” to do business in the State of Texas and licensed in the State of Texas to issue such insurance and the certificate of insurance in a form as filed with and approved by the Texas Department of Insurance.

The insurance required shall be written by an insurance company having an A VIII rating or better by A.M. Best and shall be written in limits for not less than the minimum required by law or the following:

1. Commercial General Liability (including Premises- Operations; Independent Contractors' Protective; Products andCompleted Operations; Broad Form Property Damage):

(a) General Aggregate $2,000,000

(b) Products Comp/Ops.Aggregate $1,000,000

(c) Personal & Adv. Injury $1,000,000

(d) Each Occurrence $1,000,000

(e) Per Project Aggregate $2,000,000

2. Workers Compensation Coverage & Employers Liability:

(a) Each Accident $1,000,000

(b) Disease-Policy Limit $1,000,000

(c) Disease-Each Employee $1,000,000

3. Automobile Liability:

(a) Owned/Non-owned and Hired $1,000,000

4. Excess/Umbrella Liability: $1,000,000

5. If applicable Architect/Engineers Professional: $1,000,000

6. An "Original Certificate of Insurance" will evidence compliance with the insurance requirements and must be included withthe proposal.

7. Other insurance requirement as agreed upon in the contract addendum for each individual project.

ALL PROPOSERS MUST FURNISH CERTIFICATE OF INSURANCE WITH THEIR PROPOSAL. ONLY THE SELECTED PROPOSER IS REQUIRED TO NAME WEATHERFORD ISD AS ADDITIONAL INSURED.

Response Form A

NO BID NOTIFICATION

The Weatherford Independent School District is interested in receiving competitive pricing on all items it bids or proposes. We place significant value on quality vendors and we also desire to keep your firm as a bidder and a supplier of materials, equipment and/or services. Therefore, it is important for us to determine why you are not bidding on this contract item. We will analyze your response and attempt to determine if future changes are necessary in our specification development and procedures.

I/We DID NOT SUBMIT A BID/PROPOSAL FOR THE FOLLOWING REASONS: (Please place an X by one or more of the reasons listed below.)

1. ___ Do not supply the requested product/service.

2. ___ Quantities offered or scope of job is TOO SMALL to be supplied by my company.

3. ___ Quantities offered or scope of job is TOO LARGE to be supplied by my company.

4. ___ Specifications are “too tight” or appear to be written around a proprietary product.(Please elaborate on this item.)

5. ___ Cannot bid against MANUFACTURER or JOBBER on this item.

6. ___ Time frame for response was too short. (Please elaborate on your primary reason for thisjudgment.)

7. ___ Other

______________

If you wish to remain on the Weatherford I. S.D. vendor list for future bid/proposal opportunities for this item(s), please indicate:

_____ I do wish to remain on the vendor list. _____ I do not wish to remain on the vendor list.

Company Name Date

Address (city, state, zip) Phone

Response Form B

Non-Collusion Bidding Statement

This is to certify that the undersigned bidder has neither directly nor indirectly, entered into any agreement, participated in any collusion nor otherwise taken any action in restraint of free competitive bidding in connection with this proposal.

It is agreed by the undersigned bidder that the signed delivery of this bid/proposal represents the bidder’s acceptance of the terms and conditions of this invitation to bid/offer a proposal including all specifications and special provisions.

Note: Signature of the authorized representative SHALL be of an individual who legally may enter his/her organization into a formal contract with the Weatherford Independent School District.

Signature ___________________________________ Date:_________

Suspension or Debarment Certification

**Vendor: By signing this form, your company is stating that you have not been

debarred from doing business with an entity that is entitled to federal funding**

Federal Rule (8) Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award

$25,000 or greater (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 (8) above, when federal funds are expended by WISD, WISD requires the proposer certify that during the term of an award by the WISD resulting for this procurement process the Independent

Contractor certifies that they are not debarred from receiving a contract from the federal government as

provided therein.

