Rental of Portable Medical Refrigerators

SUBMITTAL - Offer and Acceptance
SUBMITTAL - Offer and Acceptance
OFFER BY THE OFFEROR
Offeror Statement. By signing below, I represent and certify that I am submitting a binding offer and am
authorized to bind the offeror to fully comply with the solicitation to which I submit this offer. I
acknowledge that I have received, read, and understood the entire solicitation document packet sections,
including any addenda issued, and agree to be bound by its terms. I understand and agree that offers
submitted with incomplete and/or unsigned offer and acceptance may not be considered and may be
rejected as nonresponsive.
Company Name:
Company Address:
City, State, Zip:
City Vendor Registration No.:
Printed Name of Officer or Authorized Representative:
Title:
Signature of Officer or Authorized Representative: X
Date:
Email Address: Phone Number:
ACCEPTANCE BY THE CITY
City Staff Only. By signing below, the City's representative affirms they are duly authorized and that they accept
this offer as clarified herein. Contractor is now bound to sell the materials or services specified in the Contract.
Contract Number: Effective Date:
Printed Name of City's Authorized Procurement Staff:
Title of City's Authorized Procurement Staff:
Signature: Date:
Email: Phone:
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SUBMITTAL - Offer and Acceptance
OFFER CERTIFICATIONS
Instructions. By submitting this offer, I, my firm and its principals (collectively "Offeror") certify the
following statements are true now and will be for the term of any resulting contract.
OFFEROR HEREBY CERTIFIES
1. Debarment.
Offeror is not currently suspended or debarred from offering on any federal, state, or City of Austin
contracts.
2. Collusion.
Offeror has not in any way directly or indirectly (1) colluded, conspired, or agreed with any other person,
firm, corporation, offeror, or potential offeror to the amount of this offer or the terms or conditions of this
offer; or (2) paid or agreed to pay any other person, firm, corporation Offeror or potential Offeror any
money or anything of value in return for assistance in procuring or attempting to procure a contract or in
return for establishing the prices in the attached Bid or the Bid of any other Offeror.
3. Conflicts of Interest.
Offeror has not (1) received any compensation or a promise of compensation for participating in the
preparation or development of the underlying Solicitation or Contract documents; (2) have not otherwise
participated in the preparation or development of the underlying Solicitation or Contract documents,
except to the extent of any comments or questions and responses in the solicitation process, which are
available to all Offerors, so as to have an unfair advantage over other Offerors, provided that we may have
provided relevant product or process information to a consultant in the normal course of its business; or
(3) have not participated in the evaluation of Offers or other decision making process for this Solicitation
and, if we are awarded a Contract, no individual, agent, representative, consultant, subcontractor, or
sub-consultant associated with us, who may have been involved in the evaluation or other decision
making process for this Solicitation, will have any direct or indirect financial interest in the Contract,
provided that we may have provided relevant product or process information to a consultant in the normal
course of its business.
4. Texas Local Government Code, Ch. 176.
In accordance with Chapter 176 of the Texas Local Government Code, Offeror has not (1) had an
employment or other business relationship with any local government officer of the City or a family
member of that officer that results in the officer or family member receiving taxable income; (2) given a
local government officer of the City one or more gifts, other than gifts of food, lodging, transportation, or
entertainment accepted as a guest, that have an aggregate value of more than $100 in the twelve-month
period preceding the date the officer becomes aware of the execution of the Contract or that City is
considering doing business with the Offeror; and (3) had a family relationship with a local government
officer of the City in the third degree of consanguinity or the second degree of affinity.
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SUBMITTAL - Offer and Acceptance
5. Texas Local Government Code, Ch. 2271.022, Boycotting Israel.
Pursuant to Texas Government Code 2271.002, Offeror verifies that we do not boycott Israel and will not
boycott Israel during the term of the resulting contract.
6. Texas Government Code, Ch. 2275, Specified Business with Specified Countries.
Pursuant to Texas Government Code Chapter 2275, Offeror verifies that if we have remote or direct
access to communication infrastructure systems, cybersecurity systems, the electric grid, hazardous
waste treatment systems, or water treatment facilities as a result of any City contract, that we are not
owned by or the majority of stock or other ownership interest of our firm is not held or controlled by (1)
individuals who are citizens of China, Iran, North Korea, Russia, or a Governor-designated country; or (2)
a company or other entity, including a governmental entity, that is owned or controlled by citizens of or is
directly controlled by the government of China, Iran, North Korea, Russia, or a Governor-designated
country; or (3) headquartered in China, Iran, North Korea, Russia, or a Governor-designated country.
