Harris County Department of Education (HCDE) RFP Cover Sheet Job No.: 07/036JC Due Date: 1/25/08 DUE NO LATER THAN 1:00 P.M. LATE BIDS WILL NOT BE ACCEPTED Request for Proposal (RFP): Streaming Audio and/or Visual Service for Harris County Department of Education (HCDE). PLEASE NOTE Carefully read entire proposal document and specifications. Complete all forms submit your bid with all appropriate supplements. Please submit your hard copy proposal in a sealed envelope with job no., description, and marked “SEALED PROPOSAL”. RETURN PROPOSAL TO: Attn: Jack Cutting – Purchasing Harris County Department of Education 6300 Irvington Blvd., Room 226 Houston, TX 77022-5618 For additional information contact Jack Cutting at (713) 696-0744 You must sign below in INK, failure to sign WILL disqualify the offer. All prices and responses must be typewritten or written in ink Company Name: ____________________________________________________ Company Address: ____________________________________________________ City, State, & Zip ____________________________________________________ Taxpayer I.D. # ____________________________________________________ Telephone # __________________ Fax # ______________ e-mail ______________ Print Name ____________________________________________________ Signature ____________________________________________________ Your signature attests to your offer to provide the goods and/or services in this proposal according to the published provisions of this Job. Contract is not valid until HCDE Board has approved the award. ACCEPTED BY: __________________________ HCDE Board Approval Page 1 of 25 DATE: ________________ TABLE OF CONTENTS Items checked below represent components which comprise this bid/proposal package. If the item IS NOT checked, it is NOT APPLICABLE to this bid/proposal. Offerors are asked to review the package to be sure that all applicable parts are included. If any portion of the package is missing, notify the Purchasing Department immediately. It is the Offeror's responsibility to be thoroughly familiar with all Requirements and Specifications. Be sure you understand the following before you return your bid packet. __X__ 1. Cover Sheet (page 1) Your company name, address, the total amount of the bid/proposal, and your signature (IN INK) should appear on this page. __X__ 2. Table of Contents (page 2) This page is the Table of Contents. __X__ 3. Terms and Conditions (page 3-5) You should be familiar with all of the requirements. __X__ 4. Specifications (page 6-11) This section contains the detailed description of the product/service sought by the HCDE. __X__ 6. Price Delivery Information (page 12-13) __X__ 7. Attachments (Submittals) Page 2 of 25 __X__ a. Proposal Submission Form (page 14) __X___ b. Felony Conviction Notice (page 15) __X__ c. Bid Certification Sheet (page 16) __X__ d. No Response Form (page 17) __X__ e. References (page 18) __X__ f. Minimum Insurance Requirements (page 19) __X__ g. Streaming Audio/Visual Service Questionnaire (page 20) __X__ h. Conflict of Interest Questionnaire (page 21-23) __X__ i. Safe and Secure School Policy (page 24) __X__ j. Historically Underutilized Business From (page 25) TERMS AND CONDITIONS ASSIGNMENT - Any award made as a result of this solicitation, may not be transferred, assigned, subcontracted, mortgaged, pledged, or otherwise disposed of or encumbered in any way by the vendor. CANCELLATION – HCDE reserves the right to cancel this solicitation. (See paragraph “Financial Responsibility”). CHANGES - Any changes to the requirements specified herein will be communicated to all proposers by the issuance of an addendum. All proposers shall comply with the requirements specified in any addendum issued by HCDE. CUSTOMER REFERENCE LIST – The proposer may be required to submit a customer reference list. CONTRACT TERM – The initial term of the contract will be for a period of one (1) year with HCDE having the option to renew the contract four (4) additional years in one (1) year increments. Consequently, the total term of the contract may be for a period of five (5) years. Because all services will be provided on an “as needed” basis, HCDE makes no representation either orally or in writing to the amount of temporary services HCDE will use during the term of the contract(s). DISQUALIFICATION - A proposer may be disqualified before or after the proposals are opened, upon evidence of collusion with the intent to defraud, or perform other illegal activities for the purpose of obtaining an unfair competitive advantage. EXCEPTIONS – Proposers are responsible for identifying any exceptions to the requirements specified herein. Any exceptions must be noted on the proposer’s letterhead and returned with the proposal. Proposals, which are qualified with conditional clauses, items not called for, or irregularities, may be considered non-responsive by HCDE. FOB – All shipments shall be FOB destination full freight allowed. FINANCIAL RESPONSIBILITY – HCDE assumes no financial responsibility for any costs incurred in developing and submitting a