PULASKI COUNTY SPECIAL SCHOOL DISTRICT 925 East Dixon Road/P.O. Box 8601

Little Rock, Arkansas 72216

(501) 324-2000

May 10, 2017 Request for Proposals (RFP17-021) Application and Hiring Tracking System To Whom It May Concern: The Pulaski County Special School District (PCSSD) invites your offer to provide Application and Hiring Tracking Software Systems per the scope of work in the attached request for proposals. In a sealed envelope, return your original and four (4) copies along with an electronic version of your proposal to the Purchasing Department, 925 East Dixon Road, Little Rock, AR 72216, no later than 8:00 a.m., Wednesday, May 24, 2017. Please reference the following on the outside of the envelope(s): attn.: Purchasing Department, bid number, opening date and time. The proposal opening is open to the public but only the Vendors names responding will be read into the public record. Offers will be taken under advisement upon opening and the District will notify the apparent most qualified vendor(s) for further negotiations as needed. Do not contact any district official concerning this RFP without first receiving permission from the Director of Finance. The District reserves the right to reject any or all responses and waive any irregularities or formalities in proposals received. The District reserves the right to negotiate with the apparent acceptable vendor(s). Price alone will not be the determining factor. Award will be based upon those considerations, which are in the best interest of the District and will be made to the responsive, responsible offerer whose proposal is judged to be the most effective and economical for the purpose intended, according to the requirements and specifications stated in the Request for Proposal.

________________________________________________________________________________ VENDOR PERTINENT INFORMATION FOR RFP17-021 We, the undersigned, have read all the requirements set forth in this request for proposal including specifications, instructions, conditions and pertinent information regarding the articles being bid on and we agree to furnish these articles at the prices stated.

Arkansas Sales or Use Tax Register No.

State Contractor License

__

______

Federal ID No. _______________________________ Company Name:____________________________________________________________________________ Address: _________________________________________________________________________________ Telephone No.

________Fax No.

________

E-mail ___________________________

Name & Title: _____________________________________________________________________________ (Person authorized to sign bids) (Print)

Signature _________________________________________________________________________________ BIDS ARE SUBJECT TO REJECTION UNLESS SUBMITTED ON THIS FORM

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The following General Instructions, Terms and Conditions (Section I); Special Instructions and Terms (Section II); Scope of Work (Section III): and Cost Proposal (Section IV) will become part of any contract entered into in the event any or all of the proposal is accepted by the Pulaski County Special School District. Any Special Instructions and Terms included in the Request for Proposals override the General Instructions, Terms and Conditions. SECTION I: GENERAL INSTRUCTIONS, TERMS AND CONDITIONS DEFINITION OF TERMS RFP shall mean Request for Proposals. The words vendor, bidder, offerer, company, proposer and contractor may be used synonymously in this document. The terms “District”, “Owner”, or “PCSSD” are used interchangeably and refer to the Pulaski County Special School District. SUBMISSION OF PROPOSAL Proposals must be submitted to this office using the forms included on or before the date and time specified for proposal opening. Each proposal should be placed in a separate envelope completely and properly identifying the proposal number, proposal title and proposal opening date/time. Late proposals will not be considered under any circumstances. Failure to sign the proposal will result in disqualification. The person signing the proposal should show title or authority to bind his/her firm to a contract. Signature must be in ink. Proposal must be typed in Microsoft Word. ASSIGNMENTS Neither this contract nor any interest therein or claim there under may or shall be assigned or transferred by the contractor except as expressly authorized in writing by the District. No contract, subcontract or agreement shall be made by the contractor with any other party for furnishing any of the product, work or services herein contracted without the written approval of the District. CONFLICT OF INTEREST By submitting a proposal, the contractor represents and warrants that no director or employee of the District is in any manner interested directly or indirectly in the proposal or contract which may result from the proposal or in any of the expected profits which might arise there from; further, that no attempt has been made to influence or gain favorable advantage by communicating directly or indirectly with any official of the PCSSD. It is understood that any action taken which might tend to degrade the integrity of the competitive proposal process will be considered as grounds for disqualification or a breach of this contract. CONTRACT AGREEMENT The contract between the District and the contractor shall consist of (1) the Request for Proposal (RFP) and any amendments thereto, (2) these General Instructions, Terms and Conditions, and (3) the offer/contract submitted by the contractor in response to the RFP. In the event of a conflict in language between (1) and (3) referenced above, the provisions and requirements set forth and/or referenced in the RFP shall govern. However, the Purchasing Director reserves the right to clarify any contractual relationship in writing with the concurrence of the contractor, and such written clarification shall govern in case of conflict with the applicable requirements stated in the RFP or the contractor’s offer/contract. In all other matters not affected by the written clarification, if any, the RFP shall govern. The successful offerer will receive written notification of intent to award containing any clarifications and/or approved modifications. CONTRACT CHANGES In no event shall any understanding or agreement, contract modification, change order or other matter which would constitute a deviation from the terms of this contract be effective or binding upon the District unless expressly stated and agreed to in writing executed by the Director of Purchasing or their designee.