7. ERCOT Protocols Sec. 16.1.4(1)(b), Lone Star Infrastructure Protection Act.
Pursuant to ERCOT Protocols Section 16.1.4(1)(b), we verify that if we provide Critical Electrical Grid
Equipment (CEGE) or Critical Electric Grid Services (CEGS), any CEGE or CEGS we provide were not
manufactured, produced, created, or otherwise provided by a Lone Star Infrastructure Protection Act
(LSIPA) Designated Company.
Critical Electric Grid Equipment (CEGE). (1) Equipment accessible by means of routable
connectivity that, as installed, can be used to gain remote access to or control of ERCOT System
Infrastructure, the ERCOT Wide Area Network (WAN), or Market Information System (MIS), if such
equipment, if destroyed, degraded, misused, or otherwise rendered unavailable would, within 15
minutes or less of its mis-operation, non-operation, or required operation, adversely impact the
reliable operation of ERCOT System Infrastructure. Redundancy of affected facilities, systems, and
equipment shall not be considered when determining adverse impact. (2) For Load Resources, this
definition only applies to equipment used to send and receive ERCOT telemetry and ERCOT
Dispatch Instructions. (3) For purposes of this definition, "reliable operation of ERCOT System
Infrastructure" means operating elements of ERCOT System Infrastructure within equipment and
electric system thermal, voltage, and stability limits so that instability, uncontrolled separation, or
cascading failures of ERCOT System Infrastructure will not occur as a result of a sudden
disturbance, including a cybersecurity incident, or unanticipated failure of system elements.
Critical Electric Grid Services (CEGS). Services and software provided by a vendor for the
operation, control, monitoring, maintenance, or use of Critical Electric Grid Equipment (CEGE),
excluding access specifically allowed by the purchaser for product warranty or support purposes.
ERCOT System Infrastructure. The Transmission Facilities, distribution facilities, Resources,
Settlement Only Generators (SOGs), and Emergency Response Service (ERS) Resources that
comprise the ERCOT System and the physical and virtual cyber assets used to control the ERCOT
System.
Lone Star Infrastructure Protection Act (LSIPA) Designated Company. An Entity (including an
LSIPA Affiliate) that meets any of the company ownership or headquarters criteria listed in Texas
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SUBMITTAL - Offer and Acceptance
Business and Commerce Code, Section 117.002(a)(2)(A)-(b)(2)(B) or Texas Government Code
Section 2275.0102(a)(2)(A)-(b)(2)(B).
Lone Star Infrastructure Protection Act (LSIPA) Designated Country. China, Iran, North Korea,
Russia, or a country designated by the Governor as a threat to critical infrastructure pursuant to
Texas Business and Commerce Code, Section 117.003 or Texas Government Code, Section
2275.0103.
Lone Star Infrastructure Protection Act (LSIPA) Affiliate. An Entity that, directly or indirectly,
through one or more intermediaries, controls, is controlled by, or is under common control with the
LSIPA Designated Company. For purposes of this definition, "controls," "controlled by," or "under
common control with" shall mean (1) the ownership of 20 percent or more of the outstanding
securities of an Entity or (2) the power of an Entity, directly or indirectly, through one or more
intermediaries, to direct the management and/or policies and procedures of another Entity.
Ownership by an Entity of equity securities (whether publicly traded or not) of another Entity shall
not result in control for purposes of this definition if the holder owns (in its name or via
intermediaries) 20 percent or more of the outstanding securities of the Entity, and: (a) the securities
are held as a passive investment; (b) the holder does not have representation on the Entity's board
of directors (or equivalent governing body) or vice versa; and (c) the holder does not in fact exercise
influence over day-to-day management decisions.
8. Texas Government Code, Ch. 2274, Boycotting Firearms Entities.
Pursuant to Texas Government Code Chapter 2274, Offeror verifies that, if we have 10 or more full-time
employees: (1) we do not have a practice, policy, guidance, or directive that discriminates against a
firearm entity or firearm trade association; and (2) will not discriminate during the term of the resulting
contract against a firearm entity or firearm trade association.
9. Texas Government Code, Ch. 2276, Boycotting Energy Companies.
Pursuant to Texas Government Code Chapter 2276, Offeror verifies that, if we have 10 or more full-time
employees: (1) we do not boycott energy companies; and (2) will not boycott energy companies during
the term of the contract.
