1. No category

SPECIAL CONDIT10NS FOR DELiVERIES
Should‖ be determined by enherthe Mu‖ Regional Co‐ Opl KILLEEN ISD,or awarded vendors that more
i¨
than once delivery a week to any ofthe drop sites withln the Sch∞ I DistHcts iS necessary,please list any
addttonalfees below.Be Specinc as 10 fOmulas,fees,or any other charges incurred.
Mnmum numttr d cases
α
red each sh"m耐
r 2瓦 四 豚″
メ4__"6“ θ
1、
￨lο
"unds b be dell℃
Additional fee if any for other warehouse
回 me b ttm由 針 dぃ
Oisticts: N C M
∞騰
O
ご
Please provide any other additional information below:
Vendor 11^^r'.
chotls
Au詢 oHzed COmpany ttdが
co-u
SNamα
-ne'-
roc,As
ι amク }na
Dノ
`ρ
′
∫
Signature of ComPanY Ofiici
Complde and retum witt ProposJ
t Shlp RFP#2014‐ 10
Page 16
of29
FELONY CONVICTION NOTIFICATION
Subsection (a)'
State of Texas Legislative Senate Bill No. 1, Section 44.034, Notrfication of Criminal History,
musl give advance notice to
states 'a person oibusiness entity that enters into a conlract with a school districl
of a felony The
the distriit if the person or an owner or operator of he business entity has been rynygted
of a felony"'
notice must include a general description of the conduct resulting in tre mnviction
if the district
person or business
Subsection (b) states "a school district may terminate a confact with a
^enti$
entity failed to give notice as required by Subseclion (a) or
determines that the person
or businesj
the person or business
*i.i.pr...ntaO the conduct resulling in tre mnviction. The district must mmpensate
"
entity for services perlormed before the termination of he conhact
This Notice ls Not Required of a Publicly Held Corporation
Vendofs Name
Aufrorized Company Official's Name (Printed):
Cl
l"n0'a Itl't
Wenrrs
A.Myfrmisapublic|yheldcorporation;therefore,hisreportingrequirementisnotapplicable'
Signature of ComPanY Ofiicial:
B.
My
frm
is not owned nor operated by
been convicted of a felonY.
Signature of ComPanY Ofiicial:
c.
who has/have been convicted of a felony'
[/y lirm is owned or operated by the following individual(s)
Name of Felon(s):
Details of Conviclion(s
Signature of CompanY
fficial:
Complete and retum with Prooosal
@shipRFP#20l4-10
Page 17 of 29
'‐
U ^‐
■
'
― ‐ ●― ― ―
………
●
●―
…
´
￨‐
￨ヽ
ヽ
￨―
_
●●
CertincaliOn Rogarding Lobbying
Exceedhg S1001000 h Federd
Applicable to Granls,Subgrants,C00perauve Agreements,and Conlracts i
Funds.
such fa‖ ure
edge and be‖ ef,that:
The unders 9ned certies,to he best of his Or her kno悧
t
槙焉
朧
黒
Mim焉
腎
野蠍蝦黙γ
豊
識豊
oぃ 所ヽ
け n〆
Narne/Address of Organizalion
,
q n,
)ial
Signature
W
COmplote and retumり 輌山 Pr。 ●OSal
p RFP#201410
Page 18 of 29
Reauestfor ProDOSd
Reglon 10 Education Service Center
Tol
6d,
Yhひ″
From:
Organization Name
VendorshallnotpreparethisProposalincollusionwithanyotherVendorsandlhemnlenbofthisProposal
or agent
a uy m,. organization nor by an employee
as to prices, terms or condition,
prior
persons engaied in lhis type of business actirrity
any other vendor or to any other
;;;;i ;;.;;;uni..t
of this organization to
and has
t,. .rrhorized agent or offi-cer signing this Proposal is notand/ or
proposal due date.
to the official
the conditions
concemeo in any agreement to control
not been, for six months, drrectty oiinuirectty
purpose
hereon'
anv personio propose or noi
;;;i;#;p;"p".;,
i.r.r.r,
",.il;;ii;a;Lnced
thavereadthemmpleteProposalRFP#tI!+IIFULLLINEGRooERYITEfutSWAREHoUSE'DIRECT
contained in the
uno*|,rtv the accuracy of all information
in
disrids
member
sHlp ior
Mriiiii;;';;p
Proposal.