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CONTRACT GUIDELINES Offerers agree that a contract does not become effective until it is awarded and a written agreement, purchase order, award letter, or other notice to proceed is executed or issued by the District. INDEMNIFICATION AND LEGAL COMPLIANCE The contractor shall at all times observe and fully comply with any and all Federal, State and local laws, statutes, orders, ordinances and regulations. The contractor agrees to save, hold harmless and to indemnify the District, its agents, employees, officers and board members against any and all liability, losses, claims or costs of whatsoever kind or nature relative to the performance of the contract or any occurrence or accident in connection with inadequate design, breach of contract, material failure, default or the performance of any work, services or products supplied, pursuant to the award, whether to property or persons. Further, contractor shall indemnify, hold harmless and defend the District, its agents, employees, officers and board members from any lawsuits, causes of action, claims, liabilities and damages, of any kind and nature, including but not limited to, attorney’s fees and costs, arising out of the performance of this contract whether attributable in whole or in part to any act, omission or negligence of the District, its agents or employees, including, but not limited to, any and all lawsuits, causes of action, claims, liabilities, and damages which the District, its agents or employees may sustain by reason of any failure by contractor to indemnify as provided herein, or any failure by contractor to otherwise perform its obligations pursuant to this contract, or by reason of the injury to or death of any person or persons or the damage to, loss of use of or destruction of any property resulting from work undertaken herein. MINORITY BUSINESS POLICY It is the policy of the District that minority business enterprises shall have the maximum opportunity to participate in the District’s purchasing process. Therefore, the District encourages all minority businesses to compete for goods, services, and construction contracts. NON-COLLUSIVE AFFIDAVIT By submitting a proposal, the company and the individual personally signing the proposal represent and warrant that such proposal is genuine and is neither collusive nor made for or on behalf of any person not named, and that he has neither induced nor solicited any other company to place a sham proposal nor directly or indirectly caused another company to refrain from or be unable to present a proposal. NON-DISCRIMINATION The company shall not discriminate against, or segregate, a person or a group of persons on account of race, color, creed, religion, sex, sexual orientation, marital status, familial status, national origin, ancestry, disability or condition of acquired immune deficiency syndrome (AIDS) or AIDS-related complex in carrying out its duties and obligations pursuant to this agreement nor shall the company or any person claiming under or through the company establish or permit any such practice or practices of discrimination or segregation. The company must include in any and all subcontracts a provision similar to the preceding. PENALTY FOR COLLUSION If at any time it shall be found that the person, firm or corporation to whom a contract has been awarded has, in presenting any proposal, colluded with any other party or parties, then, in the sole discretion of the District, the contract so awarded shall be null and void or considered breached and the contractor shall be liable to the District for any and all loss and damage of whatsoever nature, which the District may suffer and the District may seek a new contractor. PROPRIETARY INFORMATION All information submitted in response to this RFP is public and will be available to interested parties after an award is made by the PCSSD. The bidder should not include as a part of the response to the RFP any information which the bidder believes to be a trade secret or otherwise privileged or confidential. If the bidder needs to include such material with a proposal, then the material should be supplied under separate cover and identified as confidential. The District does not warrant or agree to, but will endeavor to, keep that information confidential. Contractor acknowledges that information in the possession of the District may be subject to the provisions of the Arkansas Freedom of Information Act.