proposal. FORMAT –Proposals shall include one (1) original complete and four (4) copies of the proposal. Proposers are responsible for ensuring their proposal is received at the time and place specified on the cover page. HCDE is not responsible for proposals that arrive late, or proposals that do not have all the required information. INDEMNIFICATION - The vendor shall indemnify and hold harmless HCDE from all liabilities, costs, expenses, attorney fees, fines, penalties or damages for any or claimed infringement of any patents, trademarks, copyright or other corresponding right(s) which Page 3 of 25 is related to any item the vendor is required to deliver. The vendor’s obligation to this clause shall survive acceptance and payment by HCDE. INSURANCE – The successful proposer shall be required to provide HCDE with copies of certificates of insurance, named as additional insured, Texas Workman’s Compensation and General Liability Insurance. INTERPRETATION – This solicitation represents the basis for any award, and supersedes all prior offers, negotiations, exceptions and understandings (whether orally or in writing). The information submitted should be self-explanatory and not require any clarification or additional information. INVOICES – HCDE and cooperative members will be invoiced directly; payment terms are net thirty (30) days. PENALTIES- If a successful proposer is unable to provide the awarded items at the quoted prices, after the proposal has been opened, HCDE may take the following action(s): • Insist the successful proposer honor the quoted price(s) specified in their respective proposal; • Have the successful proposer pay the difference between their price, and the price of the next acceptable proposal (as determined by HCDE); • Recommend to HCDE’s Board of Trustees the successful proposer no longer be given the opportunity to submit a proposal to HCDE. PERFORMANCE - The successful proposers will use best efforts to provide the services mutually agreed upon. POSTPONEMENT - The time and place established for the receipt of the proposals will not be changed unless otherwise specified (in writing) by HCDE’s Director of Purchasing. PRICES- All prices shall be firm for the contract. All prices quoted shall include a four (4%) percent participation fee to be remitted to HCDE by the winning contracting company. HCDE will invoice contractor for this participation fee on a monthly basis of gross payments made by the Buyer (This does not include work undertaken by HCDE). PROFESSIONAL SERVICE CONTRACT – The successful proposers will be required to complete a Professional Service Contract. QUESTIONS – Questions regarding the requirements specified in this solicitation must be faxed to (713) 694-0732 attn: Jack Cutting no less than three (3) working days before the proposals are due. Questions must be sent on the proposer’s letterhead, dated and signed by an authorized representative of the proposer’s company. HCDE will not Page 4 of 25 answer verbal questions. Any responses to the proposer’s questions will be reduced in writing by HCDE and provided to all proposers. QUALITY - Any order issued as a result of this solicitation will conform to the specification and descriptions identified herein. Unless otherwise specified, the vendor will not deliver substitutes without prior authorization. RESPONSIBLE PROPOSER - A responsible proposer is a proposer who has adequate financial resources (or the ability to obtain such resources), can comply with the delivery requirements (taking into consideration existing business commitments), and is a qualified and established firm regularly engaged in the type of business that provides the items listed herein. RESPONSIVE PROPOSAL - Refers to a proposal that complies with all material and administrative aspects of this solicitation. RETURN OF PROPOSALS – Proposals once submitted will not be returned. TAXES - HCDE is tax – exempt. Proposals prices should not include taxes. TIE PROPOSALS - Should a tie occur (i.e., unit price is the same) between a nonresident proposer and a Texas resident proposer, Purchasing will make an award to the Texas resident proposer, as defined in Vernon’s Annotated Civil Statues Article 601g, Sections 1 and 2. TITLE AND RISK OF LOSS - The title to any item shall pass upon acceptance or payment, whichever is later. Page 5 of 25 SPECIFICATIONS Request for Proposal (RFP): Streaming Audio and/or Visual Service for Harris County Department of Education (HCDE). BACKGROUND This Request for Proposal (RFP) is a solicitation for proposals to provide streaming audio and/or video services hosting, software and hardware necessary to index and archive meetings and other programs for Harris County Department of Education (HCDE) Choice Facility Partners (CFP) Division. In addition, Choice Facility Partners is interested in other functionality of products available such as integrating the audio and/or video recordings with the meeting minutes in an automated fashion with a voting system. For information regarding the proposal process, contact Jack Cutting of the Purchasing Division at (713) 696-0744 and for technical questions contact Nathanial Jones at 713/696-8274 or Gary Lu at 713/696-8278. TECHNICAL SPECIFICATIONS AND REQUIREMENTS We perceive the following services and components as being necessary to our expanded offering: A. Web Streaming and Hosting Services 1. Encode, Capture, Interface a. The ability to encode live and/or archived multimedia content and generate single or multiple bitrate output files with the ability to adjust frames, video size and audio codec. b. The ability to encode live and/or archived multimedia content and generate audio and/or video only output files suitable for internet or internet streaming. 