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UNITED INDEPENDENT SCHOOL DISTRICT

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					                                     UNITED INDEPENDENT SCHOOL DISTRICT
                                                   PURCHASING DEPARTMENT
                                                         PROPOSAL INVITATION




UNITED INDEPENDENT SCHOOL DISTRICT (“DISTRICT”) INVITES YOUR FIRM TO SUBMIT PROPOSALS FOR:


                                      Voluntary Group Dental Insurance

RFP NUMBER:                         016-2011

RFP MUST BE DELIVERED BY:           April 12, 2011 no later than 3:00 pm

RFP MUST BE DELIVERED TO:           UNITED INDEPENDENT SCHOOL DISTRICT
                                    SERVICE CENTER – PURCHASING DEPARTMENT
                                    3501 E. SAUNDERS
                                    LAREDO, TEXAS 78041

ADDITIONAL REQUIREMENTS
Proposals shall be submitted in triplicate.

ALL OR NONE PROPOSALS
This may or may not be an all or none proposal

F.O.B. DESTINATON
Bids/proposals must be submitted on a F.O.B. Destination Freight prepaid basis. All additional cost must be
quoted. Unit cost must include the cost of profit, freight, packaging, insurance overhead, etc. No additional
changes will be accepted. Possessions of goods will not pass to the DISTRICT until received at the DISTRICT’S
receiving dock.

QUALIFICATION OF PROPOSER
The DISTRICT may make such investigations as deemed necessary to determine the qualifications and / or ability of
the bidder to perform in accordance with the bid terms and conditions specified herein. The bidder shall furnish to
the DISTRICT all such information as the DISTRICT may request. The DISTRICT reserves the right to reject any bid if
the bidder fails to satisfy the DISTRICT that such bidder is properly qualified to carry out the obligations of the
contract.




                                                          Company Name:______________________________________
                                                          I have Read and agree to all terms on this page (initials):______
INSURANCE REQUIREMENTS
(Unless otherwise directed by DISTRICT, the following insurance provisions will apply)
Contractor will furnish a certificate(s) of insurance within 10 days after receipt of award notification. The DISTRICT
shall be included as an additional insured. The contractor will maintain the following type of coverage with the
required minimum limits with an insurance carrier authorized to do business in the State of Texas by the State
Board of Insurance and will be written by companies with A.M. Best ratings of A or better. Said certificate will
include a clause obligating the Insurer to give ten days prior written notice of any material change in the insurance
including cancellation. The following are the types of coverage and acceptable limits that will be maintained:

         A.       Worker’s Compensation:
                  State:                 As Per Statutory Provisions
                  Employer’s Liability:  $500,000

         B.       Comprehensive General Liability:
                  Bodily Injury:             $1,000,000 each occurrence
                                             $1,000,000 general aggregate
                  Property Damage:           $1,000,000 each occurrence
                                             $1,000,000 general aggregate
                  Products & Completed Operations:
                                             $1,000,000 general aggregate
                                             (To be maintained for a period of two years after Final Payment;
                                             Contractor shall continue to provide evidence of such coverage to
                                             Owner on an annual basis during this period)
                  Personal & Advertising Injury:
                                             $1,000,000 general aggregate
                  Medical Expenses:          $5,000 general aggregate


                  Property Damage Liability Insurance shall provide X, C, and U (Explosion, Collapse, Underground
                  Resources & Equipment) coverage.
                  Contractual Liability:     Property Damage shall be included in Comprehensive General Liability
                                             Coverage.
                  Personal Injury:           With Employment Exclusion deleted; shall be included in
                                             Comprehensive General Liability Coverage.
         C.       Commercial Automobile Liability
                  (Including owned or non-owned, hired, or any other vehicles):
                                             Combined Single Limit$1,000,000
         D.       Umbrella Excess Liability coverage shall be:

                                             $1,000,000 per project location
                                             $1,000,000 minimum aggregate
                                             $1,000,000 per $10,000,000 of project location value

In the event of loss of or damage beyond reasonable repair to DISTRICT’S property due to Contractor's (including
Contractor's employees, agents or subcontractors) negligence or intentional act, Contractor will, at DISTRICT’S
option, either: (1) promptly replace the property, or (2) promptly reimburse DISTRICT for the replacement costs of
the property. If Contractor proposes to exercise the former option, Contractor must provide to DISTRICT detailed
information about the replacement property and obtain DISTRICT’S consent before replacing the
property. However, DISTRICT reserves the right to replace the property at any time (and seek reimbursement
from Contractor) unless DISTRICT has consented to Contractor's replacement property.



                                                            Company Name:______________________________________
                                                            I have Read and agree to all terms on this page (initials):______
WARRANTY
Bidder must submit warranty information and service agreement information together with the bid. Failure to
provide such information may be cause for rejection of the bid.

EXPRESS WARRANTIES
Implies wear of merchantability and implied warranty of fittings for a particular purpose shall apply to all
purchases initiated by this document. The bidder shall assume all liabilities incurred within the scope of
consequential damages and incidental exposes as set faith in the uniform commercial code which result from
either delivery or use of product which does not meet specifications within this document. The warranty
conditions as stated herein shall approx. and shall not be nullified, voided or altered in any way by the inclusion of
the bidder pre-painted forms with this document.

TERM OF CONTRACT
This solicitation will initially be for a 12-month contract, and it may be extended in one (1) year increments by
mutual agreement of both parties for a maximum possible total of 48 months. There shall be no upward price
changes for the first year. Upward price changes (not to exceed 3%) for subsequent option years may be
negotiated, however upward price changes may be cause for the DISTRICT not to exercise an extension option.

DELIVERY DATE
The DISTRICT must have delivery within 30 days after awarding of contract. Delivery date will be a factor to
consider in determining bid award.

IDENTICAL PROPOSALS
In the event of tie bids, the DISTRICT, shall select by the casting of lots or coin toss.

CONTINUATION OF SERVICES
In the event, subsequent to the execution of a service contract with UISD, there is a change in the make up of the
provider's ownership and/or the person(s) substantially performing and providing services to UISD, as determined
by UISD, under the service contract is no longer a member or affiliated with the provider, UISD reserves the option
to continue the service contract with the new provider ownership or with the person(s) who substantially
performed and provided services to UISD, and in such case, the service contract will be modified accordingly.
Other provisions herein on assignment or subcontracting remain effective to the extent they do not conflict with
this Continuation of Services provision.

ASSIGNMENT
No right or interest or obligation in the contract shall be assigned or delegated without the written permission of
the DISTRICT. Any attempted assignment or delegation by proposer shall be wholly void and totally ineffective.

RIGHT OF AWARD
The DISTRICT reserves the right to award as may be in its best interest. The District may accept or reject any and
all options proposed. The DISTRICT may negotiate with the top proposers.

CONTRACT
The RFP specifications set out by the DISTRICT, the response to the RFP specifications by the awarded proposer(s),
and the written award notification will result in a binding contract without further action by either party. If
proposer requires that a specific contract be signed, that contract must be submitted as part of the response to
the RFP. Please note that in the event that any terms in proposer’s contract conflict with the RFP terms, the RFP
terms will supersede, and reference to RFP will be incorporated into the language of the executed contract.




