HomeMy WebLinkAboutBid 2026-02Item Cover Page
POSTED AGENDA ITEM WORDING
SUMMARY
DATE:April 23, 2026
AGENDA SECTION:REGULAR AGENDA
ITEM TYPE:Bid Approval
DEPARTMENT:Fire Marshal's Office
REQUESTED BY:James Nykaza
Presentation, possible action, and discussion on approval of Request for Proposals (RFP) No. 2026-02
and authorization to enter into contract negotiations with Ardurra for Grant Administration and
Management Services for a five (5) year term.
RFP# 2026-02 Grant Administration and Management Services. Ardurra was the top company to
preform the requirements of the RFP.
FINANCIAL INFORMATION
BUDGETED ITEM:No
AMOUNT BUDGETED:0
AMOUNT REQUESTED:0
ACCOUNT NUMBER:0
AGENDA ITEM NO. 4.c
CITY COUNCIL AGENDA ITEM REPORT
SUBMITTING INFORMATION
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RECOMMENDED ACTION
Approve a 5 year contract with Ardurra to administer and manage the grants as described in the RFP
2026-02.
ATTACHMENTS
RFP-2026-02 Letter
RFP# 2026-02 Evaluation Grading Criteria
Grant Administrative and Management Services RFP
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Evaluation Grading Criteria
Company Name Cost Work
Performance
Capacity to
Preform Experience Total
20% 20% 30% 30% 100%
Ardurra 20 20 25 30 95
Grant Works 20 20 25 29 94
Colliers 5 15 10 20 50
B&A 5 10 10 15 40
City of Humble, Texas
Notice to Proposers
Sealed Responses Solicitation #2026-02
Grant Administrative and Management Services
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City of Humble, Texas
Notice to Proposers
Sealed Responses Solicitation #2026-02
Grant Administrative and Management Services
The City of Humble is soliciting sealed request for proposals for well-qualified administration/management firm/professional
service provider(s) to assist the City in the overall application and management of its Grant Funding including but not limit ed
to HUD and Congressional Allocations, including all COVID19, American Rescue Plan Act, and other economic recovery
related funding and Programs, CDBG-Mitigation, CDBG-DR, HMA/BRIC, 404 HMGP, TxDOT Grants, Emergency Management
Grants, TWDB Grants, and FEMA related project grants. Sealed responses, in triplicate, should be addressed to the Financ e
Director, City of Humble, 114 West Higgins, Humble, Texas 77338 and shall be labeled “RFP 2026-02 GRANT
ADMINISTRATIVE AND MANAGEMENT SERVICES DO NOT OPEN” and should be received no later than April 1, 2026, 2:00
PM One digital copy of the proposal shall be submitted via email to ccollins@cityofhumble.net. RFPs will be opened publicly
at that time at 114 West Higgins, Humble, TX, 77338. Proposals received after the time and date deadline will not be
accepted. Further proposal instructions and submission requirements will be included in the detailed request or proposals.
The request for proposals will be available beginning March 1, 2026, from James Nykaza, Emergency Management
Coordinator, 110 W. Main Street, Humble, Texas, 77339, jnykaza@cityofhumble.net, 281-446-4928.
PUBLISH DATES: 5
City of Humble RFP Timeline
EVENT DATE
Issuance of RFP
Published
Proposal Due Date (time)
Proposal Opening (time)
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REQUEST FOR
PROPOSALS
RFP# 2026-02
GRANT ADMINISTRATIVE AND MANAGEMENT SERVICES
CITY OF HUMBLE, TEXAS
The City of Humble (City) is seeking to enter into a services contract with well-qualified administration/management
firm/professional service provider(s) to assist the City in the overall application and management of its Grant Funding
including but not limited to HUD and Congressional Allocations, including all COVID19, American Rescue Plan Act, and
other economic recovery related funding and Programs, CDBG-Mitigation, CDBG-DR, HMA/BRIC, 404 HMGP, TxDOT
Grants, Emergency Management Grants, TWDB Grants, and FEMA related project grants. The consultants will work under
the direction of the City Manager or his designee on all grant funded projects as assigned through a written Task Order.
The consultant will enter into a five (5) year agreement with the City that will specify the billing rates, personnel to be
assigned, and other terms. No retainer fee is anticipated, but a monthly strategy and update meeting will be conducted for
no more than three (3) hours for which the above referenced agreement will include and apply.
Scope of Work –
The professional administration/management firm/consultant selected will be specifically Tasked to perform a specific
Scope of Work and will be authorized to bill at the agreed upon rates for an established number of hours per assigned Task
Order. The Consultant is to provide contract-related management services, including but not limited to the following areas:
Pre-Funding Services
Grant Administrator will assist in research, solicitation, and development of project scope(s) and the completion of all
opportunities identified by the City as well as identify grant opportunities for the City. The Consultant/administrator will
work with the designated local government personnel to provide the concise information needed for submission of any
applicable funding applications and related documents. The required information shall be submitted in a format to be
described by the proper governing or private agency.
Post-Funding Services
The Consultant/ Administrator will administer and complete all administrative and management activities as they pertain
to the post-funding requirements from applicable Grantor(s). The selected administrative firm must follow all
requirements of the granting agency or private entity. Post-Funding Services may include but not be limited to:
Documentation Management, Compliance Monitoring, Professional Services Procurement, Oversight of Construction,
Construction Management, Project Management, Budget Monitoring, Representing the City as a Designated
Representative, Public Presentations to City Officials and the general public, etc.
Grant Close-Out Services
The Consultant/Administrator will lead and complete all Close-Out activities to ensure that all project requirements were
met and that the project is prepared for any applicable external review or audit. The Consultant/Administrator will notify
the City of any potential compliance issues before Grant Close-Out and recommend resolutions to address each
compliance related item.
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Selection Process -
The selection of a firm/individual for the provision of these services will be based on the proposer’s competence,
expertise, and ability to perform the work on a per-project basis either through its own forces or through the use of
project teams that may include sub-consultants. The final scope of work for each project assigned will be negotiated and
included in the final Agreement before award. Dependent upon the funding involved, the City may include additional
terms that are required by other agencies such as HUD, EPA, TX DOT, etc. The City will use an evaluation panel comprised
of City personnel to review Respondent’s Proposal. From that review, the
City shall select the Proposal that best fits the City’s needs based on the scoring criteria established in this notice. The City
reserves the right to but shall not be obliged to interview any number of potential selections before making its final
selection. Should the City choose to interview any proposers, notification of the date and time of the interview shall be
provided at a time convenient for the City. The City reserves the right to select more than one proposer with whom to
contract for services.