Signature
Typed name
NOTARY PUBLIC
′
θ3_day Of望 堕L,aο ツ
My com面 SSOn ex口 reSOnthe
State of California
County ofAlam€da
S卿
:薔
猾
alr下 陥
∝
躙肥
露榔器
i::露甲
;‖
proved t9 m9。 nthe b,Jig」:a“ sfadory e● dence to be the
AttACHMENT B
b鮮
∫
脚糧
端
制
1脚 l:珊 乱
L器 脱
W盤 瓢I船慇胤i牌 淵訛
朧∫
any Federal depaiment or agency
Where the prospectve orerOr、
unabtt tO Ce山 ly to any of he stalements Of lhヽ
Ce由 lcaOon,Such
prospec‖ ve pattcipant sha‖ atach an explanaJon 10 1hiS Proposal.
繕
膏
織
襦
鮮
贈
熙
雛
郡驀 鮒
lb e remedieS,induding suspens:on andlordebament
澗 :nⅧ ふ肥 思
'鵬朧鴨
増
褥
鮮 i鼈 翻 撚 I[F譜
subnllted Or has beCOme eroneOus
酬f∬Wtti畳 曜
肌
塁
驚
i革櫛礫
嘴暖
駒
鼈
‖
贄織‐
滞も
乱
躍需
ま
糠
:躍
l野
op
ll轟
D―
l:lilil鞘 i撤 ￨:i[￨￨]lil:iilI[1li!唱
Op may pursue and a‖ avallable remedies,including suspension andノ
debarrnent
Po● nid Vendσ Namα
ιれ(S 6r narら
"`
edAuhonzttRepresentatvα Oa SFoaぃ
￢
‖
[aqQe.d C* ?
etrw+
■
sab｀
ら
Mailing Address:
sじ
Comdete and retum面 th ProDOSJ
o「
ヽONυ A?レ εab移
ATTACHMENT C
CONFuCT OFINTEREST QUE釧 ONNAIRE
希 轟 嵩蒜葡高 凛 而雨 覇 高石面 百 T甲 而 ter
i76 of●
ob∽
!
Government Cpde by a person doin3 bu“ ness With the gOVernmental en,w
悧酬:鷲 蹴l選 輩
‖
累
獅芋
事
事裏
ギ♀
y琳
‖に
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Ⅲ
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.…
awarc Offacts that requrc the statemen
にto be ntd,`section1176006′ LocJ
nmttt
.'600ら 回 G″ 軒
L“ S'轟 °
°
i5SCm● demeano“
讐よl浜露‖∬よ
盟 i■ 1乱哩
]彙
d口 "品 C
not
an uttated cOm口 eted quesiOnnJre with the appropnate ttng authCriヽ
nmO威
J6oVσ
, =● ‐と,こ ●
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171｀ ´
dHon■
7610061al,Lc(a16oVernmont
,ヒ
dettb.dh'dOn 17●
1轟
OrUna町 ■ed queS10nn」 に
lavaFterthe
datethё
慟
711 buShe■
∞ de,卜 peぃ an3111 nolbO「
「漏ま:I獅 ↓
iT滞 滞葛富
麗I響 僣
Щ■
he hW reqJreSthat,unに
「
'ltに
s recommerldatlonS
h resPeCt tO expenditures Of money
tO a local government ofncer Of he governmentalentity wi」
:こ be the a価 atOn O「 bい inest tebt1015hや
品
‖
NI肝
叫 昴 画 針 ホe
Cttibe the a簡 ‖at10n or busincSS
巨。vcrnmental
entity fOr which thiS questionnalre is nled AND dぃ
AdOpt“ ,V02′ 005
FULL LINE CROCERY ITEMS VVAREHOUSE,Di10■
Ship RFP■
201410
Page 21 of29
Nam[Of h“ l goVernme咸
●憮
erulⅢ who"輌
r toへ
(COmp ete thⅢ ect10n onlv rthe an"。
に rい OS'口 li訛
B′
。r c
6TFince s retedonshiP.