                                                               Company Name:______________________________________
                                                               I have Read and agree to all terms on this page (initials):______
DETERMINING AWARDS
In conformance with Texas Education Code Section 44.031, in determining to whom to award a contract, the
DISTRICT shall consider:

1.   the purchase price;
2.   the reputation of the vendor and of the vendor’s goods or services;
3.   the quality of the vendor’s goods or services;
4.   the extent to which the goods or services meet the DISTRICT’s need;
5.   the vendor’s past relationship with the DISTRICT;
6.   the impact on the ability of the DISTRICT to comply with laws and rules relating to historically underutilized
     businesses;
7.   the total long-term cost to the DISTRICT to acquire the vendor’s goods or services; and
8.   any other relevant factor specifically listed in these specifications;

RIGHT TO HOLD PROPOSALS
The DISTRICT reserves the right to hold proposals for 90 days before awarding the contract.

PURCHASE OF ADDITIONAL UNITS
The bid is guaranteed to be firm for 90 days after award so those additional units may be purchased. If additional
quantities are still needed, the DISTRICT reserves the right to extend bid for an additional 90 days. On catalog and
price list discounts the bid/proposal is good for the contract period.

RIGHT TO INCREASE OR DECREASE QUANTITIES
The DISTRICT reserves the right to increase or decrease quantities subject to the availability of funds during the
period the bid/proposal is guaranteed to be firm.

RIGHT TO EXTEND RFP
The DISTRICT in accordance with the vendor may extend proposal on a monthly basis if needed.

AVAILABILITY OF FUNDS
All awards are subject to approval upon availability of funds. In the event funds do not become available, the
contract may be terminated with a written notice.

SALES TAX EXEMPTION
The DISTRICT qualifies for exemption of the Texas limited sales, exercise and use tax; sales tax will not be changed
on these purchases.

RIGHT TO REJECT PROPOSALS
The DISTRICT reserves the right to accept or reject any or all proposals or any part thereof and to waive any and all
minor informalities or technicalities in any part of the proposal not deemed to be in the best interest of the
DISTRICT.

REBATE
If a rebate is offered by the manufacturer of a proposal item(s) after proposal is awarded, the successful proposers
will advice the DISTRICT and deduct the rebate from the proposal price.

INSPECTION OF BID ITEM(S)
The bid item(s) will be inspected upon arrival. All defects will be repaired or replaced at the expense of the
successful proposer.




                                                           Company Name:______________________________________
                                                           I have Read and agree to all terms on this page (initials):______
SUBSTITUTIONS
Substitutions from the brand(s) proposed will not be accepted unless approved in writing by the Purchasing
Director. Samples of possible substitution items may be requested at that time.

TERMINATION FOR CAUSE
The DISTRICT shall have the right to cancel or default all or part of the undelivered portion of the order if the
contractor breaches any of the terms hereof, including warranties, if the contractor becomes insolvent or commits
acts of bankruptcy. Other factors shall include service performance.

TERMINATION WITHOUT CAUSE
The DISTRICT in accordance with this provision may terminate the performance under this order in whole or in
part. Termination hereunder shall be effected by the delivery to the contractor or a “Notice of Termination”
specifying the extent to which performance of work under the order in terminated and the date upon which such
termination becomes effective.

CERTIFICATION OF PAYMENT
Payment by the DISTRICT will be made within 30 days after the date on which the District receives the goods under
the contract or the date on which the performance of services under the contract was completed, or the date on
which the District received the invoice for the goods or services, whichever is later. This procedure is in
accordance with the District’s policy CHF Legal “Purchasing and Acquisition – Payment Procedures”.

FELONY CONVICTION NOTIFICATION
A person or business entity that enters into a contract with the DISTRICT shall notify the DISTRICT if the person or
an owner or operator of the business entity has been convicted of a felony. Such notice shall include a general
description of the conduct resulting in the conviction. Failure to provide such information may result in
termination of the contract. Vendors must complete and submit the “Felony Conviction Affidavit” included with
the Bid/Proposal form. Furthermore, District Policy CH Local states that “The District shall not consider for
contract approval a business whose owner or operator has a criminal record that includes a conviction, deferred
adjudication, plea of guilt, or no lo contendere for any felony offense”.

VENUE
It is understood and agreed by both the successful bidder and the DISTRICT that venue for any litigation from this
contract shall lie in Webb County, Texas.

SUBMISSION OF RFP
All bids/proposals, whether delivered by hand or mail, are due in sealed envelopes endorsed with RFP 016-2011
“Voluntary Group Dental Insurance” no later than 3:00 pm, Tuesday, April 12, 2011, at the DISTRICT’s Purchasing
Office located in the Service Center on 3501 E. Saunders, Laredo, Texas 78041. Responses sent by overnight mail
shall have Proposal number written on delivery ticket.

FACSIMILIES / E-MAILS
Proposals may not be faxed or e-mailed.

OPENING OF BIDS/RFP
Bids will be publicly opened at the Purchasing Department conference room, Service Center Building. Request for
Proposals (RFP) will only identify proposers.

PROPOSAL INTERPRETATION
No interpretation to the meaning of the “Invitation to Bid” or other documents will be given orally. Every request
will be in writing, addressed to the Purchasing Director, and must be received at least five days prior to the date
fixed for the opening of the bids. Any and all such interpretations and supplemental instructions will be in the
form of written addenda to the “Invitation to Bid”, which if issued, will be mailed to all known prospective of any
                                                           Company Name:______________________________________
                                                           I have Read and agree to all terms on this page (initials):______
bidder to receive any such addenda or interpretations shall not relieve such bidder from any obligation under his
bid as submitted. All addenda so issued shall become part of the contract document.

MODIFICATIONS OR WITHDRAWALS BEFORE PROPOSAL OPENING
Modifications or withdrawals of bids/proposals will be accepted only when the same is received on or before the
fixed time scheduled for opening. Such requests must be executed in writing, or withdrawn in person by the
bidder, or his/her authorized representative, provided his/her identity is made known and he/she signs a receipt
for the bid/proposal documents.

MODIFICATIONS OR WITHDRAWAL BY SUCCESSFUL PROPOSER
Modifications or withdrawal of a bid by the successful bidder will be accepted only if the change is the best
interest of the DISTRICT, not prejudicial to other bidders and executed in writing.

LATE PROPOSAL
All bids delivered will be stamped with the time and date as proof they were received on or before the requested
time and date. Bids received after the requested time and date will be considered late and returned unopened. If
a return address is not provided, a late bid will be opened for identification and returned.

PROPOSAL FORM
All proposals must be submitted on the proposal form furnished to insure uniformity, If there is a substitute
product that vendor would like to propose, in addition to the product referenced, please make a copy of the
proposal form and submit it with your original bid. Please provide response on this bid even if you do not wish to
participate, failure to send back proposal form may result in deleting that company’s name off our vendor list
records.