The City will negotiate a professional services contract from the proposer(s) so solicited until at least one proposer has
been successfully contracted. The City, at its sole discretion, may choose to discontinue the negotiation process and not
contract for services as advertised.
The City of Humble will not provide compensation or defray any cost incurred by any firm or individual related to the
response to this request. The City reserves the right to negotiate with any and all persons or firms as it chooses. The City
also reserves the right to reject any or all RFP(s), accept any RFP deemed most advantageous, waive any irregularities or
informalities in a RFP received, and to revise the process schedule as circumstances require.
The successful proposer(s) will be required to enter into a General Services Agreement, similar to Exhibit “A” of this
solicitation. This RFP and the successful proposer(s)’ response, or any part thereof, may be incorporated into and made a
part of the final contract. The City reserves the right to award to other than the lowest-priced offeror and negotiate the
final terms and conditions of the contract. The City also retains the right to revise the agreement based on review of laws
passed by the Texas Legislature, results of recent case law or other considerations. The City reserves the right to reject any
or all proposals, including without limitation the rights to reject any or all nonconforming, non-responsive, unbalanced, or
conditional RFPs and to reject the RFP of any Proposer, if the City believes that it would not be in the best interest of the
Project to make an award to that Proposer, whether because the RFP is not responsive or is unqualified, or of doubtful
financial ability, or fails to meet any other pertinent standard or criteria established by the RFP.
Evaluation Criteria -
The criteria that will be used to evaluate the responses are (weight factor):
• Experience – 30%
• Work Performance – 30%
• Capacity to Perform – 20%
• Proposed Cost – 20%
Contracting with small and minority businesses, women's business enterprises, and labor surplus area
firms
Small and minority businesses, women's business enterprises, and labor surplus area firms are encouraged to participate in
this RFP as either a Prime Contractor or as a Sub-Contractor. The City shall require that all Proposers identify the extent to
which a Small, Minority, or Woman owned business is included in the submitted proposal. Selected proposer(s) shall also
be required to identify during the contract negotiations the extent to which Small/Minority/Woman businesses will
participate in actual project deliverables within each Task Order that is authorized.
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Submission Requirements
Sealed submittals are required. All submittals must be received before April 1, 2026, at 2:00pm by the Finance Director,
City of Humble, 114 West Higgins, Humble, Texas 77338. Proposals must be received and time stamped by the Finance
Director Office prior to the aforementioned time. Proposals received after the time and date deadline will not be accepted.
All submittals must be labeled on the outside of the proposal packaging with the Proposer’s name and the name of the
Project. Late submittals will not be considered. Submittals that do not comply with all terms and conditions shall be
deemed non-responsive and will be rejected. An original (signed) proposal, two hard copies, and one digital copy of each
proposal is required. Each response shall be submitted as outlined in this section. Responses received that are not in this
prescribed format may be rejected. The proposal shall include an outside label which includes:
Firm/Individual Name
Sealed Package – DO NOT OPEN
Proposal# 2026-02– City of Humble Grant Administrative and Management Services
The Proposal shall consist of:
Table of Contents
A table of contents shall be next, followed by tabbed dividers separating each of the following sections:
1. Cover letter and Executive Summary: Provide at least the following:
• Introduction
• Legal name of the firm/individual, date of formation
• Location of the office that will be engaged in the work • Contact persons
• Legal business description (individual, corporation, joint venture, etc.)
• Statement of availability and commitment of the firm
• Statement of interest including a narrative and unique proposal
• List of services proposed to be performed
• Signature of authority authorized to enter into a contract
2. Project Experience and References: Provide at least the following:
• Overview and a brief history of the firm including experience with managing recent grant funded projects;
• Verifiable examples of at least three (3) relative projects completed in the State of Texas, with emphasis on
projects within the last five years, including
o Project name and location
o Name of project manager
o A detailed synopsis of services provided
o Date of completion or project status
o Client name and contact person
• History of accomplishing services within established time and budget
• Demonstrate the extent of ability to identify and resolve project obstacles
• References shall be other than the City of Humble. Failure to supply required references may deem proposal as
non-responsive.
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3. Workload Capacity and Performance:
Provide a descriptive narrative that conveys the firm/individual’s depth and knowledge of Grant Administration and
Grant Management including a conceptual approach to the task(s) proposed. Address the following information:
• Ability to dedicate the necessary resources to the work
• History of the ability to perform within budget constraints
• Ability to deliver projects within a specified schedule
• Ability to handle multiple projects simultaneously at various stages of development
• Work plan and contingency plan; ability to sustain a loss of a key team member without compromising project
quality, schedule or budget
4. Staffing:
Provide at least the following:
• Organizational chart for personnel who may be engaged
• Resumes of key personnel
5. Financial and Legal Status:
• Include documentation associated with the firm’s Workman’s Compensation, liability, errors, and omissions or
other insurance coverage’s that would be applicable to the work.
• List any actions taken by any regulatory agency against or involving the firm or its agents or employees with
respect to any work performed.
• Jurisdictions, disciplines and trade categories in which your organization is legally qualified to do business.
(Please indicate registration or license numbers)
6. Management and Organizational Approach:
• Describe the Firm’s understanding of providing professional services in the respective discipline for these grant
administrative services.
• Describe your firm's approach to delivering the services.
• Describe the Firm’s procedures and methods associated with scheduling, coordination, analysis, quality
assurance and control, documentation and reporting.
7. Proposed Cost of Services -
Please provide your proposed rate sheet for personnel necessary for the identified scope of services. Identify the
method that is proposed to establish a maximum billable amount per a given Task Order. Identify if the proposal is
based on a project percentage or fixed cost based on rates and level of effort by necessary personnel. Confirm if
additional costs will be billed separately or if proposed costs are all inclusive.
