BRYAN INDEPENDENT SCHOOL DISTRICT
INVITATION TO BID# 3644
MAGAZINES SUBSCRIPTIONS 2014-2016
101 NORTH TEXAS AVENUE
BRYAN, TEXAS 77803
The undersigned hereby agrees to all terms and conditions set forth in the Invitation to Bid.
Company
____________________________________________________________________
Name
____________________________________________________________________
Signature
____________________________________________________________________
Address
____________________________________________________________________
City/State/Zip
____________________________________________________________________
Phone
____________________________________________________________________
Fax
____________________________________________________________________
E-Mail
____________________________________________________________________
Date
____________________________________________________________________
SECTION 1- GENERAL/BID SUBMISSION
1.1
Bryan Independent School District (BISD) is soliciting competitive bids from suppliers to provide magazine
subscriptions for the 2014-2015 and 2015-2016 school years. Initial orders will be placed in June 2014
with expected delivery starting August 23, 2014.
1.2
Suppliers shall submit one original and one copy (Total 2) of the completed bid. Suppliers shall return a
signed copy of the terms and conditions with their bid packages. All bids must be sealed and marked
“Bid # 3644 - Magazine Subscription Bid” on the outside of the envelope. Bids are due by 1:00
pm on May 28, 2014 in the Business Services Office, 101 North Texas Ave, Bryan, TX 77803. Bids will
be opened at 3:00 pm in Room 208 of the same location. Late bids will be marked “LATE” along with
the time received and will not be considered in the evaluation of the bid.
1.3
Tabulation and evaluation of bids will be made subsequent to bid opening. No award will be made at bid
opening.
1.4
Each bid must include an executed “Felony Conviction Notification.”
1.5
Each bid must include a completed “Conflict of Interest Questionnaire” in accordance with Chapter 176 of
the Texas Local Government Code, effective January 1, 2006.
1.6
Each bid must include a signed certification of non-debarment from federal funds.
1.7
Questions concerning this bid can be directed Melissa Martin, Purchasing & Document Coordinator, at
(979) 209-1048.
SECTION 2 - TERMS AND CONDITIONS
2.1
BISD reserves the right to reject any/all bids or accept the bid deemed most advantageous to the school
district.
2.2
BISD may request additional information and to waive any/all formalities.
2.3
Award criteria are based on the most advantageous combination of factors to ensure quality magazines
for BISD. In determining best value for the district, purchase price is the primary factor. The following
criteria may be considered in the evaluation and determination of lowest evaluated price.
•
Price
•
Quality and Reputation of Products Offered
•
Long-Term Costs of Products to District
•
Reputation and Past Performance of Suppliers
•
Ability to Comply with HUB Laws
•
Customer Preference
2.4
BISD will not accept any substitute items.
2.5
Bid quantities provided by purchaser are estimated quantities only and do not imply an obligation to buy
on the part of the purchaser. BISD reserves the right to increase or decrease bid quantities at the stated
bid prices.
2.6
BISD will place orders on an executed purchase order based on the stated bid price.
2.7
Suppliers are encouraged to submit prices based on one standard overall discount percentage that are
reasonable in the spirit of competition. Suppliers shall hold their discount prices until May 31, 2016.
2.8
All prices must be bid F.O.B. destination, Bryan, Texas. All magazines must be delivered to the campus
libraries at the addresses listed on the bid specifications and purchase orders.
2.9
BISD reserves the right to reject damaged or substandard items. Suppliers will be notified of rejected
items given an opportunity to retrieve unless a prior arrangement has been made. BISD will not be held
responsible (cost, storage, or return shipping) for damaged or substandard items.
SECTION 3 - BID SCHEDULE
3.1
All suppliers shall submit an individual price for each magazine per school and a total for each school on
the attached forms. Bidders shall state the magazine retail price and the discount price based on the
standard discount percentage.
3.2
The bidders shall list any exceptions to the terms stated in this document.
3.3
All bidders shall supply one standard discount percentage for the entire requirement. Please enter your
discount percentage here:
________________%
3.4
Overall Total Retail Price
$_________________________________
3.5
Overall Total Discount Price
$_________________________________
FELONY CONVICTION NOTIFICATION
State of Texas Legislative Senate Bill No. 1, Section 44.034, Notification of Criminal History, Subsection (1),
states “a person or business entity that enters into a contract 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 a contract 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 contract.”
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):
_____________________________________________________________________
A.
My firm is a publicly-held corporation, therefore, this reporting requirement is not applicable.
Signature of Company Official:
________________________________________________________________
B.
