VENDOR AGREEMENT INSTRUCTIONS

If you have not taken exception or deviation to the agreement language in the solicitation attributes, please insert your company name on the first page below. This PDF document is a tillable form. Download the document to your computer, fill in your company name at the top

of page 1, save t he file, and upload to the AGREEMENT section of the "Response Attachments" tab. Next, download the AGREEMENT SIGNATURE FORM from the "Attachment" tab. This PDF document is a tillable form. Download the document to your computer, fill in the requested company information, print the file, SIGN the form, SCAN the completed and signed AGREEMENT SIGNATURE FORM, and upload to the AGREEMENT SIGNATURE FORM section of the " Response Attachments# tab.

If you have taken exception to any of the agreement language and noted the exception in the deviations section of the attributes for the agreement, complete the AGREEMENT SIGNATURE FORM, but DO NOT SIGN until those deviations have been negotiated and resolved with TIPS management. Upload the unsigned form to the AGREEMENT SIGNATURE FORM section of the "Response Attachments" tab, because this is a required document.

Page 0 of 11

VENDOR AGREEMENT

Between Nearpod Inc., a Delaware Corp. and (Company Name)

THE INTERLOCAL PURCHASING SYSTEM (TIPS)

For Interactive Presentation Systems #161101

General Information

This Vendor Agreement ("Agreement") made and entered into by and between The lnter1ocal

Purchasing System (hereinafter referred to as "TIPS" respectfully) a government cooperative

purchasing program authorized by the Region 8 Education Service Center, having its principal place of business at 4845 US Hwy 271 North, Pittsburg, Texas 75686 and Nearpod Inc., a Delaware for­

profit corporation whose principal place of business is located at: 18305 Biscayne Blvd., Suite 301, Aventura, FL 33160 ("Nearpod» or "Vendor"). This Agreement consists of the provisions set forth below, including provisions of all Attachments referenced herein. In the event of a conflict between

the provisions set forth below and those contained in any Attachment, the provisions set forth shall

control.

The vendor AgreemPnt shall indude and incorporate by reference this Agreement, the terms and

conditions, special terms and conditions, any agreed upon amendments, as weU as all of the sections

of the solicitation as posted, includit1g any addenda and the awarded vendor's proposal. Once

signed, if an awarded vendor's proposal varies or is unclear in any way from the TIPS Agreement,

TIPS, at its sole discretion, will decide which provision will prevail. Other documents to be included

are the awarded vendor's proposals, task orders, purchase orders and any adjustments which have been issued.

Definit ions

PURCHASE ORDER is the TIPS member's approval providing t he authority to proceed with the

negot ia ted delivery order under the Agreement . Special terms and conditions as agreed to

between Nearpod and TIPS member will be added as addendums to the PO. Item s such as certif icate of insurance, bonding requirements, small or disadvantaged business goals are some

of the addendums possible.

Page 1 ofll

Terms and Conditions

Freight

All deliveries shall be freight prepaid, F.O.B. destination and shall be included in all pricing offered unless otherwise clearly stated in writing.

Warranty Conditions

All services and products shall have a warranty described in Nearpod's Terms and Conditions

found in Exhibit A to this document, which may be amended by Nearpod with the written

approval of TIPS, which shall not be unreasonably withheld, conditioned, or delayed. The immediately preceding sentence regarding TIPS' approval of Nearpod's Terms and Conditions

will on ly be applicable to clients or members purchasing through TIPS. Notw it hstand ing

anything to the contrary in this contract, the warranty conditions at the time of purchase of a

Ncarpod license by any TIPS member shall remain in effect for the duration of that purchased

license.

Customer Support

Nearpod shall provide timely and accurate custo'ller support to TIPS members. Nearpod shall respond to such requests w ithin two (2) working days after receipt of the request. Nearpod

shall provide training regarding products and services supplied by the Nearpod un less

otherwise clearly stated in wr it ing at the time o f purchase. A working day shall be defined as any day that is not a Saturday, Sunday or legal holiday.

Agreements

All Agreements and agreements between Nearpod and TIPS members shall strictly adhere to the statu tes that are set forth in the Uniform Commercial Code as most recently revised .

Agreements for purchase will normally be put into effect by means of a purchase order(s) executed by authorized agents of the participatirg government entities.

Davis Bacon Act requirements will be met when Federal Funds are used for construction and/or

repair of buildings.

Tax exempt status

A taxable item sold, leased, rented to, stored, used, or consumed by any of the following governmental entities is exempted from the taxes imposed by this chapter: {l ) the United

States; (2) an unincorporated instrumentality of the United States; (3) a corporation that is an

agency or instrumentality of the United States and is wholly owned by the United States or by

another corporation wholly owned by the United States;{4) the State of Texas; (5) a Texas county, city, special district, o r other pol itical subdivision; or (6) a state, or a governmental unit

of a stat e that borders Texas, but only to the extent that the other sta te o r governmental unit

exempts or does not impose a tax on s1milar sales of items to this state or a political subdivision

of this state. Texas Tax Code§ 151.309. Page 2 of 11

Assignments of Agreements No assignment of Agreement may be made without the prior written approval of TIPS. Payment can only be made to the awarded Vendor or vendor assigned dealer.

Disclosures

1. Vendor affirms that he/she has not given. offered to give, nor intends to give at any t ime hereafter any economic opportunity, future employment, gift, loan, gratuit y, special discount, trip, favor or service to a public servant in connection with this Agreement.

2. Vendor shall att ach, in writing, a complete description of any and all relationships that might be considered a conflict of interest in doing business w ith participants in the TIPS program.

3. The vendor affirms that, to the best of his/her knowledge, the offer has been arrived at

independently, and is submitt ed without collusion with anyone to obtain informat ion or gain any favoritism that would in any way limit competition or give an unfair advantage over other vendors in the award of this Agreement.

Renewal of Agreements

Term of Agreement is one year with renewal options for up to two additional years as provided in the solicitation, if sales are reported t hrough the Agreement and both parties agree in w rit ing.

Automatic Renewal Clauses Incorporated in Awarded Vendor Agreements w ith TIPS Members Resulting from the Solicitation and with the Vendor Named in this Agreement.

No Agreement for goods or services with a TIPS member by the awarded vendor named in this Agreement that results from the solicitation award named in t his Agreement, may incorporate an automat ic renew al clause with wh ich the TIPS member must comply. All renewal terms incorporated in an Agreement by the vendor w ith t he TIPS member shall only be valid and enforceable when the vendor receives written confirmation by purchase order or executed Agreement issued by the TIPS member for any renewal period. The purpose of this clause is to avoid a TIPS member inadvertently renewing an Agreement during a penod in which the governing body of the TIPS member has not pro>'erly appropriated and budgeted t he funds to sat isfy the Agreement renewal. This term is not negotiable and any Agreement between a TIPS member and a TIPS awarded vendor w ith an automatic renewal clause that conflicts with these terms is rendered void and unenforceable.

Shipments

If Nearpod physically ships any product, then actual shipping costs will be invoke to the TIPS member.

Page 3 of 11

Invoices

The Vendor or vendor assigned dealer shall submit invoices, to the TIPS member. Each invoice shall include the TIPS member's purchase order 1umber. The shipment tracking number or pertinent information for verification of TIPS member receipt shall be made available upon request

Payments

The TIPS member will make payments directly to the Vendor or vendor assigned dealer at net 30 days after receiving invoice.

Pricing

The vendor contracts to provide pricing to TIPS and its members as proposed in Nearpod's response to TIPS' RFP and that pricing shall be the lowest available to same cooperative purchase customers w ho have purchased same quantities and services or products. When the foregoing conditions are present, Nearpod, Inc. shall prospectively revise proposed pricing downward for the duration of the agreement. Price increases will be honored. However, the Vendor shall honor previous prices for thirty (30) days after written notification to TIPS of an increase and in compliance with the RFP price adjustment methods.

Pricing may always be less to TIPS members t han proposed by Nearpod, Inc. but never greater.

All pricing submitted to TI PS shall include the participation fee, as provided in t he solicitation, to be rem itted to TIPS by the Vendor. Vendor will not show adding the fee to the invoice presented to customer. Failure to render the participation fee to TIPS shall constitute a breach of this agreement and shall be grounds for termination of this agreement and any other agreement held with TIPS. Not withstanding anything to the contrary in this agreement, Vendor is not required to remit the participant fee until the Vendor has received payment from t he TIPS member on the assessed t ransaction. The participant fee shall be 2% of the TIPS member's purchase price.

Participat ion Fees

Vendor or vendor assigned dealer contracts to pay the participation fee for all Agreement sales to TIPS on a monthly scheduled report. Vendor must login to the TIPS database and use the "Submission Report" section to report sales. The Vendor or vendor assigned dealers are responsible for keeping record of all sa les t hat go through the TIPS Agreement. Failu re t o pay the participation fee will result in termination of Agreement. Please contact TIPS at tips@tips­usa.com or call (866) 839·8477 if you have questions about paying fees.

Page 4 of 11

Indemnity

1. Indemnity for Personality Agreements. Vendor agrees to indemnify and hold harmless and defend TIPS, TIPS member(s), officers and employees, from and against all t hird party claims and suits for damages, injuries to persons (including death), tangible property losses, and eKpenses including court costs and attorney's fees, arising out of, or resulting from, Vendor's negligent or iMentional acts, including all such causes of action based upon common, const itutional, or statutory law except to the eKtent caused by the negligent or intent ional acts or omissions of the TIPS, TIPS member(s), o fficers, employees, or agents.

Indemnity for Performance Agreements. The Vendor agrees to indemnify and hold harmless and defend TIPS, TIPS memberls), officers and employees from and against all third party claims and suits for damages, including injuries to persons (including deat h),

t angible property losses, and expenses including court costs and attorney's fees, arising out of, or resulting from, Vendor's negligent or Intentional acts, including all such causes of action based upon common, constitutional, or statutory law, except to the extent caused by t he negligent or intentional 2cts or omissions of the TIPS, TIPS member(s), officers. employees, or agents.

Multiple Vendor Awards

TI PS reserves the right to award multiple vendor Agreements for categories when deemed in the best interest of t he TIPS membership. Bidders scoring 80% or above will be considered for an award. Categories are established at the discretion of TIPS.

State of Texas Franchise Tax

By signature hereon, t he bidder hereby certi fies that he/ she is not currently delinquent in the payment of any franchise taxes owed the State of Texas under Chapter 171, Tax Code.

Miscellaneous

The Vendor acknowledges and agrees that continued participation in TI PS is subject to TIPS sole discretion and that any Vendor may be removed from the participation in the Program at any time with or without cause. Nothing in the Agreement or in any other communication between TIPS and the Vendor may be const rued as a guarantee that TIPS participants will submit any orders at any time. TIPS reserves the right to request addit ional proposals for items already on Agreement at any time.

Purchase Order Pricing/ Product Deviat ion

If a deviation of pricing/product on a purchase order occurs, TIPS is to be notified within 24 hours of receipt of order.

Page 5 of 11

Cancellation for non-performance or Agreement deficiency

TIPS may terminate any Agreement i f TIPS Members have not used the Agreement, or if purchase volume is determined to be "low volune" in any 12-month period. TIPS reserves the right to cancel the whole or any part of this Agreement due to failure by awarded vendor to carry out any obligation, term or condition of the Agreement. TIPS may issue a w ritten deficiency notice to awarded vendor for acting or failing to act in any of the following:

• Provid ing materia l that does not meet the specifications of tbe Agreement;

• Providing work and/or material that was not awarded under the Agreement;

• Failing to adequately perform t he services set forth in the scope of work and specifications;

• Failing to complete required work or furnish required materials within a reasonable amount of time;

• Failing to make progress in performance of the Agreement and/or giving TIPS reason to believe that awarded vendor will not or cannot perform the requirements of the Agreement; and/or

• Performing work or providing services under the Agreement prior to receiving a TIPS reviewed purchase order for such work.

Upon receipt of the written deficiency, awarded vendor shall have ten (10) days to provide a satisfactory respon~e to TIPS. Failure to adequately address all issues of concern may result in Agreement cancellat ion. Upon cancellation under th is paragraph, all goods, materials, work. documents, data and reports prepared by awarded vendor under this Agreement shall become the property of the TIPS Member on demand.

TIPS Member Purchasing Procedures

Purchase orders are issued by participating TIPS member to the awarded vendor indicating on the PO "Agreement Number". Purchase Order is emailed to TIPS at tipspo@tips-usa.com.

• Awarded vendor del ivers goods/services directly to the participating member.

• Awarded vendor invoices the participating TIPS member directly. • Awarded vendor receives payment direct y from the participating member.

• Awarded vendor reports sales monthly to TIPS (unless prior arrangements have been made with TIPS to report monthly).

Licenses

Awarded vendor shall maintain in current status all federal, state and local licenses, bonds and permits required for the operation of the business conducted by awarded vendor. Awarded vendor shall remain fully informed of and in compliance with all ordinances and regulations pertaining to the lawful provision of services under the Agreement. TIPS reserves the right to stop work and/or e<~ncel Agreement of any awarded vendor whose license(s) expire, lapse, are suspended or terminated.

Page 6 of 11

Novation

If awarded vendor sells or transfers all assets or the entire portion of the assets used to perform this Agreement, a successor in interest must guarantee t o perform all obligations under this Agreement. TIPS reserves the right to accept or reject any new party. A simple change of name agreement will not change the Agreement obligations of awarded vendor.

Site Requirements (when applicable to service or job)

Cleanup: Awarded vendor shall clean up and remove all debris and rubbish resulting from t heir work as required or directed by TIPS Member. Uoon completion of work, the premises shall be left in good repair and an orderly, neat, clean and unobstructed condition .

Preparation: Awarded vendor shall not begin a project for which TIPS Member has not prepared the site, unless awarded vendor does the preparation worl< at no cost, or until TIPS Member includes the cost of site preparation in a purchase order.

Site preparation includes, but is not limited to: moving furniture, installing wiring for networks or power, and similar pre-installation requirements.

