Harris County Department of Education (HCDE) ITB Cover Sheet

Harris County Department
of Education (HCDE)
ITB Cover Sheet
Job No.:
09/015JC
Due Date:
02/27/09
DUE NO LATER THAN 1:00 P.M. CST
LATE BIDS WILL NOT BE ACCEPTED
Invitation to Bid (ITB) for: Books for Harris County Department of Education
(HCDE) Adult Education Division.
PLEASE NOTE
Carefully read entire bid document
and specifications. Complete all forms
submit your bid with all appropriate
supplements.
Please submit your hard copy bid in a
sealed envelope with job no., description,
and marked “SEALED BID”.
RETURN ITB TO:
Attn: Jack Cutting– Purchasing
Harris County Department of Education
6300 Irvington Blvd., Room 226
Houston, TX 77022-5618
For additional information contact Jack Cutting at (713) 696-0744
You must sign below in INK; failure to sign WILL disqualify the offer. All prices and responses
must be typewritten or written in ink.
Total Amount of Bid: $_________________
Company Name:
____________________________________________________
Company Address:
____________________________________________________
City, State, & Zip
____________________________________________________
Taxpayer I.D. #
____________________________________________________
Telephone # ______________ Fax # ___________ e-mail _______________________
Print Name
____________________________________________________
Signature
____________________________________________________
Your signature attests to your offer to provide the goods and/or services in this bid according
to the published provisions of this Job. Contract is not valid until HCDE Board has approved
the award.
ACCEPTED BY: __________________________
HCDE Board Approval
Page 1 of 26
DATE: ________________
TABLE OF CONTENTS
Items below represent components which comprise this bid package. Offerors are asked to review the
package to be sure that all applicable parts are included. If any portion of the package is missing,
notify the Purchasing Department immediately.
It is the Offeror's responsibility to be thoroughly familiar with all Requirements and Specifications. Be
sure you understand the following before you return your bid packet.
1.
Cover Sheet (page 1)
Your company name, address, the total amount of the bid, and your signature (IN INK) should appear
on this page.
2. Table of Contents (page 2)
This page is the Table of Contents.
3. Terms and Conditions (pages 3-4)
You should be familiar with all of the requirements.
4. Specifications (page 5)
This section contains the detailed description of the product/service sought by the HCDE.
5. Price Delivery Information (pages 6-10)
6. Attachments (Submittals)
A.
Bid Submission Form (page 11)
B.
Felony Conviction Notice (page 12)
C.
Bid Certification Sheet (page 13)
D.
No Response Form (page 14)
E.
References (page 15)
F.
Minimum Insurance Requirements (page 16)
G.
Questionnaire (page 17)
H.
Conflict of Interest Questionnaire (pages 18-19)
I.
HUB Certification Form (page 20)
J.
IRS Form W-9 (pages 21-22)
K.
Antitrust Certification (page 23)
L.
Debarment Certification (page 24)
M.
Sole Source Affidavit (pages 25-26)
Page 2 of 26
TERMS AND CONDITIONS
ASSIGNMENT - Any award made as a result of this solicitation, may not be transferred, assigned,
subcontracted, mortgaged, pledged, or otherwise disposed of or encumbered in any way by the
proposer.
THE BUY AMERICA ACT - HCDE and cooperative members have a preference for domestic end
products for supplies acquired for use in the United States when spending federal funds. Purchases
that are made with non-federal funds or grants are excluded from the Buy America Act.
CANCELLATION – HCDE reserves the right to cancel this solicitation. (See paragraph “Financial
Responsibility”).
CHANGES - Any changes to the requirements specified herein will be communicated to all
proposers by the issuance of an addendum. All proposers shall comply with the requirements
specified in any addendum issued by HCDE.
CUSTOMER REFERENCE LIST – The proposer may be required to submit a customer reference
list.
DISQUALIFICATION - A proposer may be disqualified before or after the bids are opened, upon
evidence of collusion with the intent to defraud, or perform other illegal activities for the purpose of
obtaining an unfair competitive advantage.
EQUAL OPPORTUNITY – It is the policy of HCDE not to discriminate on the basis of race, color,
national origin, gender, limited English proficiency or handicapping conditions in its programs.
EXCEPTIONS – Proposers are responsible for identifying any exceptions to the requirements
specified herein. Any exceptions must be noted on the proposer’s letterhead and returned with the
bid. Bids, which are qualified with conditional clauses, items not called for, or irregularities, may be
considered non-responsive by HCDE.