My firm is not owned or 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:
______________________________________________________________
The undersigned affirms that they are duly authorized to execute this contract, that this company, corporation,
firm, partnership or individual has not prepared this bid in collusion with any terms or conditions of said bid have
not been communicated by the undersigned nor by any employee or agent to any other person engaged in this
type of business prior to the official opening of this bid.
THIS BID MUST BE SIGNED.
REJECTION OF BID.
(PLEASE PRINT OR TYPE)
FAILURE TO SIGN THIS BID WILL BE SUFFICIENT REASON FOR
COMPANY: __________________________________________________
ADDRESS: __________________________________________________
CITY, STATE, ZIP CODE _______________________________________
TELEPHONE NO. (
) _______________ FAX NO. (
)________________________________
SIGNATURE: _________________________________________________
Print Name: _____________________________________________
TITLE: ______________________________________________________
Bryan Independent School District
ITB #3644 - Magazine Subscriptions
Lamanda Latzlau
Bryan High School Library
3450 Campus Dr.
Bryan, TX 77802
Magazine Title
ArtNews
Car and Driver
Cooking Light
Digital Photo
Ebony
ESPN
Fitness
Food Network
Glitter
Good Housekeeping
Health Magazine
HGTV Magazine
J-14
National Geographic
O: the Oprah Magazine
Otaku USA
Outdoor Life
Parents
People
Pure Nintendo
Reader's Digest
Seventeen
Sports Illustrated
Teen Ink
Texas Highways
Time Magazine
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
26
List Price
Discount Price
Bryan Independent School District
ITB #3644 - Magazine Subscriptions
Lamanda Latzlau
Rudder High School Library
3251 Austin's Colony Parkway
Bryan, TX 77808
Magazine Title
ArtNews
Car and Driver
Cooking Light
Digital Photo
Ebony
ESPN
Fitness
Food Network
Glitter
Good Housekeeping
Health Magazine
HGTV Magazine
J-14
National Geographic
O: the Oprah Magazine
Otaku USA
Outdoor Life
Parents
People
Pure Nintendo
Reader's Digest
Seventeen
Sports Illustrated
Teen Ink
Texas Highways
Time Magazine
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
26
List Price
Discount Price
Denise Kersten
Davila Middle School Library
2751 N. Earl Rudder Freeway
Bryan, TX 77803
Magazine Title
Boys' Life
Girls' Life
J-14
LaTeen
Odyssey
Outdoor Life
Poder Hispanic
Smithsoniam
Sports Illustrated for Kids
Teen Ink
Texas Highways
Texas Parks & Wildlife
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
12
List Price
Discount Price
Bryan Independent School District
ITB #3644 - Magazine Subscriptions
Denise Kersten
Jane Long Middle School Library
1106 N. Harvey Mitchell
Bryan, TX 77803
Magazine Title
Boys' Life
Girls' Life
J-14
Odyssey
Outdoor Life
People
Poder Hispanic
Smithsoniam
Sports Illustrated for Kids
Teen Ink
Texas Highways
Texas Parks & Wildlife
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
12
List Price
Discount Price
Denise Kersten
Sam Rayburn Middle School Library
1048 N. Earl Rudder Frwy
Bryan, TX 77802
Magazine Title
Boy's Life
Girl's Life
J-14
LaTeen
Odyssey
Outdoor Life
Poder Hispanic
Smithsoniam
Sports Illustrated for Kids
Teen Ink
Texas Highways
Texas Parks & Wildlife
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
12
List Price
Discount Price
Denise Kersten
SFA Middle School Library
801 Ennis
Bryan, TX 77803
Magazine Title
Boys' Life
Girls Life
J-14
LaTeen
Odyssey
Outdoor Life
Poder Hispanic
Smithsoniam
Sports Illustrated for Kids
Teen Ink
Texas Highways
Texas Parks & Wildlife
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
12
List Price
Discount Price
Bryan Independent School District
ITB #3644 - Magazine Subscriptions
Carol Frosch
Bonham Elem Library
3100 Wilkes Dr.
Bryan, TX 77803
Magazine Title
American Girl
Boy's Life
National Geographic for Kids
National Geographic for Kids
Texas Parks and Wildlife
Zoobooks
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
1 YR
1 YR
6
List Price
Discount Price
Carol Frosch
Bowen Elem School Library
3870 Copperfield
Bryan, TX 77802
Magazine Title
American Girl
Kids Discover
Ranger Rick
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Carol Frosch
Branch Elem Library
2040 W Villa Maria
Bryan, TX 77807
Magazine Title
American Girl
Kids Discover
Ranger Rick
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Dana Yezak
Crockett Elem Library
401 Elm Street
Bryan, TX 77801
Magazine Title
American Girl
National Geographic Kids
Ranger Rick
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Bryan Independent School District
ITB #3644 - Magazine Subscriptions
Carol Frosch
Fannin Elem Library
1200 Baker Ave
Bryan, TX 77803
Magazine Title
American Girl
Kids Discover
National Geographic Kids
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Robin Cox
Henderson Elem Library
801 Matous
Bryan, TX 77802
Magazine Title
American Girl