8. Items G, H and I under Additional, Instructions, Notifications and Information
• Addendum with acknowledgement
• Complete and include the Disclosure Requirements Acknowledgement
• Complete and include the Certification to Do Business
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Additional Instructions, Notifications, and Information
A. No Gratuities/Lobbying- Respondents shall not offer gratuities, favors or anything of monetary value to or
lobby any official or employee of the City for the purposes of influencing this selection. Any attempt by the
Respondent to influence the selection process by any means, other than disclosure of proposal and credentials
through the proper channels, shall be considered a violation of the procedures of this procurement process and
grounds for exclusion from the selection process and possible legal action.
B. Verification Not to Boycott Israel (Texas Government Code 2270)- As required by Texas Government
Code Chapter 2270, Contractor verifies that it does not boycott Israel and will not boycott Israel through the
term of this Contract. For purposes of the verification, “boycott Israel” means refusing to deal with, terminating
business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or
limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an
Israeli-controlled territory, but does not include an action made for ordinary business purposes.
C. Transactions With Terrorist Organizations Prohibited (Texas Government Code 2252.152)-
Pursuant to Chapter 2252, Texas Government Code, Contractor shall certify that at the time of execution of this
Contract, neither the Contractor, nor any wholly owned subsidiary, majority-owned subsidiary, parent company
or affiliate of the same (1) engages in business with Iran, Sudan, or any foreign terrorist organization as
described in Chapters 806 or 807 of the Texas Government Code, or Subchapter F of Chapter 2252 o f the Texas
Government Code, or (2) is a company listed by the Texas Comptroller of Public Accounts under Section
806.051, 807.051, or 2252,153 of the Texas Government Code.
D. All Information True- Respondents represents and warrants to the City that all information provided in the
response shall be true, correct and complete. Respondents who provide false, misleading, or incomplete
information, whether intentional or not, shall be subject to exclusion from the selection process.
E. Contract Negotiations- This RFP is not to be construed as a contract or as a commitment of any kind. If this
RFP does result in the Firm receiving a request for a proposal from the City, the specific scope of work,
associated fees, and other contractual matters will be determined during contract negotiations. To ensure
appropriate staff is assigned to the Project, the City may include the “key persons” clause in contract
negotiations.
F. No Obligation- The City reserves the sole right to (1) evaluate the responses submitted;(2) waive any
irregularities therein; (3) select candidates for the submittal of more detailed or alternative proposals (4) accept
any submittal or portion of submittal; (5) reject any or all Respondents submitting responses, should it be
deemed in the City of Humble’s best interest; of (6) cancel the entire process.
G. Insurance- The respondent shall have the appropriate Workman’s Compensation, liability, and errors and
omissions insurance coverage, written by an insurer to transact insurance in the State of Texas.
H. Inquiries- All questions regarding this RFP shall be submitted by email to the following City contact and email
address: James Nykaza, Emergency Management Coordinator, 110 W. Main Street, Humble, Texas, 77339,
jnykaza@cityofhumble.net, 281-446-4928
I. Addendum- Any addendum(s) to this RFP shall be published at https://www.cityofhumbletx.gov/humble-
public-notices/.
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J. Conflicts of Interest- Chapter 176 of the Texas Local Government Code requires that any person, who enters
or seeks to enter into a contract for the sale or purchase or property, goods or services with a local government
entity and who has an employment or other business relationship with a local government officer or a family
member of the officer, as described by Texas Local Government Code Section 176.006, shall file a completed
conflict of interest questionnaire with the City within 7 business days after the latter of:
1) The date the person begins discussions or negotiations to enter into a contract, including submission of
a bid or proposal, or 2) the date the person becomes aware of facts that require the statement to be filed.
The Conflict of Interest Questionnaire* (Form CIQ) is included, and must be returned with your
submission. The form is also available from the Texas Ethics Commission at www.ethics.state.us. The City’s
Identification Number under Item No. 3 on Form 1295 for RFP No. 2026-02 will be *******.
*Please consult your own legal advisor if you have questions regarding this form.
Acknowledgment of Texas Local Government Code Chapter 176 Requirements
A complete text of the law may be found at the following link:
http://www.statutes.legis.state.tx.us/Docs/LG/htm/LG.176.htm.
BY DOING BUSINESS OR SEEKING TO DO BUSINESS WITH THE CITY OF HUMBLE, YOU ACKNOWLEDGE THAT YOU HAVE
BEEN NOTIFIED OF THE REQUIREMENT OF CHAPTER 176 OF THE TEXAS LOCAL GOVERNMENT CODE AND THAT YOU ARE
SOLELY RESPONSIBLE FOR COMPLYING WITH THEM.
Acknowledgment:
Vendor Name
Signature
Printed Name
Title
Date
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K. Certification of No Collusion- Respondents are required to include the following signed certification with
the Proposal.
The undersigned affirms that they are duly authorized to execute this contract, that this Proposal has not been prepared in
collusion with any other firm, and that the contents of this document have not been communicated to any other firm prior to
the official opening. Further, the undersigned affirms that the firm agrees to all terms and conditions contained in the
Certification Form.
RFP issued by the City of Humble, Texas on the _________ day of ___________________, 2026
Firm/Individual _______________________________________ TIN: _____________________________
_______________________________________ ___________________________
Signature of Authorized Representative Date
_______________________________________________ __________________________________
Printed Name Title
____________________ _________________________ _________________________________
Phone # email Address website
_____________________________________________________________________________________________
Mailing Address- Street City State Zip
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L. System for Award Management. Consultant/Firm and its Principals may not be debarred or suspended
nor otherwise on the Excluded Parties List System (EPLS) in the System for Award Management (SAM). Include
verification that the company, as well as the company’s principals, are not listed (are not debarred) through
the System for Award Management (www.SAM.gov). Enclose a printout of the search results that includes the
record date.