ls VES)
officer with whom
A, B' C & D' must be cgmpleted.for each
This section, item 5 including subParB
necessarY'
Attach edditional Patcstd this Form CIQaE
the filer has affiliation or other relationshlp'
ol´ ●CeiVing Or‖ kel,tO reCetve taxable
A.lS the l― l BOVernment o爾 Cer n3med in this Sec」
hcome from the merofthe qu“
"nnJに '口
Ve= 口
No
B Is the nler of the qu`tiOnnallereceiVIngOrilkelytOreceivetaXableincomefromOratthC
‐ 18● Vemment Officer named in this sectiOn AND the taxable income iS not from
direction of the!。
local govemmental
entiry? E
va E
tb
C. :S the nler Of thiS queSt10nn3ire afF:iated With a corPorition Or other busineSS entity that the
orh01dsanownershipof10percentor
′
es aS an oFnCer or drector′
local government oFncer seぃ
more? E Y6 ENc
De$ribe each affili.tion or business relationshiP'
'llr
2′ 2015
。11′ ●
い。
^d。
FULL LINE GROCERY ITEMS WAREH00SE,DI「
麒 Ship RFP#201牛 10
Page 22 of29
-
Disclosure of Lobbying Activities
c;,piJ"ii"-r"-
-
N
ll ?ldts
psl Laobl
(9( wt/' (oodts does
u's'c'
1352
l,r*',"ff"r,,"J,,,Ji1i;"11',:':i"lH::i"'31
Approved by
OMB
1.
LI
-
6,
For Material Change OnlY:
date Of last
[コ
Disl
initial filing
Year-
quafierreport.-.-
Ente' Na'ne
5. lfReportiDg Entity in No 4 is SubawardeE'
and Address of Prime:
4. Name and Address of Reporting EDlity:
hme
a.
b. marerial change
c. Post'award
lgteement
d. loan
e, loalr guarl[tee
f. loan insuranc€
□
r-t
LJ
r-r a. bid/offer/rPPlication
lJ t. initial award
a. contract
6. g1.n,
c. cooperative
3. Report TYPe:
2. Status ofFcdelal Actiotr;
Type of Federal Actior;
lfk.Ow・
ly窒
ct. i{ known?
7. Federal Program Neme / Dcscliption:
Fedetal Department / Agency:
CFDA Number, if aPPlicable:
iiii"a;r,a*f,
(1111温
last name' firsttrame' Mt):
や
Srこ f“ rent tom No 10a)Oast namc,
i炉
:Ck狙 血 ap口
‖
∬"
詫
総
…
of Pay-"nt ("heck all lhat appty)
? a. cash
1riil.
a. rctainer
? b- o.e-time fce
? c. commission
? d. contirgeni fee
?
? b. in-kindl spccifY: oature
e.
cd or"be pcfお rmed and
鳳:鳳 T器 :ぶ ]:席 :i融 輌H
dcfered
)
"f
S.,"t."rr",,rd-g
employee(s)' or Me rnber(s)
"ff"er(s)'
Sheet(s) SF-LLL-A,
lljl‖11裏
鷲 驀瑕
繋
::ilT;",J;
if
necessarY)
? No
SF LLL'A atlached: ? Yes
IW盤 躙邪∬
諄輝畷i暇11照
驚
鷲
'
? I. o!h!r; sPecifY:
value
,5rc"",inr"", ttttAs)
“
?