Does Vendor agree they are not debarred as specified above? YES Initial of Authorized Company Official.

RESPONSE FORM C

Felony Conviction Notification

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 services performed before the termination of the 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 convictions has been reviewed by me and the following information furnished is true to the best of my knowledge.

Check the appropriate box and sign the form. My firm is a publicly held corporation; therefore, this reporting requirement is not applicable.

AUTHORIZED SIGNATURE:

My firm is not owned nor operated by anyone who has been convicted of a felony.


My firm is owned or operated by the following individual(s) who has/have been convicted of a felony.

Name of Felony:


DATE:

Contractor is responsible for the performance of the persons, employees and/or subcontractors Contractor assigns to provide services for the WISD pursuant to this Contract on any and all WISD campuses or facilities. Contractor will not assign individuals to provide services at a WISD campus or facility who have a history of violent, unacceptable, or grossly negligent behavior or who have a felony conviction, without the prior written consent of the WISD Purchasing Department. Prior to supplying labor services under this Contract, Contractor shall provide a list identifying the individuals, employees and subcontractors that may be assigned to WISD along with a letter signed by an appropriate officer of Contractor that affirms compliance with this provision. Contractor will revise such letter each time there is a change in Contractor's personnel assigned to a WISD campus or facility, but in any case, annually on the anniversary date of this Contract, if applicable.

COMPANY NAME:

Details of Conviction(s):

RESPONSE FORM E

EXECUTION OFFER FORM I, or we , the duly authorized undersigned, having carefully read the CSP, and do hereby agree to enter into a contract with WISD by tendering this offer to perform the work required and/or provide the product(s) or services specified in this solicitation and I agree to the terms and conditions specified herein. I, or we, will deliver the product(s) per specifications found in this CSP document for the prices indicated. I

I, or we, also certify to the accuracy of the certifications required (including, but not limited to, Felony Conviction Notice) which accompany this offer.

The prices in this offer have been determined independently, without consultation, communication, or agreement for the purpose of restricting competition, as to any matter related to such prices, with any other offeror or with any competitor. I, or we, are authorized to submit this offer and have not been a party to any collusion among offer/offerors in restraint of freedom of competition by agreement to offer at a fixed price or to refrain from offering; or with any WISD employee, Board Trustee, or consultant as to quantity, quality, or price in the prospective contract, or in any terms of the prospective contract except in any authorized discussion(s) with WISD’s Purchasing personnel; or in any discussions or actions between offer/offerors and any WISD employee, Board Trustee, or consultant concerning exchange of money or other things of value for special consideration in the award of this contract.

Company Name: ___________________________________________________________________________

Address _______________________________________________________________________________________

Website Address: ____________________________________________________

Email Address: ______________________________________________________________________________________________

Phone: ____________________________________ FAX: ________________________________________

Authorized Signature:

TITLE: _______________________________________________________________________

Funding Out Clause Pursuant to Texas Local Government Code Sec. 271.903, any proposal offer accepted by Weatherford ISD and all contracts to be approved are subject to the budgeting and appropriation of then currently available funds. See statute for specifics or consult your legal counsel. Not a negotiable term. Failure to agree will render your proposal non-responsive and it will not be considered. Do you understand

and agree to these terms? YES NO Not a negotiable term.

RESPONSE FORM F

RESIDENT/NONRESIDENT CERTIFICATION

Chapter 2252, Subchapter A, of the Texas Government Code establishes certain requirements applicable to bidders/proposers who are not Texas residents. Under the statute, a “resident” proposer is a person whose principal place of business is in Texas, including a person whose ultimate parent company or majority owner has its principal place of business in Texas. A “non-resident” proposer is a person who is not a Texas resident. Please indicate the status of your company as a “resident” proposer or a “non-resident” proposer under these definitions.

☐ I certify that my company is a Resident Proposer.

☐ I certify that my company is a Nonresident Proposer.