2. Indexing a. Ability to index (time stamp) live multimedia content. b. Ability to index (time stamp) archived multimedia content. 3. Streaming a. Support live streaming of multimedia content via the internet and intranet. b. Support archived on-demand streaming of multimedia content via the internet and intranet. c. The system must be able to support multicast streaming over a jurisdiction’s internal data network. d. Please recommend to Choice Facility Partners an optimal and efficient method of streaming live multimedia content via an Page 6 of 25 internal data network. This includes encoding parameters (bitates, frames, AV codes, video size) and broadcast method (multicast vs. unicast). 4. Mobile encoding and streaming a. It is anticipated, that some jurisdictions will have the need to conduct board meetings from remote locations. Please describe your system’s ability to: Encode and stream remote meetings from varying WAN/LAN interconnected locations. 5. Multimedia content administration a. Provide system administration functionality that provides the following capability: Create multimedia events Delete multimedia events Publish multimedia events Schedule one-time events Schedule recurring events Security Indices to facilitate both multimedia content and Board Agenda synchronized navigation within the event Keywords Document attaching Inserting hyperlinks Trim File joining Create CD versions of the multimedia event with indices and attachments. 6. Web presence a. Create and deploy internet and intranet user interfaces that seamlessly integrate into the jurisdiction’s website and remain consistent with current appearance. b. The ability to create and deploy numerous special purpose web inter faces. As an example, sporting events, art and culture, etc. c. Must support Window Media Player. 7. Multimedia content security a. System must be able to accommodate flexible security requirements, whereby the event administrator can choose logon credentials, or not. b. System must feature username and password logon functionality. c. System must feature event pre-registration capability, as required. d. Restrict multimedia content by category; group or department code. e. The ability to manage access by TCP/IP address. Page 7 of 25 f. Provide the ability to stream multimedia content to internet users without compromising the security of the county’s internal network. 8. Multimedia content source compatibility. Need to support (at minimum) the following multimedia input/output sources: a. CD/DVD b. VHS c. Support at minimum the following electronic media file types: .wmv (windows media video) .wma (windows media audio) .asf (advanced streaming format) .flw (multimedia flash video) .ppt (powerpoint) d. The ability to support the following video source interfaces: Video input: DV, SDI, S-video,Composite video BNC Audio input: Balanced and unbalanced stereo Video output: Composite BNC, S-Video Audio output: Balanced and unbalanced stero 9. Pre and post installation a. Provide pre-installation analysis by qualified vendor personnel. b. Vendor will plan reasonably to ensure that key vendor expertise will be available throughout this project. c. Provide a project plan that outlines tasks necessary for project completion from the date of contract award through final acceptance. The plan must describe the installation, testing, conversion, web interface, training and implementation. d. Provide on-site implementation specialist(s) to demonstrate, install, test and train key agency personnel on system use. e. Deliver and install an operational application within 60-90 days after the awarding of the contract depending on the scope of solution. f. Must provide a complete set of manuals and other system documentation (including software user’s guides and operating system reference manuals) at the time of installation. g. Describe the amount of support, in your experience, required to keep the system operational. h. Describe any required system environmental needs and space requirements. 10. Vendor technical support and monitoring a. Vendor must provide 24x7x365 system monitoring, maintenance and user support. Page 8 of 25 b. Vendor must provide system upgrades and fixes at no cost to the client member. Note, all system upgrades and fixes must be communicated and coordinated with agency staff prior to implementation. 