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REJECTION OF PROPOSALS The PCSSD may reject any and all proposals or any part thereof and may reject a proposal of any party who has failed to perform, been unfaithful and/or delinquent in any former relationship with the District. The District reserves the right to waive any irregularities or formalities in any solicitation or proposal response. The District shall be the sole judge as to which proposal is best and in determining that fact, may consider the contractor’s business integrity, financial resources, experience, facilities and/or capacity for performing the work. RESERVATIONS This RFP does not commit the District to award a contract, to pay any costs incurred in the preparation of a proposal in response to this request, or to procure or contract for services or supplies. The District reserves the right to accept, or reject, in part or its entirety, any proposal received as a result of this RFP, if it is in the best interest of the District to do so. SEVERABILITY The finding or determination of any part or parts of the General Instruction, Terms and Conditions is void, unenforceable, invalid or voidable shall result in only that part being stricken with the remainder to continue in full force and effect. STATEMENT OF EXPERIENCE AND QUALIFICATIONS The company may be required, upon request, to prove to the satisfaction of the District that they have the skill, experience and the necessary facilities and financial resources to perform the contract in a satisfactory manner and within the required time. If the evidence of competency is not satisfactory, the proposal of such company may be rejected. WITHDRAWAL OF PROPOSAL A proposal may be withdrawn before the expiration of the time during which proposals may be submitted, without prejudice, by submitting a written request for its withdrawal to the Director of Purchasing.

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SECTION II: SPECIAL INSTRUCTIONS AND TERMS TERMS The required services are to commence not later than a date to be agreed upon by and between PCSSD and the company selected to provide the software program(s) listed in this proposal and, unless terminated sooner, shall continue in force for (1) five years with the option of one (1) annual extension at the same prices upon agreement of the contractor. The contract will be automatically renewed at the end of the contract term with a written confirmation. If sufficient cost savings are not present, either party may withdraw from the contract with thirty (30) days written notice. RENEWAL OPTION PCSSD reserves the right to renew this agreement annually for up to five (5) additional one (1) year periods based on the natural agreement of both the Contractor and owner. STANDARD OF PERFORMANCE The Company shall perform according to the terms and conditions as stated herein, and according to the highest standards and commercial practices. Instances of poor performance by the Company will be documented and submitted to the Company for immediate review and corrective action. Continued poor performance will be deemed a breach of the specifications of the RFP, and shall be grounds for immediate termination of the contract. A review meeting will be called between the Company and PCSSD when documented instances of poor performance occur. A plan for corrective action agreeable to both parties will be drafted and implemented. PCSSD retains the absolute right to assess whether and when performance is subsequently acceptable. TERMINATION AND ASSIGNMENT In the event that sufficient sales are not present, the contract awarded in response to the RFP (the "Contract") may be terminated by either party by giving the other not less than 30 days written notice of intent to terminate as of the date specified. The vendor must address the issue of insufficient sales in the proposal, defining what is insufficient by volume, quantity, or cost, etc. The Contract will not be assignable without prior written consent of both parties. An attempted assignment without such consent shall be void and of no effect. INQUIRIES Inquiries related to the RFP should be directed to the attention of Vertina Banks, Buyer, either by email [email protected], or fax (501) 490-1274. Any request for clarification must be submitted in writing (fax or email are acceptable) to the Purchasing Department no later than 8:00 a.m. on Wednesday, May 17, 2017. There will be no response to questions received late. Any clarification given to a prospective bidder will be furnished in writing to all prospective bidders as an amendment, if such information modifies these specifications or is deemed to be necessary in responding to this RFP. OPENING DATE Sealed, written, competitive proposals will be received until 8:00 a.m. on or before Wednesday, May 24, 2017, in the PCSSD Purchasing Department, Attn.: RFP # 17-021, Vertina Banks, 925 East Dixon Road, P. O. Box 8601, Little Rock, AR 72216-8601. PROPOSAL SHALL BE IN AN SEALED ENVELOPE CLEARLY MARKED RFP 17-021 ALONG WITH THE TIME AND DATE OF OPENING ON THE OUTSIDE. If it is not, the envelope will be opened to be identified and the prices and other information will be exposed. In this event, PCSSD will not be responsible for the security of the information. Each proposal must be signed by an authorized officer of the Company and must be held firm for acceptance for a minimum period of 90 days after the opening date. Proposals received late will not be considered under any circumstances. The proposal opening is open to the public but only the Vendors names responding will be read into the public record.