FOB – All shipments shall be FOB destination full freight allowed.
FINANCIAL RESPONSIBILITY – HCDE assumes no financial responsibility for any costs
incurred in developing and submitting a bid.
FORMAT –Bids shall include one (1) original complete bid. Proposers are responsible for ensuring
their bid is received at the time and place specified on the cover page. HCDE is not responsible for
bids that arrive late, or bids that do not have all the required information.
INDEMNIFICATION - The proposer shall indemnify and hold harmless HCDE from all liabilities,
costs, expenses, attorney fees, fines, penalties or damages for any or claimed infringement of any
patents, trademarks, copyright or other corresponding right(s) which is related to any item the
proposer is required to deliver. The proposer’s obligation to this clause shall survive acceptance and
payment by HCDE.
INSURANCE – The successful proposer shall be required to provide HCDE with copies of
certificates of insurance, named as additional insured, Texas Workman’s Compensation and General
Liability Insurance.
INTERPRETATION – This solicitation represents the basis for any award, and supersedes all prior
offers, negotiations, exceptions and understandings (whether orally or in writing). The information
submitted should be self-explanatory and not require any clarification or additional information.
INVOICES – HCDE will be invoiced directly by proposer; payment terms are net thirty (30) days.
Page 3 of 26
PENALTIES- If a successful proposer is unable to provide the awarded items at the quoted prices,
after the bid has been opened, HCDE may take the following action(s):
• Insist the successful proposer honor the quoted price(s) specified in their respective bid;
• Have the successful proposer pay the difference between their price, and the price of the next
acceptable bid (as determined by HCDE);
• Recommend to HCDE’s Board of Trustees the successful proposer no longer be given the
opportunity to submit a bid to HCDE.
PERFORMANCE - The successful proposers will use best efforts to provide the services mutually
agreed upon.
POSTPONEMENT - The time and place established for the receipt of the bids will not be changed
unless otherwise specified (in writing) by HCDE’s Director of Purchasing.
PRICES- All prices shall be firm for the term of the contract.
QUALITY - Any order issued as a result of this solicitation will conform to the specification and
descriptions identified herein. Unless otherwise specified, the proposer will not deliver substitutes
without prior authorization.
QUESTIONS – Questions regarding the requirements specified in this solicitation must be faxed to
(713) 696-0732 attn: Jack Cutting no less than three (3) working days before the bids are due.
Questions must be sent on the proposer’s letterhead, dated and signed by an authorized representative
of the proposer’s company. HCDE will not answer verbal questions. Any responses to the proposer’s
questions will be reduced in writing by HCDE and provided to all proposers.
RESPONSIBLE PROPOSER - A responsible proposer is a proposer who has adequate financial
resources (or the ability to obtain such resources), can comply with the delivery requirements (taking
into consideration existing business commitments), and is a qualified and established firm regularly
engaged in the type of business that provides the items listed herein.
RESPONSIVE BID - Refers to a bid that complies with all material and administrative aspects of
this solicitation.
RETURN OF BIDS – Bids once submitted will not be returned.
TAXES - HCDE is tax – exempt. Bid prices should not include taxes.
TIE BIDS - Should a tie occur (i.e., unit price is the same) between a non-resident proposer and a
Texas resident proposer, Purchasing will make an award to the Texas resident proposer, as defined in
Vernon’s Annotated Civil Statues Article 601g, Sections 1 and 2.
TITLE AND RISK OF LOSS - The title to any item shall pass upon acceptance or payment,
whichever is later.
WARRANTY – All products must be warranted to be free from defects in material and
workmanship.
Page 4 of 26
SPECIFICATIONS
Invitation to Bid (ITB) for: Books for Harris County Department of
Education (HCDE) Adult Education Division.
BACKGROUND
The intention of this Invitation to Bid (ITB) is to solicit bids for books for HCDE’s Adult Education
Division. The books shall be new, the latest edition in good condition and packaged and shipped
properly to avoid damage.
HCDE is utilizing the Invitation to Bid (ITB) method for the procurement of this service in
accordance with Section 44.031 Purchasing of Contracts, Item (1) Competitive Bidding.
For information regarding the bid process, contact Jack Cutting of the Purchasing Division at (713)
696-0744.
TIME TABLE
HCDE anticipates following the time table listed below for this job:
09/015JC Time Table
Item
1
2
3
4
Activity
Job Starts to Advertise (1st run)
Job Advertised (2nd run)
Bids Due
Award Date
Date
1/30/09
2/02/09
2/27/09
4/21/09
The table above is only an estimate and may vary.
