Request for Applications (RFA): 2026 – Aging Services Alamo and Bexar AAA Contracted Supportive Services for FY26 – FY30

ATTACHMENT A
APPLICATION TITLE PAGE
Alamo and Bexar AAA Contracted Supportive Services for FY26 - FY30
Legal Name of Proposing Entity
Name of Owner/Director of Entity
Title
Mailing Address
Physical Address (If different than mailing)
Telephone Number
Fax Number
E-mail Address
Contract Signatory Authority & Title
Federal Tax ID Number
Historically Under-Utilized Business? If "yes", Yes No
attach copy of current certification.
Corporation Sole Proprietor
Partnership
Legal/Tax Status of Organization
Other (Specify) _________________________
RESPONSE FORMS Page 1

ATTACHMENT B
CERTIFICATION SHEET
All specifications and terms and conditions of the RFA have been read.
Our Company accepts the specifications and conditions unless otherwise accepted in writing to the Executive
Director, Alamo Area Council of Governments (AACOG).
Company Name:
Mailing Address:
City: State Zip Code
Phone: Fax:
Web
Site:
Email
:
Name of Representative authorized to sign for bidder:
(Print name) (Signature)
(a) Does your "residence state" require bidders whose principal place of business is in Texas to underbid bidders whose
residence state is the same as yours by a prescribed amount or percentage to receive a comparable contract?
"Residence State" is defined as the state in which the principal place of business is located. YES NO
(b) What is that amount or percentage?
I certify that the above information is correct:
Name
Position
Signature
Date
RESPONSE FORMS Page 2

ATTACHMENT C
ACKNOWLEDGEMENT FORM
Having carefully examined the terms and conditions and specifications within this RFA
document, the undersigned Proposer's Agent hereby proposes and agrees to furnish the
proposed product(s)/service(s) in strict compliance with the specifications as quoted.
The Proposer affirms that, to the best of his knowledge, the response has been arrived at
independently and is submitted without collusion with anyone to obtain information or
gain any favoritism that would in any way limit competition or give them an unfair
advantage over other bidders in the award of this RFA.
The Proposer affirms that he/she has not participated in any act of favoritism, gratuity,
or inside dealings with any member of the staff of AACOG or its Board of Directors.
Company Name:
President/Designee:
Position:
Signature:
Date:
RESPONSE FORMS Page 3

ATTACHMENT D
CONFLICT OF INTEREST QUESTIONNAIRE
This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular OFFICE
Session. USE
Date Received
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).
By law this questionnaire must be filed with the records administrator of the local
government 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.
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
3.
Name of local government office with whom filer has employment or business relationship.
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
from the local government 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 office named in this section.
4.
Signature of person doing business with governmental entity Date
RESPONSE FORMS Page 4

ATTACHMENT E
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION FOR COVERED CONTRACTS AND GRANTS
Federal Executive Order 12549 requires the Texas Department of Aging and Disability Services (DADS) to screen each covered potential
contractor/grantee to determine whether each has a right to obtain a contract/grant in accordance with federal regulations on debarment,
suspension, ineligibility, and voluntary exclusion. Each covered contractor/grantee must also screen each of its covered
subcontractors/providers.
In this certification "contractor/grantee" refers to both contractor/grantee and subcontractor/sub grantee; "contract/grant" refers to both contract/grant
and subcontract/sub grant.
By signing and submitting this certification the potential contractor/grantee accepts the following terms:
1. The certification below is a material representation of fact upon which reliance was placed when this contract/grant was entered into. If it is
later determined that the potential contractor/grantee knowingly rendered an erroneous certification, in addition to other remedies available
to the federal government, the Department of Health and Human Services, United States Department of Agriculture or other federal
department or agency, or the Texas Department of Aging and Disability Services may pursue available remedies, including suspension and/or
debarment.
2. The potential contractor/grantee shall provide immediate written notice to the person to which this certification is submitted if at any time
the potential contractor/grantee learns that the certification was erroneous when submitted or has become erroneous by reason of changed
circumstances.
3. The words "covered contract," "debarred," "suspended," "ineligible," "participant," "person," "principal," "proposal," and "voluntarily
excluded," as used in this certification have meanings based upon materials in the Definitions and Coverage sections of federal rules
implementing Executive Order 12549. Usage is as defined in the attachment.
4. The potential contractor/grantee agrees by submitting this certification that, should the proposed covered contract/grant be entered into, it
shall not knowingly enter into any subcontract with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from
participation in this covered transaction, unless authorized by the Department of Health and Human Services, United States Department of
Agriculture or other federal department or agency, and/or the Texas Department of Aging and Disability Services, as applicable.
Do you have or do you anticipate having subcontractors/sub grantees under this proposed contract? YES NO
5. The potential contractor/grantee further agrees by submitting this certification that it will include this certification titled "Certification
Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion for Covered Contracts and Grants" without modification, in all
covered subcontracts and in solicitations for all covered subcontracts.
6. A contractor/grantee may rely upon a certification of a potential subcontractor/sub grantee that it is not debarred, suspended, ineligible, or
voluntarily excluded from the covered contract/grant, unless it knows that the certification is erroneous. A contractor/grantee must, at a
minimum, obtain certifications from its covered subcontractors/sub grantees upon each subcontract's/sub grant's initiation and upon each
renewal.
7. Nothing contained in all the foregoing shall be construed to require the establishment of a system of records in order to render in good faith
the certification required by this certification document. The knowledge and information of a contractor/grantee is not required to exceed
that which is normally possessed by a prudent person in the ordinary course of business dealings.
8. Except for contracts/grants authorized under paragraph 4 of these terms, if a contractor/grantee in a covered contract/grant knowingly enters
into a covered subcontract/sub grant with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in the
transaction, in addition to other remedies available to the federal government, Department of Health and Human Services, United State
Department of Agriculture, or other federal department or agency, as applicable, and/or the Texas Department of Aging and Disability
Services may pursue available remedies, including suspension and/or debarment.
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION FOR COVERED
CONTRACTS AND GRANTS
Indicate which statement applies to the covered potential contractor/grantee:
1. The potential contractor/grantee certifies, by submission of this certification, that neither it nor its principals are presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from participation in this contract/grant by any federal department or agency
or by the State of Texas.
2. The potential contractor/grantee is unable to certify to one or more of the terms in this certification. In this instance, the potential contractor/grantee
must attach an explanation for each of the above terms to which he is unable to make certification. Attach the explanation(s) to this certification.
NAME OF CONTRACTOR/GRANTEE
VENDOR ID NO. /FEDERAL EMPLOYER'S IDNO.
Signature of Authorized Representative Printed/Typed Name of Authorized Representative
Date Title of Authorized Representative
THIS CERTIFICATION IS FOR FY 26 PERIOD BEGINNING October 1, 2025 and ENDING September 30, 2026.
RESPONSE FORMS Page 5