PROPOSAL FORMAT Each Company should submit a base proposal and four (4) copies in the specified manner, but may also propose other options to PCSSD either as additions or alternates to the base proposal. Such additional offerings should be clearly identified. PCSSD prefers that Company's response to this RFP be submitted in same Item (paragraph) sequence as RFP - using same Item (paragraph) Numbers for reference. PCSSD requests that RFP17-021

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Companies submit one original and four (4) copies of their proposals plus required attachments. Bidders are cautioned that only written information contained in this RFP (including amendments) are to be relied upon for preparation of a proposal. PROPOSAL MATERIALS CONSERVATION Proposals shall be submitted on 8-1/2 x 11 inch paper. The proposal should follow the format laid out under Section I. Binders, brochures, and materials not specified in the RFP are neither requested nor desired. Please do not submit these with your proposal. If additional information is required, it will be requested by PCSSD after review of the proposals. Cost for Proposal Preparation PCSSD will not reimburse Company's cost incurred in the preparation and submission of proposals. All proposals shall become the property of PCSSD upon submission. PCSSD reserves the right to negotiate rates, terms and conditions from the selected qualified companies, subsequent to the submission of proposals. Telegraphic Proposals. Telegraphic, fax, or electronic proposals sent directly to PCSSD offices will not be considered. Proposals must be received in sealed envelope only. Acknowledgment of Amendments. Companies must acknowledge receipt of amendments by letter, telegram, or fax within 48 hours of receipt. Failure to provide such acknowledgment may be grounds for disqualification. Further Information. Companies are cautioned that PCSSD is not obligated to ask for or accept after opening date, data which is essential for a complete and thorough evaluation of the proposal. PCSSD may award a contract based on initial submissions without any further discussion of such proposals. Accordingly, each proposal should be submitted on the most favorable and complete price and technical terms possible. Proprietary Information. After the award of the Contract, all proposals will be open for public inspection. Financial data, trade secrets, test data, and similar proprietary information will, to the extent permitted by law, remain confidential provided such material is clearly so marked by the Company prior to submission of this RFP; however, net cost information may not be confidential. INSURANCE All proposals must contain a letter of intent from an insurance company authorized to do business in the State of Arkansas stating its willingness to insure the Company pursuant to the terms of any contract resulting from the RFP. The Company shall procure and maintain, at the Company's expense, the following insurance coverage for the period of the Contract. Failure to submit an insurance certificate by the time provided may be cause for proposal disqualification. The following are recommended amounts for insurance coverage: (The District reserves the right to lower/raise the coverage if it is in the best interest of the District). The District must be named as additional issued, and the certificate must contain a clause that the insurer will not cancel or change the insurance without first giving PCSSD a minimum of 30 days prior written notice. Certificates evidencing the effective dates and amounts of such insurance must be provided to PCSSD: Workers Compensation: As required by the State of Arkansas: Statutory Limits. Comprehensive General Liability (Broad Form) coverage in amounts specified under the contract for work at the facility prior to the signing of the contract. Public Liability Insurance Minimum shall be $1,000,000 dollars coverage. Each Occurrence $1,000,000 dollars coverage. The required insurance must be written by a company licensed to do business in the State of Arkansas at the time the policy is issued. In additional, the company(s) must be acceptable to the Owner and Owner’s agent. Examination of Records. The Company agrees that PCSSD or any of its duly authorized representatives shall at any time during the term of this Contract have access to, and the right to audit and examine, any pertinent records of the Company related to this Contract. Such records shall be kept by Company for a period of not less than five (5) years from the date the records are made, unless PCSSD authorizes their earlier disposition. Company agrees to refund to PCSSD

