Required Forms If subcontractors are used under the contract that has no stated HUB goal, Exhibits H-1, H-2, H-4 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: Assigned Goal: % Federally Funded State Funded Prime Provider: Total Contract Amount: Prime Provider Info: DBE HUB Both Vendor ID #: DBE/HUB Expiration Date: (First 11 Digits Only) If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Subprovider(s) Contract or % of Work* Totals *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ Total DBE or HUB Commitment Percentages of Contract % (Commitment Dollars and Percentages are for Subproviders only) EXHIBIT H-2 Texas Department of Transportation Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: Date: Supplemental Work Authorization (SWA) #: to WA #: SWA Amount: Revised WA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider: Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). Contract No. EXHIBIT H-3 Texas Department of Transportation Subprovider Monitoring System for Federally Funded Contracts Progress Assessment Report for month of (Mo./Yr.) / Contract #: Original Contract Amount: Date of Execution: Approved Supplemental Agreements: Prime Provider: Total Contract Amount: Work Authorization No. Work Authorization Amount: If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. DBE All Subproviders Category of Work Total Subprovider Amount % Total Contract Amount Amount Paid This Period Amount Paid To Date Subcontract Balance Remaining Fill out Progress Assessment Report with each estimate/invoice submitted, for all subcontracts, and forward as follows: 1 Copy with Invoice - Contract Manager/Managing Office 1 Copy – TxDOT, BOP Office, 120 X. 00xx, Xxxxxx, XX 00000, 000-000-0000, toll free 000-000-0000, or Fax to 000-000-0000 I hereby certify that the above is a true and correct statement of the amounts paid to the firms listed above. Print Name - Company Official /DBE Liaison Officer Signature Phone Date Email Fax Contract No. EXHIBIT H-4 Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Contract Number: Total Contract Amount: $ Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of , 20 Notary Public County My Commission expires: 12/06 DBE-H4.A Contract No. EXHIBIT H-5 Federal Subprovider and Supplier Information The Provider shall indicate below the name, address and phone number of all successful and unsuccessful subproviders and/or suppliers that provided proposals/quotes for this contract prior to execution. You may reproduce this form if additional space is needed. Name Address Phone Number The information must be provided and returned with the contract. Signature Date Printed Name Email Phone # Contract No. HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html HSP-PAR Rev. 9/05
DATA USED FOR CALCULATIONS The calculations for payments under this Agreement shall be initially based upon the valuations that are placed upon all taxable property in the District, including the Applicant’s Qualified Property, by the Appraisal District in its annual certified tax roll submitted to the District for each Tax Year pursuant to TEXAS TAX CODE § 26.01 on or about July 25 of each year of this Agreement. Immediately upon receipt of the valuation information by the District, the District shall submit the valuation information to the Third Party selected and appointed under Section 4.3. The certified tax roll data shall form the basis of the calculation of any and all amounts due under this Agreement. All other data utilized by the Third Party to make the calculations contemplated by this Agreement shall be based upon the best available current estimates. The data utilized by the Third Party shall be adjusted from time to time by the Third Party to reflect actual amounts, subsequent adjustments by the Appraisal District to the District’s certified tax roll or any other changes in student counts, tax collections, or other data.
Supplemental JBoss Software Conditions Software Access and Software Maintenance for Supplemental JBoss Software is intended and available for Development Purposes only and for up to 25 users for each 16 Core Band Subscription of Red Hat JBoss Middleware Software that you purchased. If you deploy or use the Supplemental JBoss Software for Production Purposes or for more than 25 users, you agree to purchase the appropriate Software Subscriptions for each Unit that you deploy or use. Red Hat’s Open Source Assurance Program applies only to the Red Hat JBoss Middleware Software Subscription that you purchased (such as Red Hat JBoss Enterprise Application Platform in the example above) and does not apply to Supplemental JBoss Software. JBoss xPaaS Subscriptions (defined below) are not considered Supplemental JBoss Software. Each installation and use of JBoss xPaaS Subscriptions Software for either Development Purposes or Production Purposes is a Unit and requires a paid Software Subscription.