Boy's Life
National Geographic Kids
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Dana Yezak
Houston Elem Library
4501 Canterbury
Bryan, TX 77802
Magazine Title
American Girl
Boy's Life
Ranger Rick
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Robin Cox
Johnson Elem. Library
3800 Oak Hill
Bryan, TX 77802
Magazine Title
American Girl
Boy's Life
National Geographic Kids
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Robin Cox
Jones Elem Library
1400 Pecan Street
Bryan, TX 77803
Magazine Title
American Girl
Boy's Life
National Geographic Kids
Sports Illustrated Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Bryan Independent School District
ITB #3644 - Magazine Subscriptions
Dana Yezak
Kemp Elem Library
750 Bruin Trace
Bryan, TX 77803
Magazine Title
American Girl
National Geographic Kids
Ranger Rick
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Carol Frosch
Milam Elem Library
1201 Ridgedale
Bryan, TX 77803
Magazine Title
American Girl
Kids Discover
Ranger Rick
Sports Illustrated for Kids
ZooBooks
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
1 YR
5
List Price
Discount Price
Dana Yezak
Mitchell Elem Library
2500 Austin Colony
Bryan, TX 77808
Magazine Title
American Girl
Kids Discover
Ranger Rick
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Dana Yezak
Navarro Elem Library
4619 Northwood
Bryan, TX 77803
Magazine Title
American Girl
Boys Life
Ranger Rick
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Bryan Independent School District
ITB #3644 - Magazine Subscriptions
Robin Cox
Neal Elem Library
801 W Martin L King
Bryan, TX 77803
Magazine Title
American Girl
Boy's Life
National Geographic Kids
Sports Illustrated for kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Robin Cox
Ross Elem Library
3300 Parkway Terrace
Bryan, TX 77802
Magazine Title
American Girl
Boy's Life
National Geographic Kids
Sports Illustrated for Kids
Campus Total
Term
1 YR
1 YR
1 YR
1 YR
4
List Price
Discount Price
Angela Wells
Library Processing Center
800 S. Texas Ave
Bryan, TX 77803
Magazine Title
Library Sparks
Campus Total
Term
1 YR
1
List Price
Discount Price
FORM
CONFLICT OF INTEREST QUESTIONNAIRE
CIQ
For vendor or other person doing business with local governmental entity
OFFICE USE ONLY
This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code
by a person who has a business relationship as defined by Section 176.001(1-a) with a local
governmental entity and the person meets requirements under Section 176.006(a).
Date Received
By law this questionnaire must be filed with the records administrator of the local governmental
entity not later than the 7th business day after the date the person becomes aware of facts
that require the statement to be filed. See Section 176.006, Local Government Code.
A person commits an offense if the person knowingly violates Section 176.006, Local
Government Code. An offense under this section is a Class C misdemeanor.
1
Name of person who has a business relationship with local governmental entity.
2
Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not
later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.)
3
Name of local government officer with whom filer has employment or business relationship.
Name of Officer
This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has an
employment or other business relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional
pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment
income, from the filer of the questionnaire?
Yes
No
B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the
direction of the local government officer named in this section AND the taxable income is not received from the local
governmental entity?
Yes
No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local
government officer serves as an officer or director, or holds an ownership of 10 percent or more?
Yes
No
D. Describe each employment or business relationship with the local government officer named in this section.
4
Signature of person doing business with the governmental entity
Date
Adopted 06/29/2007
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion –
Lower Tier Covered Transactions
This certification is required by the regulations implementing Executive Order 12549,
Debarment and Suspension, 7 CFR Part 3017, Section 3017.510, Participants’
responsibilities. The regulations were published as Part IV of the January 30, 1989,
Federal Register (pages 4722-4733).
(before completing certification, read attached instructions.)
(1) The prospective lower tier participant certifies, by submission of this proposal, that
neither it nor its principals is presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from participation in this
transaction by any Federal department or agency.
(2) Where the prospective lower tier participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an
explanation to this proposal.