SCOPE
The books listed in the price delivery information below should be priced with unit price and total
amount on the bid. Vendor should indicate the complete delivery time from the receipt of a purchase
order.
Page 5 of 26
PRICE DELIVERY INFORMATION
Bidders must complete the open boxes below. HCDE reserves the right to award bid as it sees
most beneficial. Books will be shipped FOB Destination.
I.
Item
Book Title
1
Civics and Lit.
Student Book
2
3
Literacy Skills
Workbook
Ready for the
Interview Student
Book
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Teachers Guide (All
Components)
Citizenhip: Passing
the Test (Student
Pack)
Stand Out Basic
(Class Set) (25/set)
Stand Out Basic,
Lesson Planner, 2nd
Edition
Assesment CD-ROM
with ExamView
Stand Out 1, (Class
Set)
Stand Out 1, Lesson
Planner
Assesment CD-ROM
with ExamView
Stand Out 2, (Class
Set)
Stand Out 2, Lesson
Planner
Assesment CD-ROM
with ExamView
Stand Out 3, (Class
Set)
Stand Out 3, Lesson
Planner
Assesment CD-ROM
with ExamView
Stand Out 4, (Class
Set)
StandO Out 4,
Lesson Planner
Page 6 of 26
Publisher
New
Readers
Press
New
Readers
Press
New
Readers
Press
New
Readers
Press
New
Readers
Press
Heinle &
Heinle
Bidder:
ISBN
Qty
Unit
Price
$
2888-AES09
200
2890-AES09
200
2226-AES09
200
2889-AES09
9
CITPK-AES09
10
1424031656
4 set
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
978-1-42401927-4
978-14240-09992
4
Heinle &
Heinle
6
1424031664
978-1-42401929-8
978-1-42400974-9
4 set
1424031672
978-1-42401934-2
978-1-42400989-3
4 set
1424031680
978-1-42401935-9
978-1-42400994-7
4 set
1424031699
4 set
978-1-42401936-6
4
4
6
4
6
4
6
Total
Amount
$
Item
Book Title
20
Assesment CDROM with
ExamView
Stand Out 5, (Class
Set)
Stand Out 5, Lesson
Planner
Assesment CDROM with
ExamView
Downtown Basic,
Text/Workbook
Pkg
Downtown Basic
Text/Workbook/Au
dio CDs Pkg
Downtown 1, text
book/Workbook Pkg
Downtown 1,
Teacher's Edition
Textbook/Workboo
k/CDs Pkg
Downtown 2, text
book/Workbook Pkg
Downtown 2,
Teacher's Edition
Textbook/Workboo
k/CDs Pkg
Downtown 3, text
book/Workbook Pkg
Downtown 3,
Teacher's edition
Textbook/Workboo
k/CDs Pkg
Downtown 4, text
book/Workbook Pkg
Downtown 4,
Teacher's Edition
Textbook/Workboo
k/CDs Pkg
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
Complete Pre-GED
Complete GED
Preparation
Complete Pre-GED
Preparation
Side By Side Plus
Level 1 Value
Package
Test Package 1
Side By Side Plus
Level 2 Value
Package
Page 7 of 26
Publisher
ISBN
Qty
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
978-1-42400997-8
6
Heinle &
Heinle
978-1-42401783-6
6
Heinle &
Heinle
978-1-42409840-8?
100
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
Heinle &
Heinle
McGrawHill/Conte
mporary
978-1-424098446
978-1-42409840-8?