M. Public Information Disclosures- All materials submitted to the City in response to a competitive
solicitation, upon receipt by the City become public property, and are subject to the Texas Government Code
Chapter 552 (Texas Public Information Act). There will be no disclosure of contents to competing teams and all
responses will be kept confidential during the selection process to the degree permitted by law. The City is
subject to the Texas Public Information Act (Texas Government Code 552). In accordance with the provisions
of Texas Government Code 552.110, trade secrets, commercial or financial information that may be privileged
or confidential by statute or judicial decision, are exempt from required public disclosure. All submissions shall
be opened in a manner that avoids disclosure of the contents to competing respondents and keeps the
responses secret during negotiations, in accordance with the statutory provisions of Texas Government Code
552.104. A public opening will not be conducted with this procurement process.
N. Proprietary Information- If a Respondent does not desire proprietary information in the proposal to be
disclosed, each page must be identified and marked “proprietary” at the time of submittal. The City will, to
the extent provided by law, endeavor to protect such information from disclosure. The final decision as to
what information must be disclosed, however, lies with the Texas Attorney General. Failure to identify
proprietary information will result in all unmarked sections being deemed non-proprietary and available upon
public request. Respondents shall not be permitted to mark the entire Proposal as proprietary. All
information, documentation, and other materials not marked “confidential” shall be subject to public
disclosure, after awarding the contract.
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Certification Regarding Lobbying
(To be submitted with each bid or offer exceeding $100,000)
The undersigned certifies, to the best of his or her knowledge and belief, that:
(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any
person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of
any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
(b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant,
loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure
Form to Report Lobbying,” in accordance with its instructions.
(c) The undersigned shall require that the language paragraph 1 and 2 of this anti-lobbying certification be
included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts
under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was
made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction
imposed by 31, U.S.C. § 1352 (as amended by the Lobbying Disclosure Act of 1995).
The Contractor , , certifies or affirms the truthfulness and accuracy of each statement of its
certification and disclosure, if any. In addition, the Contractor understands and agrees that the provisions of 31
U.S.C. § 3801 et seq., apply to this certification and disclosure, if any.
Signature of Contractor’s Authorized Official
Printed Name and Title of Contractor’s Authorized Official
Date
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INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall be completed by the reporting entity, whether sub -awardee or prime Federal recipient, at the
initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. sec tion
1352. The filing of a form is required for each payment or agreement to make paymen t to any lobbying entity for
influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete
all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by
the Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the
outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the
information previously reported, enter the year and quarter in which the change occurred. Enter the date of the
last previously submitted report by this reporting entity for this covered Federal action.
4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if
known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a pr ime
or subaward recipient. Identify the tier of the sub-awardee, e.g., the first sub-awardee of the prime is the 1st tier.
Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks “Sub-awardee,” then enter the full name, address, city, State
and zip code of the prime Federal recipient. Include Congressional District, if known.
6. Enter the name of the federal agency making the award or loan commitment. Includ e at least one organizational
level below agency name, if known. For example, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full
Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
commitments.
8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g.,
Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract,
grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included
prefixes, e.g., “RFP-DE-90-001.”
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter
the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.
10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure
Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last
Name, First Name, and Middle Initial (MI).
11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unles s it
displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348 -0046. Public
reporting burden for this collection of information is estimated to average 10 minutes per response, including time for revie wing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the co llection
of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348 -0046), Washington,
DC 20503
16
Approved by OMB
0348-0046
Disclosure of Lobbying Activities
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure)
Type of Federal Action:
a. contract
_ b. grant
c. cooperative agreement
d. loan
e. loan guarantee
f. loan insurance
Status of Federal Action:
a. bid/offer/application
b. initial award
c. post-award
Report Type:
a. initial filing
b. material change
Name and Address of Reporting Entity:
Prime _ _
Sub-awardee Tier
, if Known:
Congressional District, if known:
If Reporting Entity in No. 4 is Subawardee, Enter
Name and Address of Prime:
Congressional District, if known:
Federal Department/Agency: 7. Federal Program Name/Description:
CFDA Number, if applicable:
Federal Action Number, if known: 9. Award Amount, if known:
$
10. a. Name and Address of Lobbying Registrant
(if individual, last name, first name, MI):
b. Individuals Performing Services
(including address if different from No. 10a)
(last name, first name, MI):
11. Information requested through this form is
authorized by title 31 U.S.C. section 1352. This
disclosure of lobbying activities is a material
representation of fact upon which reliance was placed
by the tier above when this transaction was made or
entered into. This disclosure is required pursuant to 31
U.S.C. 1352. This information will be reported to the
Congress semi-annually and will be available for public
inspection. Any person who fails to file the required
disclosure shall be subject to a civil penalty of not less
than $10,000 and not more than $100,000 for each such
failure.
Signature: _
Print Name: _ _
Title:
Telephone No.: _ Date: _ _
Authorized for Local Reproduction
Standard Form - LLL (Rev. 7-97)
Federal Use Only
17
EXHIBIT “A”
REQUIRED CONTRACT PROVISIONS – Language to be addressed in Contract
2 CFR 200.326 Contract provisions. The non-Federal entity's contracts must contain the applicable provisions described in
Appendix II to Part 200—Contract Provisions for non-Federal Entity Contracts Under Federal Awards. The non-Federal
entity's contracts must contain the applicable provisions described in Appendix II to Part 200—Contract Provisions for non-
Federal Entity Contracts Under Federal Awards.
All Contracts
THRESHOLD PROVISION CITATION
>$150,000
(Simplified
Acquisition
Threshold)
Contracts for more than the simplified acquisition threshold currently set at
$150,000, which is the inflation adjusted amount determined by the Civilian
Agency Acquisition Council and the Defense Acquisition Regulations Council
(Councils) as authorized by 41 U.S.C. 1908, must address administrative,
contractual, or legal remedies in instances where contractors violate or breach
contract terms, and provide for such sanctions and penalties as appropriate.
2 CFR 200
APPENDIX II
(A)
>$10,000
All contracts in excess of $10,000 must address termination for cause and for
convenience by the non-Federal entity including the manner by which it will be
effected and the basis for settlement.
2 CFR 200
APPENDIX II
(B)
None
Rights to Inventions Made Under a Contract or Agreement. If the Federal award
meets the definition of “funding agreement” under 37 CFR §401.2 (a) and the
recipient or subrecipient wishes to enter into a contract with a small business firm
or nonprofit organization regarding the substitution of parties, assignment or
performance of experimental, developmental, or research work under that
“funding agreement,” the recipient or subrecipient must comply with the
requirements of 37 CFR Part 401, “Rights to Inventions Made by Nonprofit
Organizations and Small Business Firms Under Government Grants, Contracts
and Cooperative Agreements,” and any implementing regulations issued by the
awarding agency.