11. The ability to interface with electronic transcription/close captioning devices and for the text to be searchable. Describer functionality for closed captioning meetings. 12. Ability to podcast in both audio MP3 and video MP4 formats. 13. Ability to integrate with document/agenda management system. Please provide at least two examples. B. Voting system for Board Meetings The voting system shall deliver at a minimum all necessary hardware and software to deliver functionality described below: 1. Visual display units used to cast votes, motions, and request to speak a. Work in conjunction with a minutes annotation tool to allow ease of use to the clerk or secretary to systematically and automatically capture data b. Systematically determine attendance record c. Provide a touch screen or push-button interface to board members d. Provide the ability to annotate meeting minutes during meeting e. Capture motions; including amendments, substitute and free form motions f. Document viewing Ability to select and view associated, supporting documents that have been loaded into the system g. Request to speak Provide chairman’s touch screen/personal computer (PC) and meeting controller’s touch screen/PC with a queue from which the chairman can select the next individual to speak. If push-button system describe the interface. The queue should be ordered ascending by the time request sent Ability for the board chairman, controller or chairman designee to set and display a countdown timer on the two (2) monitors connected to the system; i.e. a clock timer that will countdown from five (5) minutes or by any amount set by the end user indicating the current speaker’s remaining time. Ability for countdown timer to leverage current speaker system and sound a horn indicating the amount of time, extended to the speaking individual, has expired. Page 9 of 25 h. Capture discussion summaries i. Provide ability to systematically manage agendas. System will allow for agendas to be uploaded into the system that are in the following formats: .PDF- Adobe acrobat file .DOC – Microsoft word documents j. Cast vote; yes, no or abstain k. Votes recorded live Ability to display votes in a prompted manner Ability to display votes on multiple monitors l. Describe all hardware to provide connectivity from meeting controller’s PC to displays 2. Display a. Custom designed display of results b. Simple interface for changing displayed data c. Describe all hardware and software necessary to connect multiple monitors to meeting controller’s touch screen/PC. C. Professional Services 1. The vendor(s) shall provide a training program; complete with Agendas that will be used to train all staff members that will provide system support. 2. The vendor(s) shall provide all associated training; user manuals, and technical training materials. Describe training support beyond development. 3. Describe all on-going professional services in detail including, but not limited to, on –going technical support, software upgrades, monitoring of solution, storage and distribution, etc. D. Cost List and describe all associated costs necessary for web streaming and voting system as a whole or in modules. If tier pricing depending on size of jurisdiction size, please include price breakdown for each item proposed. For on-going monthly managed services, pricing should be included on a month basis. Please include all costs for your complete package with breakdowns for software by name, function and number of required licenses; all hardware costs specifying manufacturer and model; services; and finally, the costs for monthly managed services with a description of what it entails. If any cost increase for management, licenses or other fees are anticipated at annual renewal, state how these will be negotiated (i.e. tied to inflation) Page 10 of 25 The above represents Choice Facility Partners current perception as to its requirements for streaming multimedia with an integrated voting system. In your solution please feel free to respond directly to each requirement or to craft your own solution as you perceive our needs or that best fits your company’s service offerings. The successful proposer agrees to pay the HCDE/CFP program 4% of each gross sale for the listed hardware, licenses & services (Pricing should be inclusive of this fee). This is to be included in the company overhead and not as a separate line item on the purchase order. E. Detailed Marketing Plan Vendor shall provide a detailed marketing plan as part of the RFP proposal that will meet with the approval of the CFP marketing director. Proposer shall divulge any conflicting programs with CFP and how they will ameliorate them. EVALUATION CRITERIA Proposals will be evaluated based on the criteria listed below corresponding to requested scope of services: 1. Price . 