碁
le
1零
l:…
ii0b,0oo ror each
l嵩
……
話
三
コ
二
厖
五
五
藁
宝
女
量
齢
量
萱
遣
such rairure'
Aurhorized Io, Local Rcproduction
sundard From " LLL
Federal Use OolY:
cOmplete and retum Wlth ProD型
P#Ⅲ 綱
0
P∞ o23● f29
PROCUREMENT
lnstructions for Completion of
SF-t!1, Disdosure
of
Lobblng Aclivities
at the iniliation or
repo,t.i .itty vthette-r, subawardee or pflms Federal recipient'
This drsdosure form shall be mmprereo"ty ile
Thafilingof a
1352'
31 u.S,c' ttaion
ciangi to a previors filing,.pursuant to
receipt of a mvered Federat action, or a ri'aeriat
an
to-influence
auemptng
p.vr["., any lo'bbyng entity for influencing or
l.
form is reauired for ead, pay*enr o,
of
Member
ol
a
emplovee
in
oi congress' or
an omta 6'
offcer or emplovee of any agency, .
space
if
tre
inlormation
rn" sr-uL-n Continuafion Sh;t for sdditional
conoress in connection wfi, a covereo r"Jlrar-*i*."'ur.
change report Reler to the
+pri roiuor' trt".initial filing and material
on 6e form is inadequare. corpr"t"
infomation'
additional
dv ut omo oitvtanag#dnt ano audgettur
tit
agoil.ii" irii
*irovt'
#;';ii;;i;tl
frjtiliiirri
il##;;
ililproritn"o
'l.Identrythetypeofcol,eredFederalactionbrwhicirlobbyingac.tivityisand/orhasbeenSecuredtoinfluencetheoutmme
of a covered Fedenal Action'
the
report €used bv a materiarchanse to
last
of
he
date
the
quarter in wiridr ure ctrange ocflred. Ente]
,ntormation p|.rriourry
Action'
FeGral
reporring int'ty for this co'rcred
check
oreviously submitted report oitris
tnouoe congressional Distict' if known '
uni ,ip .oa" ot t ,+orting. entiv.
uty,
udo*o,
nam",
'or
EnEr he
award
prime
sub
or
"
a
be,
exoecls to
tt .t O".idtr*.i it i*
but'ecipient
are not
he appropriate classificra.
is he 1d tror' Subawards indude
suo#J'el
ot
tie,
ldentifv he
3 l::lXflTl,'.'5,#,fl,*?:ffiff:ittJl;*n
,"porr#I""n; il;,#i
*n i:-i..P..P"P
,t#
,t
4.
n
i[. ffi*"S;",,
il''i1i""l;i':!F:f:-:llt'*
t''
,
and zip
enterheturrname' address' citv' state
- ',lTy"'i:l*ry;T'ffr'ihTlffiTi:,JT1ffiJi"ffiffyDistrict known'
H;;iil; p*; Fed;alrocipient lndude congre$ional
organizalional level
or toan,rrit *t. lnclude at least one
awara
F."i:ifi;ffiffi;g"u;
the
of
name
the
6. Enter
r"n"portalion' united states coa$ Guard'
below agenc'v name, il #:i##itfi;'i"lmenior
enter the tullcatalog of
coue,eo r"oeJ tJon tit , 1). lf known,
#;fi#;iil;it,
p{ogram
Federat
h€
Enter
commifnents'
7.
loan
grants' cooperarive mre€rnents' bans' and
if
Ass."'*'idiini'i'ilfor
8.
FBderal Domestic
Enbr rre mosr app.p,in.
i"tu"olillrn,irfrg
u nlr.oera
il;;ihdb grant
nu.l",l nriffi; iii'p|.ip,iJ (lrq
acrton idenlified in item 1(e
s ' Requesl [or
numberi rre mnract' grant' or
announcement
number;
i"o."r.gu."yt. lndude p]efixes, e
ur.
by
proposal mnrol number msigned
award numbeq he applicat;
9G001."
