RECEIVED

」じN03 2015

BUSINESS SEPピ ICES

COVER SHEET

RFP#2014‐1l BAKERY PRODUCTS: BREADExtension through 6′ 30ノ16

Sign and return this form by the due date of Tuesday, June 9.2015 4:30 pm.

K) No change in pricing

Pricing will changeAttach signed pricing sheets and also pricing sheets inelectronic format (CD or flash drive)

l understand a‖ terms and cond忙ions of BAKERY PRODUCTS: BREAD RFP#2014-1l extension

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SPECIAL CONDIT10NS FOR DELIVERIES

Should tt be determined by elherthe Mul卜 Regional Co‐Op,member dist面 cts,or awarded vendors that more

than once del市 ery a week to any ofthe drop sites wlhin the School Dlst‖ cts is necessary,please‖ st any

additional fees below. Be specinc as tO fOrlnulas,fees,or any other charges incurred.

Please provide any other additional information below:

轟oN e

Vendor Name:

AuthoHzed Company OmdJヽ Namα b,chろ′ん″′́

Signature of Company Official:

Complete and retum with Proposal

BAKERY PRODUCTSi FRESH BREAD RFP#2014‐ 11 Page 15 of 28

FELONY CONVICTION NOTIFICATION

State of Texas Legislative Senate Bill No. 1, 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 lhe 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 terminalion of the contract."

This Notice ls Not Required of a Publicly Held Corporalion

Vendor's Name

Authorized Company Official's ltame (printeU): baa.- %*oe14

A. My firm is a publicly held corporation; therefore, this reporting requirement is not applicable.

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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 or operated by the followlng individual(s) who has/have been convicted of a felony.

Name of Felon(s):

Details of Conviction(s):

Signature of Company Official:

Comdete and return wlh PЮ posJ

BAKERY PRODUCTS: FRESH BREAD RFP#201411 Page 16 of 28

Certification Regarding Lobbying

Applh.bb to Grants, Subgrants, Cooperative Agreements, and Contracts Exceeding $100,000 in Federal

Fu nds.

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 llle !!e required

certification shall be subject to a civil penalty of not less than $'10,000 and not more than $100,000 for each

such failure.

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

(1) No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to

any person for influencing or attempting to influence an officer or employee of any agency, a Member of

Congress, an officer or employee of congress, or an employee of a Member of Congress in connection with

the Jwarding of a Federal contract, 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 conlract, grant, loan, or cooperative agreemenl.

(21 lf any funds other than Federal appropriated funds have been paid or will be paid to any person for

influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer

or employee of congress, or an employee of a Member of Congress in connection with this Federal grant or

cooperative agreemenl, the undersigned shall complele 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 apprcpriate tiers and that all

subrecipienls shall certify and disclose accordingly.

為 9

L鈍軍L西笙 ら“Name/Title of Submitting Official

升 /`´〃Dale

Comdete and return wlh ProposJ

BAKERY PRODUCTSI FRESH BREAD RFP#2014‐ 14 Page 17 ol28

Reouest for PropOsal

ATTACHMENT ANOTARIZED STATEMENT VAL:DAT!NG PROPOSAL CONTENTS NON COLLuS:ON STATEMENT

Vendorshall not prepare this Proposal in collusion with any other Vendors and the conlents of this Proposal

as to prices, terms or conditions may not be communicated by this organization nor by an employee or agent

of this organization to any other Vendor ot lo any other persons engaged in this type of business activity prior

to the official Proposal due date. However, the authorized agent or officer signing this Proposal is not and has

not been, for six months, directly or indirectly concemed in any agreement to control the conditions and/ orprices of services proposed, or has not influenced any person to propose or not purpose thereon.

I have read the complete Proposal RFP #2014-11 BAKERY PRODUCTS: FRESH BREAD for member

districts in Multi Region Co-Op and verify the accuracy of all information contained in the Proposal.

Region 10 Education Service Center

)e,lru Brntryv-Typed name

NOTARY PUBLiC

Mycomttm Ⅸ,際 m樋笙 dtt d岬鮒

Comdete and return wlh PЮ posJ

ATTACHMENT B

NANCY F SOLIS

My Commisslon Exptres

september 2,2015

BAKERY PRODUCTSi FRESH BREAD RFP#2014‐ 11 Page 18 of28

To:

From:

CERTIFICATION REGARDING DEBARMENT. SUSPENSION. INELIGIBILITY. AND

VOLUNTARY EXCLUSION

ln accordance with Executive Order 12549 DEBARMENT AND SUSPENSION, the prospective vendor

certifies by submission of this Proposal, that neither it nor it's principals is presently debaned, suspended,

proposed for debarment, declared ineligible, or voluntarily excluded from participating in this transaction by

any Federal departmenl or agency.