INSTRUCTIONS FOR ATTACHMENT E CERTIFICATION
1. By signing and submitting this proposal, the prospective contractor/grantee is providing the certification set out above.
2. The inability of a contractor/grantee to provide the certification required above will not necessarily result in denial of
participation in this covered transaction. The prospective contractor/grantee shall submit an explanation of why it
cannot provide the certification set out above. The certification or explanation will be considered in connection with
the department or agency's determination whether to enter into this transaction. However, failure of the prospective
contractor/grantee to furnish a certification or an explanation shall disqualify such contractor/grantee from
participation in this transaction.
3. The certification in this clause is a material representation of fact upon which AACOG will rely if we enter into this
transaction. If it is later determined that the prospective contractor/grantee knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government or us, AACOG may terminate this
transaction for cause or default.
4. The prospective contractor/grantee shall provide immediate written notice to AACOG if at any time the prospective
contractor/grantee learns that its certification was erroneous when submitted or has become erroneous by reason of
changed circumstances.
5. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant,"
"person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause,
have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549.
You may contact AACOG for assistance in obtaining a copy of those regulations (13 CFR Part 145).
6. The prospective contractor/grantee agrees by submitting this proposal that, should the proposed covered transaction
be entered into, it shall not knowingly enter into any lower-tier covered transaction with a person who is debarred,
suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized
by AACOG.
7. The prospective contractor/grantee further agrees by submitting this proposal that it will include the clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower-Tier Covered
Transactions, "provided by AACOG, without modification, in all lower tier covered transactions and in all solicitations
for lower tier covered transactions.
8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower- tier covered
transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless
it knows eligibility or that the certification is erroneous. A participant may decide the method and frequency by which
it determines the ineligibility of its principals. Each participant may, but is not required to, check the No procurement
List.
9. Nothing contained in the foregoing shall be construed to require the establishment of a system of records to render in
good faith the certification required by this clause. The knowledge and information of a participant is not required to
exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.
10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction
knowingly enters into a lower-tier covered transaction with a person who is suspended, debarred, ineligible, or
voluntarily excluded from participation in this transaction, in addition to other remedies available to AACOG,
AACOG may terminate this transaction for cause or default.
RESPONSE FORMS Page 6

ATTACHMENT F
NON-DISCRIMINATION CERTIFICATION
The Contractor has agreed to comply with:
1. Title VI of the Civil Rights Act of 1964, as amended (42 USC 2000d), which prohibits
employment discrimination based on race, color or national origin; 45 CFR 80
2. Section 504 of the Rehabilitation Act of 1973, as amended (29 USC 794) which prohibits
discrimination against qualified individuals with disability in,
(1) Programs and activities receiving financial assistance from HHS, 45 CFR 84, (2) Notice of
exercise of authority under regarding recipients with fewer than fifteen employees, 45 CFR
84.52(d)(2), (3) Admission or treatment against substance abusers suffering from medical
conditions 45 CFR 84.53, and (4) Programs or activities conducted by HHS 45 CFR 85;
3. Title IX of the Education Amendments of 1972, as amended, (20 USC 1681) prohibits
discrimination on the basis of sex (gender) in Federally Assisted Education Programs 45 CFR 86
4. The Age Discrimination in Employment Act of 1975, as amended (42 USC
6101), which prohibits discrimination on the basis of age in (1) Programs or activities receiving
federal financial assistance 45 CFR 90; and (2) Programs or services receiving HHS financial
assistance 45 CFR 91.
5. Title II of the Americans with Disabilities Act, 28 CFR Part 35.
NAME OF VENDOR/GRANTEE:
Printed/Typed Name & Title of Authorized
Signature of Authorized
Representative
Representative
Date:
RESPONSE FORMS Page 7