2. Reputation of Vendor 3. Quality of Vendor’s Service 4. Extent to which service meets district needs 5. Vendor’s past relationship with the district 6. Impact on historically underutilized businesses 7. Total long term cost to district 8. Previous work with governmental agencies Total 20% 15% 15% 15% 15% 10% 5% 5% 100% The proposal that receives the highest evaluation score and meets HCDE specifications will be the party receiving the award recommendation. The proposal shall remain confidential information until an award decision has been made. After the award has been made, all proposers will be allowed to view proposal results or request bid tabulation results. Page 11 of 25 PRICE DELIVERY INFORMATION I. Offeror must complete the open boxes using information supplied in the description section listed above. Multiply “Qty.” X “Unit Price” for “Extension.” WEB STREAMING PRICING Item Description Unit of Measure Qty. ONE TIME FEES 1 Software Lot 1 2 Hardware Lot 1 3 Professional Services Lot 1 4 Optional Services Lot 1 Lot 1 Lot 1 Lot 1 TOTAL ANNUAL SOLUTION FEES 4 Hosted Fees 5 Non-Hosted Fees 6 Other Fees Page 12 of 25 Proposer: Unit Price Extension VOTING SYSTEM PRICING Item Description Unit of Measure Qty. Proposer: Unit Price Extension ONE TIME FEES 1 Software Lot 1 2 Hardware Lot 1 3 Professional Services Lot 1 4 Optional Services Lot 1 Lot 1 Lot 1 Lot 1 TOTAL ANNUAL SOLUTION FEES II. 4 Hosted Fees 5 Non-Hosted Fees 6 Other Fees Payment Terms: Please provide your payment terms in the space below: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Page 13 of 25 Attachment a. PROPOSAL SUBMISSION FORM RFP NO. 07/036 JC Streaming Audio and/or Visual Service Please Print Whereas on the _____________ day of _____________________________, 2008 (print name of company) ___________________________________________________________________________ has reviewed RFP 07/036 JC and has responded in accordance with the terms and conditions therein: ______________________________________ _____________________________________ Street Address City, State, Zip Code ______________________________________ _____________________________________ Telephone Number Fax Number ______________________________________ ______________________________________ Name of Authorized Individual Signature of Authorized Individual Page 14 of 25 Attachment b. FELONY CONVICTION NOTICE State of Texas Legislative Senate Bill No. 1 Section 44.034, Notification of Criminal History, Subsection (a), states “a person or business entity that enters into an agreement with a school district must give advance notice to the district if the person or an owner or operator of the business entity has been convicted of a felony. The notice must include a general description of the conduct resulting in the conviction of a felony” Subsection (b) states “a school district may terminate the agreement with a person or business entity if the district determines that the person or business entity failed to give notice as required by Subsection (a), or misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for services performed before the termination of the agreement” Note: This notice is not required of a Publicly-Held Corporation I, the undersigned agent for the firm named below, certify that the information concerning notification of felony convictions has been reviewed by me and the following information furnished is true to the best of my knowledge. Vendor’s Name:______________________________________________ Authorized Company Official’s Name (Printed or Typed):_________________________ A) My firm is a publicly-held corporation, therefore the above reporting requirement does not apply Signature of Company Official:______________________________________________ B) My firm is not owned nor operated by anyone who has been convicted of a felony Signature of Company Official:______________________________________________ C) My firm is owned or operated by the following individual(s) who has/have been convicted of a felony: Name of individuals:_______________________________________________________ Detail of Conviction(s):____________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Page 15 of 25 Attachment c. BID CERTIFICATION SHEET In order for a bid to be evaluated and considered, the following information must be provided. As defined by Texas House Bill 602, a "nonresident bidder" means a bidder whose principal place of business is not in Texas, but excludes a contractor whose ultimate parent company or majority owner has its principal place of business in Texas. I certify that my company is a "resident bidder": Signature:___________________________ Date:_____________________ -----------------------------------------------------------------------------------------------------------If you qualify as a "nonresident bidder," you must furnish the following information: What is your resident state? (The state your principal place of business is located) ______________________________________________________________ Address (include City, State and Zip Code) (A) Does your "residence state" require bidders whose principal place of business is in Texas to underbid bidders whose residence state is the same as yours by a prescribed amount or percentage to receive a comparable contract? "Residence State" means the state in which the principal place of business is located. Yes______ No______ (B) What is the amount or percentage?