2 CFR 200
APPENDIX II (F)
None
Debarment and Suspension (Executive Orders 12549 and 12689)—A contract
award (see 2 CFR 180.220) must not be made to parties listed on the
governmentwide exclusions in the System for Award Management (SAM), in
accordance with the OMB guidelines at 2 CFR 180 that implement Executive
Orders 12549 (3 CFR part 1986 Comp., p. 189) and 12689 (3 CFR part 1989
Comp., p. 235), “Debarment and Suspension.” SAM Exclusions contains the
names of parties debarred, suspended, or otherwise excluded by agencies, as
well as parties declared ineligible under statutory or regulatory authority other
than Executive Order 12549.
2 CFR 200
APPENDIX II
(H)
None
Records of non-Federal entities. The U.S. Department of Housing and Urban
Development (HUD), Inspectors General, the Comptroller General of the United
States, the Texas General Land Office (GLO), and the pass-through entity, or
any of their authorized representatives, must have the right of access to any
documents, papers, or other records of the non-Federal entity which are
pertinent to the Federal award, in order to make audits, examinations, excerpts,
and transcripts. The right also includes timely and reasonable access to the non-
Federal entity's personnel for the purpose of interview and discussion related to
such documents.
2 CFR 200.336
18
None
Financial records, supporting documents, statistical records, and all other non-
Federal entity records pertinent to a Federal award must be retained for a period
of three years from the date of submission of the final expenditure report or, for
Federal awards that are renewed quarterly or annually, from the date of the
submission of the quarterly or annual financial report, respectively, as reported to
the Federal awarding agency or pass-through entity in the case of a subrecipient.
Federal awarding agencies and pass-through entities must not impose any other
record retention requirements upon non-Federal entities. The only exceptions are
the following:
(a) If any litigation, claim, or audit is started before the expiration of the 3-year
period, the records m ust be retained until all litigation, claims, or audit findings
involving the records have been resolved and final action taken.
(b) When the non-Federal entity is notified in writing by the Federal awarding
agency, cognizant agency for audit, oversight agency for audit, cognizant agency
for indirect costs, or pass-through entity to extend the retention period.
(c) Records for real property and equipment acquired with Federal funds
must be retained for 3 years after final disposition.
(d) When records are transferred to or maintained by the Federal awarding
agency or pass-through entity, the 3-year retention requirement is not applicable
to the non-Federal entity.
(e) Records for program income transactions after the period of performance.
In some cases, recipients must report program income after the period of
performance. Where there is such a requirement, the retention period for the
records pertaining to the earning of the program income starts from the end of
the non-Federal entity's fiscal year in which the program income is earned.
(f) Indirect cost rate proposals and cost allocations plans. This paragraph
applies to the following types of documents and their supporting records: indirect
cost rate computations or proposals, cost allocation plans, and any similar
accounting computations of the rate at which a particular group of costs is
chargeable (such as computer usage chargeback rates or composite fringe
benefit rates).
(1) If submitted for negotiation. If the proposal, plan, or other computation is
required to be submitted to the Feder al Government (or to the pass-through
entity) to form the basis for negotiation of the rate, then the 3 -year retention
period for its supporting records starts from the date of such submission.
(2) If not submitted for negotiation. If the proposal, plan, or other computation
is not required to be submitted to the Federal Government (or to the pass -
through entity) for negotiation purposes, then the 3-year retention period for the
proposal, plan, or computation and its supporting records starts from the end of
the fiscal year (or other accounting period) covered by the proposal, plan, or
other computation.
2 CFR 200.333
19
None
Contracting with small and minority businesses, women's business enterprises,
and labor surplus area firms.
(a) The non-Federal entity must take all necessary affirmative steps to assure
that minority businesses, women's business enterprises, and labor surplus area
firms are used when possible.
(b) Affirmative steps must include:
(1) Placing qualified small and minority businesses and women's business
enterprises on solicitation lists;
(2) Assuring that small and minority businesses, and women's business
enterprises are solicited whenever they are potential sources;
(3) Dividing total requirements, when economically feasible, into smaller tasks
or quantities to permit maximum participation by small and minority businesses,
and women's business enterprises;
(4) Establishing delivery schedules, where the requirement permits, which
encourage participation by small and minority businesses, and women's business
enterprises;
(5) Using the services and assistance, as appropriate, of such organizations
as the Small Business Administration and the Minority Business Development
Agency of the Department of Commerce; and
(6) Requiring the prime contractor, if subcontracts are to be let, to take the
affirmative steps listed in paragraphs (1) through (5) of this section.
2 CFR 200.321
None
Verification No Boycott Israel. As required by Chapter 2270, Government Code,
CONTRACTOR hereby verifies that it does not boycott Israel and will not boycott
Israel through the term of this Agreement. For purposes of this verification, “boycott
Israel” means refusing to deal with, terminating business activities with, or otherwise
taking any action that is intended to penalize, inflict economic harm on, or limit
commercial relations specifically with Israel, or with a perso n or entity doing business
in Israel or in an Israeli-controlled territory, but does not include an action made for
ordinary business purposes.
Texas
Government
Code 2270.002
None
Foreign Terrorist Organizations. Pursuant to Chapter 2252, Texas Government
Code, [Company] represents and certifies that, at the time of execution of this
Agreement neither [Company], nor any wholly owned subsidiary, majority-owned
subsidiary, parent company or affiliate of the same (i) engages in business with Iran,
Sudan, or any foreign terrorist organization as described in Chapters 806 or 807 of
the Texas Government Code, or Subchapter F of Chapter 2252 of the Texas
Government Code, or (ii) is a company listed by the Texas Comptroller of Public
Accounts under Sections 806.051, 807.051, or 2252.153 of the Texas Government
Code. The term "foreign terrorist organization" in this paragraph has the meaning
assigned to such term in Section 2252.151 of the Texas Government Code.
Texas
Government
Code 2252.152
Option Contract
Language for
contracts
awarded prior to
Grant Award
The contract award is contingent upon the receipt of CDBG -MIT funds. If no such
funds are awarded, the contract shall terminate.