Organization Name
PR/Award Number or Project Number
Name and Title of Authorized Representative
Signature
Date
Instructions For Suspension/Debarment Certification Statement:
1. By signing and dating the certification statement, the bidder certifies that neither it nor
any of its principals (e.g., key employees) has been proposed for debarment,
debarred or suspended by a federal agency on the date signed.
2. The prospective bidder shall provide immediate written notice to the person to which
this proposal is submitted if at any time the prospective bidder learns that its
certification was erroneous when submitted or has become erroneous by reason of
changed circumstances.
3. Federal and State penalties exist for vendors and districts that knowingly enter into
contracts with suspended / debarred person.
Residence Certification
In accordance with Article 601g. as adopted by the 1985 Texas Legislature, the following will apply.
The pertinent portion of the Act has been extracted and is as follows:
Article 601g. State of Political Subdivision Contracts for Construction, Supplies, Services, Bids by
Non-Resident Section 1(a) in this Act:
1. “Governmental agency of the state” means an incorporated city or town, a county, a public
school district, a special-purpose district or authority, or a district, county, or justice of the
peace court.
2. “Nonresident Bidder” means a bidder whose principal place of business is not in this state, but
excludes a contractor whose ultimate parent company or majority owner has its principal place
of business in this state.
3. “Texas Residential Bidder” means a bidder whose principal place of business is in this state,
and includes a contractor whose ultimate parent company or majority owner has its principal
place of business in this state.
The state or governmental agency of the state may not award a contract for general construction,
improvements, services, or public works projects, or purchase of supplies, materials, or equipment to
a nonresident bidder unless the nonresident’s bid is lower than the lowest bid submitted by a
responsible Texas resident bidder by the same amount that a Texas resident bidder would be
required to under bid a nonresident bidder to obtain a comparable contract in the state in which the
nonresident’s principal place of business is located.
I certify that as defined in Article 601g, that:
Company Name:
____________________________________________
_____ Yes, I am a Texas Residence Bidder
_____ No, I am a _____________ Residence Bidder
Printed Name:
____________________________________________
Signature:
____________________________________________
Statement of Non-Collusion and Non-Discrimination
My signature certifies that the accompanying bid:
1. Is not the result of, or affected by an unlawful act of collusion with another person or company
engaged in the same line of business or commerce, or any act of fraud punishable under
current local, state, and/or federal ordinances, statutes, regulations, and/or policies.
Furthermore, I understand that fraud and unlawful collusion are crimes under Federal Law, and
can result in fines, prison sentences, and civil damage awards.
2. During the performance of any contracted awarded, the Seller will not discriminate against any
employee or applicant for employment because of race, religion, color, sex, or national origin,
or handicaps, except where religion, sex, or national origin is a bona fide occupational
qualification reasonably necessary to the normal operations of the Seller. The Seller agrees to
post in conspicuous places, available to employees and applicants for employment, notice
setting forth the provisions of this non-discrimination clause.
3. The Seller, in all solicitations and advertisements for employees placed by, or on behalf of, the
Seller, will state that such Seller is an equal opportunity employer.
4. Notices, advertisements, and solicitations placed in accordance with Federal Law, rule, or
regulation, shall be deemed sufficient for the purpose of meeting the requirements of this
section.
5. The Seller shall include the provisions of the foregoing paragraphs 2, 3, and 4 in every
subcontract or purchase order over $10,000.00 so that the provisions will be binding upon
each subcontractor or vendor.
I hereby certify that I am authorized to sign as a Representative for the Seller:
Name of Seller
_______________________________________
Address:
_______________________________________
City/State/Zip:
_______________________________________
Signature:
_______________________________________
Name (Print):
_______________________________________
Title:
_______________________________________
Date:
_______________________________________
W-9
Form
(Rev. August 2013)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
Print or type
See Specific Instructions on page 2.
Name (as shown on your income tax return)
Business name/disregarded entity name, if different from above
Exemptions (see instructions):
Check appropriate box for federal tax classification:
Individual/sole proprietor
C Corporation
S Corporation
Partnership
Trust/estate
Exempt payee code (if any)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶
Other (see instructions) ▶
Address (number, street, and apt. or suite no.)
Exemption from FATCA reporting
code (if any)
Requester’s name and address (optional)
City, state, and ZIP code
List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3.
Social security number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Employer identification number
Part II
–
–
–
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below), and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 3.
Sign
Here
Signature of
U.S. person ▶
Date ▶
General Instructions
withholding tax on foreign partners’ share of effectively connected income, and
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. The IRS has created a page on IRS.gov for information
about Form W-9, at www.irs.gov/w9. Information about any future developments
affecting Form W-9 (such as legislation enacted after we release it) will be posted
on that page.