proposat (RFp)
g
loan
'RFP-DE-
9'ForacoveredFedera|actionwheretherehasboenala,Jalg.olloancommitnentbytheFederalagency,entertfie
in item 4or 5'
-tt't''ent for he prima entlty idenlified
Federal amount of he
10Ia)Enterthefullname,aoaress,city,stateandlpmdeoftrelobbyinJ.tiv"nsug"oovmerepoftingentityidentifiedin
*ii'ttt
"
lrlll* ;xln*:rJ,ffi
,,',
!:f
fi:fffl.ffi0fi,b-ins *|-,i,r,, *d
fl'j*Ui"?U}$d]!"'['fi$)or
reasonabry
incrude
ur
address if dinerent from 10
entitv (item
expecry to be pard by the reportins
(a) Enrer Last
4). to
the robbvins
entity(itemrot.rno*t*iJfil"iilffi."y'*.rilb'#maoeLacruaitorwrrb€;ade(planned).che*allboxesfrat
to be made'
ttp't lnbt he otmulatveamomt of oavment madeor Plann€d contibution' speo! the
apply. lf this is a mate'ia *'igt
12
paffii!
riraoe trrough an in-klnd
all boxes that apply. tt
check the appropriate uor 1esi. cnect<
payment
nalure and vilue of the in+ind
nature'
i''rlo[ill boxes fiat apPly lf other'soecifY
u":<
it'f
13. ched( the apprcp'i'tt
14. provideaspecifcandd#i;l;#il;;itt",.ri,ititXtt'.tioviitnaspetrormea'o.rYillbeexpectedtoperhrm'
not just time spent in actual conht
att prepararry aJiliaeo acljvity.
tnoroe
,*;,iJ.
,r,riJ.,
unv
ot
Membe(s)
and rhe date(s)
ol, momcei(.), employee(s)' or
Federal official(s) or employee(s)
with Federat offcials. tdenhry he
r
intaciJ
of Congress that were contact€d'
is atached'
not t sr-u-t-'l continuation shee(s)
s lilii'r,l.il"it'
l6.Thecertitvingofro,'nt"'[i"loi'iniit"ro*pti"ir'iyt'"tame'title'andtslephonenumber'
ngbtt D C 20503.
P口 ∝t゛ 漁 Ю04o‐ W語 品
lshl RFP I
Page 24 of 29
t**5*
FAIIILY CODE
CERTIFIGATION REGARDING TEXAS
code, added by s.B_. M, Acb,73d Legislature,
As oer section 14.52 of the lexas Famiry
proposat the fo,owins affidavit:
unJ iri,nit,riti the
R.S. (1993), all
ilruffii;o;ilrc
pavtng
l.theundersignedvendor,doherebyacknowledgethatNosole.proprietor,parlner,majorityShareholderofa
is 30 davs oI more delinquent in
u"in""t
10"/'
of
owner
an
crmoration, or
"ntlV I understand that under this is' a sole
ag"e'enl
cnild support unde, . .owt o'dt'
partner' maiority shareholder
in w-hich a sole poprietor,
.i.rf]"i"ifity
corpoiati.^
partnerstrip,
paving child
oroDnetorship,
u so dlvi or m# delinquent in
.rtiiv
or
or a corporation, or an owner
i' tlot ttisiutt to Proposal or receive a state
ni'fiJ]
o|.
a
oroe'
a
cou,t
support under
*i'#;i;;;iitt
lt';ffidffttt
1&;,;;;;.;ih.i
6;;;;i;G;;nt
-'-
contract.
itt cf 's
ORGANIZAT:ON NAME
■らマ タ ヽ
Con
nt^
lt'c'^s
q+c+s-
4a多 し
し
ADDRESS
we船 ヽク
31ム
PR:NTED NAME AND T:TLE OF AUTHORIZED REPRESENTAT:VE
SIGNATURE
comolete and return wth ProDOSal
DiredShpRFP#201■
10
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需 謂懲
n.