INDEMNIFICATION
Vendor shall fully indemnify, save and hold harmless the District, its officers, employees, and agents (hereinafter
“the Indemnities”) against any and all liability, damage, loss, claims, demands, and actions of any nature
whatsoever on account of personal injuries (including, without limitation on the foregoing, worker’s compensation
and death claims), or property loss or damage of any kind whatsoever, which arise out of or are in any manner
connected with, the performance of the contract, unless such injury, loss or damage is caused by the sole
negligence of indemnities. Vendor shall at its own expense investigate all such claims and demands, attend to
their settlement or other disposition, defend all actions based thereon and pay all charges of attorneys and all
other costs and expenses of any kind arising from any such liability, damage, loss, claims demands, and actions.

CONTACTING BOARD MEMBERS
Pursuant to United I.S.D. Board Policy CHE (LOCAL): Vendors or Board Members shall not contact (oral/written)
each other individually for the purpose of soliciting a purchase or contract or discussing an outstanding bid or
proposal that the vendor has submitted or will submit a bid or proposal between the time a request for proposal
or a bid is formally released and a recommendation is made by the administration to the Board. If a vendor or
Board member violates this prohibition during this time frame, consideration of the vendor for award shall be
invalidated. Board members shall be notified of possible violations and actions taken. All requests for proposal
and bid invitations shall include a copy of this policy.

CRIMINAL HISTORY BACK GROUND
                                      th
Senate Bill 9, passed during the 80 Legislative Session requires that all Texas public school districts receive
certification from any entity with which it contracts to provide services that it has obtained a criminal history
background check on all employees hired before January 1, 2008 who (1) have continuing duties related to
contracted services; and (2) have direct contact with students. Therefore, all entities and individuals who contract
with the District to perform services, must complete the attached UISD form “CERTIFICATION OF CRIMINAL
HISTORY RECORD INFORMATION”, which includes an information sheet related to the services to be performed


                                                           Company Name:______________________________________
                                                           I have Read and agree to all terms on this page (initials):______
and the duties related to those services that employees will be performing and the type of contact that those
employees might have with students

CONFLICT OF INTEREST (CIQ) FORM
According to Local Government Code, Chapter 176, a person or an agent of a person who contacts or seeks
contracts for the sale or purchase of property, goods, or services with United Independent School District (the
District) must file a complete Conflict of Interest Questionnaire with the Purchasing Department when submitting
to the District a response to a request for proposals or bids, correspondence, or another writing related to a
potential agreement with the District. This Conflict of Interest Questionnaire must be completed and returned with
the response to a request for proposals or bids. Failure to do so may result in disqualification of the response.

OTHER INFORMATION
For additional information, contact Mr. Hector Cavazos, Purchasing Manager, at (956) 473-7921. Proposal should
be mailed or delivered to:

                                      United Independent School District
                             C/O Ms. Cordelia Flores Jackson, Director of Purchasing
                                                3501 E. Saunders
                                                Laredo, TX 78041




                                                          Company Name:______________________________________
                                                          I have Read and agree to all terms on this page (initials):______
                                                   SPECIFICATIONS
                                           Voluntary Group Dental Insurance
                                                     RFP 016-2011

GENERAL REQUIREMENTS AND INSTRUCTIONS
A. Information

    1.     The information contained in these specifications is confidential and is to be used only in connection with
           preparing a proposal for the following employee benefit plan:

                                                Voluntary Group Dental Insurance

    2.     United ISD reserves the right to accept or reject all or any part of the proposals, waive minor
           technicalities, and award the proposal to best serve the interest of the District. The District also reserves
           the right to waive or dispense with any of the formalities contained herein.

    3.     Proposals are to be submitted on the basis of the specifications contained herein. Alternate proposals will
           also be considered, provided the alternatives are clearly explained. All deviations from the specifications
           must be clearly identified and explained.

    4.     The information contained herein is believed to be accurate and up-to-date, but is not intended to be an
           express or implied warranty.

    5.     No telephone, electronic, or fax proposals will be accepted. Proposals may only be accepted if delivered
           by U.S. Postal Service, Federal Express, UPS, etc. Hand delivery of proposals is recommended. The
           District will not be responsible for missing, lost, or late mail. Any proposals received after the time set for
           opening will be returned to the proposer unopened.

    6.     Vendors are cordially invited to the proposal opening, but are not required to attend.

B. Legal

All parties submitting proposals are expected to comply with federal, state and local insurance laws and
regulations relative to the preparation and submission of insurance proposals. Specifically, the services to be
provided are expected to be in compliance with the Americans with Disabilities Act (ADA), Family Medical Leave
Act (FMLA), Health Insurance Portability and Accountability Act (HIPAA), insurance laws and insurance regulations.
All proposals that are submitted will be presumed to be in compliance with all applicable laws

C. Communication

    1.     Proposals are to be sealed in an envelope clearly labeled “Proposal – Voluntary Group Dental Insurance
           RFP Number: 016-2011”. Proposals are to be prepared in triplicate and submitted as specified on page 10.

    2.     Requests for information, written or otherwise shall be directed to:
           Mr. Cesar Vasquez, United Independent School District Risk Management Benefits Officer at
           cvasquez@uisd.net, Office (956) 473-6416, Fax: (956) 473-6497.
           With carbon copy to:
           Ms. Dolores Schandua, United Independent School District Purchasing Office Procurement Officer at
           dschandua@uisd.net, Office (956) 473-7921, Fax: (956) 473-7950



                                                               Company Name:______________________________________
                                                               I have Read and agree to all terms on this page (initials):______
    3.   Copies of all correspondence relevant to this assignment will be distributed to all interested participants.

D. Time Frame

    1.   The specifications will be available to interested parties on or after 8:30 A.M. March 28, 2011 at the
         United ISD, Purchasing Office, 3501 E. Saunders, Laredo, Texas 78041.
    2.   Proposals must be delivered to United ISD, Purchasing Office no later than 3:00 P.M., Tuesday,. April 12,
         2011 in sealed envelopes, clearly marked:
                               “Proposal – Voluntary Group Dental Insurance RFP #016-2011”

    3.   The sealed envelopes will be opened in public at 3:00 P.M. on Tuesday, April 12, 2011. The envelopes
         shall be opened in a manner to avoid disclosure of contents to competing vendors and the contents shall
         be kept confidential during the process of proposal negotiations.

    4.   Proposal clarification and negotiations with selected dental insurance providers on or about Tuesday,
         April 5, 2011.

    5.   The parties submitting the selected proposal will be notified on or about June 1, 2011 of the District’s
         decision.

    6.   Contract effective date for the Group Dental Insurance Plan will be September 1, 2011.

    7.   Open enrollment meetings will be conducted during the period August 1-31, 2011.

E. Proposals

1        Proposals must be clearly explained and identified. All costs, including optional programs, must be clearly
stated and summarized.

2       Exceptions to or deviations from the specifications must be explicitly identified. Proposals are to be
prepared in triplicate.

3       Each party submitting a proposal is asked to screen their designated proposals for correctness and
compliance with the specifications.

4      Requests for interpretation of the specifications will be provided by Cesar Vasquez. All such responses will
be made in writing. Oral explanations will not be binding.

5        The amount of agent’s commission and service work to be provided by the agent is to be included as part
of the submitted proposal.

6       The contents of the proposals shall be kept confidential during the process of negotiations. After the
insurance contracts are awarded, all proposals will be available for public inspection. Any trade secrets and
confidential information shall be so labeled to avoid public disclosure of such information.