Registered sex offender restrictions: For work to be performed at schools, awarded vendor agrees that no employee of a sub-contractor who has been adjudicated to be a registered sex offender will perform work at any time when students are or reasonably expected to be present. Awarded vendor agrees that a violation of this condition shall be considered a material breach and may result in the cancellation of the purchase order at the TIPS Member's discre tion.

Awarded vendor must identify any additional costs associated w ith compliance of this term. If no costs are specified, compliance with this term will be provided at no additional charge.

Safety measures: Awarded vendor shall take all reasonable precautions for the safety of employees on the worksite, and shall erect and properly maintain all necessary safegua rds for protection of workers and the public. Awarded vendor shall post warn ing signs against all hazards created by the operation and work in progress. Proper precautions shall be taken pursuant to state law and standard practices to protect workers, general public and existing structures from injury or damage.

Smoking

Persons working under Agreement shall adhere to local smoking policies. Smoking will only be

permitted in posted areas or off premises.

Invoices

The awarded vendor shall submit invoices to the participat ing entity clearly stating "Per TIPS Agreement". The shipment tracking number or pertinent information for verification shall be made available upon request.

Page 7 of 11

Marketing Awarded vendor agrees to allow TIPS to use their name and logo wit hin website, marketing materials and advertisement. Any use of TIPS name and logo or any form of publicity, inclusive of press releas~, regarding this Agreement by awarded vendor must have prior approval from TIPS, which shall not be unreasonably withheld.

Supplemental agreements

The entity participating in the TIPS Agreement and awarded vendor may enter into a separate supplemental agreement to further define the level of service requirements over and above the minimum defined in this Agreement i.e. invoice requirements, ordering requirements, specialized delivery, etc. Any supplemental agreement developed as a result of this Agreement is exclusively between the participating entity and awarded vendor. TIPS, its agents, TIPS members and employees sha ll not be made partv to any claim for breach of such agreement.

Survival Clause

All applicable software license agreements, warranties or service agreements that were entered into between Vendor and Customer unoer the terms and conditions of the Agreement shall survive the expiration or termination of the Agreement. All Purchase Orders issued and accepted by Order Fulfiller shall survive expiration or termination of the Agreement.

Legal obligations It is the responding vendor's responsibility to be aware of and comply with all local, state and federal laws governing the sale of products/services identified in this RFP and any awarded agreement thereof. Applicable laws and regulations must be followed even il not specifically identified herein.

Audit rlgilts

Awarded Vendor snail, at their sole expense, maintain appropriate due diligence of all purchases made by TIPS Member tilat utilizes til is Agreement . TIPS and Region 8 ESC each reserve the r ight to audit tile accounting for a pe·iod of three (3) years from the time such purchases are made. This audit right shall survive termination of this Agreement for a period of one (1) year from the effective date of termination. TIPS snail have authority to conduct random audits of Awarded Vendor's pricing that is offered to TIPS Members. Notwithstand ing the foregoing, in t he event that TIPS is made aware of any pricing being offered to eligible entities that is materially inconsistent with the pricing under this agreement, TIPS shall have the ability to conduct the audit internally or may engage a third-party auditing firm, at TIPS' sole cost and expense. In the event of an audit, the requested materials shall be provided in the format they are regularly kept by Nearpod, and at the location designated by Region 8 ESC or TIPS.

Page 8 of 11

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 fully particulars of Force Majeure in writing to t he 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 hereinafter pro•1ided, but for no longer period, and such party shall endeavor to remove or overcome such inability with all reasonable dispatch.

Scope of Services

The specific scope of work for each job shall be determined in advance and in writing between TIPS Member and Nearpod. It is okay if t he TIPS member provides a general scope, but Nearpod should provide a written scope o f work to t he TIPS member as part of the proposal.

Once the scope of the job is agreed to, the TI PS member will issue a PO and/or an Agreement with the estimate referenced as an anachment along with bond and any other special provisions agreed to for the TIPS member. If special terms and conditions other than those covered w ithin this solicitation and awarded Agreements are required, they will be attached to the PO and shall take precedence over those in this Agreement.

Project Delivery Order Proc·edures

The TIPS member having approved and signed an interlocal agreement, or other TIPS membership document, may make a request of the awarded vendor under this Agreement when t he TIPS member has services that need to be undertaken. Notification may occur via phone, the web, ema1l, fax, or in person. Upon notification of a pending request, the awarded vendor shall make contact with the TIPS member as soon as possible, but must make contact w ith the TIPS member within two working days.

Scheduling of Projects

Scheduling of projects (If applicable) w ill be acco'Tlpllshed w hen the TIPS member issues a purchase order that will serve as "the notice to proceed". The period for the delivery order w ill include the mobilization, materials purchase, installation and delivery, design, weather, and site cleanup and inspection. No additional claims may be made for delays as a result of these items. When the tasks have been completed the awarded vendor shall notify the client and have the TIPS member inspect the work for acceptance under the scope and terms in the PO. The TIPS member will issue in writing any corrective actions that are required. Upon completion of these items, t he TIPS member will issue a completion notice and final payment will be issued.

Page 9 of 11

Support Requirements

If there is a dispu te between the awarded vendor and TIPS member, TIPS or i ts representatives will assist in conflict resolution or third party (mandatory mediation), if requested by either party. TIPS, or its representatives, reserves the right to inspect any project and audit the awarded vendors TIPS project files, documentation and correspondence.

Incorporation of Solicitation The TIPS Request for Proposals or the Request for Competitive Sealed Proposals solicitation and all associated documents and forms made part of the solicitation process, including any addenda, that resulted in the execution of this agreement are hereby incorporated by

reference into this agreement as if copied verbatim, and attached hereto as composite Exhibit ·s .....

Special Terms and Conditions

It is the intent of TIPS to Agreement with a reliable, high performance vendor to supply products and services to government and educational agencies. It is the experience of TIPS that the following procedures prov1de TIPS, the Vendor, and the participating agency the necessary support to facilitate a mutually beneficial relationship. The specific procedures will be negotiated with the successful vendor.

• Agreements: All vendor purchase orders and/or Agreements/agreements must be emailed to TIPS at tipspo@tips-usa.com. Should an agency send an order direct to vendor, it is the vendor's responsibility to forward the order to TIPS at the email above within 48 business hours and confirm its receipt with TIPS.

• Promotion of Agreement: It is agreed that Vendor will encourage all eligib le entit ies to purchase from the TIPS Program. Encouraging entities to purchase directly from the Vendor and not through TIPS Agreement sa violation of the terms and conditions of this Agreement and will result in removal of the Vendor from the TIPS Program.

• Daily Order Confirmation: All Agreement purchase orders will be approved daily by TIPS and sent to vendor. The vendor must confirm receipt of orders to the TIPS member (customer) within forty-eight 48 business hours or two (2) working days.

• Vendor custom website for TIPS: If Vendor is hosting a custom TIPS website, t hen updated pricing must be posted by 1" of each month.

• Back Ordered Products: If product is not expected to ship within 3 business days, customer is to be notified within 48 hours and appropriate action taken based on customer request.

Page 10 of 11

TIPS Vendor Agreement Signature Form

Interactive Presentation Systems #1161101

CompanyName Nearpod Inc., a Delaware corporation Address 18305 Biscayne Blvd ., Suite 301

city Aventura state FL Zip 33160 Phone 3Q5.67 7 .5Q3Q ext 2268 Fax 305.655.1999

Email of Authorized Representative rfps@ nearp0d .COm Name of Authorized Representative Fe I i pe s 0 m mer Title President

0 te March 15, 2017

TIPS Authorized Representative Name M e..r(J; -tk \Sct("+v~

Title I/ ice Pres iol.el'\+ of- Oper~non s

TIPS Authorized Representative Signat~ , ~ Approved by ESC Region 8 ~ 1J/:i.; Date '3 -'7- 2.oJ7

Page 11 of 11

EXHIBIT '·A~ T O ·n I'S AGR£1:::\IEI'OT

Term~ and Conditions

By accessing or registering on the Nearpod website. or by downl oading any of the Nearpod

mobile appl ications (collectively. "Ncarpod \ll3tcrials"). you agree to become hound by

thc~c T cnns and Conditions. If you do nul agree to all the Terms and Cond itoons. then you

may not acc.::ss th.:: Ncarpod "eb,itc or usc any of our products or scrv ice.

11\IPORTANT NOTE: l'ea'l>od ,, intended for u'e by reachers and by educational

msrirurions, public or private.

If you arc interested in using Ncao·pod for wmmcrcial or corporate purposes. we' ll be

happy to discuss your options. but fir~r you should contact us at b< "" ,,,.,,,,,! '''"'· Commercial. corporate or other misuse of Ncarpod may result in the cancellation of the

account.

We provide our s.::rviccs to teache~. and \lcarpod rs a,·ailablc in the US to md" oduals aged

I~ years or older.

Outside the US, if you arc under the age of majority in your country of rc~idence, you must

review this Agreement with your parent or guardian to make sure that you and your parcm

01 guardian understand it. We will notify you of any updates by posting on Nea.,od and

notifying you by email using the emnil add res, on your accouor.

'carpod aod rhc ~carpod Materials comply" ith applicable law. including the Family

educational Riglus and Privacy Act (FrRPA) and Children's Online Pri,acy rrorecrion

ExhtbfrN tO TIPS Agreern~V~t P&ge1of9

Act (COPPA). We do not intentionally collo.:ct ~ny personally idcmifiable inforrn:lllon from

users under the age of 13. If you arc a p.1rcn1 or guardian or tcachn and behcYc that your

child or student has provided Ncarpod with pcr.;onally identifiable information. please

notifY L • .-- ,., •... ,! , · , so that we can mmcdiately delete the information from our

Sel'\·ers.

T cr·ms of Service

I. In order to access the t\earpod Matcnal~. you may be required to pro' rdc ccnain

information (such as name. e-mail. etc.) You agr,·c that any infonn.1tion you proYidc will

ah\~ys be accurate.

2. The l\carpod Materials may contam m:ncria l rhat is owned by or licens~d to u~. TI1i~

material inc ludes. but is not limited to, the dc~ign, layout. look, appearance. and graphics.

Reprod uction of such material outside the Nc.trpod Materials is prohibited.

3. Nearpod owns all legal right. title. and intcrc;,t in and to the 1'\carpod Materials. mcluding

any intcllecnral property rights. whether those nghts are registered or not. and whcre~;cr in

the world those rights may exist. Anempung to copy. duplicate. reproduce. sell. trade. or

resell the !\earpod \.1atcrials is 'tnctl) proh bited without our pnor wrincn agreement.

Unaurhori,o.xl use of the Ncarpod Matcn.tb may give rise to a claim tor damage> and ben

criminal otfcnsc.

4. Oy using the Nearr od Materials. you may rrovidc contents and any other mutct·ials,

in formation. ideas, concepts, and knO\\-how ("Content''). Under no c ircumstances will

Nc:orpod hecom~ liable for any payment to Y<'U for any information that you provide. You.

ami notl'\earpod. arc solely rc>ponsible for aey Content you make a\ailablc through your

u,.; of the t\earpod ~1aterials. Ncarpod docs not control the Content hosted 'ia the 'crvice,

nor doe~ 11 guarantee the accuracy, integrity or quality of such Content. Users <hall retain

EXh1bi1''A~ 10 "l iPS Agreement Pogo 2of9

<~II rights, including intellectual propeny nght<. tor user-generated Content that they create

with rhetr i'lcarpod account. unlcs< the) enter a publishing agreement with 1\carpOd.

We arc no\ responsible or liable in .my wuy for any Content provided by other~. However,

we reserve the ri ghr at all tiln~s to determine whether Content is appropriate and in

compliance with this Agreement, und mny pre-screen and remove Content ut uny rime if

such Content is found to be in violation of this Agreemem or is otherwi<e objcct ionublc.

Copyright Claims (Digital \.ti\lcnnium Copyright Act)

Ncarpod respects the intellccnt.al propcny rigtrs of others. and requires that the people who

U>C the Sites do the same. It i~ our policy w re<pond promptly to claims of intdlcctual

J>I'Opcny misuse. Our procedures for responding to alleged copyright in fringement arc

coMistcnt with the fom1 suggested by the United States Digital Millennium Copyright Act,

the text of which can be found nt the U.S. Copyright Ol'fiec web

~itc ' ' l\''. ''fH , e ~ .I I •1 ·J . Please note that you will be liabk for

damages (including CO$ IS ;md attorney~' fcc~) if you make any material mi>rcpresentation~

"h~'ll making or countering a copyright infrmgerncnt claim.

If you believe that your work bas been copied and is accessible on thi~ ~ire m a way that

consttrutcs copyright infiingemcnt, you may nollfy us by providing our copyright agent

wil h lhe following ill fOrmation in writing:

11. Jdcntification of the copyrighted work claimed to have been infringed. or, if

multiple copyrighted works at a single online site are covered by u >ingle

notification, a rerre,entati\'e list of >uch works at that site.

b . Identification of the matcnal that i;, claimed to be infrinl,,'ing orto be the subject

of infringing actl\ ity and that is 10 be remon!d or acccs> to whtch tS 10 be

ExhJb•rA ~ to TIPS Agreement P•o• 3or9

dtsabled and infonnation reasonably >ufficiem to pcnnit 1\'carpod to locate the

material (e.g .. LRL).

c. Information reasonabl y sufficient to permit ~.::arpod to contact you. such a>

name, postal add ress. telephone number, an~ if a\·ailablc. an cmatl addres~ at

which you may be contacted.

d. Include the following statement: " I have a good faith bel ief tlwt u:.c of the

material described above m the nunner complained of is not authori7cd by the

copyright owner. its agent. or rhe Ia\' "

c. lndude the tollowing ~tatcmcnt: "Th..: information in the nutilicaflon is

accurate. ami under penally of ;)Crjury. I am the wp)nght owner or am

authorized to act on behalf of the o" ncr of an exclusive right that ;, allcg..:dly

infringed."

f. A physical, electroni c or dtgital s gnarurc, in a form rc<l>Umtbly acceptable to

Ncalj)Od, of a person mtthorizcd hl act on behalf of the owner of an exclusive

right that is allegedly infringed.

g. Send written communi c;.ttion to the following contact:

I X305 niscaync Bhd.