協柵 淵
鯰脚
諜
樹[‖蝋[欄晶道i馘
r鼎
)epattnentof Health「 DH)
Texas Depament of Health
Manufactured Food D市 iS10n
l100 West 49th Street
Austin TX78756‐ 3199
(888}963・ 7111
A copy ofthe F∞ d WhOlesaler License must be included With PrOposal
0レ ″
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‐‐●epreSenlatVe
Name a口 u いuじ υlハ uu,vl‐
No
M
cOpy Of Food WhOlesaler Llcense included wlth PrOposal:Ves o「
si9nature
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Clean Air and Water Act
or regulations issued pursuant to the
l, the Vendor, am in compliance with all applicable stan^dards, orde6
CleanAirActof 19ZO asemenoJ{+ZuS.C.fASzlrll,Section50SolfreCleanWaterAct,asamended(33
Agency Regulation,40 cFR Part 15 as
U.i.C. igOSj i*r.utive Order ttzias ano Environmenlal Protection
required under OMB Circular A-102,
grantor agency and to the united states
o, Paragraph 14 (1) regarding reporting violations to the
inuiro.r"nt p.t"ciion Agency Assistant Administrator for lhe Enforcement'
Attachment
potential Vendor Nrme,
Cvel's
coao<-r {,..,.,as
ι α′レi働
Title of Authorized Representative:
Ma‖ ng Address:
Signature:
Comdeb and retum輛 th ProoosJ
shゃ
RFP#201■ 10
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1,C‐
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CERTIFiCAT10N OF PROPOSAL SPECiFICAT:ONSrrERMS a CONDIT10NS
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弥埜
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RFP ttm14・ 10
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COMPANY NAME:
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Complete and return with ProDosal
■2014‐ 10
i
Company Name
Page 26 of 29
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RECEIVED
MAY 2 9 2014
PROPOSAL ACKNOWLEDGMENT
FULLLINEGROCERYITEMSWAREHOUSE,DIRECTSHIP
BUSINESSSERVICES
IRFP# #2011n01
TO: Education Service Cenler Region l0
General
undersigned, having carefully read the lnstructions to Offerors'
of Offerors, and Proposal Forms' do
ConOition., Noticqto Offerors, Contract-Speciflcatlons, Responsibilities
to perform.the work.required
agiee to enter into a contract witr Region 10 by tendering this offer
l, or we, the duly autrorized
trereUy
will deliver he product(s) per speciflcations
anaioi prJrioe tne product(s) specified in tiris soiicitation. l, or we,
also certify to the accuracy o1 the
found in this Poposal document for he prices indicaled. l, or we,
or Clean Air and Water Act)
..,tiR*tion, required (inctuding, but not limited to, Felony Conviction Notice
*niin
..*rpun,
this offer. l, oi we, will follow all applicable state or federal laws.
without mnsultation, communication' or
The prices in lhis offer have been determined indepondently,
prices,
any other
with
purpose of restricting competition, as to any matter related to suoh
been a party to any
oirioi.i -,itn any competitor. l, or wel are auhorized to submit this ofier and have nol at a fixed pnce or to
by agreemenl to offer
*liusion umong offer/oiferors in restraint of feedom of competiton
to quantity, quality' 0r
tro, otrJring; or with any Region 10 employee, Board Director, or consultant as
in any ierms of the prospective contract except in any authorized
price in the prospective contract,
'-itt Region 10's Business personnel; or in any discussions or aclions between offeriofferon
or other things of
Board Director, or consultant conc€ming exchange of money
ug*;.ni
for
th.
ir
"-t.,
iir.r*r.trf
..J .^)/-nixji",
10 eriployee,
value for special consideration in the award of his contract
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目rrn's Address:￨千 3そ S―
Nane d ttrnい が
Date:
Signature:
:Camι イina Vnas
SoacaVSb.
Phone #:
Fax #:
SS of F“ ID#:
収
PROPOSAL ENVELOPES SHOt'LD BE PLAINLY MARKED:
IRFPI授 01■ 101
‐
Mu‖ Regbnd C●
鍵 謂 継 緊 路 黙 獣 busE,回 RECT SHP
街 PЮ
"耐
鼎
:諧 翠 l器 2cHJRm面 Jm∞
r
400 East Spring Vailey Rd.
Richardson,Texas 75081
DUE:Thursday,May 29,2014 at 4:30 pm
complete and return-lulhilgpos4
画 面 雨
10
E GROCERY「 EMS WAREHOuSE,Drtt Shや RFP#2014‐
Page 29 of 29