10. Austin City Code, Ch. 4-22, Wage Theft.
Pursuant to Austin City Code, Chapter 4-22, Offeror verifies that we has not been adjudicated for wage
theft related incidents as defined in Austin City Code Chapter 4, 4-22-1 (G) & (H) within five (5) years
prior to the solicitation date of this agreement. Furthermore, this firm agrees to abide by the items
outlined in Section 4-22-5 (B) and Section 4-22-6 (A) of the Austin City Code.
11. Austin City Council Resolution No 20191114-056, LGBTQ+ Conversion Therapy.
Pursuant to City Council Resolution No. 20191114-056, Offeror is not currently and will not during the
term of the Contract engage in practicing LGBTQ+ conversion therapy; referring persons to a healthcare
provider or other person or organization for LGBTQ+ conversion therapy; or Contracting with another
entity to conduct LGBTQ+ conversion therapy. If the City determines in its sole discretion that we have,
during the term of the resulting Contract, engaged in any such practices, the City may terminate this
Contract without penalty to the City.
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SUBMITTAL - Offer and Acceptance
12. Texas Government Code, Ch. 2252.002, Nonresident Bidders.
In accordance with Texas Government Code Ch. 2252.002, the City is required apply a reciprocal (counter)
preference to offers submitted by Nonresident Bidders, consistent with any preference granted by the
state of the Nonresident Bidder's principal place of business. The City is also required to apply a reciprocal
preference to a Resident Bidder or Nonresident Bidder's offer, consistent with any preference granted by
the state where the majority of the equipment, supplies, and/or materials were manufactured. As defined
in the statute, a Resident Bidder is an offeror whose principal place of business is in Texas, including a
contractor whose ultimate parent company or majority owner has its principal place of business in Texas.
A Nonresident Bidder therefore is an offeror that is not a Resident Bidder.
Instruction. Offerors shall read and check the applicable boxes in response to both certifications below.
OFFEROR HEREBY CERTIFIES
(Check One)
Offeror IS (YES) or IS NOT (NO) a Nonresident Bidder in accordance with Texas Government
YES NO
Code Ch. 2252.002.
If "YES" is checked, provide the name of the State where Nonresident Bidder's Principal Place
of Business is located.
(State)
OFFEROR HEREBY CERTIFIES
(Check One)
Offer INCLUDES (YES) or DOES NOT INCLUDE (NO) Equipment, Supplies, and/or Materials in
YES NO
accordance with Texas Government Code Ch. 2252.002.
If "YES" is checked, provide the name of the State where majority of the Equipment, Supplies,
and/or Materials were manufactured.
(State)
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SUBMITTAL - Employer Certification Wage
Theft Ordinance - Responsibility Criteria
EMPLOYER CERTIFICATION
WAGE THEFT ORDINANCE - RESPONSIBILITY CRITERIA
CITY OF AUSTIN
Any Employer that submits an offer to the City seeking award of a city contract prior to awarding a contract
are required to certify that they have not been adjudicated for certain offenses related to wage theft. See City
of Austin Ordinance No. 20221201-031. "Wage theft" and "adjudicated" are to be understood per the
definitions set forth in Austin City Code Chapter 4, 4-22-1 (G) and (H).
Solicitation or Agreement Title:
Solicitation Posting Date or Agreement Start Date:
All Employers are required to complete the City of Austin Wage Theft
Training within 30 days of being awarded a contract with the City.
Contact the Wage Compliance Team to register for a class.
I hereby certify, under penalty of perjury under the laws of the State of Texas, that the below certification
is true and correct and that I am authorized to make the following certification on behalf of the firm listed
herein.
CERTIFICATION:
This firm has NOT been adjudicated for wage theft related incidents as defined in Austin City Code
Chapter 4, 4-22-1 (G) & (H) within five (5) years prior to the above-stated date. Furthermore, this firm
agrees to abide by the items outlined in Section 4-22-5 (B) and Section 4-22-6 (A) of the Austin City
Code.
Firm Name:
Name of Employer - Print Full Legal Entity Name of Firm
Signed:
Signature of Authorized Person Print Name of Person Making Certification for Firm
Title: Place:
Title of Person Making Certificate Print City and State Where Signed
Date:
EMPLOYER CERTIFICATION - WAGE THEFT PROGRAM Revised 09.14.23
If you have questions or need more information, contact us at wagetheft@austintexas.gov.