A'~ntura, Florida 33160

h. Send clcctronically->igncd communication to "''

OMCA Counter-Notification Pruc.:durc: Aller receiving a notification of alleged

infringement, Nearpod will remove or dbahlc access to the rnatcria l claimed to he

infringing or c laimed to be the subject of inli·inging activity. At the same time. Ncarpod

will provide the pro,•ider or affected material with a copy of the notice. The provider of

affected material may make a counter notitkllion pursuant to ,;cction> 5 12(g)(2) and (3)

ofth..: Dt!,>ital \1illennium Copyright Act. Plc.t..: be advised that you may be held liable for

damages tf you make material mo>r<:pn:~cnta oons pursuant to fcdcr.tl Ia" m tbc counter

ExttibWA" IO TIPS Agreement Poge 4ol9

nonfication. When we recet'e a .:ountcr m"llification. we may rcinstah.: the material in

quel:non. To file a l·ounter notification "uh us. the pro,·ider of affected material must

rmwidc a wrinen communication (by JM>"mltmil, overnight mail. or, when digitall y-signed,

by emai l) that sets forth the items specified below. To expedite our abi lity to process your

counter notitication. pkasc usc the following tormat (includ ing section numb~rs):

a. Identify the material that Ncarpod has removed or to which Ncarpod has dt><tblcd

acces-; and the location at which the material appeared betorc it \\a> rcmo,cd or

access to it "as disabled.

b. PrO\ide your name. po>t:tl <~ddrc>>. tdephonc number, email addrc>s. and a

>tatcment that you consent to the JU'hdtcnon of Federal Di>trict Court for the

j udictal distJi ct in Miami. rlorid,t (tf your addre-;s is omsidc of the United Stmc,,

for any judicial district i11 which Ncarpod may be found), and that you will accept

service of process fmm the person who provided the initial notiticatinn of

in fringement or an agt!nt of such pcr~r.n.

c. Include the following statement: ·•r ~wear, under penalty of perjury, that I have a

good f.1ith belief !hat the removed mmerial ""s removed or dbablcd a> a re~ulr nf

a mistake or misidentiticatton of the n·atcrial to be rcmo\Cd or disabled."

d Sign the paper or affix an el~trontc or digital signature to !he communication in a

tonn reasonably acceptable tn "<earpod.

c. Send wrilt~'D communicatiOn to the following

I ~3()5 l:l1scayne Blvd.

A \Cll tunt, florida 33 160

f. Send ck nromcally- or digitally-signed communication

to ' ~ _ ___ : . .•. . ~ . Upon receipt of a counter notification in subsmmial

compliance with the OMC'A. 'lcarpoe "'ill provide the pcn.on "ho provided the

mitial notification of clatmed mfringcmcnt with a copy of the counter noufication

PO!Je Sof 9

promptly. Aficr 1\.'CCtpt of th~ ~ount.:r nmification. 'lcarpod will generally replace

the remo,•cd material and ~a•c dtsabl ng access ro it. unlc.s };carpod's designated

agent first receives notice from the person who submitted the initial noutication

that such person has tiled an action seek ing a court order regarding the removed

material.

Ncarpod is generally unable to evaluate the merits of trademark d isputes because trademark

nght> may be based on registration or common law use, exist only for ~ertain categories of

goods or service-; and rna} diller intcm;otionally. Therefore, :-lcarpod cxp..'Cts you to resolve

trademark disputes directly with the mdi' idual rather than utili7ing 1\carpod as an

intermediary.

5. You are responsible for maintaining the confidentiality of passwords associated with any

nccoum you usc to access the Nearrod Matenals and you are respo nsible f(w all activit ies

that occur under your account(s). You arc solely responsible for any consequences, lo~~cs,

or damages tha t we may directly or indirectly incur or suffer d ue to any unaurhori?cd

activitie~ conducted by you. lf you b~comc aware of an) unauthorized use nf your

pa>Mvord or of your account. you ab'T.:e to notify Nc;u-pod unmediarcly

at

6. You agree the usc of any data rc l<ttcd ro the Ncarpod Materials shall he in accordance

with 1'\curpod's !.'.!.• cili:L!.::.?!!L-

7. We may provide various open communication tools on the Nearpod Matcri;ds. such as

blog comments, blog post>. chat (orums. tnc>sagc boards. ;md the like. fly posting

mformation or otherwise using any upcn cummunicarion tools as m~ntioned, you agr.:c

that )OU "ill not upload. post. share. or othcmisc distribute any content that: (i). ts illegal.

threatening, defamatory. harassing. dcgrddmg. mtimidating. fraudulent. ractst, and

( .)d'llbii"A" to TIPS Agreement Pago 6of 9

pomogmphi.: or contains any type of inJppro~riatc or explicit language; (ii). infnngc> an)

trad.:rnar~ copyTight. trade secret. or oth~r prupnetary right of any pany: or (111). attempt>

any type of unauthori7cd advertising.

8. We reserve the right lO anonymously track and report a user's activity inside of the

Ncarpod Materials using non-personally idcntitiahlc information as more fully discussed

in our -"'·).J:'• '«0 . We wi ll not udvcnisc or market to studentS who ll>c Ncurpod. nor

"ill any student information collected by :-.earpod be shared with third parties for

"d' ~rtising and marketing purpo>.:>

9. We may, ~t our sole discretion. ,u,pcnd u tcmtinate your access to all or pan of the

Ncarpod Muterials with on\ithout notice and for any rca<on. including. without limitation,

breach of this Agreement.

!lulu Ownt•rship

I he 1\carpod account owner is tbc owner of any dam, including student Content, subtmttcd

through the :-..earpod Materials. NcJrpod retains a perpetual, irrevocable. worldwide,

~ubliccn..ablc and transferable right to u~c. publish. diSplay. modifY and copy anonytm?cd

Content For the a' otdance of douht, 'ueh 1non)mized Content sball not mcludc any

pcr;onally identifiable information.

('ancelling Yout· Account

You may cancel your Ncarpod !'~tid Account ar anytime, and cancellation will be ctlcctivc

immedia tely. Your Nearpod Pa id Account will continue in effect unless and until you

cancel your Paid Account or we terminate it. Should you elect to c;mcel your Paid Account.

pkase note that you will not be issued a rcfunJ for any previous paymentS.

P•oc 7of9

Db claimcr of Wa r ran ties

1 h~ Ncarpod Materials are pro"ided •·a• ,,_.. Ncarpod h~reby disclaim-; all warranties of

any kond. express or implied. including. without limitation. the \\<OOT.onties of

merchantability, fitness for a particular purpnsc. and non-infringement. Near pod docs not

make any warramy Lhatthc Ncarpod Material> will he cn·or-frcc or that access thereto will

he continuous or unimerruptcd.

You understand that you usc the 'carpod Materials at your own discretion and ri>k. You

arc •oldy re~pon.;ihle for any damage to }OW computer or other de\·ices and tor an) los•

of data that may rc•uh from the do" nload of >JCb com em. We do not pro•tdc any \\\lrntOI)'

or gmonmtee as to the accuracy, performance. completeness. or suitability of the

inf<)nnmion and materials found or oftcrcd on the NearJl<~ Maocrials. You acknowledge

1ha1 ~uch infonnation and maocria ls may con:ain inaccuracies or cnors and we cx 1wc~~ly

exclude liabilioy for any such imoccuracics nr eo·rors ro the liollcst extent permined hy law.

Ncarpod docs 110t guarantee or warrant ohm any content you may store or access through

the Nearpod sen·ice will not be subject to inadvertent damage. loss or removal.

It i:. your rc,ponsibility to maintain approrriatc alternate backup of your infonnation and

data.

Limi lalion of Liability

In no event will Ncarpod be liable witll rc,pcct to any subject matter of this agreement

under any contract, negligence. strict liabi lil y, or other legal or equitable theory for: (i) any

$1lCCial, irocidcntal. or consequential damages: (ii) the cost of procurcmcnl for substitute

products or seo·v iccs; (iii) for intcnuption of usc or loss or comoprion of data; or (iv) for

any amounts that exceed the fees paid by you to Ncarpod.

EJ!hibit"A* to TIPS Agreement Pago8ol9

Gcnrral Representolioo and \Varranty

You rcprc;cot and warrant that (il your u;.: or our Product will be in >trict accordance "ith

the PrivaC} Policy as stated below. with this Agreement and with all applicable law~ and

regulations (including. '' ithuut ltmiltltton, any local laws or regulations in your country,

s late, c ity, or other governmental arc:. , regard ing onl ine conduct and acceptable content)

nnd (ii) your usc of the Product will not in ti·ingc or misappropriate the intcllcchml propct-ry

rights of any third party.

.\1 i"cllaneous

I h1> Agreement constinucs the cntrrc agr.:cmcnt between 'IICOlrpOd and you conccnung the

~llbJcCt matter hereof: and it may on I) be modified by a written amendment stgncd by an

aut horit.cd executive ofNcarpod, or by th e post ing by Nearpod of arc' i>cd \·crsion. Except

to the extent that applicable law. iftmy, pmvide.• otherwise, this Agreement and any access

IV or usc of the Nearpod Materia ls will b~ J,'Ovcmcd by the laws of tbc stutc of Florida.

U.S.A.

Contact Information:

I l!JUS Bi<caync Blvd.

A\ cntum, Florida 33160

If you have any questions or COilllllCllt' about this Agreemcm or our erh_..!;_::. 1'." . you

can comacc us at prnth:}· ·.l:_..n .. ·.~)l~.'.l' "'(·!

rtTccti\'C Date for Ttl'S agreement \1arch 15, 2015

I:Jthib•t"A" to TIPS Agreement P•s• 9ot9

CompositeExhibit“B”

The lnterlocal Purchasing System (TIPS Cooperative) Supplier Response

Bid Information

S.d Creator Mr. David Mabe General

Email Phone Fax

Bid Number Title

Bid Type Issue Date Close Date

Manager david.mabe@tips-usa.com + 1 (903) 243·4 759 + 1 (866) 7 49-667 4

161 101 Addendum 4 Interactive Presentation Systems RFP 11/1/201612:00 AM (CT) 111312017 03:00:00 PM (CT)

Suppl1er lnformat1on

Company Nearpod Inc. Address 18305 Biscayne Blvd

Ste 301

Contact Department Building Floor/Room Telephone Fax Ema11 Submitted Total

Aventura. FL 33401

(855) 632·7763 (305) 655-1999

111312017 02:49:23 PM (CT) $0.00

Contact Information

Address Reg1on VIII Education Service Center 4845 US Highway 271 Ncrth Pittsburg, TX 75686

Contact Kim ThOmpson, TIPS Office Manager

Department Building

Floor/Room Telephone +1 (866) 839-8477 Fax + 1 (866) 839·84 72 Email blds@tips-usa.com

Sh1p to Information

Address

Contact

Department Building

Floor/Room Telephone Fax

Email

By submitllng your response, you certify that you are authonzed to represent and bind your company.

Signature Felipe Sommer Email rfps@nearpod.com

Supplier Notes

Thank you for your business!

Bid Notes

S.d ACbVIbeS

Bid Messages

161 101 Addendum 4 ·Page 1 of 6

Bid Attributes Please review !he following and respond where necessary # Name

Yes- No

2 Yes· No

3 Yes - No

4 States SeNed:

5 Company and/or Product Description:

6 Primaty Contact Name

Note Response

Disadvantaged/Minority/Women Business Enterprise • No OIMM'BE (Required by some participating governmental enlltoes) vendor cenrles that their firm is a 0/MIWBE? Vendor must upload proof of certification to the "Response Attachments" 0/M/\II'BE CERTIFICATES sectJon.

Htghly Underutilized Business · HUB (Required by some No participating governmental entities) Vendor certifies that their firm 'sa HUB? Vendor must upload proof of certiriCation to tile "Response Attachments" HUB CERTIFICATES seClion.

The Vendor can provide services and/or products to aliSO Yes us States?

If answer is NO to qLestion 113, please list which states can be served. (Example: AR, OK, TX)

Thos informabon will appear on the TIPS websote in the company profile section, if awruded a TIPS contract. (Limh 750 characters.)

Primary Contact Name

Nearpod is a mobde learning platform and content marketplace tllat helps teachers reimagine the way they teach using mobile devices in the classroom. Teachers and Sh.Jdents k>ve the platform, and Apple and Google often highlight Nearpod as an essential classroom tool. As a result, engagement has grown exponentially since rts launch in 2012 -Nearpoo ctmenlly reaches almost SM students monthly in over 10,000 schools. While most of Nea.rpod's usage and focus to date has been in the US, the product also sees significant adoplion in leading international markets. 1.3M teachers registered with the platform. and they downloaded tM tnteracbve lessons from the Nearpod Store Using Nearpod. teachers collect over 10M insights into student leam•ng every month.

The company has offices in Miami (FL) and San Francisco (CA) and was founded by Berkeley classmates and experienced entrepreneurs Felipe Sommer and Guido Kovalskys, a recetlt education fellow at Stanford's Oestgn School. Nearpod is backed by a premium pool of investors: Reach Capital. Store Ventures, Rothenberg Ventures. Emerson Collecliva, Slantord University (via its StartX fund), Marc Bennioff (Salesforce.com CEO). and Deborah Ouazzo (Ma1laging Partrler at GSV Advisors).