F. Disqualification and Rejection of Proposals

Failure to comply with the requirements or the procedures set forth herein, or to satisfy the insurance and
servicing criteria as set forth in the specifications, may result in disqualification. It is not intended that exceptions
to the specifications will, in and of themselves, result in disqualification.


                                                             Company Name:______________________________________
                                                             I have Read and agree to all terms on this page (initials):______
G. Selection Criteria

United ISD reserves the right to reject any or all of the proposals, in whole or in parts; to waive any informality in
any proposal, and to accept the proposal which, in its discretion, is in the best interest of the District. Proposals
will be carefully evaluated for cost effectiveness, for coverage provisions, and for compliance with the coverage
and servicing criteria contained in the specifications. The contract will be awarded to the responsible vendor who
submits a superior but economical proposal based on the relative importance of the following selection criteria:

                                        A.   Coverage
                                        B.   Cost
                                        C.   Service
                                        D.   Professional/Financial

H. Terms of Contracts

United ISD is seeking a four year contract with the option to terminate the contract during the term of the
contract or at the end of each anniversary date on one of the following basis:

    A. Fixed price for the four year period, or
    B. Three annual renewal adjustments determined by formula at the time the contract is awarded, or
    C. One year contract with three annual renewal options for rate and premiums deemed to be
       favorable to the District. Renewal rates are to be provided to District by June 1 (90 days prior to
       anniversary date).

United ISD reserves the right to terminate the contract at the expiration of each budget period ending on
August 31 of each calendar year.

The contract must contain a 90 day notice of cancellation clause (except for non-payment) and a 90 day
notice of non-renewal or material change of contract language.

I. Authorized Signature

All proposal forms must be signed by persons who have legal authority to bind the insurer and administrator to
the services that are proposed.

J. Continuity of Coverage

All participants covered by the current plan are to receive immediate coverage under the new plan. Continuity of
Coverage for current participants is to be on a “no loss-no gain” basis for all insurance coverages.

K. Enrollment

Each selected Provider will be expected to provide knowledgeable licensed agents to explain benefit provisions for
enrollment meetings during the time specified. The selected Providers will also be responsible for providing
enrollment materials prior to the employee benefit enrollment meetings. A tentative schedule of campus
enrollment meetings shall be provided to the Business Office/Payroll Department prior to enrollment.




                                                            Company Name:______________________________________
                                                            I have Read and agree to all terms on this page (initials):______
                                          Hold Harmless Agreement
                                     Voluntary Payroll Deduction Insurance

The United ISD (The District) requests that the Voluntary Payroll Deduction Insurance Company (The Company)
execute a Hold Harmless Agreement that will include the following provisions:

   1.   The Company, its agents and representatives shall comply with all pertinent written directives and
        reasonable request of the District regarding the solicitation of employees and the purchase of Voluntary
        Payroll Deduction Insurance.

   2.   The Company shall indemnify and hold harmless the School Board, the District, its administrators and
        employees, from every claim and demand, excluding those based upon negligence or act of the School
        Board, the District, its administrators, employees, agents and representatives, which may be made by
        reason of the negligence of the Company or its officers, directors, employees, agents or representatives
        resulting in the purchase of Voluntary Payroll Deduction Insurance by the District through the Company.

   3.   The Company, at its own expense, shall defend any legal proceedings that may be brought against the
        School Board, the District, its administrators and employees, regarding any claim or demand for which the
        Company is required hereunder to indemnify the School Board, the District, its administrators and
        employees and shall satisfy any judgment that may be rendered against any of them by reason of the
        purchase of Voluntary Payroll Deduction Insurance by the District through the Company. The District shall
        promptly notify the Company by Registered or Certified Mail upon the receipt of any such claim or
        demand.

   4.   The District reserves the right, upon sixty (60) days written notice to the District, by Registered or
        Certified Mail, to terminate this Agreement but such termination shall in no manner affect any liability of
        the Company incurred prior to such termination.

   5.   The Indemnification / Hold Harmless agreement on the next page must be completed and submitted
        along with the proposal.




                                                          Company Name:______________________________________
                                                          I have Read and agree to all terms on this page (initials):______
                                INDEMNIFICATION/HOLD HARMLESS AGREEMENT


This Indemnification/Hold Harmless Agreement made and entered to be effective as of the first day of September,
2011 (the “Effective Date”) by and between (INSURANCE COMPANY) with principal offices at _______________
(State)_______________and (INSURANCE AGENT), with principal offices at ______________, (State) _________
and United Independent School District, with a principal office at 201 Lindenwood, Laredo, Texas, 78045
("DISTRICT") for group dental insurance services.

      WHEREAS, (INSURANCE COMPANY) has been selected to provide group dental insurance services to District
      employees by the DISTRICT’s Board of Trustees;


      WHEREAS, (INSURANCE AGENT) has been selected as the agent in connection with the group dental
      insurance services to be provided by (INSURANCE COMPANY) to the DISTRICT’s employees;


      WHEREAS, in consideration of the selection of (INSURANCE COMPANY and AGENT) as the DISTRICT’s
      exclusive providers of group dental insurance services, (INSURANCE COMPANY AND AGENT) agree as
      follows:

Indemnification: (INSURANCE COMPANY and AGENT) agree to indemnify and hold harmless the DISTRICT and its
employees, trustees, and agents from any and all losses, costs, or expenses, including attorney’s fees, lawsuits,
actions, personal injury claims, or other claims or liability of any character or type incurred by the DISTRICT or its
trustees, employees, or agents as a result of the execution of the Agreement dated _________, 2011, between
(INSURANCE COMPANY and AGENT) and DISTRICT or the performance of the services to be provided by
(INSURANCE COMPANY and AGENT) to the DISTRICT employees, or as a result of the negligence or misconduct of
(INSURANCE COMPANY and AGENT) or any of its employees, agents, or officers. The terms of this provision shall
survive termination of this Agreement for any claims that occur within the time period of the INSURANCE
COMPANY or AGENT’s services to the DISTRICT.

Term and Termination. The parties agree that the term of this Agreement shall be coterminous with the
Agreement between the DISTRICT and (INSURANCE COMPANY and AGENT) executed on _________________,
2011.




                                                            Company Name:______________________________________
                                                            I have Read and agree to all terms on this page (initials):______
                     INDEMNIFICATION/HOLD HARMLESS AGREEMENT



IN WITNESS WHEREOF, the parties have executed this Agreement to be effective as of the Effective Date first
above written.


(INSURANCE COMPANY)

 By:


 Name:


 Title:



(INSURANCE AGENT)

 By:


 Name:


 Title:



UNITED INDEPENDENT SCHOOL DISTRICT

 By:


 Name:


 Title:




                                                      Company Name:______________________________________
                                                      I have Read and agree to all terms on this page (initials):______
RFP ASSUMPTIONS:

   1.   Proposal is to be based on benefits as described in Background and Exhibit section of RFP
        specifications.

   2.   District does not contribute to the cost of the dental insurance plan. However, dental insurance
        premiums will be eligible under the District’s IRC Section 125 Cafeteria Plan.