Purpose of Form
A person who is required to file an information return with the IRS must obtain your
correct taxpayer identification number (TIN) to report, for example, income paid to
you, payments made to you in settlement of payment card and third party network
transactions, real estate transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or contributions you made
to an IRA.
Use Form W-9 only if you are a U.S. person (including a resident alien), to
provide your correct TIN to the person requesting it (the requester) and, when
applicable, to:
1. Certify that the TIN you are giving is correct (or you are waiting for a number
to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
applicable, you are also certifying that as a U.S. person, your allocable share of
any partnership income from a U.S. trade or business is not subject to the
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
exempt from the FATCA reporting, is correct.
Note. If you are a U.S. person and a requester gives you a form other than Form
W-9 to request your TIN, you must use the requester’s form if it is substantially
similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S.
person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or organized in the
United States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in
the United States are generally required to pay a withholding tax under section
1446 on any foreign partners’ share of effectively connected taxable income from
such business. Further, in certain cases where a Form W-9 has not been received,
the rules under section 1446 require a partnership to presume that a partner is a
foreign person, and pay the section 1446 withholding tax. Therefore, if you are a
U.S. person that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your U.S. status
and avoid section 1446 withholding on your share of partnership income.
Cat. No. 10231X
Form W-9 (Rev. 8-2013)
Bryan Independent School District
Purchasing Department
101 North Texas Avenue, Bryan, Texas 77803
(979) 209-1048
(979) 209-1098
Sole Source Affidavit
An item can be purchased without the benefit of a competitive process if the purchase complies with Section 44.031(j) of the Texas
Education Code. An item is considered “sole source” if there is no other like item available in the marketplace that would serve
the same purpose or function, and only one price for the product because of exclusive distribution or marketing rights.
Tex. Educ. Code §44.031(j) states: Without complying with §44.031(a), the Board of Trustees of a school district may purchase an
item that is available from only one source including:
(1) an item for which competition is precluded because of the existence of a patent, copyright, secret process, or
monopoly:
(2) a film, manuscript, or book;
(3) a utility service, including electricity, gas, or water, and
(4) a captive replacement part or component for equipment.
Note: The exceptions provided by Subsection 44.031(j) do not apply to mainframe data-processing equipment and peripheral
attachments with a single-item purchase price in excess of $15,000.
By signing below, I confirm that I have reviewed Section 44.031 of the Texas Education Code, and hereby represent and
certify that our product (described below) is a “sole source” item pursuant to Section 44.031(j) of the Texas Education Code.
[Note: the item below must be described without brand names, trademarks or other proprietary designations.]
In addition, we certify that no suspension or debarment is in place, which would preclude receiving a federally funded contract.
Company
Address
City, State, Zip Code
Telephone No.
Fax No.
Email Address
Authorized Signature
Title
SUBSCRIBED AND SWORN to before me on this
day of
, 20
Notary Public, State of
Printed Name
(Seal)
Date Commission Expires
Notice: A person commits a felony if s/he knowingly makes a false entry in a governmental record. Texas Penal Code,
Sole Source Affidavit
section 37.10.
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Bryan Independent School District
Purchasing Department
101 North Texas Avenue, Bryan, Texas 77803
(979) 209-1048
(979) 209-1098
Sole Source Affidavit
BEFORE ME, the undersigned official, on this day, personally appeared ___________________________________,
A person known to me to be the person whose signature appears below, who after being duly sworn upon his oath deposed
and said:
1.
My name is
felony, and am competent to sign this affidavit.
2.
I am an authorized representative of the following company or firm:
3.
The above-named company or firm is the only provider of the following sole source item (Note: the item must be
described without brand names, trademarks or other proprietary designations):
4.
Relative to the item identified above, I hereby represent and certify that:
a.
b.
c.
d.
e.
. I am over the age of 18, have never been convicted of a
There is no other like item available for purchase that would serve the same purpose or function;
There is only one price for the item because of exclusive distribution or marketing rights;
If the item is protected by a patent, copyright, secret process or monopoly, competition in providing the item is
precluded by the existence of a patent, copyright, secret process or monopoly;
The item is not mainframe data-processing equipment or peripheral attachments; and
No suspension or debarment is in place, which would preclude receiving a federally funded contract.
(Signature)
SUBSCRIBED AND SWORN to before me on this
day of
, 20
(Notary Public, State of
)
(Printed Name)
(Seal)
(Date Commission Expires)
Notice: A person commits a felony if s/he knowingly makes a false entry in a governmental record. Texas Penal Code,
section 37.10.
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