Natali Barski

161 101 Addendum 4 - Page 2 of 6

7 Pnmary Contact Tille Primary Contact Trtle Special ProteCts

8 Pr~ma'Y Ca<uact Emaol Pnmary Contact Ema1l rfp@nearpod.com

9 Primary Contact Phone Ent&r 10 digit phone number (No dashes or exterl&•oos) 3056775030 Example 8668398477

10 Pr~mary Contact Fax En1or tO digrt phone numbet (No dashes or extenSions) 3056551999 Example. 8668398477

11 Pnrnary Contact Mobole En!er 10 drgJl phone number (No dashes or exJonsoons) 7866831546 Example: 8668398477

12 Secondary Comact Name Secondary Contact Name John Kru!hoffer

13 Secondary Con1act Trtle Secondary Cont~t Titla VP of Sales

14 Secondary Contact Email Secondary Contact Emarf jOhnk@nearpod oom

15 Secondary Contact F'horte Fn!e< 10 digit phone nurnbe< (No dashes or extensoons) 3056775030 Example 8668398477

16 Secondary Contact Fax Enter 10 digil phone number (No dashes 0< extensions) 3056551999 Example: 8668398477

17 Secondary Con1act Mobrle Enter 10 digit phone number (No dashes or extensiOns) 7862009034 Example 86683984?7

18 Adm.., Fee Contact Name Admin Foo Contact flame Thts peiSOn is re51)011- lor Marlin L.ede payong the admin fee 1X> TIPS

19 Adm11\ Fee Contact Email Admtn Fee Contact Emed finance@.lnearpod com

20 Admin Fee Con1act Phone Enter 10 digit phone number. (No dashes or extenStOns) 3056775030 Example: 8668398477

21 Purcllase OrOO< Contact Name PIJrehase Order Con:act Name This petSOn rs responsi>le Martin L.ede lor roc:eMng Purcl1ase Orclo<o from TIPS.

22 i>urchase Order Conlae1 Ema I Purchase Order Con:act Ema l suppcn@nearpod oom

23 Purchase Order Co1ltact Phone Enter 10 digit phone number (No dashes 0( extensions) 3056775030 Example: 8668:l984?7

24 Company Website Company Website (fo<mat • www.cornpany oom) hnpsJ/nearpod corn/

25 Feclera! 10 Number Feeler at 10 Number .tso knOwn as lhe Emptoysr 4&0993679 ldenl rrcauon Number (Formal· 12·3456789)

26 Primary Address Pnmary Address 18350 lljscayne Blvd .• Suite 301

27 Pnmory Address Cijy Pnmary Address City Avenlora

28 Primary Address State Primary Address Slats (2 Dig~ Allbrevialion) F~

29 Pr1111ary Address Zrp Primary Address Zip 33160

161101 Addendum 4 ·Page 3 of 6

30 Seatch Wotd& Please •st search -cis to oo posted in the TIPS Nearpocl cHoarntng, e learning. database about your company that TIPS webSite users interactive software, digital contenl might search Words may be product names conten~ Saas. cloud based, rnanutacturets, 01 ot1or WOtdS associated with the cloud-based, tocenses. common calegOiyof lhatd YOU MAY NOT UST COle SUIIldard stalldatd-aligned, NON.CATEGORY I-EMS (llmot 500 wo<ds) (F«mat otandard a1ogned. K12 K 12. K-12. product paper. conotructoo. maoofactll<e< name. e1t: I 1$1 Konde<. Kinde<ganen,

Klndol'garden. First, 2nd. Second 3<d. Third. 4th, Fourt~ . Sth. Fifth. S.xth. 6th 7th, Seventh, 8111. Eighth, toot. ossessm&l,t, assessment toot, IO<mabve, mobile learning platform, content marketplace. content, curriculum, tutO<ong, engaging,

31 Yes· No Oo you wish to be elg1ble to panicipatc itl a TIP$ contract Yes in wh1Ch a TIPS membot ufllizes lederal funds on contrac1s exceedrng StOO,OOO? (Non-Construction) (If YES, vendor should download th~ Federal Regulations lor Contracts document lr«n the Attachments secbOn. t tl out the form and subfM t11e <loaJmem in the "Response Anachments FEDERAl FUNDS section I (Vendor must also dov.nload the &ispens.on or Debarment Cenrficate <loaJment ~"'" the J.nachments section. Iii out the torm and subrM the docu'nent in the ·Response Allachrnents SUSPENSION OR DEBARMENT section.)

32 Yes- No Certrfic4toon ol Ro~ (Required by the Slate of No Texas) Cornt>any SUbmtn1ng bid is a Texas res1derrt bldder?

33 Company Resloenco (City) Vendor's principal place of business is in the city of? Aventufa

34 Company Residence (Slate) Vendor's principal ptace of business is in the state of? Florida

35 Felony Conviction Nouce . (Rcquorlld by the State of Texas) My firm os, as outlined on (No Response Required) PAGE 5 '" the lnsttt..Cl!ons to Biddefs document· (OuestJons 36 • 37)

36 Yes- No A pubtocly held corparatJon; tl1erelore thos reporting No requir"""'"' '" not applocabte,

37 Yes- No IS owned 01 _.,ad by JndMduat(s) ..no hasA\ave been No corwctlld at a lelony? ~ ans..'l)r IS YES. a de1aied exptanatoo of the na-ne(s) and convietoon(s) must oo uploadod to tha ·Response Attachments• FElONY CONVICTION sectJOn

38 Pnang lnforma1;on. Prcmg infO<mation sectoon (Questions 39 - 42) (No Response Required)

39 Yes - No In addiUOn to the typical unit pucmg fumisllod herefn, the Yes Vendor &grees to furnish all current and future products at prices that are proportionate to Ooaler Pricing. If answer 18 NO, include a stc:~tement detailing how pficing tor TIPS parucopants would be calCulated in the PRICING document tl1at is uplollded Ia the "Response Attachments" PRICING sectron

4() Yes· No Pnang subrMtod inWcles tl1e TIPS admlrliSIJabon fee? Yes

41 Yes- No Vendor agrees 10 niiTl 10 TIPS the requ~ed admnstlallon Yes 188?

42 Yes · No Addllional doscounls t:l TIPS members tor bull< quanllb9s Yes a< scope ol wor1<?

161 101 Addendum 4- Page 4 of 6

43 Start T1me Average stafl lime a1ter receipt of customer order Is __ 5 working days?

44 Years Experience Company years experience in this category? 4

45 Resellers· Does the vendor ha\'e reseners that it will name under this No contract? (If appbcable. vendor should download the Reseller/Dealers spreadsheet from the Attachments section, fill oot the fe<m and submft the document in lhe ' Resp<Jnse Attachm•nts" RESELLERS section

46 Prices are guaranteed for? (_Monlh(s). _ Year(s). or Term of Contract) (Standard Term of CorHract term is ~Term ot Cortracr)

1611 01 Addendum 4 - Page 5 of 6

Line Items

Response TocaJ· $000

161101 Addendum 4- Page 6 of 6

I References

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

!organization lcitv !state !contact Name I contact Phone Eanes ISO Austin Texas Carl Hooker 512-732-9026 Round Rock ISO Round Rock Texas Lannon Heflin 512-797· 1895 El Paso ISO El Paso Texas Timothy Ho lt 915 230 2640

Regulatory Standing Form

1 certify to TIPS for the proposal auached that my company is 10 good standing wtth all governmental

agendes rederal or state that regulat!' any part of our business operations. If not explatn below or

attach explanation.

S'gnatur!'

Name of Authoriz!'d Signatory

Name of Company

Date

Notice to Vendors Conflict of Interest Disclosure Statements Texas Local

Government Code, Chapter 176 for Education SeMce Center and TIPS

\'e<!Ocn a-e req,Aed to~ a ~a c' Interest 0\.~re \FOtl"' 0017 •. 1!1 ;he D'oS!rict If an emp!9yment 0! buaineu relatlon$hip !!! lamdy relatJOnlhip exists ber.wee-> me VE!!'Oar ~ a lOCal gc~t office. ("t.GCY) o' ~ llls:r.ct or 8 lwrtt ll'emllef of i;e ~GO THERE ARE PQlEHTIAL CRIM!HAL PEHALTI£S FOR FAilURE TO COMPlY WITH TEX LOCAL GOVT. CODE CHAPTER 17& Certa.n t.erms used neren are oefined 111 Cnaplel 176 Venoors m enccutaged to re\ fl'M and beoo'lle fanJJar .,Ill a1 dsctosure requ reme11ts of Chap!<" '76 and Form CIO The •nt0011atoo cort.med hele>n s ror ,nformatlon purposes or.1y aro sllal not oe construed as legal ac·~~ee '\/enact <neao'S a person WllO entetS or seeks 10 en;er "In a cootract w•lll a local gD\'I!fllr"ental en:i;y. -he te<m mc•~aes en agent (inciud'<ig '"'emplOyee) of a vendor.

A vendor Is roqulrod to til& a completed form CIQ if the vendor hu a business relationship with C·F B ISO (the "District") and.

1 has an emplc,ment or o1ller ous;r.ess relatonsnip ~:II a Local Go•..emment OffiCer ( LGO 'I olllle Ois!llct or a fam~f memDef o! me LGO;

2 has g .en a lGO of 1M O:S:OC:. or a fanly nember o1 the LGO. one or more glfis rt-31 have lt'.e aggre<Jate vat.le rt we 1t'a1 $100 1n !lle 12-month flE!'OO speofed ~~La: Go it Code Sectl<r l16Jl03(a)t2)!BJ e1.t1od1r.g any g ~ d~scr bed t>y Section 176 003:a- II Ot

3 ~as a ram')' re.atorsl'it> wr.l' a LGO o' :ne C stnct

Form CIQ must be liltd wi!l! the aporopriale District rewds ldmln•ttrator

'lOt aler 1\"IWII!le s.ec.oen11 oosiless 113) af.er w.e .a:er o! 11 l'le da:e lhall'le \lllf'OOr.

(A) DegH'!S dllltusSIO<tS o; nego~.a:.ons to enter II' to a OOIII!3d "m the Dis:ric!; e< (B! soomt11o tt'& Dls!rd an appltca:Jon. response to 1 teQ~;eSI !or oroposals e< btds corre$pC)flderlee, or OIIW ...n!ing rC!a!e<! 1o a po1ent1al ce<>tract wiL1 the Dlsln<:t. or

[2) l!le date the ''Cndor becomes aware (A) of an emplOyment c: ether bl;scness reiatooosh1p w th a LGO. or a lamo'Y member ol mo LGO: (6) thai the vtlfldor has grven one or more g.fts descnbec aro>Je, 01 (C) of a farr.ily relabonsh•? wdl a LGO

2 Tho •IO<Idor also s~ail rue a.~ upda:ed completed ques!lonnaile (Fom" CIC! not tater 111M t~e se te<lth buSIIleSS day atte< the da:e on -.Nell Ire •.-endot beromes awa<e of an event tlla: v.Cllld Make a sta:emern'" the questlonnaint in oomplete or <1acx:t11 a :e

Local Government Off1«11 !LGOs! of theE~ SeMc:e c.nw R!g!cn 8111d TIPS as of SFember 01, 2016, include

Members of the EOOca8on Serllce Cenllr Rlgicln 8111d TIPS Board ofT rus1ees: curre-.n 1>st lllllld at h:tpJ/ WWII reg8 nelf106J11_2

2 Executl'le OireclOr' Or. Oa'f'O ~;t:s

3. An employee of Education SeMce Cenle< RegKln 8111d TIPS who exercises discretion In the planning, recommending, selecting. 01 conlractlng of a vendor a 1'$1 may be found ill nttp1/www.reg8.netl80330...2

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

Th11 quevtionnaire reftect• c:haug:t$ made to the law by H B~ '23, a.tth L•g., Aoguf.ar Session. OFACE US£ ONLY

1•1 &; Q:;"iionnwre ~s be-:~g fi.ie<l:n accQ!"~a~ With Chaptar 17!1- local Gc,'tmll"'tf"'t Code b-1 a •tendoc ~ ~"olS .1 buSif'to£SS rc-~;p 111 ~red Of~ 176 00111-a wt.~ a~ ga:«rW'I"~Ia erdt) and~ On -""' \ll1tJdo.• rr~IS IQQU11~it ~ Sac:IJ,on ,70 000.01

~; "'" ,...c:. q;.re-s:'.OfV\M.!·• t'"Ji.llt be t.1.eo w11n :n.. t~·dl..ct'".o1\l'$:""~ cf:ne cx.a1 ~o~,.~ C~n~1'f ""ot -4Uir :_.,.,;u• t-"'G :t_n o-..~S!f"~ &J' 3"'1M l"'rC oa:e trc ..._.--del blco"r"es ao\a:e o' fae":1o !hat·~.; ·• :.N! s'.a!~ to M

. '"" S.O 5c-:.t.¢"'l: '7S OM 11 ~ .. IX.3! G!l'wCM'':ifYU Coo•

A ;tr,dOt' OC)nli"'N:' an otfe.,..e 11 tt 1 .. ._I'!COI' (('0,,.. ngly v·olattt Soct-on 176.006, ~ Go .. .mment Cocw A"' o'hm4~ uf'der t!"!-;s wcticn !So Ml~de.meanor.

~ N~,. of vendor who has a business relationahlp wiih local govHnmenllll entity.

Nror-~lnc. I o..l):i/1J..iY'Jf'"e Cor~:>

~ 0 Check this box if you ore filing an upd.11e to a previously 1~..0 questionnaire. (The law requii'8S !hat you~ e an upd3ted eompie!ed qu«;:ronna~<o Wltn tl>o approp<~<tte fotlng <lulho<lt) not Inter than the 7th bus.ncss day altar the date on which

you beGame aware that the ong•nally Med questlonna•re "as incomplete or inaceutate.)

~ Name of locill government olli~r about whom the information Is being disclosed.

• I "'"""' of Off~·

.!.1 Describe eoch employment or other business relationship w~h tho local government oHleer, or a family member of the officer. as described by Section 176.003(aX2XA). Also describe any family relationship with the localgovemm$n1 officer. Complete subparts A and 8 for each employ mont or business relationship described. Attnch odditionat pagos to this Form CIO as necessary.

A 19 the <ocal govemment off.cet or a family membe< oltho ol!~eer receiv.ng or tlkoty to recervet3J<aolo 1ncome, otr.er than <IIVestmem u>eome from the vendor?