978-0-83845047-5
978-1-42409844-6
978-1-42409851-4
978-0-83845165-6
978-1-42409841-5
978-1-42409849-1
978-0-83845328-5
978-1-42409842-2
978-1-42409850-7
978-0-83845620-0
978-1-42409847-7
978-0-07286356-7
SteckVaughn
SteckVaughn
978-1-41905399-3
978-0-73988785-1
Pearson
Longman
Pearson
Longman
0138140235
978-0-13026752-8
50
Pearson
Longman
0138140243
50
1424031702
978-1-42401937-3
4 set
4
10
75
10
10
75
10
10
75
10
10
75
7
7
200
200
100
6
Unit
Price
Total
Amount
Item
Book Title
44
45
46
Test Package 2
Side By Side Plus
Level 3 Value
Package
Side by Side 3
Teacher's Guide 33rd Edition
47
48
49
Test Package 3
Side By Side Plus
Level 4 Value
Package
Side by Side 4
Teacher's Guide3rd Edition
50
Test Package 4
51
52
53
54
55
56
57
58
59
60
61
62
63
64
Number Power 3:
Algebra
Number Power 4:
Geometry
Number Power 5:
Graphs, Charts,
Schedules, and
Maps
Number Power:
Review
English in Action,
Teachers Guide 1
English in Action,
Teacher's Guide 2
English in Action,
Teacher's Guide 3
English in Action,
Teacher's Guide 4
Basic English
Grammar (Red)
Fundamentals of
English Grammar
(Black)
Achieving TABE
Success in
Reading, Level E
WB
Achieving TABE
Success in
Reading, Level E
Reader
Achieving TABE
Success in
Reading, Level M
WB
Achieving TABE
Success in
Reading, Level M
Reader
Page 8 of 26
Publisher
ISBN
Qty
Pearson
Longman
978-0-13026767-2
6
Pearson
Longman
0138140251
50
Pearson
Longman
Pearson
Longman
978-0-13512612-7
978-0-13026885-3
Pearson
Longman
0138140227
Pearson
Longman
Pearson
Longman
978-0-13512613-4
978-0-13026890-7
Contempo
rary
0-8092-2388-0
100
Contempo
rary
0-8092-2382-1
100
0-8092-2381-3
100
150
Heinle
Pearson
Longman
0-8092-2379-1
978-0-83845184-7
978-0-83845193-9
978-0-83845196.0
978-0-83845201-1
978-0-13184937-2
Pearson
Longman
978-0-13049447-4
100
Contempo
rary
978-0-07704459-6
250
Contempo
rary
978-0-07704463-3
250
McGrawHill/Conte
mporary
978-0-07704460-2
350
McGrawHill/Conte
mporary
978-0-07704464-0
350
Contempo
rary
Contempo
rary
Heinle
Heinle
Heinle
7
6
50
10
6
2
5
4
6
100
Unit
Price
Total
Amount
Item
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
Book Title
Achieving TABE
Success in
Reading, Level D
WB
Achieving TABE
Success in
Reading, Level D
Reader
Achieving TABE
Success in
Reading, Level A
WB
Achieving TABE
Success in
Reading, Level A
Reader
Achieving TABE
Success in
Mathematics, Level
E
Achieving TABE
Success in
Mathematics, Level
M
Achieving TABE
Success in
Mathematics, Level
D
Achieving TABE
Success in
Mathematics, Level
A
Achieving TABE
Success in
Language, Level E
Achieving TABE
Success in
Language, Level M
Achieving TABE
Success in
Language, Level D
Achieving TABE
Success in
Language, Level A
Ventures Basic Level
Classroom Pack
(25/pack)
Ventures Level 1
(Classroom Pack)
Ventures Level 2
(Classroom Pack)
Ventures Level 3
(Classroom Pack)
Ventures Level 4
(Classroom Pack)
82
American History 1
Student Book
83
American History 1
Resource Binder
Page 9 of 26
Publisher
ISBN
Qty
McGrawHill/Conte
mporary
978-0-07704461-9
250
McGrawHill/Conte
mporary
978-0-07704465-7
250
McGrawHill/Conte
mporary
978-0-07704462-6
200
McGrawHill/Conte
mporary
978-0-07704466-4
200
McGrawHill/Conte
mporary
978-0-07704467-1
250
McGrawHill/Conte
mporary
978-0-07704468-8
350
McGrawHill/Conte
mporary
978-0-07704469-5
250
978-0-07704470-1
200
978-0-07704455-8
300
978-0-07704456-5
350
978-0-07704457-2
250
978-0-07704458-9
150
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
Cambridg
e
Cambridg
e
Cambridg
e
Cambridg
e
Cambridg
e
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
978-0-52172117-2
978-0-52172115-8
978-0-52172114-1
978-0-52172113-4
978-0-52172112-7
10
pk
8 pk
8 pk
6 pk
6 pk
978-0-07704435-0
30
978-0-07704436-7
1
Unit
Price
Total
Amount
Item
Book Title
84
American History 2
Student Book
85
American History 2
Resource Binder
86
World History
Student Book
World History
Teacher's Resource
Binder
87
88
Biology Student
Book.