__________% I certify that the above information is correct: _______________________________________ _________________________ Typed Name Position ______________________________________ Company Name Page 16 of 25 Attachment d. NO RESPONSE FORM RFP NO. 07/036 JC Streaming Audio and/or Visual Service for Harris County Department of Education (HCDE) Please Print Whereas on the ___________ day of ____________________, 2008 (print name of company) __________________________________________________________________________ has reviewed HCDE’s solicitation No. 07/036 JC, and elects not to submit a proposal: ______________________________________________ Street Address ______________________________________________ City, State, Zip Code ______________________________________________ Telephone/Fax Number ______________________________________________ Name of Authorized Individual ___________________________________________ Signature of Authorized Individual Page 17 of 25 Attachment e. References Please provide at least three (3) references (co. name, address, telephone no. and contact) that have used your communication system in the last 3-4 years. A. ______________________________ ______________________________ ______________________________ ______________________________ B. _______________________________ _______________________________ _______________________________ _______________________________ C. ________________________________ ________________________________ ________________________________ ________________________________ Page 18 of 25 Attachment f. Minimum Insurance Requirements • The contractor shall, at all times during the term of this contract, maintain insurance coverage with not less than the type and requirements shown below. Such insurance is to be provided at the sole cost of the contractor. These requirements do not establish limits of the contractor's liability. • All policies of insurance shall waive all rights of subrogation against HCDE, its officers, employees and agents. • Upon request, certified copies of original insurance policies shall be furnished to HCDE. • HCDE reserves the right to require additional insurance should it be deemed necessary. A. Workers' Compensation (with Waiver of subrogation to HCDE) Employer's Liability, including all states, U.S. Longshoremen, Harbor Workers and other endorsements, if applicable to the Project. Statutory, and Bodily Injury by Accident: $100,000 each employee. Bodily Injury by Disease: $500,000 policy limit $100,000 each employee. HCDE shall be named as "additional insured" on workers’ compensation policy. B. Commercial General Liability Occurrence Form including, but not limited to, Premises and Operations, Products Liability Broad Form Property Damage, Contractual Liability, Personal and Advertising Injury Liability and where the exposure exists, coverage for watercraft, blasting collapse, and explosions, blowout, catering and underground damage. $300,000 each occurrence Limit Bodily Injury and Property Damage Combined $300,000 Products-Completed Operations Aggregate Limit $500,000 Per Job Aggregate $300,000 Personal and Advertising Injury Limit. HCDE shall be named as "additional insured" on commercial general liability policy. C. Automobile Liability Coverage: $300,000 Combined Liability Limits. Bodily Injury and Property Damage Combined. HCDE shall be named as "additional insured" on automobile policy. Page 19 of 25 Attachment g. Streaming Audio and/or Visual Service Questionnaire (add additional sheets if necessary) 1. How long has your company been in business providing streaming audio and/or visual service? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 2. How many clients do you currently serve? __________________________________________________________________ __________________________________________________________________ 3. What areas of the state of Texas have you worked in over the last five years? __________________________________________________________________ __________________________________________________________________ 4. Please provide last certified financial statement of your company’s: Balance Sheet and Income Statement 5. What is your firms experience in working with educational and governmental entities? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 6. Do you have 24/hr., 7/day customer service support? __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Page 20 of 25 Attachment h. CONFLICT OF INTEREST DISCLOSURE STATEMENT HCDE is required to comply with Texas Local Government, Code 176 and Disclosure of Certain Relationships with Local Government Officers. This means any company that does business with HCDE must fill out a Conflict of Interest Questionnaire (CIQ) if the following situation exists: 1. The person has employment or other business relationship with the local government officer or a family member resulting in the officer or family member receiving taxable income. 