O vas ~No B. •s t"e •t<'dor rece • ...ng 0< l<eiy to reeel\ a taxa!>il nr.orm~. omer l'"an mes1IT>e<1toncome ftom or atl!lo d>toctiO<'I of the local gowemm;;nt olfJCe< or a fam..y member 01 the olfocer AND the taXab'e .nc:ome s not rGCelved from the local govommenml erntt17

Oves ISJNo fil Describe each employment or business relatoonship tlultthe •endor named In Section 1 maontains with a eorporatoon or

other business entity with respec110 which the loc.tl government officer serves as an officer or dil9<:tor, 011' holds an ownership Interest of one percent or more.

~ D Cneck thts bo> 1f tne w'>dor nas g·.e<l the local govem~t offiCe< or a fam<ly member of the officer one or me<o gfts as des::<ibed •n 5ectK><l.11S003oa~2 81 e~ gdts <lesetoed"' Secoon 1760031•1).

1.J r->- :J ... )~ ..... .~ ....

_ ..... , .--· JQo. !?J I 2.0 13-Sigmnure o1 vendOr doing b"s.r-ess w•1h fh~ govec~~nr.at oru!; Odie

I hi$ certiticauon tS req\lin.'<l hy •he n:gulati<>IIS Implementing Executi\'e Order 12549, llcbanncnt and '"'pension. 7 CJ R Pan 30P. SecttO!l JUI7.~10.1'orrlclp.1HS' responsibilities. Tite regulali<'n\ "ere publi\hrd ,,, 1':<<1 I v ul' the Jr.11ua~ 30. 1989. F~&rJI II··~'·''•'' (f'<lsC> ·1712-17B t. Copies of the regulillion< m•) h.: l>btllnh:d In c.•nwcltn£ the Deparunenr ot •\);rkuhur" ;lt,"'"'" "11h \\l1kh this lrall.<aCiion ontttnateJ.

1 'I l'h~ rn"pcttl\-e lo"cr uer pan:CIP.llll c~rr•ti...,., I>) ,w.m;,,ion of this proposal. that nctther •t nor iL' princ•p>l, » prcsentl) debarr..t <u~..t. 1"''1"' .... -d for debarment. declared m•h~tble. or 'olunllnl) e.,d<ldtd !Tom parHctpJlH>n llltht•ll'3tl>-3<lioa b) an~ f..JeraJ d•panmcnt or •lt'l.'ll<.")

(:!) \\'he"'-' ~h\,· prospecthe lo"er uc1 f""trtt<.:lr.mt h unah1t- to tertjfy ro any of the \UU .. "m(tl\''1 jn th~ '""-rtifoc<tliun. ~uch prospectl'e partkip•nl>hall arwch an expl:~notion to thi• prop<»>SI

tt.~ "' !!,.., ) · ·~C. / D~L.fit..'\'".!!f 0f"2anil4tlon N~me

7'!':> PRJA.,ard 'iumb•r or Projeet Namr

l\.tm~ •nd Title of Autborind Rrprr~enlaHu·

Si~:naturt Oat• ' ? - (9 ' {.