   3.   The District desires to receive proposals for a four year period on one of the following basis:

            a.   Fixed price for the four year period, or

            b.   Three annual renewal adjustments determined by formula at the time the contract is awarded,
                 or

            c.   One year contract with three annual renewal options for rate and premiums deemed to be
                 favorable to the District. Renewal rates are to be provided to District by June 1 (90 days prior to
                 anniversary date).

   4.   The District will sponsor only one company for voluntary group dental insurance.

   5.   Sponsorship by the District will include payroll enclosure educational material.

   6.   Group employee education meetings may be allowed prior to or following the scheduled school day, at
        the discretion of the building supervisor. These meetings should not exceed 20 minutes.

   7.   At completion of enrollment, the District is to be provided with a master payroll deduction list that
        includes age, benefit amount and premium for both employee and dependent, if applicable. Two lists are
        to be provided; one for biweekly employees and one for monthly employees.

   8.   All employees are to have the opportunity to enroll in the District sponsored voluntary group dental
        insurance plan during an open enrollment period on a guarantee issue basis.

   9.   Effective date is to be September 1, 2011. All participants enrolled in the group dental insurance program
        are to be covered on a “no loss/no gain basis”, including employees on leave of absence and COBRA
        participants.




                                                            Company Name:______________________________________
                                                            I have Read and agree to all terms on this page (initials):______
QUESTIONS:

1.   Describe organization submitting proposal.

        a.    Dental Provider Name:

       b.     Address:

        c.    Contact Person:

       d.     Telephone Number:

       e.     Email Address:

        f.    Year Founded (Insurance Company):


2.   Describe Financial Stability of Dental Provider:

        a.    Insurance Company:           Yes           No              A.M. Best Rating/Size:

       b.     Risk Pool:                   Yes           No              Financial Information:        Yes                No

        c.    Is Dental Provider authorized to do business in Texas?     Yes               No


3.   Provide three (3) Texas client references (preferably school districts):

                                                                                                      Number of
        Name of Client                Contact Person             Telephone Number                     Employees




4.   Describe Claim Payment Services:

      a.     Where will claims be paid?




                                                            Company Name:______________________________________
                                                            I have Read and agree to all terms on this page (initials):______
          b.    For telephone inquiries on status of claim:
                     Can insured speak directly to claim examiner?                                         Yes               No

                     Is a toll free telephone number available for checking status of claim?               Yes               No

                     If yes, what are the hours of operation?

          c.    What is the normal claim processing time?

          d.    What is the company standard for claim processing time?

          e.    Describe the appeal process:

                1.   May a claim appeal be handled by telephone?                                           Yes               No
                        If yes, please describe:




                2.   Describe your written claim appeal procedures:




                3.   What is the maximum allowable time for insured to submit a claim appeal?




                4.   What is the normal response time for a claim appeal?

          f.    Do you allow services by Mexican dentists?
                        If yes, please describe reimbursement procedure:




          g.    Reasonable & Customary (R&C) allowance:

                1.   Describe basis for determining R&C?:




                2.   What is the R&C percentile used in quoted rates?




5.   If proposal includes a dental network, provide the following information in Excel format:

         1.    List of Laredo dentists in-network, with specialty.
         2.    List of San Antonio dentists in-network, with specialty.
         3.    List of Corpus Christi dentists in-network, with specialty.

                                                             Company Name:______________________________________
                                                             I have Read and agree to all terms on this page (initials):______
6.   For participants currently enrolled in dental insurance plan:

          Will credit be given for length of time in dental plan for satisfying benefit waiting period?                Yes

                Comment:                                                                                               No




7.   Provide R&C Allowance used in quoted rates for zip codes 78040, 78041, 78043, 78044, 78045 and 78046
     for the following ADA Codes:

                       ADA
                       Code                   Description                      R&C Allowance
                       0120      Periodic Exam
                       0210      Intraoral X-rays
                       0272      Bitewing X-rays
                       1110      Prophylaxis (Cleaning) Adult
                       1203      Fluoride Treatment-Child
                       1351      Sealant per tooth
                       2150      Amalgam-two surfaces, permanent
                       2331      Resin Compos-Two Surfaces
                       2790      Crown-full cast precious metal
                       2950      Core build-up, including any pins
                       3320      Root Canal, bicuspid
                       4341      Periodontal Scaling
                       4910      Periodontal Maintenance
                       6240      Pontic-Porcelain
                       7230      Removal Impacted Tooth
                       9220      Sedation General Anesthesia


8.   Describe basis for determining premium rate:

     a.    Explain procedure for establishment of incurred but not reported (IBNR) claims, first year and thereafter.




                                                              Company Name:______________________________________
                                                              I have Read and agree to all terms on this page (initials):______
      b.   What trend factors have you used in your dental proposal?

                   Utilization                        Inflation                                    Total




      c.   How do you calculate trend adjustments-mid-point or effective date?

      d.   Describe your renewal rating formula in detail, including deficit recovery:




9.    Please describe rate guarantee:

      a.   For what period of time are rates guaranteed?

      b.   Is a longer rate guarantee available?                  Yes             No

                If so, please describe:


10.   Agent Information: Proposal may be submitted direct or through agent appointed by the insurance company.
      The District prefers the insurance company to submit one proposal through the agent selected by the insurance
      company. Please provide the following information for the agent selected by the insurance company. However,
      if multiple agents are used, please provide the following information for each agent.

           a.    Estimated amount of annual commission:

           b.    Copy of agent's E&O Insurance Certificate, with minimum of $1,000,000.

           c.    Copy of agent's insurance license.

           d.    Name/Mailing address of agent:




           e.    Agent's relationship with insurance company (length of time, number of groups, amount of premium):




                                                             Company Name:______________________________________
                                                             I have Read and agree to all terms on this page (initials):______
f.   Agent client references (prefer government entities):




g.   Agent services to be provided:




h.   Agent experience in Dental insurance industry:




                                                      Company Name:______________________________________
                                                      I have Read and agree to all terms on this page (initials):______
                                 United Independent School District
                                     Voluntary Dental Insurance

                          Total Number of Participants 1/4/2011 = 2949

Total/Age
 140
                                                 Sum of Male                Sum of Female
                                                 Sum of Count
 120


 100


  80


  60


  40


  20


   0
       21 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 75 80
                                                Age


                                   Total Participation
                                                                              2949

                      2268




                                                681




                    Female Cnt                Male Cnt                        Total




                                                   Company Name:______________________________________
                                                   I have Read and agree to all terms on this page (initials):______
         Employee Only - Low Plan
                                                  409


   307




                    102




Female Cnt        Male Cnt                     Sub-Total




      Employee/Family - Low Plan
                                                 1176


   855




                    321




Female Cnt        Male Cnt                     Sub-Total




                      Company Name:______________________________________
                      I have Read and agree to all terms on this page (initials):______
         Employee Only - High Plan
                                                   149


   114




                     35




Female Cnt         Male Cnt                     Sub-Total




      Employee Family - High Plan
                                                  1215

   992




                     223



Female Cnt         Male Cnt                     Sub-Total




                       Company Name:______________________________________
                       I have Read and agree to all terms on this page (initials):______
United Independent School District
    Voluntary Dental Insurance
Summary of Enrollment by Zip Code
         March 21, 2011