Optional
EO Clause for Construction Contracts > $10K including administration & engineering contracts associated with
construction contracts
20
THRESHOLD PROVISION CITATION
>$10,000
Equal Employment Opportunity. Except as otherwise provided under 41 CFR
Part 60, all contracts that meet the definition of ‘‘federally assisted construction
contract’’ in 41 CFR Part 60–1.3 must include the equal opportunity clause
provided under 41 CFR 60–1.4(b), in accordance with Executive Order 11246,
‘‘Equal Employment Opportunity’’ (30 FR 12319, 12935, 3 CFR Part, 1964 –1965
Comp., p. 339), as amended by Executive Order 11375, ‘‘Amending Executive
Order 11246 Relating to Equal Employment Opportunity,’’ and implementing
regulations at 41 CFR part 60, ‘‘Office of Federal Contract Compliance
Programs, Equal Employment Opportunity, Department of Labor.’’
41 CFR 60-1.4 Equal opportunity clause.
(b) Federally assisted construction contracts. (1) Except as otherwise provided,
each administering agency shall require the inclusion of the following language
as a condition of any grant, contract, loan, insurance, or guarantee involving
federally assisted construction which is not exempt from the requirements of the
equal opportunity clause:
The applicant hereby agrees that it will incorporate or cause to be incorporated
into any contract for construction work, or modification thereof, as defined in the
regulations of the Secretary of Labor at 41 CFR Chapter 60, which is paid for in
whole or in part with funds obtained from the Federal Government or borrowed
on the credit of the Federal Government pursuant to a grant, contract, loan,
insurance, or guarantee, or undertaken pursuant to any Federal program
involving such grant, contract, loan, insurance, or guarantee, the following equal
opportunity clause:
During the performance of this contract, the contractor agrees as follows:
(1) The contractor will not discriminate against any employee or applicant for
employment because of race, color, religion, sex, sexual orientation, gender
identity, or national origin. The contractor will take affirmative action to ensure
that applicants are employed, and that employees are treated during
employment without regard to their race, color, religion, sex, sexual orientation,
gender identity, or national origin. Such action shall include, but not be limited to
the following:
Employment, upgrading, demotion, or transfer; recruitment or recruitment
advertising; layoff or termination; rates of pay or other forms of compensation;
and selection for training, including apprenticeship. The contractor agrees to post
in conspicuous places, available to employees and applicants for employment,
notices to be provided setting forth the provisions of this nondiscrimination
clause.
(2) The contractor will, in all solicitations or advertisements for employees
placed by or on behalf of the contractor, state that all qualified applicants will
receive consideration for employment without regard to race, color, religion, sex,
sexual orientation, gender identity, or national origin.
(3) The contractor will not discharge or in any other manner discriminate
against any employee or applicant for employment because such employee or
applicant has inquired about, discussed, or disclosed the compensation of the
employee or applicant or another employee or applicant. This provision shall not
apply to instances in which an employee who has access to the compensation
information of other employees or applicants as a part of such employee's
essential job functions discloses the compensation of such other employees or
applicants to
41 CFR §60-
1.4(b) and
2 CFR 200
APPENDIX II (C)
21
individuals who do not otherwise have access to such information, unless such
disclosure is in response to a formal complaint or charge, in furtherance of an
investigation, proceeding, hearing, or action, including an investigation
conducted by the employer, or is consistent with the contractor's legal duty to
furnish information.
(4) The contractor will send to each labor union or representative of workers
with which he has a collective bargaining agreement or other contract or
understanding, a notice to be provided advising the said labor union or workers'
representatives of the contractor's commitments under this section, and shall
post copies of the notice in conspicuous places available to employees and
applicants for employment.
(5) The contractor will comply with all provisions of Executive Order 11246 of
September 24, 1965, and of the rules, regulations, and relevant orders of the
Secretary of Labor.
(6) The contractor will furnish all information and reports required by
Executive Order 11246 of September 24, 1965, and by rules, regulations, and
orders of the Secretary of Labor, or pursuant thereto, and will permit access to
his books, records, and accounts by the administering agency and the Secretary
of Labor for purposes of investigation to ascertain compliance with such rules,
regulations, and orders.
(7) In the event of the contractor's noncompliance with the nondiscrimination
clauses of this contract or with any of the said rules, regulations, or orders, this
contract may be canceled, terminated, or suspended in whole or in part and the
contractor may be declared ineligible for further Government contracts or
federally assisted construction contracts in accordance with procedures
authorized in Executive Order 11246 of September 24, 1965, and such othe r
sanctions may be imposed and remedies invoked as provided in Executive Order
11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of
Labor, or as otherwise provided by law.
(8) The contractor will include the portion of the sentence immediately
preceding paragraph (1) and the provisions of paragraphs (1) through (8) in
every subcontract or purchase order unless exempted by rules, regulations, or
orders of the Secretary of Labor issued pursuant to section 204 of Executive
Order 11246 of September 24, 1965, so that such provisions will be binding upon
each subcontractor or vendor. The contractor will take such action with respect
to any subcontract or purchase order as the administering agency may direct as
a means of enforcing such provisions, including sanctions for noncompliance:
Provided, however, that in the event a contractor becomes involved in, or is
threatened with, litigation with a subcontractor or vendor as a result of such
direction by the administering agency, the contractor may request the United
States to enter into such litigation to protect the interests of the United States.
The applicant further agrees that it will be bound by the above equal opportunity
clause with respect to its own employment practices when it participates in
federally assisted construction work: Provided, that if the applicant so
participating is a State or local government, the above equal opportunity clause
is not applicable to any agency, instrumentality or subdivision of such
government which does not participate in work on or under the contract.
The applicant agrees that it will assist and cooperate actively with the
administering agency and the Secretary of Labor in obtaining the compliance of
contractors and subcontractors with the equal opportunity clause and the rules,
22
regulations, and relevant orders of the Secretary of Labor, that it will furnish the
administering agency and the Secretary of Labor such information as they may
require for the supervision of such compliance, and that it will otherwise assist
the administering agency in the discharge of the agency's primary responsibility
for securing compliance.