ATTACHMENT G
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS, AND COOPERATIVE
AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief, that:
(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee
of an agency, a Member of Congress, an officer or employee of Congress, or an employee of
a Member of Congress in connection with the awarding of any Federal contract, the making
of any Federal grant, the making of any Federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any Federal
contract, grant, loan, or cooperative agreement.
(2) If any funds other than Federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
undersigned shall complete and submit Standard Form-LLL, ``Disclosure Form to Report
Lobbying,'' in accordance with its instructions.
(3)The undersigned shall require that the language of this certification be included in the
award documents for all sub awards at all tiers (including subcontracts, sub grants, and
contracts under grants, loans, and cooperative agreements) and that all meal delivery service
contractors shall certify and disclose accordingly. This certification is a material representation
of fact upon which reliance was placed when this transaction was made or entered into.
Submission of this certification is a prerequisite for making or entering into this transaction
imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
Statement for Loan Guarantees and Loan Insurance
The undersigned states, to the best of his or her knowledge and belief, that:
If any funds have been paid or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an officer or employee
of Congress, or an employee of a Member of Congress in connection with this commitment
providing for the United States to insure or guarantee a loan, the undersigned shall complete
and submit Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in accordance with
its instructions. Submission of this statement is a prerequisite for making or entering into this
transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the
required statement shall be subject to a civil penalty of not less than $10,000 and not more
than $100,000 for each such failure.
Signature
Title
Organization
RESPONSE FORMS Page 8

REQUEST TO BE ADDED TO BIDDER/ VENDOR LIST
AACOG is an equal opportunity agency within the meaning and spirt of the law and does not discriminate on the basis of
race, age, color, sex (including sexual orientation and gender identity), disability, national origin, or religion. All contractors
and vendors are required to comply with AACOG's EEO policies and/or provide adequate notification that they comply with
applicable EEO laws
AACOG requires all vendors interested in conducting business with the agency to complete a "Request to be added to Bidder/
Vender List" packet prior to being eligible to receive opportunities to bid for agency projects.
In addition, AACOG has a centralized purchasing function and requires that a purchase order number be issued and
authorized before any order is processed. The contact for Purchase Order numbers is the Procurement Department,
(210)362-5200, procurement@aacog.gov
NOTE: AACOG programs are on a cost reimbursement from the funding sources. AACOG will bill the funding source for
purchases subsequent to receipt of goods or services and invoices. Invoices are required for all purchases. Payment will be
forwarded to the vendor upon reimbursement from the funding source. Vendors should note that this process may take sixty
(60)to ninety (90) days for payment to be processed. Contact for the status of payments is Accounts Payable at (210)362-
5280.
RETURN THIS FORM TO:
Alamo Area Council of Governments
2700 NE Loop 410, Suite 101
San Antonio, TX 78217
ATTN: Procurement Department Phone:
(210)362-5200
Email: procurement@aacog.gov
I, , hereby attest that I have read and understand the above terms for conducting
business with the Alamo Area Council of Governments.
Company Name:
Send Payment(s) to- Address:
City/ State/ ZIP code:
Telephone Number:
Fax Number:
Website Address:
Email Address:
Representative:
RESPONSE FORMS Page 9

REQUEST TO BE ADDED TO BIDDER/ VENDOR LIST
Please list the type of products/ services you provide and attach any catalogs/ brochures/ samples. Use this list below to
describe your products/ services *required*. Please check the service(s) for which you are applying:
Caregiver Information Caregiver Support
Caregiver Counseling
Services Groups
Caregiver Training Chore Maintenance Congregate Meals
Evidence-Based
Emergency Response Health Maintenance
Intervention
Instruction and Legal Assistance 60
Home Delivered Meals
Training yrs and older
Personal
Mental Health Services Physical Fitness
Assistance
Residential Repair Respite In Home Respite Out of Home
Social Reassurance Transportation
Choose which County(ies) that you are applying for:
Atascosa Bandera Bexar
Comal Frio Gillespie
Guadalupe Karnes Kendall
Kerr McMullen Medina
Wilson All Counties
Please assist us by completing the following:
1. Type of Request:
New Vendor Change of Address Updated Information
2. Ownership:
Sole Proprietorship Partnership Corporation
Governmental Agency *Non- Profit Agency Other ______________________
3. Tax Identification Number:
Attach completed W-9 form unless tax exempt. http://www/irs.gov/pub/irs-pdf/fw9.pdf
DUNS Number, if applicable:
RESPONSE FORMS Page 10