       Zip Code      Total
        76131          1
        77058          1
        78014          2
        78016          1
        78019          1
        78040         233
        78041         673
        78042          5
        78043         351
        78044         18
        78045        1097
        78046         517
        78052          1
        78067          1
        78076          3
        78207          1
        78209          1
        78223          1
        78254          1
        78344          2
        78355          1
        78361          6
        78369          2
        78504          1
        78547          1
        78620          1
        78801          1
        78845          1

                                       *Not including COBRA participants




                  Company Name:______________________________________
                  I have Read and agree to all terms on this page (initials):______
                                Voluntary Dental Participants
                             FMLA and Temporary Disability Leave

Control #      DOB        Gender   Start Date    End Date        Plan             Notes
2011-001      9/19/1978     F         3/1/2011    6/1/2011       E/O LOW
2011-002     10/22/1976     F        3/10/2011    6/3/2011       E/F LOW
2011-003      5/29/1976     F        3/21/2011    6/2/2011       E/O HIGH
2011-004      8/12/1970     F        8/31/2010   3/30/2011       E/O HIGH
2011-005      8/10/1981     F        1/16/2011   5/15/2011       E/F HIGH         Temporary Disability
2011-006      5/25/1965     F         2/3/2011   5/11/2011       E/F HIGH
2011-007     10/12/1950     M        3/11/2011   6/13/2011       E/F HIGH
2011-008      5/23/1980     F        1/11/2011   4/13/2011       E/F HIGH
2011-009      7/13/1977     F        2/14/2011   5/17/2011       E/O HIGH
2011-010      6/29/1977     F         3/9/2011    6/3/2011       E/F HIGH
2011-011     12/27/1979     F        1/11/2011   4/11/2011       E/O LOW
2011-012      7/18/1964     F        3/21/2011    6/3/2011       E/F HIGH
2011-013      5/25/1967     F        2/25/2011   5/31/2011       E/F HIGH
2011-014       9/2/1975     F        1/20/2011   4/25/2011       E/O LOW
2011-015      12/6/1976     F       11/11/2010   5/15/2011       E/F HIGH
2011-016     12/16/1972     F        1/20/2011   4/26/2011       E/F HIGH
2011-017      12/1/1974     M         3/9/2011   4/18/2011       E/F HIGH
2011-018       3/3/1967     F        2/14/2011   5/18/2011       E/O HIGH
2011-019       6/9/1975     F        2/21/2001   5/13/2011       E/F HIGH
2011-020      4/14/1972     F         4/4/2011   8/31/2011       E/F HIGH
2011-021      4/23/1984     F         3/8/2011    6/3/2011       E/F LOW
2011-022      6/24/1964     F         3/3/2011    6/3/2011       E/F HIGH
2011-023       2/6/1955     F        3/21/2011   8/26/2011       E/F HIGH
2011-024       7/3/1969     F        3/24/2011   6/20/2011       E/O HIGH
2011-025      11/7/1971     F         1/4/2011    4/4/2011       E/O HIGH
2011-026      5/18/1988     M        2/23/2011   5/26/2011       E/O LOW
2011-027      9/23/1971     F         3/7/2011    6/3/2011       E/O HIGH
2011-028      1/13/1974     F         3/1/2011   5/11/2011       E/F HIGH
2011-029      9/23/1980     F         2/7/2011   5/18/2011       E/O HIGH
2011-030     12/16/1979     F        4/27/2011    6/3/2011       E/O HIGH
2011-031      6/10/1954     F         3/2/2011    6/3/2011       E/O HIGH
2011-032      10/4/1960     F        2/25/2011   5/27/2011       E/F HIGH
2011-033     12/23/1945     F         3/4/2011    6/3/2011       E/O LOW
2011-034      8/22/1979     F        3/28/2011    6/2/2011       E/O HIGH
2011-035      6/23/1971     F        3/23/2011   8/26/2011       E/O HIGH

*As of March 11, 2011




                                                 Company Name:______________________________________
                                                 I have Read and agree to all terms on this page (initials):______
                             Voluntary Dental Participants
                                        COBRA


Control #          DOB           Gender           Plan            COBRA End Date
C2011-001       12/24/1944          F           E/F HIGH               November-11
C2011-002         9/1/1939          F           E/O HIGH                  June-11
C2011-003         3/1/1967          F           E/F HIGH               December-11
C2011-004        4/26/1942          F           E/O HIGH               December-11
C2011-005       11/17/1952          F           E/F HIGH               November-11
C2011-006       10/11/1971          F           E/O LOW                   May-11
C2011-007        3/20/1950          F           E/F HIGH               November-11
C2011-008         9/6/1985          F           E/O HIGH               November-11
C2011-009        6/26/1950          F           E/F HIGH               November-11
C2011-010        1/20/1978          F           E/F HIGH               December-11
C2011-011        2/17/1947          F           E/O HIGH               November-11
C2011-012        2/25/1958          F           E/O HIGH               November-11
C2011-013        5/30/1980          F           E/F HIGH               February-12
C2011-014       12/31/1980          F           E/O HIGH                  July-12
C2011-015        5/27/1949          F           E/F HIGH               November-11
C2011-016         7/4/1954          F           E/O HIGH                January-12
C2011-017        9/30/1963          F           E/F HIGH                  July-12
C2011-018        6/14/1975          M           E/O LOW                   May-11

*As of March 11, 2011




                                                    Company Name:______________________________________
                                                    I have Read and agree to all terms on this page (initials):______
PREMIUM QUOTE:
Attach schedule of rates, with complete description of benefits, exclusions, take-over provisions and rate
guarantee.




 Company Name                                              Authorized Signature



 Address                                                   Typed Signatory's Name & Title



                                                           Telephone/Fax Number



 Agent Name                                                Signatory's Email Address



 Agent Address                                             Date




                                                      Company Name:______________________________________
                                                      I have Read and agree to all terms on this page (initials):______
                             PROPOSAL VARIATION STATEMENT

I certify that all specified coverage and services will be provided except as indicated below. If
needed, please add separate sheet(s) to explain reasons why your proposal differs from criteria
outlined in the specifications.




 Company Name                                              Authorized Signature



 Address                                                   Typed Signatory's Name & Title



                                                           Date




                                                     Company Name:______________________________________
                                                     I have Read and agree to all terms on this page (initials):______
ALL BIDS MUST BE F.O.B. DESTINATION.

DELIVERY INFORMATION
Bid item(s) will be delivered within ___________ days after the purchase order is issued.

WARRANTY INFORMATION
Length of Warranty on parts _________________
Length of Warranty on Labor ________________

COMPANY INFORMATION
Company has been in business _______________years
Companies tax identification # ________________________
Number of Employees            ________________________

REFERENCE INFORMATION
Please provide at least five (5) references for similar services/equipment provided. Please print information
clearly. Incomplete references will not be considered and may affect your proposal status.