Where the prospective offeror is unable to certify to any of the statements of this certification, such

prospective participant shall attach an explanation to this Proposal.

The certification in this clause is material representation of the fact upon which reliance was placed when this

transaction was entered into. lf it is later determined that the prospective offeror knowingly entered an

erroneous certification, in addition to other remedies available to the Federal Govemment, the Multi-Regional

Co-Op may pursue any and all available remedies, including suspension and/or debarment.

Additionally, the prospective vendor shall provide immediate written notice to the person to whom this

Proposal is submitted if at any time the prospective offeror leams that its certification was enoneous when

submitted or has become enoneous by reason of changed circumstances.

The prospective vendor agrees by submiiting this form that, should the proposed covered transaction beentered into, it shall not knowingly enter into any transactions with a person or firm who is debared,suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless

authorized by the Multi-Regional Co-Op.

Except for transactions authorized under the previous paragraph, if a prospective offeror in a covered

transaction knowingly enters into a transaction with a person who is suspended, debaned, ineligible, orvoluntarily excluded from participation in the transaction, in addition to other remedies available to the FederalGovemment, the lVulti-Regional Co-Op may pursue and all available remedies, including suspension and/ordebarment,

Potential Vendor Name:

Title of Authorized Representative:

Mailing Address:

Signature:

BAKERY PRODUCTSi FRESH BREAD RFP#2014‐ 11 Page 19 of 28

AT「ACHMENT C

CONFLICToF 1I{IIR.ESTqUESTIONNAIHE FORM CIQ

For vendor or other p€rson doing businesr with'local,gpveJnmental entityThis questionnaire is being filed in accordance with chapter 176 of the Local.

Government Code by a person doing business with the governmentalentity.

By law this questionnaire must b-e filed with the records administrator of the local

government not later than the 7th business day after the date the person becomes

aware of fucts that require the statement to be filed. See Section 176.006, Local

Government Code.

A person cornmits an offense if the person violates Section 175.006, Local Governntent

Code. An offense under this section is a Class C misdemeanor.

OFFiCE USE ONLY

)ate Received

1 Narne of person dqing business with local governmental entity.

fl Check this box if you are filing an update to a previously filed questionnaire.

(The law requires that you file an updated completed questionnaire with the appropriate filing authority not

later than September 1 ofthe year for lvhich an activitydescribed in Section 176.006(a), Local Government

Code, is pending qnd not later than the Tth business day after the date the briginally filed questionnaire

becomes incomplete or inaccurate.)

Name each employee or contractor of the local Bovernmental entity Who makes recommendations

to a local government officer of the governmental entity with respect to expenditures of money

AND describe the affiliation or business relationship,

,,loa

4 Name each local government officer who appoints or employs local 6overnment officers of thegovernmental entity for which this questionnaife is filed AND describe the affiliation or business

relationship.

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BAKERY PRODUCTSi FRESH BREAD RFP#2014… 11 Page 20 of 28

AdoptBd 11/02/2005

OFINTEREST QUEST10NNAIRE

of local government officer with whom filer has,affiliaffgn or business relationship.this seCti。口011y rthe answeF“ へ|,OrC ilVEs)|

This section, itern 5 including subparts A, B, C & D, rhust be completed for each officer with whomthe filer has affiliation or other relationship. Attach additional pages to this Form cle as necessary.

A・ L the 101al goVerh市 Ont ofFicll hahld in th“ |●clol retlivi18o「 !ikely to receⅣ e tattable

indome from the ller ofthё qles面 Onnaire7 口 v`s l□ N●|

B.に the nier ofthe questionna"eireceMngorlikely'tO rece‖ e taxableincome from or atthe

of the local government officer named in this section AND the taxable income is not fromlocal governmental entity? ! ves [ ruo

ls the filer of this questionnaire afflliated with a corporation or other business entity that theI government officer serves as an officer or director, or holds an ownership of 1O percent or

more? E vo fl no

D, Describe each affiliation or business relationship,

移託

Signature of person doing business with the governrnental entity

BAKERY PRODUCTSi FRESH BREAD RFP#2014‐ 11 Page2l ot28

Adopted l1/o2/2005

Disclosure of Lobbying Activities

OMB

Complete this form to disclose lobbying activities pursuant to 31U,S.C. 1352(See next page for public burden disclosure.) Approved by