The applicant further agrees that it will refrain from entering into any contract or
contract modification subject to Executive Order 11246 of September 24, 1965,
with a contractor debarred from, or who has not demonstrated eligibility for,
Government contracts and federally assisted construction contracts pursuant to
the Executive Order and will carry out such sanctions and penalties for violation
of the equal opportunity clause as may be imposed upon contractors and
subcontractors by the administering agency or the Secretary of Labor pursuant
to Part II, Subpart D of the Executive Order. In addition, the applicant agrees that
if it fails or refuses to comply with these undertakings, the administering agency
may take any or all of the following actions: Cancel, terminate, or suspend in
whole or in part this grant (contract, loan, insurance, guarantee); refrain from
extending any further assistance to the applicant under the program with respect
to which the failure or refund occurred until satisfactory assurance of future
compliance has been received from such applicant; and refer the case to the
Department of Justice for appropriate legal proceedings.
(c) Subcontracts. Each nonexempt prime contractor or subcontractor shall
include the equal opportunity clause in each of its nonexempt subcontracts.
(d) Inclusion of the equal opportunity clause by reference. The equal
opportunity clause may be included by reference in all Government contracts
and subcontracts, including Government bills of lading, transportation requests,
contracts for deposit of Government funds, and contracts for issuing and paying
U.S. savings bonds and notes, and such other contracts and subcontracts as the
Director of OFCCP may designate.
(e) Incorporation by operation of the order. By operation of the order, the
equal opportunity clause shall be considered to be a part of every contract and
subcontract required by the order and the regulations in this part to include such
a clause whether or not it is physically incorporated in such contracts and
whether or not the contract between the agency and the contractor is written.
(f) Adaptation of language. Such necessary changes in language may be
made in the equal opportunity clause as shall be appropriate to identify properly
the parties and their undertakings.
[80 FR 54975, Sept. 11, 2015]
23
THRESHOLD PROVISION CITATION
>$2,000
Compliance with the Davis-Bacon Act (40 U.S.C. 3141 et seq.) as
supplemented by Department of Labor regulations (29 CFR part 5) and with the
Copeland “Anti- Kickback” Act (18 U.S.C. 874; 40 U.S.C. 3145) as
supplemented in Department of Labor regulations (29 CFR part 3):
Davis-Bacon Act, as amended (40 U.S.C. 3141-3148). When required by
Federal program legislation, all prime construction contracts in excess of $2,000
awarded by non-Federal entities must include a provision for compliance with
the Davis- Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented
by Department of Labor regulations (29 CFR Part 5, “Labor Standards
Provisions
Applicable to Contracts Covering Federally Financed and Assisted
Construction”). In accordance with the statute, contractors must be required to
pay wages to laborers and mechanics at a rate not less than the
prevailing wages specified in a wage determination made by the Secretary of
Labor. In addition, contractors must be required to pay wages not less than once
a week. The non- Federal entity must place a copy of the current prevailing
wage determination issued by the Department of Labor in each solicitation. The
decision to award a contract or subcontract must be conditioned upon the
acceptance of the wage determination. The non-Federal entity must report all
suspected or reported violations to the Federal awarding agency. The contracts
must also include a provision for compliance with the Copeland “Anti-Kickback”
Act (40 U.S.C. 3145), as supplemented by Department of Labor regulations (29
CFR Part 3,
“Contractors and Subcontractors on Public Building or Public Work Financed in
Whole or in Part by Loans or Grants from the United States”). The Act provides
that each contractor or subrecipient must be prohibited from inducing, by any
means, any person employed in the construction, completion, or repair of public
work, to give up any part of the compensation to which he or she is otherwise
entitled. The non-Federal entity must report all suspected or reported violations
to the Federal awarding agency.
2 CFR 200
APPENDIX II (D)
>$100,000
Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708). Where
applicable, all contracts awarded by the non-Federal entity in excess of
$100,000 that involve the employment of mechanics or laborers must include a
provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by
Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the
Act, each contractor must be required to compute the wages of every
mechanic and laborer on the basis of a standard work week of 40 hours. Work
in excess of the standard work week is permissible provided that the worker is
compensated at a rate of not less than one and a half times the basic rate of
pay for all hours worked in excess of 40 hours in the work week. The
requirements of 40 U.S.C. 3704 are applicable to construction work and
provide that no laborer or mechanic must be required to work in surroundings
or under working conditions which are unsanitary, hazardous or dangerous.
These requirements do not apply to the purchases of supplies or materials or
articles ordinarily available on the open market, or contracts for transportation
or transmission of intelligence.
2 CFR 200
APPENDIX II (E)
>$150,000
Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution
Control Act (33 U.S.C. 1251-1387), as amended—Contracts and subgrants of
amounts in excess of $150,000 must contain a provision that requires the
non-Federal award to agree to comply with all applicable standards, orders or
regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and
the Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387).
Violations must be reported to the Federal awarding agency and the R egional
Office of the Environmental Protection Agency (EPA).
2 CFR 200
APPENDIX II (G)
>$100,000
Byrd Anti-Lobbying Amendment (31 U.S.C. 1352)—Contractors that apply or
bid for an award exceeding $100,000 must file the required certification. Each
tier certifies to the tier above that it will not and has not used Federal
appropriated funds to pay any person or organization for influencing or
attempting to influence an officer or employee of any agency, a member of
2 CFR 200
APPENDIX II (I)
and
24 CFR
§570.303
24
Congress, officer or employee of Congress, or an employee of a member of
Congress in connection with obtaining any Federal contract, grant or any
other award covered by 31 U.S.C. 1352. Each tier must also disclose any
lobbying with non-Federal funds that takes place in connection with obtaining
any Federal award. Such disclosures are forwarded from tier to tier up to the
non-Federal award.
>$100,000
All Section 3 covered contracts shall include the following clause (referred to as
the Section 3 clause):
A. The work to be performed under this contract is subject to the
requirements of Section 3 of the Housing and Urban Development Act of 1968,
as amended, 12 U.S.C. 1701u (Section 3). The purpose of Section 3 is to ensure
that employment and other economic opportunities generated by HUD
assistance or HUD-assisted projects covered by Section 3, shall, to the greatest
extent feasible, be directed to low- and very low-income persons, particularly
persons who are recipients of HUD assistance for housing.
B. The parties to this contract agree to comply with HUD's regulations in 24
CFR part 135, which implement Section 3. As evidenced by their execution of
this contract, the parties to this contract certify that they are under no contractual
or other impediment that would prevent them from complying with the part 135
regulations.