If your company is a Nonresident Proposer, you must provide the following information for your resident state (the state in which your company’s principal place of business is located):

Company______________________________________ Address______________________________________

_________________________________________ ________ ________________________________ City State Zip Code

a. Does your resident state require a proposer whose principal place of business is in Texas to underbid proposers whoseresident state is the same as yours by a prescribed amount or percentage to receive a comparable contract?☐ Yes☐ NoIf NOT a resident company of the State of Texas, does your company employee 500 or more people within the State of Texas.☐ Yes☐ No

By signature below, I certify that the information in Sections 1 (Resident/Nonresident Certification) and 2 (Firm Employment Certification) above is true, complete and accurate and that I am authorized by my company to make this certification.

___________________________________________ Signature of Company Official Title

RESPONSE FORM G

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.

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 RevenueService (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 amno longer subject to backup withholding, and

3. I am a U.S. citizen or other U.S. person (defined below), and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

SignHere

Signature of

Form W-9 (Rev. August 2013)

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.

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Name (as shown on your income tax return)

Business name/disregarded entity name, if different from above

Check appropriate box for federal tax classification:

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) ▶

Other (see instructions) ▶

Exemptions (see instructions):

Exempt payee code (if any)

Exemption from FATCA reporting

code (if any)

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)

Social security number

– –

Employer identification number

–

Part II Certification

RESPONSE FORM H

HISTORICALLY UNDERUTILIZED BUSINESS (HUB) CERTIFICATION

Bidding companies that have been certified by the Texas Building and Procurement Commission (TBPC) as Historically Underutilized Business (HUB) entities are encouraged to indicate their HUB status when responding to this Bid Invitation. The electronic catalogs will indicate HUB certification for Independent Contractors that properly indicate and document their HUB certification on this form.

I certify that my company has been certified by the Texas Building and Procurement Commission as a Historically Underutilized Business (HUB), and I have attached a copy of our HUB Certification to this form. (Required documentation for recognition as a HUB).

My company has NOT been certified by the Texas Building and

Procurement Commission as a Historically Underutilized Business

(HUB).

COMPLIANCE WITH CLEAN AIR AND WATER ACT

I, the Firm, am in compliance with all applicable standards, orders or regulations issued pursuant to the Clean Air Act of 1920, 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 as required under OMB Circular A-102, Attachment O, Paragraph 14 (1) regarding reporting violations to the grantor agency and to the United States Environmental Protection Agency Assistant Administrator for the Enforcement.

SIGNATURE OF COMPANY OFFICIAL

NAME (PLEASE PRINT)

TITLE

DATE

RESPONSE FORM I

CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity

This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.

This questionnaire is being filed in accordance with Chapter 176, Local Government Code by a

vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental

entity and the person meets requirements under Section 176.006(a).

By law this questionnaire must be filed with the records administrator of the local governmental entity not

later than the 7th business day after the date the person becomes aware of facts that require the

statement to be filed. See Section 176.006 (a-1), Local Government Code.

A vendor commits an offense if the vendor knowingly violates Section 176.006, Local

Government Code. An offense under this section is a misdemeanor.

OFFICE USE ONLY

1 Name of vendor who has a business relationship with local governmental entity.

2 Check this box if you are filing an update to a previously filed questionnaire.

☐ (The law requires that you file an updated completed questionnaire with the appropriate filing

authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)

3 Name of local government officer with whom filer has employment or business relationship.

Name of Officer

Name of Officer

4. Describe each employment or other business relationship with the local government officer, or a family member

of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local

government officer. Complete subparts A and B for each employment or business relationship described. Attach

additional pages to this Form CIQ as necessary.

Is the local government officer named in this section receiving or likely to receive taxable income, other than investment

income, from the vendor?

Yes No

Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the

local government officer named in this section AND the taxable income is not received from the local governmental entity?

Yes No

5. Describe each employment or business relationship that the vendor named in Section 1 maintains with a

corporation or other business entity with respect to which the local government officer serves as an officer or

director, or holds an ownership interest of one percent or more.

6. Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).