89
Biology Workbook
Earth and Space
Science Student
Book
90
91
Earth and Space
Sciene Workbook
Websters New
College Dictionary
Rogets II The New
Thesaurus
Key to GED
Success: Social
Studies
Key to GED
Success:
Mathematics
Keys to GED
Success: Science
Keys to GED
Success: Language
Arts, Reading
Keys to GED
Success: Language
Arts, Writing
92
93
94
95
96
97
98
II.
Publisher
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
McGrawHill/Conte
mporary
ISBN
Qty
978-0-07704438-1
30
978-0-07074439-8
1
978-0-07704447-3
30
978--0-07704448-0
1
978-0-07704536-4
30
978-0-07704132-8
30
978-0-07704148-9
30
978-0-07704152-6
30
Butler
0-395-96214-5
30
Butler
0-618-25414-5
30
Stech
Vaugh
978-1-41905351-1
30
Stech
Vaugh
Stech
Vaugh
978-1-41905347-4
978-1-41905350-4
Stech
Vaugh
978-1-41905349-8
Stech
Vaugh
978-1-41905348-1
TOTAL
Unit
Price
Total
Amount
30
30
30
30
$
Payment Terms and Shipping Point: Please provide your payment terms and shipping point in
the space below:
_____________________________________________________________________
_____________________________________________________________________
III. Delivery: Indicate the delivery date on the books you are bidding after receipt of a purchase
order.
_________________________________________________________________________________
_________________________________________________________________________________
Page 10 of 26
Attachment A
BID SUBMISSION FORM
ITB NO. 09/015 JC, Books for Harris County Department of Education
Please Print
Whereas on the _____________ day of _________________________, 2009 (print name of
company)
______________________________________________________________________
reviewed
has
HCDE’s solicitation No. 09/015JC and has responded in accordance with the terms and conditions
therein:
______________________________________
_____________________________________
Street Address
City, State, Zip Code
______________________________________
_____________________________________
Telephone Number
Fax Number
______________________________________
_____________________________________
_
Name of Authorized Individual
Signature of Authorized Individual
Page 11 of 26
Attachment B
FELONY CONVICTION NOTICE
State of Texas Legislative Senate Bill No. 1 Section 44.034, Notification of Criminal History,
Subsection (a), states “a person or business entity that enters into an agreement 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 the agreement 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
agreement”.
Note: 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.
Proposer’s Name: ______________________________________________
Authorized Company Official’s Name (Printed or Typed): ________________________
A)
My firm is a publicly-held corporation; therefore the above reporting requirement does not
apply
Signature of Company Official: ______________________________________________
B)
My firm is not owned nor operated by anyone who has been convicted of a felony
Signature of Company Official: ______________________________________________
C)
My firm is owned or operated by the following individual(s) who has/have been convicted of
a felony:
Name of individuals: ______________________________________________________
Detail of Conviction(s):____________________________________________________
____________________________________________________
____________________________________________________
Page 12 of 26
Attachment C
BID CERTIFICATION SHEET
In order for a bid to be evaluated and considered, the following information must be provided.
As defined by Texas House Bill 602, a "nonresident bidder" means a bidder whose principal place of
business is not in Texas, but excludes a contractor whose ultimate parent company or majority owner
has its principal place of business in Texas.
I certify that my company is a "resident bidder":
Signature: ___________________________ Date: _____________________
-----------------------------------------------------------------------------------------------------------If you qualify as a "nonresident bidder," you must furnish the following information:
What is your resident state? (The state your principal place of business is located)
______________________________________________________________
Address (include City, State and Zip Code)
(A) Does your "residence state" require bidders whose principal place of business is in Texas to
underbid bidders whose residence state is the same as yours by a prescribed amount or percentage to
receive a comparable contract? "Residence State" means the state in which the principal place of
business is located. Yes______ No______
(B) What is the amount or percentage? __________%
I certify that the above information is correct:
_______________________________________ _________________________
Typed Name
Position
______________________________________
Company Name
Page 13 of 26
Attachment D
NO RESPONSE FORM
ITB NO. 09/015JC, Books for Harris County Department of Education
Please Print
Whereas on the ___________ day of ____________________, 2009 (print name of
company)
__________________________________________________________________________
has reviewed HCDE’s solicitation No. 09/015JC, and elects not to submit a bid:
______________________________________________
Street Address
______________________________________________
City, State, Zip Code
______________________________________________
Telephone/Fax Number
______________________________________________
Name of Authorized Individual
___________________________________________
Signature of Authorized Individual
Page 14 of 26
Attachment E
References
Please provide at least three (3) references (co. name, address, telephone no. and contact) that have
purchased products and/or related items from you in the last 3-4 years.