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any underpayments or overcharges disclosed by any such audit, or to take other corrective action as may be required.

Permits and Licenses. The Company will obtain and maintain at its expense, and in its name, all necessary licenses and permits required to perform the services described herein. Damage to the Premises. The Company will assume full responsibility for any damage to PCSSD's equipment or premises caused by the negligent or intentional acts or omissions for the Company's employees, agents, or officers, ordinary wear and tear expected. Office Contract Administrator. The contract administrator and liaison person for all matters concerning this contract is the Director of Finance. In no event shall any understanding or agreement, contract modification, change order, or any other matter which constitutes a deviation from the terms of this contract between the vendor and any other person other than the Director of Finance or his/her designee, be effective or binding upon the District. All such actions must be formalized by a properly executed addendum to the contract. Proposal Withdrawal. A proposal may be withdrawn before the opening date by submitting a request for withdrawal to the Director of Purchasing. No withdrawals will be allowed after the opening date and time. Proposal Modification. A proposal may be modified before the opening time and date by a person authorized by the vendor. The person making the changes must provide written approval from the vendor, which will become part of the document. Furthermore, the changes must be presented in a sealed envelope which will be treated as an addendum. The exterior of this envelope must be dated and signed by an authorized representative of the vendor, have the RFP number, and the vendor’s name. The change must identify the area to be changed and then state the correction. CANCELLATION PROVISIONS Cancellation for Cause: The District may cancel the contract at any time for breach of contractual obligations by providing the contractor with a written notice of such cancellation. Should the District exercise its right to cancel the contract for such reasons, the cancellation shall become effective on the date as specified in the notice of cancellation sent to the contractor.

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SECTION III: SCOPE OF WORK, SERVICE TERMS AND CONDITIONS PURPOSE It is the intent of this solicitation to enter into a single contract for following services throughout the District: to purchase a software program that will optimize our recruitment efforts, increase pool of highly qualified applicants, and establish a paperless hiring environment. Preference will be given to those organizations that have a good record in providing services to PreK-12 school district. This service contract shall be effective from the time of award for a sixty (60) month term. The District reserves the right to renew this contract for an additional 12 month period which may be extended for additional time periods based on the mutual agreement of both parties. SCOPE OF WORK A. WORK INCLUDED. The contractor shall provide all labor, tools, materials, equipment and all incidentals required and/or implied for the complete and satisfactory Installation and maintenance of electric equipment, devices, and lighting. This work shall include, but may not be limited to, preventive maintenance, services repairs and modifications as required in keeping the equipment in a first class operating condition. Recruitment Requirements: (1) Identification of best practices of recruiting in all areas, (2) Job Posting, (3) Streamline application and screening process for all position types, (4) Reporting Analytics, (5) Manager dashboard, (6) targeted auto recruiting with previous applicants and employees, (7) Ability to provide automated notifications to Onboarding staff of new hire, (8) Position Description functionality, (9) Onboard Functions, (10) Performance Management Functions, (11) Technical functions, (12) Integration points of interest, Implementation of services, and (14) Securing and confidentiality of data. B. AWARD CRITERIA. Offers will be evaluated using only the factors stated below. Evaluation factors are stated in the relative order of importance, with the first factor being the most important. Once evaluation is complete, all responsive Offertory will be ranked from most advantageous to least advantageous. 1. Technical Proposal: the degree, completeness, and suitability of the Offeror’s proposed technical solutions to meet or exceed the requirements of this RFP. (60%) 2. Offeror’s Qualifications: The Offeror’s experience, references and key staff must provide evidence of its depth and breadth of experience, and evidence of successful performance with projects, of this similar size and scope. (20%) 3. Cost Proposal: The total cost of ownership for the base solution for the potential five year contract period. (20%)

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SECTION IV: COST PROPOSAL Price Proposal: Notwithstanding any other instructions herein, please submit the following price information as part of your official documents.