2. Your company has given one of HCDE’s local government officers or family member one or more gifts (excluding food, logging, transportation, and entertainment) that has an aggregate value of more than $250 in the twelve month period preceding the date the officer becomes aware of an executed contract or consideration of the person for a contract to do business with the District. Statements must be filed within seven (7) business days after the officer becomes aware a conflict of interest exists. Below is a listing of current HCDE Board of Trustees (BOT): Mr. Raymond T. Garcia, President Ms. Angie Chesnut, Vice-President Mr. Roy Morales Mr. Louis Evans, III Mr. Michael Wolfe Dr. Robert Peterson Mr. Carl Schwartz Dr. John Sawyer Below is a listing of current local government officers: Janell Baker Shannon Bishop Karl Boland Jim Davis Rosalind Dworkin Malcolm Greer Celes Harris Les Hooper Deborah Johnson Nathan Jones Tammy Lanier Noemi Lopez Doug Kleiner Curtis Davis Elaine Nichols Venetia Peacock Gayla Rawlinson Joanie Rethlake Jim Schul Dean Zajicek John Weber Faye Wells Page 21 of 25 Debbie Blalock Angela Drake Richard Griffin Sonny Janczak Michele Kronke Peggy McGrane Pam Newman Linda Pitre Alfonso Saldivar Natasha Truitt CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a person doing business with the governmental entity. Form CIQ OFFICE USE ONLY Date Received By law this questionnaire must be filed with the records administrator of the local government not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code. A person commits an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. 1. Name of person doing business with local governmental entity. 2. Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year for which an activity described in Section 176.006(a), Local Government Code, is pending and not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.) 3. Describe each affiliation or business relationship with an employee or contractor of the local governmental entity who makes recommendations to a local government officer of the local governmental entity with respect to expenditure of money. 4. Describe each affiliation or business relationship with a person who is a local government officer and who appoints or employs a local government officer of the local governmental entity that is the subject of this questionnaire. Page 22 of 25 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ Page 2 5. Name of local government officer with whom filer has affiliation or business relationship. (Complete this section only if the answer to A, B, or C is YES.) This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has affiliation or business relationship. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? Yes No B. Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of the local government officer named in this section AND the taxable income is not from the local governmental entity? Yes No C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? Yes No D. Describe each affiliation or business relationship. 6. Describe any other affiliation or business relationship that might cause a conflict of interest. Signature of person doing business with the governmental entity Page 23 of 25 Date Attachment i. SAFE AND SECURE SCHOOLS POLICY It is the policy of HCDE to promote a safe and secure school. All contractors and subcontractors are responsible for ensuring employees on the job site are in compliance with the following: • • • NO DRUGS, ALCOHOL, OR TOBACCO- Does your company have a drug testing policy? If yes please attach. NO WEAPONS on school grounds with the exception of normal tools used in construction. CONVICTED CHILD AND SEX OFFENDERS may not work on school grounds. You must pre-qualify your subcontractors as well. As an attachment please explain how you will make them aware of these requirements prior to starting projects? SIGNATURE OF A CORPORATE OFFICER IS REQUIRED: SIGNATURE_______________________________________ TITLE Page 24 of 25 ________________________________________ Attachment j. Historically Underutilized Business (HUB) Certification Form Bidding companies that have been certified by the State of Texas as Historically Underutilized Business (HUB) entities are encouraged to indicate their HUB status when responding to this Bid Invitation. The electronic catalogs will indicate HUB certifications for vendors that properly indicate and document their HUB certification on this form. I certify that my company has been certified by the State of Texas as a Historically Underutilized Business (HUB), and I have attached a copy of our HUB certification to this form. (Required documentation for recognition as a HUB) My company has NOT been certified by the State of Texas as a Historically Underutilized Business (HUB). ______________________________________ Signature of Authorized Representative ______________________________________ Name (Please Print) ______________________________________ Company Name (Please Print) Page 25 of 25 _________________________ Title
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