NON-DISCRIMINATION AND NON-RETALIATION CERTIFICATION
Instruction. Offerors shall read and acknowledge this certification by checking the box below. Offerors that do
not check the box below indicating their compliance with this certification shall be determined nonresponsive.
OFFEROR HEREBY CERTIFIES
Offeror has read the following and will comply with Austin City Code, Sec. 5-4-2.
(Check)
1. Not to engage in any discriminatory employment practice defined in this chapter;
2. To take affirmative action to ensure that applicants are employed, and that employees are treated during
employment, without discrimination being practiced against them as defined in this chapter, including
affirmative action relative to employment, promotion, demotion or transfer, recruitment or recruitment
advertising, layoff or termination, rate of pay or other forms of compensation, and selection for training or
any other terms, conditions or privileges of employment;
3. To post in conspicuous places, available to employees and applicants for employment, notices to be provided
by the Equal Employment/Fair Housing Office setting forth the provisions of this chapter.
4. To state in all solicitations or advertisements for employees placed by or on behalf of the Contractor, that all
qualified applicants will receive consideration for employment without regard to race, creed, color, religion,
national origin, sexual orientation, gender identity, disability, sex or age.
5. To obtain a written statement from any labor union or labor organization furnishing labor or service to
Contractors in which said union or organization has agreed not to engage in any discriminatory employment
practices as defined in this chapter and to take affirmative action to implement policies and provisions of this
chapter.
6. To cooperate fully with City and the Equal Employment/Fair Housing Office in connection with any
investigation or conciliation effort of the Equal Employment/Fair Housing Office to ensure that the purpose
of the provisions against discriminatory employment practices are being carried out.
7. To require of all subcontractors having 15 or more employees who hold any subcontract providing for the
expenditure of $2,000 or more in connection with any contract with the City subject to the terms of this
chapter that they do not engage in any discriminatory employment practice as defined in this chapter.
For the purposes of this Offer and any resulting Contract, Contractor adopts the provisions of the City's Minimum
Non-Discrimination and Non-Retaliation Policy set forth below.
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MINIMUM NON-DISCRIMINATION AND NON-RETALIATION POLICY
1. As an Equal Employment Opportunity (EEO) Non-Discrimination Policy or as an amendment to
employer, the Contractor will conduct its personnel such Policy and such provisions are intended to not
activities in accordance with established federal, state only supplement the Contractor's policy, but will also
and local EEO laws and regulations. The Contractor supersede the Contractor's policy to the extent of any
will not discriminate against any applicant or conflict.
employee based on race, creed, color, national origin,
sex, age, religion, veteran status, gender identity, 5. UPON CONTRACT AWARD, THE
disability, or sexual orientation. This policy covers all CONTRACTOR SHALL PROVIDE THE CITY A
aspects of employment, including hiring, placement, COPY OF THE CONTRACTOR'S
upgrading, transfer, demotion, recruitment, NONDISCRIMINATION AND NON-
recruitment advertising, selection for training and RETALIATION POLICIES ON COMPANY
apprenticeship, rates of pay or other forms of LETTERHEAD, WHICH CONFORMS IN FORM,
compensation, and layoff or termination. SCOPE, AND CONTENT TO THE CITY'S
MINIMUM NON-DISCRIMINATION AND NON-
2. The Contractor agrees to prohibit retaliation, RETALIATION POLICIES, AS SET FORTH
discharge or otherwise discrimination against any HEREIN, OR THIS NON-DISCRIMINATION
employee or applicant for employment who has AND NON-RETALIATION POLICY, WHICH
inquired about, discussed or disclosed their HAS BEEN ADOPTED BY THE CONTRACTOR
compensation. FOR ALL PURPOSES WILL BE CONSIDERED
THE CONTRACTOR'S NON-DISCRIMINATION
3. Further, employees who experience discrimination, AND NON-RETALIATION POLICY WITHOUT
sexual harassment, or another form of harassment THE REQUIREMENT OF A SEPARATE
should immediately report it to their supervisor. If this SUBMITTAL.