Certific:uion Regarding Lobb~ ing

~~~~mi~,;,, ofthi' u:rtifo.::nion is a prerequiSite for md~inl! or cnt.ring into this transaction and is im~ ~~ ;r~non 135~. J'itk 'I l.l. .S. Code. This centlication b ,, motcnal rcpi'Clocntation of fac•t upon \\hieh reliance wa.:~ placed \\hen this transa~.1iQn """made or enter~ tnlO All) person who fail~ to iile the n:quorc-d ccrtofkarion 'hJII be Wb)tct to a ci' il pcna~ l!f not bs thJJI S 10.000 o,d not more than S I 00,000 fllf each wth failur~.

t I • '" fedcm appr\lrrl;li,'\J hmill. ha'c ~n paid or" ·1 "epa d 1'1~ or on behalf uilhe w>dcrsogntd. 10 an~ tiC:""' tor tntluencm!: or .m.,nptmg 10 influence an otliccrc>r ""'ll"" .-.: ol an~ agClli:). a \iember of Con.~:R"'' an ott t<cr or en>ploy,., uf congress. or an etiTJ'l<" cc nf ~ \!ember uf C<lr.!fre» in connecuon ""h the:"" ..-din;~ of J r edtral cc"'~1. the lll4.king oi a Federal grnno. th< ma~or.g ~r a I cJtralloan. the emenn~; onlo a cnofl<.-rali\c a,t.·H~\.-mcnt. .tnJ the e.\.tenston. contmuauon. r.:tK"W31. d.ll\encfm¢n~ or modific:nion of a federal contnsll. 1-nllll, 10111~ or coopcratl\e agreement

(1) If Oil) lunds other rllOJl Fedeml•pprupnatcd fund' h•H heen Jl"i<l m "ill be paid tu any p<IM>II for tntlu~ocmg Clr tm~ptmAt to mflut'flC~ an oOicer or empJo~ct: of any u,g;..-nC)', a M c10b¢.r of C'ongrt!tS. nn otlker u< emplo~ eo ol rongre». ur an .:mplo)« of a Member ol ( oni>Tess in """""'"'ion "ith thi> h'\kral gnm1 or c~rau'e •!!r«:mcnt, th< Ull<k~igned shall compktc ~'"' •uhmit Stmdw fonn-LlL. -dosclosun: Form tc> Report I Ob!>)mr;.- in at:wnlanre "ith it; mstJUction'

1 i ) I he underiit!JIN shall require th.ot tlk: '"''1!114" of !hiS l"mllkauon be indudcJ on the ""w docwt=IS for :d ~.,,trOd suoowu-J, "'.,.,...jing S I 00.000 on I edernl fim<jo. at •II dl'pmpriali: tk-r>. and th31 all ~:pit'nts s!)all CC't-:1~ ;md di<clt~ .n:~<~t.linfl).

' ' "'' {;1,_,:, ['! ~ ;c, A.~i'11T'Jr-'A~ ·.~.t>>"T 1\,unc A<ldr.:ss ot Or~;nnlz:otion

/ ' ~ · M~( / rUs I\ :om,. lulc ,,fsubrnillml! otlkial

/ - .

Date

Contract Term.~ ;.nd Condirions Please initi.a l your answer and sign ou page 2 or 2 of this section

Indemnification ·rn.: F-SC Region 8 and TIPS is aT ~xas !'olitit•! Subdivision and a local go,emmenllll ertlil}; therefore. is prohibited ({om indemnil)ing third partie• pursuant to the Texas C<lnstitution (Article J, Section 51} ~xcept as specifically provided by Jaw or as urdcr<'<l by a coun of competent juri!.dkdon. A provi•ion in a contraCt 10 tndem.ojfy or hold a part> harmless is n promise to pay foe :tn0 c\pcnse; tbe indenuJiiied party incut:>. if a specilied event o<:cun.. such !IS breaclling the terms uf Lhc contract or negligently Jl<'rfunning duties un:ier the contrJ<I. Article IlL Section~ of !he T~as ('onstitution >late; th•t "no debt shnll be created by or <m behalf of the Swte ... " The Anomey Gen~ral !1.1; coun&ded that a canlrnctU<SIIy impo>cd obligatioll of indemnil)' crt'3t~ a •·debt" in rhe cou~tittltional sen.;c. Tex. At!') Gen. Op. ~o. :-IW-475 (1982). Contract clauses which 1\.'qui~ the System or insttllllit>R> to indemnify must tte deleted or qualified \l ith "lo the e\3Jmi pennincd by the Constitution and l.aw~ of the State ofTt.Klls. ·• liquidated <lnn"g<:s. nnomey's fees. wai"er of 'cndor'; liability. and \\aiv~r of mtutes of limitarions clause• should also be deleted or qualili<d " ith ··w lh~ C~ient permitted b~ lht Con~itu.tion and laws of State nr·, cxas .. ,

:-.ot a n~oliuble term. Failure to~-· "ill render yay pfo)losol non-re<ronsi>< and it "ill not be eonsid•n•tL l>o )Ou agree to th<'$r term>? YF.S ~ N()

llemedies 'I he parHes sb•~ll be '-'mitJ~d tO e.\ erc ise an~ nght or n::mC'd)' 3\'lltlflhfe. ul it eith~'f at Lm or in equity. subjrtt en the c-hoice oftn\'1>', venue d ild strvice ot procc" clause> bmitations ag,rcoo htrdn. ~othing iu this agro:.oment '""" commit tht I IPS to an arbirrot.ion n.'loolutiun of an~ disajlfe<m~nt unJcr afl)· cireumsrnuces. An~ Claim arising om oi or relatrd ~ t.lt< Con!rd<:t. except for those sped fl.-all} wai,ed under rhe tenn' ,,f the Contract. may, aft.-r de11ial of the Board of Director,., h<: 'uojcct tu mNlintion at the req,1est of <ith.:r patt) . Any i<~ue; no t r<'«>lw J hereunder must be "'' """d 10 non·binding medi:uion to be conduct«.! b) ~mutual!)· agreed upon mediator a~ a prercqui<it<: to the filing of any !a\\>ui> '""'such i~sue(sJ. The panie, >h~ll sk'tre the mediator's f~ and any associmcJ tiling fee c4uall~. ~1¢dill ion sbaU w he.!d in Camp or l'irus Count). Tc,a,. Agreements reached in modiation •hall be reduced to w1it ing. and "i ll b.: subject to tbc "ffpntVal b) the District'5 Board ~>fDir~ctors, stgned by the Ponies if approved b) ilie Board ofOircctor<. and. if >ig.ncd. ;ba!llhereaHcr lk: ~nforceable as provided I>> the la"'s of the State ofTc>as.

Do yQu aJ!ret' io these t~rms? Yf,S t:'SSf NQO"}ou do nut, please referen~ o bjcclio n in De' lutiod Corm section

Choice of Lan This agre~mellt and any Jtltlonda or other addition> and all comra.:ts IY. ;mard< re,uJting from Lhls prO<:urement prtlCC:i>, hov;ever <le,crired. shall be gon:mcd b~. construed and enforc~d in accordance \\ith the Ia\\~ of the Srmc of Texas. reg,mlh . ..s Many colltlict Hfht''~ princip1n. , .o t a negotiable term. Failure to agree will rend<r >our proposal oon·r~ponsi'e ~nd It \\ill not be considered. Oo you agree ' " ihe<e terms? YES P<'! :'IOO..D._

Jurisdidion aod Sen-i ce of l'roccss .'\n,_ Proceeding ari>UJg out of nr retauo2 to tb.is proc-urement proct~ or anycontr,ltf re;uhing from or any contemplared rmn~tion >h.ll be b!ought in a coun of competent jurisdiction in Camp County. J exas and each or the pan ies irrc•<>eably submits to the e"<dnsi\·e .iUTis.dk:ttun uf ~aid court in nny such pmc-~ding. v .. ·aives an) objection it may nuw or hereafter hnve to venue or to conveniene<: of rorum. nsrees that all daim\ in rc~~~ of the Proceeding .na11 be J..,.,U anJ dct¢tmioed on ly in any such court, and agr~t.:~ not to bring an)' proc.:~ing ari:sing ou1 of or relatjng to this prl)CUC\:rtk!'tU prOCt..-ss or nn) conU"i!ct resulting from or any· contcn>plat.:d trunsact1on in any otber court. The pam..-s agro:e !hat ei1ber <If bt>th of them may Ok a copy of this p>ta!!)1ll>h with any conn:!\ v.ducn evidence ofllle k.JlO\,lng. "'oJuntary and tfce:ly bargai_n~d {(>r ayrt:t:mcm bet~c~n d1e parUes irrcvocabty ttl waivl!' anr th'ljt.":t:tiofh LO 'rtlll~ or to ronv~nJ4!U<:~ of fhrum . Process 111 ~n~ Prnc..-~:ding rt1Crred -to in the fJI'St sentence of thi!\ Section u1ay be "'-"1"\'ed on any part~ an) where in the \\ orld.

~ot a n~miabl!! tl""rm. t .. ailure to Ul!t·ee "ill render your proposal non·re..~p~,n~ivr and il will not be coosidered. l>o you agre<: tu tho." terms• YES IX'l i'iO D

Alternative Oi•pute Resolution Prior ro lilinJ; of litigllli0<1, the. parties nt.lY selea no~>-binding mediation'"" mc:h<~d of contlict resolurl<m for issUC> an:<ing out of or relating w rhi" (lr'ncurcment process or an} contracl resalting from o:r uny .:::ontcmplat.-:d rran.saction. Tht:: pmjcs agree that if non .. binding merliaJl<m i.' chosen a; a rtSolulion proc<s.', rbc parties mu;1 agree to the cha..,cn mediator(s) !llld thlol all mediarion venue shaH be ill ,, I<K:atiO!lln Camp <tr Titu~. County. 1 exas 3!,'l"C<d I>) the pat1ies. The panies agree lo share t<~Ually tlle cost of th.: mediation ()Cfl.Ct:"i.' ?tnd \.-cnut: c.o:>l.

llu ~ ou. agree t.o the..;.t tenn~? YES 181 ... ~O_D_If )OU do not, pt~Sf: n::fcrenct objection i.n Dn·iari·on form secti~n l'a:l<' l of~ Terms and Conditions

lnfringement(s) The succe;sful •endor wolf be e~ed to indemml) and bQIJ hann less the TIPS nnd its emplo~e~!.. officers. agents, roprowmwve,., contractul"l. ass(~ nnd dr~iW>~•• from any and all third party claims and judgmmts involving mfrin~ement of pmem. copyright, tr..Ue ;c~r<t< tr~J• <.>r ser-ice tn(IJ'~S. and ~ny other inttllecn•nl or inmnglblt pt opcrty n~ht< tn con.n.:.:toon ""h the ,..,m~o,., l'f"l"'"''' ur ultimate cuntmcts dl .. rJ.!d aJld appro>ed

l)o • o11 ogrte to these terms? Yf..S 1$\l ~o_D_u~nv do not, pltase rtferenec objt<"tion in Oe.-iouon form st'<'tion

Acts or Omis~iuns I Ito <ucccssful •mdur Will i><: C\pt:Cted to indcmntf) and hold hormk" the rtP$, ib <>nice.-. cmpiO)C<."S, agent-. n:pr'-·~eBtati\'\:'lo. Cllllll tl~o.hlr"", IL\'i.igncc~ aruJ dc,.,ign"~.:~ fnmt an&J apiM\1 ..ID) :tnd afi Ji;,bilit}'. (iCtiOn5, tJaim:s:. dem;&ndS Or 'u1h, and all rcL1h:cl l lht .... .ttlnm~·s f~t.'\ .md tvpcn'IC'o an~;ng ou1 nf. or rc .. uhing from any actS or omi$5ions. ot the \''l.!r:dt)f <'r i ro;. 1;!-..:"'' employt.ei, ~bcoomK1cW" . ()f suprlieri itt th~ t:\«"lltK>O or perfonnancr of an) a,greeme.l.ll.S 11 m.l'el~ mad~ In Tlf'<; ilftd the \'CnJnr

Do ~ou agrt• to th~t trrm~? \ E!; IS} ~~oo_Dif )OU do not. please referrnce ohJectton in 0<' iatlon form srttkm

Contract Gu' ermwcc c\n) coot=t an.adc or ent<'fcd into U) the T II'S " 'UI>JcGtto anJ '' l<1 1>.: ~~~vcmed b) Sccuon 27 I I~ I ~~ 5<q, T" Loc C.o•"' {'1:\Je. Otht'n\1~. TTI"'i 00<!51101 "•"< "' go\cmmcntaltmmunoll« fmm •ui: or liabahl) c•ccpt to lhe ••~"'" C\f'fC\.'1~ "'-al\cd h) uth-:r applic:thlc ld""" in dt.:& anJ unambtfU4.lU.' I~

' or a nrgotmblrrtrm. hllurrto agrBI rtndrr •our_ propo.al ~on-rcsponsl\t and 11 \\ill nor be I'OtUidrrtd. Oo ~ou a~rer to rht>r trrrus? \'£S · 'O..D..Ntlll nttoti•blt term.

I'aymcnt Term) Tlr' ... member .. fM" m.--t ;nor at point <tf ~ak .and t;dmplk~ \\JLb lh.: ~lUI~.: o( Tc:'~ pa.~mcnt Ia\\, rex~ Go,crnm.:nt ( \ K.i.:. Ch;;:.pl\."T :::~I '-'~..: .. hutili: !hr spcc1lk) oc I.:VfbUh yout k6ftl cou.ru.tl ln<>e .an: mimmuan t<nob reqturnl oftbt Ill'S ~· "'" .u>d thepou:tt<S m3~ ne~o:ia:e castom p;l)'mtnl tenn> a> dcsirtd p<O\ ..Ud tt.e~ do not ' ,oldtt the rnttul~ rttqutrtmenrs

Funding Out Clause l'uKuaflt to 1 e:.a~ Lucdl v<l\ernmenr Code !>«. 171. 90:!. ~ny proposnl ot'f~r aeceptcd b~ I II'S Md its mcmbtrs and n II comr:tct> to 1><: di'PI\l\Ct.l Jrc 'ubjcct to the budgeting and appropriation of then current!) a~ailable fund>. Sc¢ >tatute lt>r •pcdfin or colbult > vur kg.al ~oun;el

"Otllll<I!Oii2bl~ tcnn. Failurt to agrtt' "~I rtndn your propoS* I BOA-responti•e ond it .. ill not bt ~ontider<d. Oo ~ ou agr<r to tbtsr trrm•? \ £!. r>?J '0 ..D_Not • n"otlablt trrm.

Signaltlre below -.~rt i l ies aTy ~~~~~ll~'.)_e~ LO all sections on page 1 and 1 of this document.

,,uthorizcd Signature. ___ -~">:--~-='----------

C"'c F_ ' Printed '\arne _r;....;: ~-c.;'-:;.;....:..:.;.__c.;-;.;'?;_....:...-=....: ______ _

Company >: amc and udtlrc:ss: -'':..:'~-":c."~- ..;,... __ • ., ____ . :....:: ... _ _:.fl..:f.:· f..;~..;W':;_' .:..f' f:;__..:".:'~' :,:f:.:..".::':c.' '.::' .. :c.'1..:'..::C:.::A/:_· ____ ._:?_~_0_) __ 8;_' ..:"..::vl;:.>.::.;'_•.:.f...L&:.-:"::.:II..::O::_~it..:1-_"'_:.1 _ _;4..;•..:·..:.a.,:. '' tUM tl j.

~~/C,? Date 1 { - ( ~ ~- "

-, . T clcphone ~umber __ .,_,.,_-;;:;'>_..:C.::..-,_. _•_-_ ,..;o_.,_o ___ _

P•gc 1 of~ I crrns and Conditions

DE VIA TION/CO.\lPLIA:\C£ SIGNA ITRE FORM

\Cl\11' "'r ' ,'\ '.IL

..... ., ' ~ .

Alll>Kl "' Cll 'r STA TF

' I

~A>. \Jlo\lllER ._.,-

~·-- ~ "Jf:.- -:o--- --1\am(.' Jnd s~e uf authorized official

lith~ unJ~r:-igncd bidd<'r intend~ to dcYiat.: fmm the G.:-ncral Conditions St.mdarJ Tcnns 3Jld Cnnd i u,•n~ or Item S~ificatious listed in thi' hid imitation. all such de\ iat10n' mu't he listed on thi> p<ogc. with .:~>mpi.:L<: and detailed conditt\m' und inl~)rmation included or attached. l'hc District ''ill consider an)· deviations in its bid a11Urd decisions, and the District res~::ne> the ril)lll to accept or reject ttn) bid bu~cd upon any deviahon' tndicatcd below or in an} auachmcng or inclusions.

In the: ah-c:nc:c ot any dc,·iation ent') un thi, form. the bidder assure,; the District of their full compl J.tncc "i th the Standard I cmb and Conditions. Item Sr-.-citicatmn,. and all other information contained in this Bid Jm·itation.

~o. Deviation !><(I Y c:;. De\'iauon, l.j __ __,

I r ~C> i~ checked. ple~S<" lh't below. Or attach TO this f(lnn b) >Uipling )1\Ur deviations

Insurance and l' in::erprinl ~tquirt'ments

ln\urance

I L1pplitJ~k ""d ) r•ur ,,3ff" ill be .m II PS prcmi~c> f•>r .Jdh tl) lr.inutg or m»rallati<"m etc und or with un •utumobik. )UU mu,t CarT} aut.m:obile in;urJnct· n' required b) 13\\. YtlU llln) b<: a>kcd tu pro~ide proof of in<tur:111cc. ~cc lllllt.:-hc.J "ln.!)urancc and lrtd.:mnit,.. Pro\ol-.ion~ .. ifa.pplicttblc..

.IM.ERI'RIN r

h ·~ po·~·t-:t Wl! ~ \Md<-4' ma} t>e sub;a:t w Ch .. J"<" :: "' .~., r.,, .. I'Juc.tHon Codt'. The Tc\J' hl~•3lh"' Ctl\1.:. (hapte< : > 't(t"'" ~l.u8J.l :.C.:mor: lanl!lllloe mJ) t.: h>U"lJ ••: http: "'"w.<tanr.-; ltj:.i• '~•·c ".u~

•I J t.ull hJ\C c.:untmuH\g Uuuc~ rcla~cU hJ tht· rorHrdlh:U \ot'nkc.""''. c.md