2 Status of Fcdcral Action:

□∫ぶl場蹴籍H面°n

c pOst_award

3 RcpOrt Typc:

□譜鳳∬盤ngC

For Material Change Only:

date of last report_

1. Type of Federal Action:

- a- COntIaCt

U b. grun,c. cooperative agreementd. loane. loan guaranteef. loan insurance

5. If Reporting Entity in No. 4 is Subawardee, Entet Nameand Address of Prime:

4. Name and Address of Reporting Entity:

□PHmC □洸:こayFknom

7. Federal Program Name / Description:6. Federal Department / Agency:

(including address if different from No. 10a)(last name,

fiIst name, MI):(if individual, last name, first name, MI);

13. Type of Payment (check all that apply):? a. rctainet? b. one{ime iee? c. commission? d. contingent fee? e. deferred? f. other; specify:

11. Amount of Paymeot (check all that apply):? actual ? planned

12. Form of Payment (check all that apply)a. cashb. in-kind; specify: nature

value

) of Service, including officer(s), employee(s), or Member(s)

Sheet(s) SF-LLL-A, if necessary)

14. Brief Description of Services Performed or to be Performed and

contacted, for Payment Indicated in Item 11:

15. Continuation Sheet(s) SF-LLL-A attached: ? Yes ? No

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=Z場象とD"α チ晨 絆

16. Information requested through this form is authorized by article31 U.S.C. section 1352. This disclosure oilobbying activities is a

material representation of fact upon which reliaace was placed bythe tier above when this tmnsactiol was made or entered into. Thisdisclosure is required putsuaDt to 31 U.S.C. 1352. This info.mationwill be reported to the congress semiaDnually afld will be availablefor public inspection. Any person who fails to file the requireddisclosure shall be subject to a civil penalty of not less than $10,000and not more than $100,000 for each such failure.

Authorized for Local ReproductionStandard From - LLL

Complete and retum wlh Proposa!

BAKERY PRODUCTSI FRESH BREAD RFP#2014‐ 11 Page 22 ot 28

PROCUREMENl

lnstructions for Completion of SF-LLL, Disclosure of Lobbying Actjvities

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initlation or

receipt of a covered Federal action, ora materialchange to a previous filing, pursuant to litle 31 U.S.C. section 1352. Thefiling of a

form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an

offcer or employee of any agency, a l\4ember of Congress, an offcer or employee of Congress, or an employee of a lvember of

Congress in mnnection with a covered Federal actjon. Use fre SF-LLL-A Continuatjon Sheet for additional information if the space

on the form is inadequate, Complete all items that apply for both the initial filing and material change report. Refer to the

implementing guidance published by he Offce of Management and Budget for additional information.

1. ldentiry the type of mvered Federal action for which lobbying activity is and / or has been secured to influence the outcome

of a covered Federal Action.

2. Identiry he status offre covered FederalAction.

3, ldentry the appropnate classifcalion of his report. lf his is a follow-up report caused by a material change to the

information previously reported, enter the year and quarter in which the change occuned. Enter he date of the last

previously submitted report by this reporting entty for his covered Federal Aclion.

4. Enter he full name, address, city, state and zip code ofhe reporting entity. lnclude Congressional District, if known. Check

the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or sub award recipienl.

ldentify the tier of he subawardee, e.9., the first subawardee of he prime is he 1$ tier. Subawards include but are not

limited to subcontracts, subgrants, and confact awards under grants.

5. lf the organization nling the report in item 4 checks 'Subawardee," then enter he full name, address, city, state and lpcode of the prime Federal recipient. lndude Congressional Disfict, ifknown.

6. Enter the name of he Federal Agency making the award or loan commitment. lnclude at least one organizational level

below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or descnptron for the covered Federal action (item 1). lf known, enter the full Catalog ofFederal Domestic Assistance (CFDA) number forgrants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identirying number available for the Federal aclion idenlified in item 1(e.9., Request for

Proposal (RFP) number; Invitation lor Proposal (lFB) number; grant announcement number; the contract, grant, or loan

award number; the applicaton Proposal mntrol number assigned by the Federal agency). lnclude prefixes, e.g. 'RFP-DE-

9G001.',

L For a covered Federal action where here has been an award or loan commitrnent by the Federal agency, enter the

Federal amount ofthe award / loan commitrnent for he prime entity identified in item 4 or 5.

10. (a) Enterthe tull name, address, city, state and lp code of the lobbying entity engaged by he reporting entity identified in

item 4 to influence he covered Federal action,

(b) Enter tre full names of the individual(s) performing services, and include full address if difierent from 10 (a). Enter Last

Name, First Name, and Middle Initjal (Ml).'l 1. Enter the amount of compensation paid or reasonably expected to be paid by the reporling entity (item 4) to fre lobbying

entjty (item 10). lndicate whether he payment has been made (actual) or will be made (planned). Check all boxes hatapply. lf this is a materialdrange report, enter the anmulative amountofpayment made or planned to be made.