7.7.

Signature of Vendor doing business with the governmental entity Date

RESPONSE FORM J

REQUIRED CONTRACT PROVISIONS FOR NON-FEDERAL ENTITY CONTRACTS

UNDER FEDERAL AWARDS-APPENDIX II TO 2 CFR PART 200

The following provisions are required to be in place and agreed if the procurement is funded with federal funds. The WISD is the sub grantee or Sub recipient by definition.

In addition to other provisions required by the Federal agency or non-Federal entity, all contracts made by the non-Federal entity under the Federal award must contain provisions covering the following, as applicable.

(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 WISD, WISD 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 Initial of Company Official

(B) Termination for cause and for convenience by the grantee or sub grantee 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 WISD, WISD reserves the right to terminate any agreement in excess of $10,000 resulting from this procurement process for cause after giving the Independent Contractor an appropriate opportunity and up to 30 days, to cure the causal breach of terms and conditions. WISD reserves the right to terminate any agreement in excess of $10,000 resulting from this procurement process for convenience with 30 days’ notice in writing to the awarded Independent Contractor. The Independent Contractor would be compensated for work performed and goods procured as of the termination date if for convenience of the WISD. Any award under this procurement process is not exclusive and the District reserves the right to purchase goods and services from other Independent Contractors when it is in the best interest of the District.

Does Independent Contractor agree? YES Initial of Company Official

(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 by WISD, for all construction contracts awarded by grantees and their contractors or sub grantees, the proposer certifies that during the term of an award, when federal funds are expended, by the WISD resulting for this procurement process the Independent Contractor will be in compliance with Equal Opportunity Employment laws specifically Executive Order 11246 of September 24, 1965, entitled “Equal Employment Opportunity,” as amended by Executive Order 11375 of October 13, 1967, and as supplemented in Department of Labor regulations (41 CFR chapter 60.


RESPONSE FORM J (CONTINUTED)

(H) Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or bid for an award exceeding $100,000 must file the required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of Congress, officer or employee of Congress, or an employee of a member of Congress in connection with obtaining any Federal contract, grant or any other award covered by 31 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 (H) above, when federal funds are expended by WISD, WISD requires the proposer certify that during the term and after the awarded term of an award by the WISD resulting for this procurement process the Independent Contractor certifies to the terms included or referenced in Federal Rule H above.

Does Independent Contractor certify to the provisions in Federal Rule (I) above? YES Initial of Company Official

Federal Rule (J) 2 CFR 200.233 Retention of all required records for three years after grantees or sub grantees make final payments and all other pending matters are closed.

Pursuant to Federal Rule (J) above, when federal funds are expended by WISD, WISD requires the proposer certify that the awarded Independent Contractor retain all required records for five years after grantees or sub grantees make final payments and all other pending matters are closed.


GIVE TWO CUSTOMER REFERENCES BELOW

ORGANIZATION: ______________________________________________________________________________

CONTACT PERSON: ______________________________________________________________________________

PHONE NUMBER OR EMAIL: ___________________________________________________________________________

ORGANIZATION: ______________________________________________________________________________

CONTACT PERSON: ______________________________________________________________________________

PHONE NUMBER OR EMAIL: ___________________________________________________________________________

INSTRUCTIONS SENATE BILL 9 CONTRACTOR CERTIFICATION

CONTRACTOR EMPLOYEES

Instructions to School District Contractors Regarding Criminal History Background Searches Under Senate Bill 9 Senate Bill 9 directs school district contractors to obtain state and national criminal history background searches on their employees who will have direct contact with students, and to receive those results through the DPS criminal history clearinghouse (Fingerprint-based Applicant Clearinghouse of Texas –FACT). In order for contractors to receive the information through FACT, they must first establish an account with the DPS for FACT clearinghouse access. The Company owner must sign a user agreement with the DPS. To obtain the user agreement and more information, please contact: Access and Dissemination Bureau