C. The contractor agrees to send to each labor organization or
representative of workers with which the contractor has a collective bargaining
agreement or other understanding, if any, a notice advising the labor
organization or workers' representative of the contractor's commitments under
this Section 3 clause, and will post copies of the notice in conspicuous places at
the work site where both employees and applicants for training and employm ent
positions can see the notice. The notice shall describe the Section 3 preference,
shall set forth minimum number and job titles subject to hire, availability of
apprenticeship and training positions, the qualifications for each; and the name
and location of the person(s) taking applications for each of the positions; and
the anticipated date the work shall begin.
D. The contractor agrees to include this Section 3 clause in every
subcontract subject to compliance with regulations in 24 CFR part 135, and
agrees to take appropriate action, as provided in an applicable provision of the
subcontract or in this Section 3 clause, upon a finding that the subcontractor is in
violation of the regulations in 24 CFR part 135. The contractor will not
subcontract with any subcontractor where the contractor has notice or
knowledge that the subcontractor has been found in violation of the regulations
in 24 CFR part 135.
E. The contractor will certify that any vacant employment positions, including
training positions, that are filled (1) after the contractor is selected but before the
contract is executed, and (2) with persons other than those to whom the
regulations of 24 CFR part 135 require employment opportunities to be directed,
were not filled to circumvent the contractor's obligations under 24 CFR part 135.
F. Noncompliance with HUD's regulations in 24 CFR part 135 may result in
sanctions, termination of this contract f or default, and debarment or suspension
from future HUD assisted contracts.
G. With respect to work performed in connection with Section 3 covered
Indian housing assistance, section 7(b) of the Indian Self -Determination and
Education Assistance Act (25 U.S.C. 450e) also applies to the work to be
performed under this contract. Section 7(b) requires that to the greatest
extent feasible (i)
24 CFR §135.38
25
preference and opportunities for training and employment shall be given to
Indians, and (ii) preference in the award of contracts and subcontracts shall be
given to Indian organizations and Indian-owned Economic Enterprises. Parties to
this contract that are subject to the provisions of Section 3 and section 7(b)
agree to comply with Section 3 to the maximum extent feasible, but not in
derogation of compliance with section 7(b).
A non-Federal entity that is a state agency or agency of a political subdivision of
a state and its contractors must comply with section 6002 of the Solid Waste
Disposal Act, as amended by the Resource Conservation and Recovery Act. The
requirements of Section 6002 include procuring only items designated in
guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247
that contain the highest percentage of recovered materials practicable,
consistent with maintaining a satisfactory level of competition, where the
purchase price of the item exceeds $10,000 or the value of the quantity acquired
during the preceding fiscal year exceeded $10,000; procuring solid waste
management services in a manner that maximizes energy and resource
recovery; and establishing an affirmative procurement program for procurement
of recovered materials identified in the EPA guidelines.
[78 FR 78608, Dec. 26, 2013, as amended at 79 FR 75885, Dec. 19, 2014]
2 CFR 200
APPENDIX II (J)
Mandatory standards and policies relating to energy efficiency which are
contained in the state energy conservation plan issued in compliance with the
Energy Policy and Conservation Act.
42 U.S.C. 6201
26
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who
has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the
vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local governmental entity not later
than the 7th business day after the date the vendor becomes aware of facts that require the statement to be
filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An
offense under this section is a misdemeanor.
OFFICE USE ONLY
Date Received
1 Name of vendor who has a business relationship with local governmental entity.
2 Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an
updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the
date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information is being disclosed.
Name of Officer
4 Describe each employment or other business relationship with the local government officer, or a family member of the
officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government
officer. Complete subparts A and B for each employment or business relationship describe d. Attach additional pages
to this Form CIQ as necessary.
A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income,
other than investment income, from the vendor?
Yes No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction
of the local government officer or a family member of the officer AND the taxable income is not received from the
local governmental entity?
Yes No
5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a
corporation or other business entity with respect to which the local government officer serves as an officer or
director, or holds an ownership interest of one percent or more.
6
Check this box if the vendor has given the local government officer or a family member of the officer one or more
gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).
7
Signature of vendor doing business with the governmental entity Date
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 27
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
A complete copy of Chapter 176 of the Local Government Code may be found at
http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections
cited on this form.
Local Government Code § 176.001(1-a): "Business relationship" means a connection between two or more
parties based on commercial activity of one of the parties. The term does not include a connection based on:
(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or
an agency of a federal, state, or local governmental entity;
(B) a transaction conducted at a price and subject to terms available to the public; or
(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency
and that is subject to regular examination by, and reporting to, that agency.
Local Government Code § 176.003(a)(2)(A) and (B):
(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
***
(2) the vendor:
(A) has an employment or other business relationship with the local government
officer or a family member of the officer that results in the officer or family member
receiving taxable income, other than investment income, that exceeds $2,500 during the
12-month period preceding the date that the officer becomes aware that
(i) a contract between the local governmental entity and vendor has been
executed; or
(ii) the local governmental entity is considering entering into a contract with
the vendor;
(B) has given to the local government officer or a family member of the officer one or
more gifts that have an aggregate value of more than $100 in the 12 -month period
preceding the date the officer becomes aware that:
(i) a contract between the local governmental entity and vendor has been
executed; or
(ii) the local governmental entity is considering entering into a contract with the
vendor.
Local Government Code § 176.006(a) and (a-1)
(a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business
relationship with a local governmental entity and:
(1) has an employment or other business relationship with a local government officer of that
local governmental entity, or a family member of the officer, described by Section
176.003(a)(2)(A);
(2) has given a local government officer of that local governmental entity, or a family member
of the officer, one or more gifts with the aggregate value spec ified by Section 176.003(a)(2)(B),
excluding any gift described by Section 176.003(a-1); or
(3) has a family relationship with a local government officer of that local governmental entity.
(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records
administrator not later than the seventh business day after the later of:
(2) the date that the vendor:
(A) begins discussions or negotiations to enter into a contract with the local
governmental entity; or
(B) submits to the local governmental entity an application, response to a request for
proposals or bids, correspondence, or another writing related to a potential contract with
the local governmental entity; or
(3) the date the vendor becomes aware:
(A) of an employment or other business relationship with a local government officer,
or a family member of the officer, described by Subsection (a);
(B) that the vendor has given one or more gifts described by Subsection (a); or (C) of
a family relationship with a local government officer.
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 28