ITEM

1

QTY

1

DESCRIPTION

UNIT PRICE

TOTAL PRICE

Recruitment Software to accommodate unlimited users per attached Scope of Work First year Cost Total Cost (5 year plan)

2

2

Onboarding Software to accommodate unlimited users per attached Scope of Work. First year Cost Total Cost (5 year plan)

3

3

4

4

Performance Management Software to accommodate unlimited users per attached Scope of Work. First year Cost Total Cost (5 year plan) Maintenance and support agreement for all software to accommodate unlimited users per attached Scope of Work First year Cost Total Cost (5 year plan)

5

6

5

6

Total Cost of conversion/integration per attached Scope of Work. First year Cost Total Cost (5 year plan) Professional Services for implementation of all listed products per attached Scope of Work. First year Cost Total Cost (5 year plan)

7

7

Operational Manuals/Documentation per attached Scope of Work First year Cost Total Cost (5 year plan)

8

8

On-site Training for all software. First year Cost Total Cost (5 year plan)

Grand Total

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ITEM 1

2

3

QTY Daily

Daily

Hourly

DESCRIPTION

TOTAL PRICE

Optional Item: Additional Off-Site Training beyond training included in initial software training Amount Per Day

$

Optional Item: Additional On-Site Training beyond training included in initial software training Amount Per Day (indicate daily rate for on-site training to include: travel, meals, lodging and all other expenses.)

$

Optional Item: Future programing/development/customization/ consulting services Amount Per Hour

$

Additional Options

OTHER REQUIRED SUBMITTALS 1. Company profile including but not limited to qualifications and years in business. 2. Listing of all personnel which you intend to use for the performance of this work. Include name, trade classification, qualifications, length of relevant experience and relevant training. Copy of Arkansas License(s) 3. Copy of work related Certificates of Certification(s) 4. Copy of profile, staffing, handling of emergencies, years in business and other information relevant to work under this RFP Scope of Service 5. References of services (must be at least 3) for work as specified in this RFP; provide the following: Company name, contact name, address, telephone number, type of equipment serviced and whether reference was a term, maintenance, installation, or repair contract. 6. Other: information or documentation the bidder deems might be relevant to the evaluation process for this service contract. 7. Completion of pages 9 – 13.

Note: The proposal opening is open to the public but only the Vendors names responding will be read into the public record.

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Company Qualifications Yes

No

#

Description

1

Company must provide an internet based application tacking, candidate management and hiring process for a PreK-12 School District.

2

Company must provide an electronic application process for all types of candidates, including, but not limited to teacher, classified, administrative, auxiliary, paraprofessionals, substitutes, volunteers coaches etc.

3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

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Company must be able to allow current employees to apply for in house vacancies. Company must provide an automatic notification and correspondence management system to candidates. Company must provide an automatic reference form component. Company must provide the capability to allow interview worksheets with personalized notes. Company must provide the automatic tier access to authorized users. Company must be able to screen highly qualified candidates based Arkansas Department of Education. Company must be able to automatically notify the district when an ineligible candidate submits an application. Company must be able to allow the upload, scan, store and view of supplemental documents. Company must be able to provide a recruitment tool mechanism. Company must be able to provide system to track the effectiveness of recruitment. Company must be able to provide electronic distribution of application to school sites. Company must be able to provide a system to post vacancies and notification to qualified applicants. Company must be able to provide integration software programs Company must be able to provide integration software programs for any onboarding components. Company must be able to provide a reporting tool mechanism. A Representative must be available during normal working hours for customer service. Company must provide on-site training.