Texas Department of Public Safety Crime Records Service P. O. Box 149322 Austin, Texas 78714-9322 Email: [email protected] Phone: (512) 424-2365

For fastest service, please email or call. State in the message that you are a school district contractor and need to have an account established for DPS FACT clearinghouse access. Please include:

Company Name Company Address Company Phone Name of Company point of contact Phone of Company point of contact Company email to be used for notification of FACT records and messages

The information in the DPS FACT Clearinghouse is confidential, and access must be restricted to the least number of persons needed to review the records. The account must include at least one designated supervisor to make necessary changes and to monitor the site’s security and the access to the criminal history data retrieved. Additional users must be limited to those who need to request, retrieve, or evaluate data regarding the individual applicants.

PLEASE NOTE: After you sign the DPS User Agreement for FACT, DPS will provide you with a revised FAST Fingerprint Pass that you will have to provide to your employees and applicants. Your employees and applicants will use that FAST Fingerprint Pass when scheduling their FAST fingerprinting.

Criminal History Background Searches Under Senate Bill 9 The Contractor shall be responsible for compliance with all required provisions of Senate Bill 9 at no additional cost to the Owner. Senate Bill 9 requires finger printing, background checks and registration through the Texas Department of Public Safety (DPS) of all employees of the Contractor, Subcontractors, and material and/or any other type suppliers who may enter any site where Boerne ISD students are or may be attending classes, or where students are on or may be on the site for any school purpose. All inquiries related to compliance with Senate Bill 9 shall be forwarded to: Human Resources Weatherford Independent School District The Contractor shall be responsible for all costs related to compliance with Senate Bill 9 and include those costs within its proposal. Employees of the Contractor shall not be permitted to access the site and begin work until such time as all provisions of Senate Bill 9 for each employee have been satisfied.

Senate Bill 9 Contractor Certification RESPONSE FORM K Contractor Employees

Introduction: Texas Education Code Chapter 22 requires service contractors to obtain criminal history record information regarding covered employees and to certify to the District that they have done so. Covered employees with disqualifying convictions are prohibited from serving at a school district. Definitions: Covered employees: All employees of a contractor who have or will have continuing duties related to the service to be performed at the District and have or will have direct contact with students. The District will be the final arbiter of what constitutes direct contact with students. Disqualifying conviction: One of the following offenses, if at the time of the offense, the victim was under 18 or enrolled in a public school: (a) a felony offense under Title 5, Texas Penal Code; (b) an offense for which a defendant is required to register as a sex offender under Chapter 62, Texas Code of Criminal Procedure; or (c) an equivalent offense under federal law or the laws of another state.

On behalf of______________________________________ (“Contractor”), I certify that [check one]:

[ ] None of Contractor’s employees are covered employees, as defined above. If this box is checked, I further certify that Contractor has taken precautions or imposed conditions to ensure that the employees of Contractor and any subcontractor will not become covered employees. Contractor will maintain these precautions or conditions throughout the time the contracted services are provided.

Or

[ ] Some or all of Contractor’s employee are covered employees. If this box is selected, I further certify that: (1) In the event Contractor is awarded this contract with the District, Contractor shall obtain all required criminal history record information, through the Texas Department of Public Safety, regarding its covered employees. None of the covered employees that have a disqualifying conviction shall be used to carry out the duties required of this contract. Contractor has taken reasonable steps to ensure that its employees who are not covered employees do not have continuing duties related to the contract services or direct contact with students (2) If Contractor receives information that a covered employee has a disqualifying conviction, Contractor will immediately remove the covered employee from contract duties and notify the District in writing within 3 business days. (3) Upon request, Contractor will make available for the District’s inspection the criminal history record information of any covered employee. If the District objects to the assignment of a covered employee on the basis of the covered employee’s criminal history record information, Contractor agrees to discontinue using that covered employee to provide services at the District. Noncompliance by Contractor with this certification may be grounds for contract termination.

Name: ____________________________________________________________

Signature: __________________________________________________________

Date: _________________________________

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