Contact Person/           Phone                      Description of service/equipment provided
Organization


_______________           _______________            ______________________________________



_______________           _______________            ______________________________________



_______________           _______________            ______________________________________



_______________           _______________            ______________________________________



_______________           _______________            ______________________________________




ACKNOWLEDGMENT OF RECEIPT OF ADDENDUM (If applicable)
Addendum no.: ___________________ Date: ___________________
Addendum no.: ___________________ Date: ___________________




                                                           Company Name:______________________________________
                                                           I have Read and agree to all terms on this page (initials):______
NON-COLLUSION STATEMENT & SIGNATURE
The undersigned affirms that he/she is duly authorized to execute this contract, that this company, corporation,
firm, partnership or individual has not prepared this proposal in collusion with any other Proposer, and that the
contents of this proposal as to prices, terms or conditions of said proposal 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 proposal. I also affirm that have not given, offered to give, do not intend to give at any time.
Hereinafter any economic opportunity, future employment, gift, loan, gratuity, specified discount, trip, favor, or
service to a private service in connection with this contract.
Further, I affirm that after the opening of this proposal, I (or any representative of my company) will not discuss
the contents of this proposal with any person affiliated with UNITED ISD, other than the Purchasing Director of his
Designee, prior to the awarding of this bid/proposal.
I understand that failure to observe this procedure will cause my proposal to be rejected.

I fully understand the terms and conditions and will fully execute them if I am awarded this proposal.

I have represented the truth concerning the felony conviction notification.

I fully understand the proposal specifications.

COMPANY _____________________________________________

ADDRESS ______________________________________________

CITY, STATE, ZIP CODE _________________________________

AREA CODE / TELEPHONE ______________________________

AREA CODE / FAX______________________________

E-MAIL ADDRESS______________________________

COMPANY WEBSITE ___________________________

____________________________
COMPANY OFFICIAL

____________________________                 _______________________             ____________ SIGNATURE
TITLE                     DATE




                                                           Company Name:______________________________________
                                                           I have Read and agree to all terms on this page (initials):______
                                      UNITED INDEPENDENT SCHOOL DISTRICT

                                         FELONY CONVICTION NOTIFICATION

                            To Be Submitted With Bid / Proposal / Statement / Quote


 Texas Education Agency Code, Section 44.034, Notification of Criminal History, Subsection (a), 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

 District Policy CH Local states that “The District shall not consider for contract approval a business whose owner or
 operator has a criminal record that includes a conviction, deferred adjudication, plea of guilt, or nolo contendere for any
 felony offense”.


Please check off one box and sign the form in the appropriate space(s):

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 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 nor operated by anyone who has been convicted of a felony.

       Signature of Company Official: ______________________________________________________________


         C. My firm is owned and operated by the following individual(s) who has/have been convicted of a felony:


       Name of Felon(s): ________________________________________________________________________

       Details of Conviction(s):
       ________________________________________________________________________________

       ________________________________________________________________________________

       Signature of Company Official: ______________________________________________________________



                                                                  Company Name:______________________________________
                                                                  I have Read and agree to all terms on this page (initials):______
                                              PROPOSER’S CHECKLIST

1.     Has one (1) original and one (1) copy of the proposal been submitted with your response?
       YES ____ NO ____
2.     Have all specification been reviewed and deviations listed on company letterhead? (If applicable)
       YES________ NO_________
3.     Is all the pricing information filled out?
       YES_______ NO________
4.     Are the performance and payment bonds included with proposal? (If applicable)
       YES_______ NO________ N/A ________
5.     Are two copies of catalog/price list enclosed? (If applicable)
       YES_______ NO________
6.     Has the certificate of non-collusion been signed?
       YES _____ NO _____
7.     Has the Felony Conviction Notification been filled out and signed?
       YES____ NO _______
8.     Has the Conflict of Interest Questionnaire (CIQ –Form) been filled out and signed?
       YES____ NO _______
9.     Has the W-9 form been filled out and signed?
       YES____ NO _______
10.    Has the Residency Certification form been filled out and signed?
       YES____ NO _______
11.    Has the Certification of Criminal History Record Information form been filled out and signed?
       YES____ NO _______
12.    Has the Vendor Acknowledgement form been filled out and signed?
       YES____ NO _______
13.    Is a self-addressed, stamped envelope enclosed for the bid results? (Optional)
       YES _____ NO ______
14.    Have all envelopes, packages or boxes labeled with the RFP #?
       YES_____     NO_____



THIS SHEET DOES NOT HAVE TO BE RETURNED WITH THIS PROPOSAL. IT SERVES AS A CHECKLIST FOR YOU.




                                                           Company Name:______________________________________
                                                           I have Read and agree to all terms on this page (initials):______
                                              NO RESPONSE FORM

                                    UNITED INDEPENDENT SCHOOL DISTRICT

                                 PLEASE COMPLETE AND RETURN IF APPLICABLE

The United Independent School DISTRICT (UISD) is interested in the reasons why you did not respond to our
invitation to propose. Please fill out the information requested and return this form to the UISD Purchasing
Department at the address below:

                                                  United I.S.D.
                                             Purchasing Department
                                           Voluntary Dental Insurance
                                                   016-2011
                                                3501 E. Saunders
                                              Laredo, Texas 78041

Reasons for No Response (please mark all those that apply to your circumstance)

___Could not meet specification requirements
___Do not supply this material or service
___Could not meet delivery requirements
___Did not have time to prepare a bid
___Cannot take additional jobs due to present workload
___Could not be price-competitive
___Other-please explain: _____________________________________________________________
___I want to remain on the mailing list for this item or service.
___I do not want to remain on the mailing list for this item or service.
___Could not bid due to illness
___Could not set price with manufacturer
___Could not meet insurance requirements
___Could not meet bonding requirements
___Job is too big




                                                          Company Name:______________________________________
                                                          I have Read and agree to all terms on this page (initials):______
                                                     CERTIFICATION SHEET
                      In order for a proposal to be considered, the following information must be provided.
                                   FAILURE TO COMPLETE MAY RESULT IN DISQUALIFICATION

        Company Name _________________________________________________________________________________

        Mailing address__________________________________________________________________________________

        City _______________________________State____________________ Zip Code____________________________

        Telephone_____________________________________ Fax _____________________________________________

        Email address ___________________________________________________________________________________

        In business under present name      ___________ years and ___________ months

                                         COMPLETE THE APPROPRIATE SECTION BELOW:

                                                      RESIDENT BIDDER

"Resident bidder" refers to a person whose principal place of business is in this state, including a contractor
whose ultimate parent company or majority owner has its principal place of business in this state.

I CERTIFY THAT MY COMPANY IS A "RESIDENT BIDDER":

MR. MRS. MS. ___________________________________________________________________________________________
(Circle One)                                  NAME (PLEASE PRINT)

POSITION ________________________________________________________________________________________________

SIGNATURE ______________________________________________DATE ___________________________________________


                                                                 OR

                                                    NONRESIDENT BIDDER

"Nonresident bidder" refers to a person who is not a resident.

IF YOU QUALIFY AS A "nonresident bidder", you must furnish the following information:
What is your resident state? (The state your principal place of business is located.) ____________________________________

Does your "residence state" require bidders whose principal place of business is in Texas to under bid vendors whose
residence state is the same as yours by a prescribed amount or percentage to receive a comparable contract? "Residence
state" means the state in which the principal place of business is located.