is not a suitable avenue for addressing their
compliant, employees are advised to contact another 6. Contractor agrees that non-compliance with Chapter 5-
member of management or their human resources 4 and the City's Non-Retaliation Policy may result in
representative. No employee shall be discriminated sanctions, including termination of the contract and
against, harassed, intimidated, nor suffer any reprisal suspension or debarment from participation in future
as a result of reporting a violation of this policy. City contracts until deemed compliant with the
Furthermore, any employee, supervisor, or manager requirements of Chapter 5-4 and the Non-Retaliation
who becomes aware of any such discrimination or Policy.
harassment should immediately report it to executive
management or the human resources office to ensure 7. The Contractor agrees that this Non-Discrimination
that such conduct does not continue. and Non-Retaliation Certificate, which the Contractor
has executed and filed with the City, will remain in
4. Contractor agrees that to the extent of any force and effect for one year from the date of filling.
inconsistency, omission, or conflict with its current The Contractor further agrees that, in consideration of
non-discrimination and nonretaliation employment the receipt of continued Contract payment, the
policy, the Contractor has expressly adopted the Contractor's Non-Discrimination and Non-
provisions of the City's Minimum Non- Retaliation Policy will automatically renew from
Discrimination Policy contained in Section 5-4-2 of year-to-year for the term of the underlying Contract.
the City Code and set forth above, as the Contractor's
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SUSPENSION AND DEBARMENT CERTIFICATION
Instruction. Offerors shall read and acknowledge this certification by checking the box below. Offerors that do
not check the box below indicating their compliance with this certification shall be determined nonresponsive.
OFFEROR HEREBY CERTIFIES
Offeror has NOT been debarred from contracting with the City of Austin, any other
(Check)
local governments or states, or the US federal government.
Suspended or Debarred Offerors. The City finds that offerors, including any subcontractors that may be included
in the Offer, that are suspended or debarred from contracting with the US federal government, any state or local
government, as of the submission date of their offer, are not sufficiently responsible to contract with the City. The
City may reject and set aside any offer, or terminate for cause any contract resulting from an offer, in which the
offeror falsely certified they were not suspended or debarred when in fact they were.

SUBMITTAL - Subcontracting Plan, No Goals
SUBCONTRACTING FORM
In accordance with the City of Austin's Minority and Women-Owned Business Enterprises (M/WBE)
Procurement Program (Program), Chapters 2-9A/B of the City Code and M/WBE Program Rules, this
Solicitation was reviewed by the Small and Minority Business Resources Department (SMBR) to determine if
M/WBE Subcontractor Goals could be applied. Due to insufficient subcontracting opportunities and/or
insufficient availability of M/WBE certified firms, SMBR has assigned no M/WBE subcontracting goals for this
Solicitation. However, Offerors who choose to use Subcontractors must comply with the procedures of City's
M/WBE Procurement Program as described below. Additionally, if the Contractor seeks to add
Subcontractors after the Contract is awarded, the Program requirements shall apply to any Contract(s)
resulting from this Solicitation.
Instructions:
A. Offerors who DO NOT intend to use Subcontractors shall check the applicable "NO" box and
complete this Subcontract Form and include it with their sealed Offer.
B. Offerors who DO intend to use Subcontractors shall check the applicable "YES" box and complete
this Subcontract Form and the Subcontract Plan and include all with their sealed Offer.
OFFEROR CERTIFICATION
Company Name
City Vendor ID Code
Is the Offeror NO
City of Austin M/WBE
certified? YES Indicate one: MBE WBE MBE/WBE Joint Venture
NO, I DO NOT intend to use Subcontractors.
Using
Subcontractors?
YES, I DO intend to use Subcontractors.
If I am awarded a Contract and I am not using Subcontractor(s) but later intend to add Subcontractor(s), before the
Subcontractor(s) is hired or begins work, I will comply with the City's M/WBE Procurement Program and submit the Request For
Change form to add any Subcontractor(s) to the Project Manager or the Contract Manager for prior authorization by the City and
perform Good Faith Efforts (GFE), if applicable. I understand that, if a Subcontractor is not listed in my Subcontracting Plan, it is
a violation of the City's M/WBE Procurement Program for me to hire the Subcontractor or allow the Subcontractor to begin work,
unless I first obtain City approval of my Request for Change form. I understand that, if a Subcontractor is not listed in my
Subcontracting Plan, it is a violation of the City's M/WBE Procurement Program for me to hire the Subcontractor or allow the
Subcontractor to begin work, unless I first obtain City approval of my Request for Change form.
Name and Title of Authorized Representative (Print or Type) Signature/Date
(062420) Page 1