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General Questionnaire A

General 1

What is the name and address of your organization? What year was your organization established?

2

Provide the location of office(s) where administrative functions will be performed?

3 4 5 6

B

C

7

Describe your technical support program.

8

Describe your training program.

9

Provide a description of the business experience and professional achievements of the principals of your firm who would be assigned to work with Pulaski County Special School District.

10

Describe the reporting capabilities of your system.

11

Describe any onboarding or electronic records capabilities of your system.

12

Describe the manner in which the technology systems may be customized by our district.

System Administration 1

Describe the technology system used to collect, assimilate and integrate the data of the program.

2

List any institutions, businesses and other entities that have access to the date collected.

Organizational Structure 1 2

D

Is your company a wholly-owned subsidiary or a division of another company? If so, identify the company's name and address. Please verify that a customer service representative will be available toll-free during normal business hours. Describe customer service program in detail. How many contracts your company had with any public school systems? If any, how many in the State of Arkansas? What is the size of your Staff? How many permanent full-time employees in your organization?

If you are a multiple site organization, how are your offices coordinated for sales and services? If you are a multiple site organization, are certain services delegated to specific offices or are all services available at any location?

Pricing Information 1

RFP17-021

Provide a detailed description of package components and pricing information for this District. Please include pricing information for training, maintenance, customization, etc.

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THE FOLLOWING MUST BE COMPLETED AND NOTARIZED OR PROPOSAL MAY BE REJECTED. Bidder Assurances and Disclosure School District Bid Name of School District: Pulaski County Special School District Bid Description/Number: RFP17-021 Application and Hiring Tracking System Bid Opening Date: Assurances: I, ____________________________________________________hereby state: 1.

2. 3.

4.

I am the duly authorized agent of _______________________________, the bidder submitting the competitive bid which is attached to this statement, for the purpose of certifying the facts pertaining to the existence of collusion among and between bidders and school district officials, as well as facts pertaining to the giving or offering of things of value to school district personnel in return for special consideration in the awarding of any contract pursuant to the bid to which this statement is attached. I am fully aware of the facts and circumstances surrounding the making of the bid to which this statement is attached and have been personally and directly involved in the proceedings leading to the submission of this bid. Neither the bidder nor anyone subject to the bidder’s direction or control has been a party: a. To any collusion among bidders in restraint of freedom of competition by agreement to did at a fixed price or to refrain from bidding. b. To any collusion with any school district official or employee as to quality, quality or price in the prospective contract, or as to any other terms of the prospective contract; or c. In any discussions between bidders and any school district official concerning exchange of money or other things of value for special consideration in the awarding of a contract. I hereby guarantee that the specifications outlined in the bid shall be followed as specified and that deviations from the specifications shall occur only as part of a formal change process approved by the Board of Directors of the school district.

Disclosure: 1. Does any school board member or employee of the school district have a financial interest in your business or hold a position as officer, director, trustee, partner, or other top level management? ______yes _______no 2. Does any school board member or employee of the school district have a family relationship with anyone employed by your business? _______yes _______no (If the answer is yes to either of the above questions, provide details in a separate attachment to this form.) 3. Did you or your company assist the school district or any agent of the school district with the development of the bid specifications? _______yes ______no If yes: a. Were you or your company compensated ______yes _______no b. Is your company’s name or identity included anywhere within the specifications? ______yes ______no c. Were you offered any preferential treatment in the bid evaluation process? ______yes ______no (If the purchase will be from the school district’s federal child nutrition food service fund, potential bidders cannot have input into the development of specification. – 7 Code of Federal Regulations 3016.60(b)). ________________________________________________________ Signature

________________________ Date

______________________________________________

____________________

Printed

Title

______________________________________________ Company

Subscribed and sworn to before me this ______day of _____________________, 20____. _________________________________________ Notary Public _____________________________ State My Commission expires: ________________________________ Any person determined to have made a false statement on the form or any bidder who acts contrary to the provisions of the form after its agent has executed the form shall be guilty of a Class C misdemeanor.

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