Certification of Meeting or Exceeding Tobacco-Free Workplace Policy Minimum Standards A. Grantee certifies that it has adopted and enforces a Tobacco-Free Workplace Policy that meets or exceeds all of the following minimum standards of:
Contract Forms This Section contains forms which, once completed, will form part of the Contract. The forms for Performance Security and Advance Payment Security, when required, shall only be completed by the successful tenderer after contract award.
DELIVERY TERMS AND TRANSPORTATION CHARGES Deliverables shall be shipped F.O.B. point of delivery unless otherwise specified in the Supplemental Terms and Conditions. Unless otherwise stated in the Offer, the Contractor’s price shall be deemed to include all delivery and transportation charges. The City shall have the right to designate what method of transportation shall be used to ship the deliverables. The place of delivery shall be that set forth the purchase order.
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS The undersigned (authorized official signing for the contracting organization) certifies that the contractor will, or will continue to, provide a drug-free workplace in accordance with 45 CFR Part 76 by:
CONTRACT EXHIBIT I PREFERRED PRICING AFFIDAVIT This preferred-pricing affidavit is entered into in accordance with section 216.0113, F.S., and as required by Contract No. 80101507-21-STC-ITSA (“Contract”) between (“Contractor”) and the Department of Management Services. As the person authorized by Contractor to sign this affidavit, I attest that the Contractor is in full compliance with the preferred-pricing clause of the Contract. Contractor’s Name: By: Signature Printed Name/Title Date: STATE OF COUNTY OF Sworn to (or affirmed) and subscribed before me this day of , by . Signature of Notary Vendor Name: FEIN# Vendor’s Authorized Representative Name and Title: Address: City, State, and Zip code: Phone Number: ( ) - E-mail: CORPORATE SEAL (IF APPLICABLE) (Print, Type, or Stamp Commissioned Name of Notary Public) [Check One] Personally Known OR Produced the following I.D.
Drug-Free Workplace Certification As required by Executive Order No. 90-5 dated April 12, 1990, issued by the Governor of Indiana, the Contractor hereby covenants and agrees to make a good faith effort to provide and maintain a drug-free workplace. The Contractor will give written notice to the State within ten (10) days after receiving actual notice that the Contractor, or an employee of the Contractor in the State of Indiana, has been convicted of a criminal drug violation occurring in the workplace. False certification or violation of this certification may result in sanctions including, but not limited to, suspension of contract payments, termination of this Contract and/or debarment of contracting opportunities with the State for up to three (3) years. In addition to the provisions of the above paragraph, if the total amount set forth in this Contract is in excess of $25,000.00, the Contractor certifies and agrees that it will provide a drug-free workplace by:
Minimum Site Requirements for TIPS Sales (when applicable to TIPS Sale). Cleanup: When performing work on site at a TIPS Member’s property, Vendor shall clean up and remove all debris and rubbish resulting from their work as required or directed by the TIPS Member or as agreed by the parties. Upon completion of work, the premises shall be left in good repair and an orderly, neat, clean and unobstructed condition. Preparation: Vendor shall not begin a project for which a TIPS Member has not prepared the site, unless Vendor does the preparation work at no cost, or until TIPS Member includes the cost of site preparation in the TIPS Sale 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, Vendor agrees that no employee of Vendor or a subcontractor 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 unless otherwise agreed by the TIPS Member. Vendor agrees that a violation of this condition shall be considered a material breach and may result in the cancellation of the TIPS Sale at the TIPS Member’s discretion. Vendor must identify any additional costs associated with compliance of this term. If no costs are specified, compliance with this term will be provided at no additional charge. Safety Measures: Vendor shall take all reasonable precautions for the safety of employees on the worksite, and shall erect and properly maintain all necessary safeguards for protection of workers and the public. Vendor shall post warning 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 the TIPS Member’s or local smoking statutes, codes, ordinances, and policies.