1.
Company Name:
__________________________________
Address:
__________________________________
__________________________________
__________________________________
2.
Contact:
__________________________________
Phone Number:
__________________________________
E-mail:
__________________________________
Company Name:
__________________________________
Address:
__________________________________
__________________________________
__________________________________
3.
Contact:
__________________________________
Phone Number:
__________________________________
E-mail:
__________________________________
Company Name:
__________________________________
Address:
__________________________________
__________________________________
__________________________________
Contact:
__________________________________
Phone Number:
__________________________________
E-mail:
__________________________________
Page 15 of 26
Attachment F
Minimum Insurance Requirements
•
The contractor shall, at all times during the term of this contract, maintain insurance coverage with
not less than the type and requirements shown below. Such insurance is to be provided at the sole
cost of the contractor. These requirements do not establish limits of the contractor's liability.
•
All policies of insurance shall waive all rights of subrogation against HCDE, its officers, employees
and agents.
•
Upon request, certified copies of original insurance policies shall be furnished to HCDE.
•
HCDE reserves the right to require additional insurance should it be deemed necessary.
A. Workers' Compensation (with Waiver of subrogation to HCDE) Employer's Liability,
including all states, U.S. Longshoremen, Harbor Workers and other endorsements, if
applicable to the Project.
Statutory, and Bodily Injury by Accident: $100,000 each employee. Bodily Injury by
Disease: $500,000 policy limit $100,000 each employee. HCDE shall be named as
"additional insured" on workers’ compensation policy.
B. Commercial General Liability Occurrence Form including, but not limited to, Premises and
Operations, Products Liability Broad Form Property Damage, Contractual Liability, Personal
and Advertising Injury Liability and where the exposure exists, coverage for watercraft,
blasting collapse, and explosions, blowout, catering and underground damage.
o $300,000 each occurrence Limit Bodily Injury and Property Damage combined
o $300,000 Products-Completed Operations Aggregate Limit $500,000 per Job Aggregate
o $300,000 Personal and Advertising Injury Limit
HCDE shall be named as "additional insured" on commercial general liability policy.
C. Automobile Liability Coverage:
o $300,000 Combined Liability Limits Bodily Injury and Property Damage Combined.
HCDE shall be named as "additional insured" on automobile policy.
Page 16 of 26
Attachment G
Questionnaire
Job No. 09/015JC, Books for Harris County Department of Education
(add additional sheets if necessary)
1. How long has your company been in the book publishing business?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
2. How long has your company been in the book distribution business?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
3. How quickly can your company respond to HCDE book orders?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
4. What else would you like to tell us about your company that makes you qualified for this job?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Page 17 of 26
Attachment H
CONFLICT OF INTEREST DISCLOSURE STATEMENT
HCDE is required to comply with Texas Local Government, Code 176 and Disclosure of Certain
Relationships with Local Government Officers. This means any company that does business with
HCDE must fill out a Conflict of Interest Questionnaire (CIQ) if the following situation exists:
1. The person has employment or other business relationship with the local government officer or a
family member resulting in the officer or family member receiving taxable income.
2. Your company has given one of HCDE’s local government officers or family member one or
more gifts (excluding food, logging, transportation, and entertainment) that has an aggregate value of
more than $250 in the twelve month period preceding the date the officer becomes aware of an
executed contract or consideration of the person for a contract to do business with the District.
Statements must be filed within seven (7) business days after the officer becomes aware a conflict of
interest exists.
Below is a listing of current HCDE Board of Trustees (BOT):
Ms. Angie Chesnut, President
Mr. Louis Evans, III, Vice-President
Mr. Roy Morales
Mr. Jim Henley
Mr. Michael Wolfe
Ms. Debra Kerner
Mr. Carl Schwartz
Dr. John Sawyer
Below is a listing of current local government officers:
Jesus Amezcua
Linda Pitre
Dean Zajicek
Page 18 of 26
Celes Harris
Joanie Rethlake
Natasha Truitt
Les Hooper
Jim Schul
FORM CIQ
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person doing business with local governmental entity
OFFICE USE ONLY
This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code by a
person 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).
Date Received
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, Local Government Code.
A person commits an offense if the person knowingly violates Section 176.006, Local
Government Code. An offense under this section is a Class C misdemeanor.
1
Name of person 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 the originally filed questionnaire becomes incomplete or inaccurate.)