YES _______       NO _______ If “YES”, What is that amount or percentage?           _____________ %

I CERTIFY THAT MY COMPANY IS A “NONRESIDENT BIDDER” AND THE ABOVE INFORMATION IS TRUE AND CORRECT:

MR. MRS. MS. ___________________________________________________________________________________________
(Circle One)                                  NAME (PLEASE PRINT)

POSITION ________________________________________________________________________________________________

SIGNATURE ___________________________________________________ DATE ___________________________________



                                                                  Company Name:______________________________________
                                                                  I have Read and agree to all terms on this page (initials):______
                        United Independent School District
                   Certification of Criminal History Record Information

SB 9, passed during the 80th Legislative Session, requires that all Texas public school districts
receive certification from any entity with which it contracts to provide services that it has
obtained a criminal history background check on all employees hired before January 1, 2008
who (1) have continuing duties related to contracted services; and (2) have direct contact with
students.
The required criminal history record information can be obtained from either of the following:
                            A law enforcement or criminal justice agency
 A private entity that is a consumer reporting agency governed by the Fair Credit Reporting Act
                                  (15 U.S.C. Section 1681 et seq.)

Although state law provides guidance as to which employees must have a criminal background
check, there is no specific definition or description as to what equals an employee who (1) has
continuing duties related to contracted services; and (2) has direct contact with students.* The
law states that the Commissioner of Education may adopt rules necessary to implement this
requirement; however, at this time none have been adopted. Therefore, all entities and
individuals who contract with the District to perform services, must complete the attached UISD
Form “Certification of Criminal History Record Information, that includes an information sheet
related to the services to be performed and the duties related to those services that employees
will be performing and the type of contact that those employees might have with students.

        Employees who are hired by an entity that contracts with a school district after January 1,
         2008 must submit to a national criminal history record information review which may
         include fingerprints and photographs before serving in the capacity described.
The school district may not allow any employee of the entity or an individual to serve at the
district if information is obtained through this review that the employee has been convicted of
one of the following:

(1) A Title 5 felony offense
(2) An offense requiring the individual to register as a sex offender
(3) An offense under the laws of another state or federal law that is equivalent to a Title 5 felony
in the state of Texas or that would require registration in the Texas sex offender databank.

At any time, a school district administrator, including a campus principal or designee, may
request copies of the actual criminal background check or national criminal history record
information review which may include fingerprints and photographs from the entity or individual
who has contracted with the school district or may obtain from any law enforcement or criminal
justice agency all criminal history record information that relates to an individual described
above.




                                                   Company Name:______________________________________
                                                   I have Read and agree to all terms on this page (initials):______
                                                                              UNITED INDEPENDENT SCHOOL DISTRICT
                                                     CERTIFICATION OF CRIMINAL HISTORY RECORD INFORMATON
            Please complete this form and attach it to your proposal packet response


            Vendor: ________________________________________________________
                                                                          Name
                               ________________________________________________________
                                                             Address / City / State / Zip Code

            RFP/CSP/RFCQ/BID Number: ___________________________________________________________
            Answer Y for Yes or N for No:
                 □           Will employees, including yourself, have continuing duties related to the proposal
                             named above?
            Until it receives further guidance, the District considers “continuing duties” to mean
            repetitive work duties rather than a one time appearance or engagement.
Section 1




                 □           Will those employees, including yourself, have direct contact with students?
            Until it receives further guidance, the District considers “direct contact” to mean services
            that may be performed independently from school district staff involvement. Direct contact
            can include chance contact such as performing routine inspections or maintenance; contact
            with groups of students during organized activities; or more obvious examples such as
            tutoring or therapy.

            If either question is answered "no", vendor should complete section 2 of this form.
            IF answer to both questions is "yes", vendor should complete section 3 of this form.



            I agree and understand employees of the company or individuals, including myself, who have
            not received the required criminal background check because the above description does not
Section 2




            apply to them/myself will be considered visitors when on school campus and must follow school
            district and campus policies related to visitors on school campuses.
                             _________________________                            _________________________
                             Signature of Vendor                                  Date



            I, _______________________________________________, certify that all employees,
            including myself, of the company that I own, operate, or manage, or myself as an independent
            contractor who have continuing duties related to the service to be performed on a United
            Independent School District Campus and who also have direct contact with students have
Section 3




            undergone the required criminal history background check or national criminal history record
            information review which may include fingerprints and photographs and that no prohibited
            contact as described herein was revealed.
                             _________________________                            _________________________
                             Signature of Vendor                                  Date



                                                                  Company Name:______________________________________
                                                                  I have Read and agree to all terms on this page (initials):______
                                           UNITED INDEPENDENT SCHOOL DISTRICT

                                  TO BE SUBMITTED WITH PROPOSAL/STATEMENT/QUOTE

                                             VENDOR ACKNOWLEDGEMENT FORM

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, 7CFR Part 3017,
Section 3017.510, Participant’s responsibilities. The regulations were published as Part IV of the January 30, 1989, Federal
Register (pages 4722-4733). Copies of the regulations may be obtained by contacting the Department of Agriculture agency with
which this transaction originated. (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, and 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.

APPLICABLE TO GRANTS, SUBGRANTS, COOPERATIVE AGREEMENT, AND CONTRACTS EXCEEDING
$100,000 IN FEDERAL FUNDS.

         Submission of this certification is a prerequisite for making or entering into this transaction and is imposed by section
         1352, Title 31, U.S. Code. This certification is a material representation of fact upon which reliance was placed when this
         transaction was made or entered into. Any person who fails to file the required certification shall be subject to civil penalty
         of not less than $10,000 and not more than $100,000 for each such failure.

         The undersigned certifies, to the best of his/her knowledge and belief, that:

         1.   No federal appropriated funds have been paid or will be paid or on behalf of the undersigned, to any person for
              influencing or attempting to influence an officer or employee of any agency, a Member of Congress, or an employee
              of a Member of Congress in connection with the awarding of a Federal contact, the making of a Federal grant. The
              making of a Federal loan, the entering into a cooperative agreement, and the extension, continuation, renewal,
              amendment, or modification of a 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 employed 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 grant 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
              covered subawards exceeding $100,000 in Federal funds at all appropriate tiers and that all subrecipients shall
              certify and disclose accordingly.

COMPLIANCE CERTIFICATION TO EPA REGULATIONS APPLICABLE TO GRANTS, SUBGRANTS,
COOPERATIVE AGREEMENTS, AND CONTRACTS EXCEEDING $100,000 IN FEDERAL FUNDS.

         I, the vendor, am in compliance with all applicable standards, orders or regulations issued pursuant to the Clean Air Act of
         1970 as amended (42 U.S.C. 1857 (h) ), Section 508 of the Clean Water Act, as amended (33 U.S.C. 1368), executive
         Order 117389 and Environmental Protection Agency Regulation, 40 CFR part 15 as required under OMB Circular A-102,
         Attachment O, Paragraph 14 (1) regarding reporting violations to the grantor agency and to the United States
         Environment Protection Agency Assistant Administrator for the Enforcement.


         ORGANIZATION NAME

         ADDRESS

         PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

         SIGNATURE                                                         DATE




                                                                    Company Name:______________________________________
                                                                    I have Read and agree to all terms on this page (initials):______

				
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posted:8/14/2011
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