Tlfk.. n!\:OJnn1enJ ... ~)I \ c:ndors C(W{:SUit lhcrr k~ {l)Yn ....... l rut 'Li~J.tn<. 1." in t..Xllllph2ACC' \\ lth thh Ia" If )OU ha.v~ 'fU-.:•..tHlfh on tKm h.\ cump1). ~'--c bd"''· Jf ~ou fu, c ~ut,hUfh on <vtttpli3::DCC with lhb lt.J.dC "'Lion. wr.ti.K:'tl~ 1 ~'lb IA:p4rnn.:nt ol l'ul>lic 'aru~ '•m-Criminsl JU>ttec l mt, ~CCC» and l>•"'-"'l>>rution B=•u. I,\~ l·h .. CI at '('JI a 1\dl''·'tat< .t\ u• 41ld )OU ,00.,14 -.end <111 cm.~ii•J.:nllf) ong >·<lu a; a contractO< w a I (>Ill> Independent Sch<luf Dh:rir:t T ..:''*"' 01.,'\ rht.'C\c: l-. 312-4~4·2..1 7 -i

"cc fonn hdcw. I (I comrlcre \!111 itled: Te>IIS l•,duc>Ation Code Chaptl'-r 22 Con truclur Certification for Contra ctor Employee$

'I e•u• Educlltion Code Ch:tpler ll Contractor Certification for Contractor t.:mployces

lntroduch<lll l e\a' £ducaulln Code Chapter~~ require> ~ntill<> that .,;cntra.:t \\ith ..:hool ili~tn<h to pro' ide s.:n iC<.'l> tO <>bt:un ~"""""' h"h~ r.:c•'rd infc.nnarion regnrd•n@ ,,,,u~'\.1 empl,lyees Contrlh.-tors must certll} to the district that !h.:) ha'e ~ompli~d Co,ered emplo}ees "ith di,qualif~iJll! cnminal hi,t.,-i~' arc prohibih:d from '''f\ mg at a ..chool distri.:.!.

11etinltt<'l1~ C ·,. ,r,•d i'IIIFiti\ i'l!< t mplo~ ee' of a ~ontrn\Oior or >Ubcunlr.tctor " ·ho ha\ c t<r" rll h~' c cunlinumg llutic:. related to th<' """ r.:c 1<> N: p.."rformed at tho: Di>ttkl :mJ h,,.., or "rl! ha' e dire.:t conlact "tth >tu<knb The Di,rricl "ill be the final arh1tcr <1f \OM I <.'Ofhtilllt<'s din.-.:t contact "rth >llltkuh f>isqu<Ji!(ying crmw•vli!iJtor••. An~ '""' iction nr other .:rimimtl hi''' '" inf.,nnurivn dc<ignared b~ the:: O"trkt. or Me M the following ot1en.~. if at the ume of the ofrense. the \ rcum "as under 18 vr enn.>lled m a pub I ic >Ch\\(>1. (J)a tduu~ ulkn~..- under Title 5. Texas Penni Ct>de; (b) an ofl'<ns" for" hich a defendant is rc'1uircd to r~~i;tcr a~ J '"~ nffender will<• Chnpter 6~. le>.as Cod~. of C'rimmal Pr,'>l:cdorc; or (C) an cqul\ alent olfen<.e under tederalln\\ or the law~ ,,f an"th.:r ,,,,, ,.

On bclmiJ vi. ("C..,ntrnctor"). I cenif) that

chec~ one ~kn• J

I\"} '\ o.'fiC •' ' the ~~~~p~cc<. oi Contractor and an) <ubcontracwr. an' .. ·o•·erl!d l!mplot<c.< ib defmed abo>e If thi~ bo\ is chetl..t:J. I funhcr ~~nil~ that (' <>Otrd.:tnr ha" ul.cn precauuoo~ or nnp."ed c.~ndition' to en<.~ that tlte empk>)ees of (\~mractM and 311\ <ubcontl'llctor "ill not become w ur,·d t!mJJo t<•,·• (ontractt>r "ill m;~intatn thc~c prcC.lUltL>lt> N

"''"d'"''"' ''"''"!l"''"' the rime the e .. >ntracted ''""'•' are pro' ded

Or

0 'llnll' or •II of the cmpi<>)CC> <>f Contractor and an) ~ulx:ontractor are mw:red emplo,wes. lfthts boA i\ checked, l funher ccnit\ that

I I) Contracti>r hJ, ohtarneJ all requir.-J crinun.ll hbtol) record mfonnatiM regarding rts covered employees. None of the ""''"r~d <mplo~cc' lin, R dt"jllalify ing cnmtnal hi<tOt)

(~ 1 If(. "nlrtct<•r 1\.'-'C"L"' mf<lmlation that a C<)\<.'fi.'d emplo~ee subsequent~ bas a reported cnminul hi>to~ . (\>rllmctor •\JU mun~tatel) rem<lH•the c<'•ered emplo)~'C lr••m c•>utraet duti<!'i and notify the Dismc1111 wrrting \\ lthm 3 business

""~' r3 t l Ill'" ''"l"e't· Coorract,)r\\111 pro' i<le the Di>tn•l "11h rhc nun< and an) t>ther I""!Ue:.t<d information ol co'"rcd "mpl"~"'"' ><• tlt!tttlll fli>tn<:l Iilli) t:'btatn criminal hi'IOI) reconi inf,~nnati<wl on the cmen~d emrlo}ee,,

1 ~) If the Dhtrrct •>lliccr< h1 the a<;'iignrncnt .;t a coH:red emplu)"C <>n rhe basis of the CO\'ered crnpiO) ee's criminal hi .;tory r<:.:ord infvnnution. ( ontroctt•r agrc<::. 10 dhcont 1111._. u~in!: that Cl>\cr,'<l cmpl<>yllC 10 provide ~rvicc, 3t the District.

-:P,c .\:' r"J ~---- 'I\.' ['fl.~""" 'l '

Pnn~d n.1n1e ot ('om pan) Representathe:

' fgnatUIT

NOO\-COLLn.l\'£ BIDOINC CF.RTIF'fCA IT

B~ 'uhmi"ion oltht> btd or proJX>S.ll. the Lliddcr certilies th:rt·

I. I Ills bid or rroposal bas been mdep.:nJ.:ntl~ arri'cd at ~nhout collusion ''ith un) othCT Biddtr nn~ith an~ Com~titoL

Thb 1-iJ or prop<>-JI has not bc~n knowingly disclos~d Jnd wiU not be knowing)) disclosed, prior to the •lp.:mng ol hid,. l)r pn)posals for this project. to any other Bidder. Competitor or potential competi tor:

3. \,, ;lllcmpt has been or will be nt<l(le to indue.: un} oth.:r J)t!r~\)11, panncn.hip t>r curporatiun to 5:ubmit or not tc> 'uhmit a bid or propo>al:

4 I h.: p.:rson signmg this bid or propo:;a! .:~rtuk~ thJt he h:JS Iully informed lllmsclf r.:ganling tht: act·urac~ nf the '<\at~.,'111cnts eontain.:d in thcs ccnificJtton. and under the penalties bcmg applicable to the Oald.:r u' ~~II a' t,, the pct"<>n ~i~ning in it> h.:hal l

!::>ignat\U\: below certifies :tceuraF_~-of ans"e~~> all ~ti••n' un thi, page. ;:;.1' . ..;./

. \uthonz~d Si)11lUturc ~/.-_,.---~""

Printed 1\ amc ...:..{7..:~_ . .::· .:..' _'..;E;.. __ ...;:X...;"_·'"-" .:..";;:i'..:· ,.._' _ _ ____ _

Company Nome and address: o! :-.1.( ""'.., . ._) . "')[-(.•!4-ift' r., t .. -.. _;,(_ .. {'";•,0,1.

Date -------~-'-~-- _

Sratulnl} .:olilllon cmcrtn!!- nuuti.:aJion n1 cnmonal hostM) <)f cmttaciN ''found in the Tc'a' Fducation Code ~·14.0~4. r,tll<l"lll!,l i, fiO Cxampl.: Ul 11 fd<>ll~ C{llll i•1tnn Mlh:c

• 'i1a1~ •>f I ~.\as legislative ~(031~ !:iill 1\o. l. Scclion -14.034. Notification vf Criminal HbtOI') . Subsection (a), >lUI~> ··a

pcN'lfl ,,, business emir~ that cmcrx into a contract" 1111 a <chool di.;tr~.:r mu-;r g.iH: ad13n~c notice ro rhc district tf the I pt:N>n ,,ran ''"'"~r vr upcr.uur of lhe bll3me:.s ~1lttl~ ha. b<.'\.'11 .:VII\ r.:lcd vf a felon~. The not tee mu>l include .1 !;Cih.ral dc...:rtJ'ItNI of !he c.)ndu~r rc,uJting in the C•''" o.:ti"n of a feloo) .-

11 Suh,.:clinn (hJ 'tak' "a ...;h,J.>I di,lrKt ma: rcnnina1c 3 contract 1\Jth a pc~n or bus me'' cnut;, tf the di<lrict dctcnn tnc' I hal I he pcr,nn •Jr husin•'•> clllll) h1ih:d ''' gi1c no1ice a, required h) <;ub<>cC1ion ta) or misrcprcS<1ltcd the cooodttci

i re,ulllll)l in Lh.: com ictl()n lht: di>trict mu>t cl•mpo:n;;ale the P"f><Jil or bu>iness entil) for scr•kes performed bt:for< tho : t~rmlnGth)n of the ~t)f\U''3C! ·•

II II\ '\CJ IIC L IS '0 I Kl\)1 IKlD m A I' I Ul.lll Y -HELUCOKI'OKA 110:-.

C••mplct~ onl~ one ofth~ lhn:c b.:k>": :\ m· /l 'i! l.

l,the undcr>ie'l'ICd B)!CtH for lhc finn nomcd bdo,., .:.:n>l) that lhc information conc.:ming notific-ation offcloo> """' icu.•ns hn> be"n rc\lC\lcd b} me and the 1~>11<""'"!:! infomtallon lumt,hl-d is true lo the b.:> I of m) !.no" lc.Jgc.

Otli,tal tel!fX~ .. 5::>V'YWY')t'.r~ <2-:es \~\-Print Authorized Comp~n~ Olliciars 'lame "----

.4.. \1~ tinn is a publici~ ht'ld cvrporalion: lh<reforc, th i\ rqx>timtz rL'<Iu•rcmcut b not appli~nbk.

:O.ignntun: of ,\ulhorited l\•mpa11~ Ollict:tl· --------------------

!3 ~~~ lirm 1s not 0" n.'<l n"r operated b) an~ one "ho has bet•P·'-·"" icrcd of a f<lon~ "T .<.::(;.

~ '11!;11li1Urc of t\ulhvrit.ed C'OOlpaU) Ut1idRI ----::f'r'?'--:..,;:--"'·,·----------- ---

'•me offel•"t('l -------------- ------- - --

11"t~ils (>t' ('on" ict ;,,n( s 1· ----------------------------------

'>•~ature oi Authnri><d Company Otlicial·

Non-Discrimination Statement and Certification In accordance with Federal ovd nghts law and U S. Department of Agncu~ure (USDA) civtl rights regulations and policies the USDA its Agencres. otftees. and employees, and institutions participating ,n or aommisteting USDA programs are prohibited from discnmrnallng based on race, color. national origm, relig ton. sex gender Identity {tncluding gender expresSlOn), sexual orientalion. disabdtty, age, marital status. famtiylparental status. income derived from a p~<blic assistance program, political beliefs, or repnsal or retaltabon for pnor civ1l (lghts activity, in any program or activity conducted or funded by USDA (not a~ bases apply to all programs) Remedies and complaint filing deadlines vary by program or inctdent.

Persons wtth d•sabthties who require altemauve means of commumcauon for program 10format1011 {e.g. , Brai!le. large print. audtotape. American Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at {202) 720·2600 (votee and TIY) or contact USDA through the Federal Relay SeiVtce at (800) 877-8339 AddrtionaHy, program tnforrration may M made a~ailable 1n languages otl'ler than Englrsh

To file a program drscnmrnal:on complaint complete the USDA Program D1scrim1nabon Complaint Form, AD-3027. found online at How to Ftle a Program Dtscr•mrnahon Complaint and at any USDA offiCe or wnte a letter addressed to USDA ana provide in the lener all of the •nformabon requested in the form To request a copy of the complaint form. cal! (866) 632-9992 Submtt your completed form or letter to USDA by (1) mad U.S Department of Agncul!ure. Office of the AsSistant Secretary tor Ctvd Rights, 1400 Independence Avenue. SW. Washington, D.C, 20250·9410; (2) fax: (202) 690-7442; or (3) ematl: program tntake@usda.gov.

!'uie r l J 1 !':t~ Ldr~~.-·11f:L'Il Arncud•n,-.~~ :Jo> o,ll 9..,..Z: Xdi.:.m 5lJ.+ •:l rite J<eiu..o1litn1i,w. Ai"'t (~f 1973; tJu· I\ gr. D.t~ .. ·n '1W:tJ(,·('h Act .. ~· J9":"5; l'u{(· :- C!R fJ.:l-r: .. i .'i ~~~ Rtid 15!-, ~;;e An;ui(\nb :.uith o:~abil:tie~ Act; dNd FNS I • r.ct •1~c~wn 113 * 1 c~~.•il Ri_-:Nf.; ( i.*nll.:th.nut# .uul Lt!"i•,.,:tlJ;t'f!l - ~u~ rit:vn Pros,•ri1m3 attd Actitni(£..~

USDA IS an equal opportunity prov1der. employer, and lender

l certJfy thatm the performance of a contract with TIPS or f1S members. that our company wlll conform to the lcregoing anli·dtscrtmtna!lon statement and comply with the ated law and regulations.

Company Name,_~.!'.::[;:...A_~_r_'•,.:.)~...:.~·.:.; .::;.:.._4_~_·_f..:.t_.::c.::o:..;,r::.:.;_:r0~f(.::~:.._''.:..< ::;,··,~/----------

Print name of authorized representative _ __::-_. ,..:.._.- .::!..:,' ,:,r-,,: __ ..;:~:::;O:.:.M:.:.::•'<cO!:;:.::'.::'·-_______ _

...4""' Signature of authonzed representative. __ ·~:.,;,'-;-':',;,......::::;.,....--J:-· _'-_· --------­

__-·,/~

Federal Requirement!> for Procurement and Contracting \\ilh small and minorih businb~c~. women's bu~ine.,_, enterprises, und labor surplus area firms.

Th.: IIPS members anticip;ttc pos5ibly u>in~ 1\:ucrol funds l(>r pwc:urem~nt under this potential award and is rc<Juin:d to obtain th.: tol lov.ing compliance 3\,urancc.

I. WiiJ you be subcontracting any of your~ ork under this 1m ard if you are successful ? 1Cird• ..,~,

0YE.SorN~ 2. If yes, do you agree to comply with the follo\\ing federal requirements? IC•n~< •••>

0YES or~oD

2 ( I R f!00.321 Con!racllng "ith ~mall and minont) bu;im:sses. '>omen's busin .. ~ cntcrpri~c:.. and labor :;urplu' arc·a firm"

tal I he non· I eJcral emir~ muSl: t:U..c allm:cc,sar) atlirmati'c 'ICJ" to a.'sure that mmority businesses. women's t;.u,incss emerprisc~. and lah<)r surplus arc~ limh ail.' used \\hen fl<l"ihl~.

d't Afl1nnatjve steps must include: 1 I) Placing q ualilicd ,mall and minnrit} hu,im:'..e' and \\Omt:n', l>u~iness ~ntcrpriscs on solidtntion lists: t 21 '''uring thai small unJ minorit~ bu.,mc'--='· iflld ,.,omen'~ bu.,lnt~"" enterpri:.e:. are solicited whenever they nr.: pot<'nu:ll sources: t} l Ul\ tdmg total r<.'quircmcnt,, \\h;:n <.-conomtcall) fcil>il>lc. into >Illalk·r ta.,ks or 4ua11titi~s tu pem1it ma,imum partidpation h} 'mall and minorit~ businesses, and \\Omen's bus i nc~' ..:nt..:rpriscs: (4\ btahli>hing dcln.:r) ,chcduks. ''here the ft:'Juiremtmt permits, "hich encourage parlicipat ion b) small and minorit} busin;!S~s. ami \\Ornt·n·s hll.'>inc~~ ~'Tltcrpn>.cs;

1 5! L smg the !.en icc, and ""'tslimcc ..... , appn>priu.:. of ~IKh orgam/:Jtions as the Small Uusincss . \dmini.;tmtion and the Mmurit~ Bu.'m~"' 0~' dopment '\~~-riC) of the l.};!partmcnt of Commerce : dlld (6 1 R.:4uiring the prime C.>ntractor, if >uhcnntr.u:Ls arc to be let. to take the affirm:nl\c >lq)S listed in pamgruphs ( l 1 thmug.h ( 5) of this :.cellon

) .. ,. . ..... •;,)

CERTlFICATlO~ llY CORPORATE OFFERER

!..Ul!:!J~I{LR l~ A CORI'ORKIIO~. THE FOLLOWI~G CERTIF!CATF. SHO!JLD BE EXECUTED Al'i'D INCLUDED AS 'PART OF PROPOSAL FORM/PROPOSAL FOR.\1.

OFFERER: NCQ.;cpo::;;{ Inc... , ct "De.Jo..~--c.. c.o-rp. (:'arne of Cor;loration)

I, certit) that 1 am the Sc.crclary of rc.l f ~· SomM(.C ('I< a me of Corporate Secretary)

the Corporation named a.~ OFFERI<:R herein above; that

FeLt pe.. So vvs ~ ('\amc of person who completed proposal document)

"ho signed the fort>going proposal nn behalf of the corporation offerer is tile authorized person thai is :acting~~~

0 WC:S\d.eot

(Title/Position of person signing propo~aJ/offer document witltin the corporation)

of tbe said Corporation; dlllt ~id prnposaVofftr was dutr signed for and in be.balf of suid corpor·ation hy authority of its governing body. and is within the scope of its corporate powers.

- .. ·---~·-------

<.'OR1'0RXJ'E SEAl

,.J . ;_/

~Vl t3, z.or=t-D:\ n.:

2 CFR PART 21\0 Contract Provisions