3
Name of local government officer with whom filer has employment or business relationship.
Name of Officer
This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an employment or other
business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment
income, from the filer of the questionnaire?
Yes
No
B. Is the filer of the questionnaire 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
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local
government officer serves as an officer or director, or holds an ownership of 10 percent or more?
Yes
No
D. Describe each employment or business relationship with the local government officer named in this section.
4
Signature of person doing business with the governmental entity
Page 19 of 26
Date
Adopted 06/29/2007
Attachment I
Historically Underutilized Business
(HUB) Certification Form
Bidding companies that have been certified by the State of Texas 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 certifications for proposers that properly
indicate and document their HUB certification on this form.
_____ I certify that my company has been certified by the State of Texas 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 State of Texas as a Historically Underutilized
Business (HUB).
______________________________________
Signature of Authorized Representative
______________________________________
Name (Please Print)
______________________________________
Company Name (Please Print)
Page 20 of 26
_________________________
Title
Attachment J
Substitute
Form
W-9
Give form to the
requester. Do not send
to the IRS.
Request for Taxpayer
Identification Number and Certification
(Rev. February 2005)
Please print or type
See Specific Instructions on page 2.
Name (as shown on your income tax return)
Business name, if different from above
Check
appropriate
box:
Individual/Sole Proprietor
Corporation
Partnership
LLC filing as Sole Proprietor
LLC filing as Corporation
LLC filing as Partnership
Address (number, street, and apt. or suite no.)
Other
Exempt from backup
withholding
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
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 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 3 for guidelines on whose number to enter.
Part II
or
Employer identification number
Certification
Under penalties of perjury, I certify that:
1.
The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2.
I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service
(IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer
subject to backup withholding, and
3. I am a U.S. person (including a U.S. resident alien).
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.)
Sign Here
Signature of
U.S. person ►
Page 21 of 26
Date ►
Purpose of FormA person who is required to file an information return with
the IRS must obtain your correct taxpayer identification number (TIN) to
report, for example, income paid to you, real estate transactions, mortgage
interest you paid, acquisition or abandonment of secured property, cancellation
of debt, or contributions you made to an IRA.
U.S. person. Use form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN to the person requesting it (the requester)
and, when applicable, to:
1. Certify the TIN you are giving is correct (or you are waiting for a
number to be issued),
2.
Certify you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee.
Note: If a requester gives you a form other than Form W-9 to request your
TIN, you must use the requester’s form if it is substantially similar to this
Form W-9.
For federal tax purposes you are considered a person if you are:
•
An individual who is a citizen or resident of the United States,
•
A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States, or
•
Any estate (other than a foreign estate) or trust. See Regulations
sections 301.7701-6(a) and 7(a) for additional information.
Foreign person. If you are a foreign person, do not use For W-9. Instead use
the appropriate Form W-8 (see Publication 515, Withholding of Tax on
Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce or
eliminate U.S. tax on certain types of income. However, most tax treaties
contain a provision known as a “saving clause.” Exceptions specified in the
saving clause may permit an exemption from tax to continue for certain types
of income even after the recipient has otherwise become a U.S. resident alien
for tax purposes.
If you are a U.S. resident alien who is relying on a exception contained in the
saving clause of a tax treaty to claim an exemption from U.S. tax on certain
types of income, you must attach a statement to Form W-9 that specifies the
following five items:
1. The treaty country. Generally, this must be the same treaty under which
you claimed exemption from tax as a nonresident alien.
2.
The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from
tax.
5. Sufficient facts to justify the exemption from tax under the terms of the
treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption
from tax for scholarship income received by a Chinese student temporarily
present in the United States. Under U.S. law, this student will become a
resident alien for tax purposes if his or her stay in the United States exceeds 5
calendar years. However, paragraph 2 of the first Protocol to the U.S.-China
treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to
apply even after the Chinese student becomes a resident alien of the United
States. A Chinese
Substitute Form W-9 (Rev. 02-2005)
Page 22 of 26
Attachment K
Antitrust Certification Statement
(Tex. Government Code § 2155.005)
I affirm under penalty of perjury of the laws of the State of Texas that:
(1) I am duly authorized to execute this contract on my own behalf or on behalf of the company,
corporation, firm, partnership or individual (Company) listed below;
(2) In connection with this bid, neither I nor any representatives of the Company have violated any
provision of the Texas Free Enterprise and Antitrust Act, Tex. Bus. & Comm. Code Chapter 15;
(3) In connection with this bid, neither I nor any representative of the Company have violated
any federal antitrust law; and
(4) Neither I nor any representatives of the Company have directly or indirectly communicated
any of the contents of this bid to a competitor of the Company or any other company, corporation, firm,
partnership or individual engaged in the same line of business as the Company.
Proposer
_______________________
Bidder
______________________
Signature
_______________________
______________________
Printed Name
Address
_______________________
______________________
Position with Company
_______________________
_______________________
Fax
_______________________
_______________________
Page 23 of 26
Official
Authorizing Bid
_______________________
Signature
_______________________
Printed Name
_______________________
Position with Company
Attachment L
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary
Exclusion—Lower Tier Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 7 CFR Part 3017, Section 3017.510, Participants’ responsibilities. The regulations were
published as Part IV of the January 30, 1989, Federal Register (pages 4722-4733). Copies of the
regulations may be obtained by contacting the Department of Agriculture agency with which this
transaction originated.
(1)
The prospective lower tier participant certifies, by submission of this bid, that neither
it nor its principals is presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in this transaction by
any Federal department or agency.
(2)
Where the prospective lower tier participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an
explanation to this bid.
________________________________________________________________________________
Organizations Name
PR/Award # or Project Name
________________________________________________________________________________
Name and Title of Authorized Representative
________________________________________________________________________________
Signature
Page 24 of 26
Attachment M
Instructions for Sole Source Affidavit
™ Applicable to: Proposers requesting to become a Sole Source Vendor
™ Criteria: In order to become a Sole Source Vendor, you must meet the Texas Education Code
Statute Number 44.031 (j) Sole Source, as described below.
Selected purchases may be exempt from competitive procurement if they meet the established
criteria for a sole source purchase:
ƒ
ƒ
ƒ
Identification and confirmation that competition in providing the item or product
to be purchased is precluded by the existence of
o a patent, copyright, secret process or monopoly
Identification and confirmation that the product is a
o film
o manuscript
o book
o utility service including electricity, gas, or water
o captive replacement part or component for equipment
Sole source does not apply to mainframe data-processing equipment and
peripheral attachments with a single item purchase price in excess of $15,000.
It is incumbent upon the district to obtain and retain documents from the vendor which clearly
delineates the reasons that qualify the purchase to be made on a sole source basis.
™ Information must be mailed to: In order to do business with the Department as a Sole Source
Vendor, HCDE must receive a notarized Sole Source Affidavit along with proof of your company
being sole source. Please mail this information to:
HCDE
Attn: Purchasing Office
6300 Irvington
Houston, Texas 77022
™ HCDE Business Office reserves the right to decide if your company is indeed a qualified Sole
Source Vendor for the Department.
Page 25 of 26
(On Vendors Letterhead)
SOLE SOURCE AFFIDAVIT
Before me, the undersigned official, on this day, personally appeared ____________________, a
person known to me to be the person whose signature appears below, whom after being duly sworn
upon his oath deposed and said:
1. My name is ______________________, I am over the age of 18, have never been convicted of a
crime and being competent to make the affidavit.
2. I am an authorized representative of the following company or firm:
_____________________________________________________________________________
3. The above named company or firm is the sole source of the following item(s), and no other
company or firm in the United States of America sales or distributes the product(s) listed below:
_________________________________________________________________________________
_____________________________________________________________________________
4. Competition in providing the above named item(s) or product is precluded by the existence of a
patent, copyright, secret process, or monopoly.
5. The product is a film, manuscript, book, a utility service (including electricity, gas, or water), or a
captive replacement part or component for equipment.
6. There is/are no other like item(s) or product(s) available for purchase that would serve the same
purpose or function and there is only one price for the above named item(s) or product(s) because of
exclusive distribution or marketing rights.
Signature of Authorized Vendor Official
Title of Authorized Vendor Signature
Signature of Supervisor of Authorized Vendor
Official
Title of Authorized Vendor Signature
Affidavit will be valid for two (2) years from date subscribed and sworn.
SUBSCRIBED AND SWORN to before me on this __________day of ___________, 20______.
______________________________
Notary Public Signature
(SEAL)
______________________________
Printed Name
______________________________
Date Commission Expires
Company: ________________________________ Contact Person: ____________________________
Address: __________________________________________________________________________
City, State, and Zip: __________________________________________________________________
Telephone Number: ___________________________ Fax: ___________________________________
Page 26 of 26
`