Required Federal contract provisions or Federal Regulations for Contracts for contracts with TIPS)

The following provisions are required to be in place and agreed if the procurement Is funded in any part with federal funds.

Th~ Til'S member is thesubgrantce oo· Subreclpieut by definition. The federal Rule numbering or idenlifiraliou below is only for reference purpose on this form and doe.~ not identify an actual fl'deral dt'llignaiinn or location of the rule. The Rult>S nc located in 2 CFR PART 2UU- Appendix II to Part 20fl­\llntract l'ro,·isions for Non-Federal F:ntity Contracts Under federal Aw•mls 2 CFR PART 200

In addir i,,n to othtr prm ision:. N4uired by the F~deralagenc' or uon-Fcd~r.~l emil). all contractS mad~ by th~ non-Fedcr.~l entit~ under the Fedenrl •mard mu&t .:<>ntain provisions co,ering rhc lollo"ing. a~appli<:able.

(A) Contracts foo- more than tb~ simplified ucquisition threshold current~· set at $150,000. which is tbe inflation adjusted amount dctrrmined by t.b• Chilian A gene~· Acquisition Council and tht· Defense Acqui,.ition Re~ulations Council (Councils) a• aull>orizcd b~· .$1 l:.S.C. 1908, must addre.•s »dmiorist..,.tivc. conto·actual, oo·tcg>tl remedies in instan<·cs where <•ontrHCtoo'S , ·iolate or breach contract term•, and prcwide for such $auctions and penalties"" >1 pfJrOllriate.

;-.. ~,,tic-e: Pu"uant to rederal Rule {A) nbov~. when feder.~l tunds are e~pended by a l iPS member. the 'liPS member reser,·es all rig!ttq and privileges umkr the applicable law;; and regulations with

••ott< oo '''' P""""'"Mjil ""' ofbre~'' of'"""" b; •'•" ,...,.

Does \endor a!!J"e'! Yt:S _ lnitin l of Autburi.ll<d Company Official ·'I

(B) Termination for c11use and for com enicnce b~· tbc gnootee or subgrnnt"e including the manner by which it uitl t.., effected and the basis for set1teroem. (All. contract.< in c.ucss ofStn •. OOU)

Pur'Uam h> rcderal Rule (13) abo, c. "h~n federal fund~ are expended h} TIPS member. flPS member rcscT\cs the ri!PJt to tcnn inare an)' agr~mem in exces~ ofSI 0,000 r<'Sulring ft,llnthis procurement pn.>cc·~' tor caust' after giving the vemk'r ;m appror,riate opponunity and up to 30 da} s, Lo cure the caur,al hrcndt of terms and conditit•n>. TIPS member reserves tbe right to wnninat~ any agreement in excess of $10.000 resulting from this procurement pro.;eys for COO\enicnce '~ ith JO days notice in writing to the award,'() ' end or. The vendor would be compot~atct! l'ur "ork performed and goods procured as of the temt inatioo date if for convenience or the TIPS mcm bcr. An) award under this procurement proco:s; i" not C\dW>ivc and the TIPS memberreserves the righttt1 purcha.<c goods and ~<,.·vices from other vendors when it is in the ~t interest oftiiC Di<trict.

""'" ""~ ••re•'l Y Efl/fllo;; ;,o '"'""'~''""om!"'> (C) litJuMI J::mvlo~ ment Op[lortunity. Except as otherwise provided under 41 CFR Part 60, all eontrads that meet the definition of "fcdrntU)' assisted const·ruction ~on tract" in 41 CFR !'art 60-1.3 must include the equat opportunit) clause provided under~! Cf.R 60-!.4(b), in accordance " ' ilh Executive Order 11246. "f•tual Employment Oppor1u.nit)"' (30 f 'R 123 J'l. 12935, 3 CH"{ Part, 1964-1965 Comtl., p. 339), as amcndL'tl by Executive Onlcr 11375, "AJlJending F.xccuriH Order 11.246 Relating to Equal Employment Opportunity," and im[llementing t'cgul~tion• at 41 CFR f>lll1 60. "Offi..,., of Federal Contraet Compllam:c J>rogrums, Et1uaJ Employment Opportunit~. Deparrmcnt of Labor."

Page I t,f 4

2 CFR P \RT 200 C onlntcl Pro' ision~

l'ur,uantto federal Rule (C) above. \\h\.'11 federal fund-; arc expended~ TIP~ member. for all C•>nstn..:ti<>n contra•!\ 3\\ urdcd in cxc~,s of S l 0.000 b) grantee'! and !heir contractor~ or >Ubgr'dlltCCS. the pr.>po«er cenifies that dunng th~ term 01 an award. "hc:n f~-.kral funds are e.>.p<:nd<ld, b} the TIPS member re~ulting for this pro~ur~mcnt prnce>s the vendur "ill ~ in compliance~ ith hqual Opportunit) l ·mph>~ m~m !a" s spccitiC;lll) f.\ec111ive Order I I :::46 <'f S<!ptcmbcr :!·t !965, entitled " I :qUill rmrh>)IIICIII OpPQmmit} ... •h tllllCn<kd by Fxccur ive Order 1!375 of October 13. 196i. nnd a' ,urrkm~nt,-d on !kpartmem ol L<~bor n:guk11ion' (~ I CTR chapter 60

O.>e< 'cndor agree ' \ t!) 0 1Jllll31 o)t Authorized ( om pan~ Official

{ 01011' ;,. fJacun Act. as amended (40 L.~.C. 3141-3148). Wlt~n required b) Feder.~l pr~nm ll'gisl2ti011, aU prime cunsiru• tivn cunlntc~\ in e•ce$~ of S2.000 a"ardnl by non-FIIdtr~l cntitiel' must includt' n pro•isioa for tomplilln~e "ith th~ lla,i\-Oacon Acl(40 li.S.C. 3141-3144, and 3H6-314l!) auupplcnu.'nlt>d by D~partmtnl of Labor rcgulution• (2'1 CFR J>an 5, "La bur St:u)llards ProYisinns Alllllic,.bl<' to Contracts CoH•rinr,: Federally Finan~d and .\ .. i<tcd (on>truction"). In accordance with the statute, coni Nero~ muM be r~quired to pay wages to luborer<o and mccbunico lit ~ rate not le~• than the pr<••·niling wuge• •pecified in a ~e determination made by tbe ~retary ur LaiJ<Jr. In addition. contrncton~ n111>t ""required tn pa~· \UI;'" not less tball once" ,.L-.,k. The non-Federal cntil) mu•t p!Jacc a cup~ of the current pre• ailing" age determination L<sued b~· thC' Department of Labor io each soJjcit"tion. Tbc decision 10 '"' ard 11 cuotro~et or subcontrnct mu,t ""conditioned upon the acceptance of th~ wagt­de!enninutioo. J'be non-federol en til) must r't'port all >IIS Jirtled or r't'pnrted \iolationsto the fedena) awardia~ "llCM~· The contracts mast abo indudc" JINl\ osion for compliance .. itb the Cnpel:lnd ' ·Anti- Klckback" A.-t (40 l i.S.C. 3 14~). "' ~upplement~>d h~ Oepartmrol of Llbur ~ulatiorL• (29 CI'R l'art 3, -Cool111r1ors and Suhcontractor• on Public l.luihllng or Public Work finwoct·d In Wbnlt or in Part by Lo11os or Grunts from the United Sinh's"). The Act provides that cacb cootraclnr or subrccipicnl must be prohibited from inducing, by HO)

mean•. 1111~ prrsun employed in the cou>lrlletion, wmplttlon, or repair of public ><or!.., to gh·~ up any part of the c'"''l'""'~tion to which he or sbt• i~ olhtr\\ t..., entitled. The noo-froend entity must report sll sosp<.>cted ur r.-portt-d 'iolutions to the Fed.eral a.,.anling ug~nC) .

l'uNIWnt to h.>der41 Rut.: (I) 1 abmc. "'"'" fo.'tkntl turnh arc C\pcndcd b~ TIPS member. dllfint! the tenn ••I ·'" a"ard for aU rontrnch and w"~filllh for construclion or repatr. v.h.:n Federal funds w-e expended. b) the llPS mcmw ...,..,ulung tor thl> pr<)o:un:m~'lll proce>s the vendor will be in compliance wilh all

··~···'~ ..... ~ "''~'~ 't" LA-..,, •cndvragn:c? YLS Jmtoal t•f Authomed ( ompany Offic•al

(F.l Contract Work flours and S,.fel) Standards Act (-40 li.S.C'. 3701-3708). Where appliC2ble. all coatracts aw<lrd<-d b) tb~ ooo-Federalt>ntil) in excess of$100.000 thatln,oi\C the employmrnt of me<bnnies or laboren mu~t illdudr a pro,·isioo for cumplianet> "ilh 40 L.S.C 3702 and 37~. :tS suppl<'tttt>nted h~ Dcpartm~nt of .La bur r11:ulations (29 CFR Part 5). llnder 40 li.~C 3701 uf the \<1. tach contractor mo.\1 be rcquin.-d to oompute IM '"'lle;o of r•ery m<'t'banic and labu,..,r on Ill~ hasis of a •tand•rd ,.ork -..~el.. of -40 bou". \\ork in e-xcess oftbl' •~>wdurd »nrl. l'leek is permis~ihlc pro>llk'd that tbe norker '' rompcosat<-d 111" rate uf notl<-s• than one and" halftime• the b:bic ntc uf I'"Y for all hours "orkcd in eHC>S of 40 hour-5 i11 tht> work week. The requirements of -10 U.S. C . • !70-1 ao~ applicable tu construction work and providr that no labor't'r or mechanic mu•t be required to work in surroundings or under workln~: conditions "hich u.-., un•anitary, h1Uardou1 or dang<·ruus. These require111cnl\ do not appJ~· to the purch~W<S of~upplics or nntt'rial> or anicles ordinarily a'ailable on the open market, ur cunlracfs fur tr~"'IIOrtafion or trammi~ion of lnttllieence.

Pu,-.,uantlo Federal Rule ( LJ abu"'· "h<m federal lund< arc c,.,..ndcd b) liPS m<-mhl:r. tile pmpoo;er •~niti~> th.ll durin~ the tcnn ,)fan a"ard b~ the TIPS mcmbtr resulting from lhi> procurcmC'Ilt process lUI ~-·n~tru.:IIOto <..<)Jllra<..h d\\atd~d b~ grantee. and '"h~rruotees the proposer agree, to be: in ~mnplianc.:. "orh ltllrequirem~'tlb Ji,t.:d or referenced tllcrein.

l'ag~ 2 ~I 4

2 CFR PART 100 Contral'l Pro\'isions ~-

Docs •cndor agree~ YES~ initial of Aulhorized C'ompan} Official

(G} Clean Air Ad (4.2 L'.S.C. 7~of-767lq.) aod tbe Federal Water Pollution Control Act (33 U.S.C. 1251-13!t7), llS umemioo--Contrncts a.nd subwants or amouou in e~co:~ of$15{1,000 m·ust contain u pro\ ision that requires the noo-.h·dcral u\\at·d to agrei' to com1lly with all applkablt• st~odard'!. orders or regulations iss ned pursuant It' the Clean Air Act (42 L.S.C. 7401-7671q) snd the Fed.,ral Wllte:r Pollution Control Act as amended (33 U.S.C. 1251-1387)_ Violations must be reported to the Federal awardln~t agency and the H.cgion><l Office of the Eo•·ironmental Protectiou Ag~ncy {F.I'A).

Pursuant to 1-ederal Rule (G) above. "b•+J>I't.'<i<.'ftll funds arc c' pendcd hy TI PS member. liPS member requires that the propo:;cr ccnif) that during the term of an a" ard by th~ TIPS member r~sulting from this procurement pro":'l.~ t~~endor agret'S to lhc terms listed and referenced th~rein.

Do~> '~ndor agree? Yr.~ Initial 11f AulborrL~ C ompanv Official

f;.' ( li) Ut•b~trmtoi ~nil Suspension (Elecuth·e Orders 12549 and 12689)-A t•o ntracl ll" ard (see 2 CFR 180.120) mu~t not be made to parties liue<.l 011 tbc govcrumcutwidt' exclusions io tbe Systern for Award Man~emcut (SAM), in aet·ordan~ witlt the 0:'118 gu.idt,fiot"S ut2 CFR ISO that implement Encutivc Orders 12549 (J CfR part 1986 Comp., p. 189) aod 12689 (J CfR part 1989 Comp .• p. 23S). "Uebar·menl and Suspension:· SAM F.xclu~ions contains the names of parties debsorn-d. •U'>p<:nded. or othcm·ise excluded by agencies, as well ><S partieJs dcciQred indigihl~ under s tatutory or regulatory authorit y other than F.xecuiive Order l2:H9.

PuNtam to r ederai Rule ( II ) abo, e . .-hen federal fund> ar~ c'pcndlxl hy TIP~ mcmhcr. TIPS member requires tbc propo.cr ccrlif) dt~J during the term of an award by the TIPS memberresultmg for thi~ pr<~urement proce;~ the "endor cc:rti fi~> that the~ arc not debarred fr.:>rn receiving a contract trom the f<deral go .. crnmenl ~"' P"" ided therein.

~

Does \ e ndor agree'? YES.J:ii'21111ilml of Auti•Ori7cd Company Ofticial .. 'tf/ }

(I) n~ rd ,\nti-Lobb)iD~ Amcndinent (J1 L.S.C. 1.152)--Conl,.,.ctnrs that app~' or bid for 1111 a wan! .u:c.eediog S 1110,000 mu~t lilt' th<' required cet1ifi.cation. Each tier certifies to t he tier above thai it l\lll not and has not used federulllppl'tlpriated funds to pay any person or orguni.tation for ioOueocing or attempting to influence an officer· or employe<• of any :a~cnc), a member of Congress, officer or cmplo~'l'C of Congn-ss, or :10 cmploytlt of ll member of C'ongres.< in connection with obtaining au)· 1<\·~Jcrul contract, grant or any other aw•.ard covered by 31 U$.C. 1352. E:H·b tier mu•t•llso di<i<'l<>s• any lobb}ing with non-federal fUltds that takes place in connection witb obtaining ao) Federal award. Sucb di•c.l<l5lln•s arc forwarded from tier 10 Her UJi to t.he non-Federal awant.

Pursuant to federal Rule (I) nh<we. wh<?ll federal funds are expended by TIPS member, TIPS m~mbcrrequires the proposer t:crtir) that dH ring lhe term and after the awarded rem> of an award by the riP~ member !'<:SUiting for this procurement procC>> the '~-ndor ~enjft~ IO the term> included t>r

referenced therein ),1"'--,.f /

IJvcs •endor agn:e'l ,;~ Initial of A\lthnri7ed Company Olticial F<'dual Rule (ll) Compliance w· I{ all applic~tblc stllndards. orders, or requirements issued under section 306 of the Clean Ail' Act (42 U.S.C. m 7(h)), section 508 of t.he Clc•n Water Act (33 U.S. C. 13611), lil'ccuth·e Order 11738, wnd [n, irunw~nlal Protecfion 1\gency regulations(~ Cf'R p~rt l5). (Cootnu:ts, subconlmcl8, and subgrants of :lmouJ>ts in excess of $HJO,IJUO)

Pur;;uuntlo rcdcral Rule ( 12) ah<we. when fed~r-..llim;h arc c'pc.mded by TIPS member, Ttl'S member requires the proposer C<.'fti l} lh;sl in pcrfonnance ot' the contracts. subcontracts, and sub!,'Tants of amonnl< in exec~:;,

Page 3 <1f 4

Page 4 of 4

2 CFR PART 200 Contract Provisions

ofS I 00.000, the vendor will b<! in compliance with all applicable 'itandards. orders, or requirements i»ucd tllld..'f ,.,crion 106 of the Clean Air Act t42 li.S.C. ! 8571hl), section 508 of the Clean Water Act (31 U.S. C. 1368), Execmiw Order ! !738. and rnnronmcmal Protection Al:enc\' re2ulations '40 CrK ... ::r '-' \ part IS). ~

D0e> \'endorcertif)• that it is in compliance with the Clean Air Act? YES~ Initial of Authorized <..'umpany Official ~

, ,.,, t'·,~; ,'.'"·< <)~L·"' .. ~.''" ('o·· • ,. , ·' Compan~ t\amc ••t,...iC '-' • " ... ~.:: .. _~ __ ...... _""...:._ _ _ ".:...;:~'~_'_-'_'>:.4~-I:...·_A_"_. _ ____ _

!'age 4 of -1