12. Check the appropriate box (es). Check all boxes frat apply. lf payment ls made hrough an in-kind contribution, speciry the

nafure and value of the in-kind payment.

13. Check the appropriate box (es). Check all boxes hat apply. lfoher, speci, nature.

14. Provide a specific and detailed description ofhe services trat the lobbyist has performed, or will be expected to perform,

and the date(s) of any seNices rendered. lnclude all preparatory and related activity, not just time spent in actual contactwith Federal offcials. ldentiry the Federal official(s) or employee(s) contacted or the offce(s), employee(s), or Membe(s)of Congress that were contacted.

'15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.'16. The certirying official shall sign and date he form print higher name, title, and telephone number.

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time forreviewing instructions, searching existing data sources, gahering and maintaining the data needed, and completing and

reviewing the collection of information. Send comments regarding the burden estjmate or any other aspect of this collection ofinformation, including suggestions for reducing his burden, to lhe Office of Management and Budget, Paperwork Reductlon

Project (0348-0046), Washington, D.C. 20503.

BAKERY PRODUCTS: FRESH BREAD RFP#201411 Page 23 of 28

PROPOSAL FORM

forCERTIFICATION REGARDING TEXAS FAMILY CODE

As per Section 14.52 of the Texas Family Code, added by S.B. 84, Acts, 73d Legislature, R.S. (1993), all

Proposers must complete and submit with the Proposal the following affidavit:

l, the undersigned vendor, do hereby acknowledge that N0 sole proprielor, partner, majority shareholder of a

corporalion, or an owner of '10% or more of another business entity is 30 days or more delinquent in paying

child support under a court order or a written repayment agreement. I understand that under this is, a sole

proprietorship, partnership, corporation or other entity in which a sole proprietor, partner, majority shareholder

or a corporation, or an owner of '10% or more of another entity is 30 days or more delinquent in paying child

support under a court order or a written repayment agreement is NOT eligible to Proposal or receive a state

contract.

ORGANIZAT!ON NAME″ ′

'その レ 0こ″ it,リ ン

ADDRESS

Complete and return wth Proposai

PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

BAKERY PRODUCTSI FRESH BREAD RFP#2014‐ 11 Page 24 ol 28

Food Wholesaler License

Firms that manufacture and/or distribute food for sale to schools are "wholesale food manufactures and/or

distributors" and must aquire the appropriate license with the Texas Department or Health, Bureau of

Food and Drug Safety, Manufactured Foods Division.

A food wholesaler is a firm that sells a food product to an intermediary (the school), which then sells the

product to the final consumer (students and stafQ. Licenses are obtained through Manufactured Foods and

the Licensing and Enforcement Division of the Texas Department of Health (TDH):

Texas Department of Health

Manufactured Food Division1'100 West 49tr StreetAustin TX 78756.3199

(888) 963-7111

A copy of the Food Wholesaler License musl be included with Proposal.

Copy of Food Wholesaler License included with Proposd$s or No

Complete and return with Proposal

Organization Name

Name and Title of Authorized Representative

BAKERY PRODUCTSI FRESH BREAD RFP#2014‐ 11 Page 25 ot 28

Clean Air and WaterAct

l, 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)), Secti,on 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 0MB 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.

Potential Vendor Name:

Ⅷ 面 価 並

"R熙鰤 闘 c

Mailing Address:

Signature:

Complete and retum wlh Proposal

BAKERY PRODUCTS: FRESH BREAD RFP#2014‐ 11 Page 26 of 28

cny:

CERTIFiCAT:ON OF PROPOSAL SPEC!FICAT!ONSrrERMS&CONDIT:ONSRFP r2014‐ 11

A‖ specinca‖ Ons,terrns,and condlions ofthe proposal have been read

Our Company accepts the specincalons and condlions unless otherwise accepled in w面 ung 10 sue Hayes,

Chief Financia1 0fFcer,and Educalon Service Cenler RegiOn 10

COMPANY NAME:

eaaress' zo'b ZsAb,Lrl

Phone:( St7) FAXttζ)製ζg功渉 Da● チ簾 14

Name of Representative Authorized to sign for vendor:

RESIDENT VENDOR CERTIFiCAT10N

h orderfor proposa lo be cOnsdered,lhe fo‖ owing hforrnalon must be proMded Fabre tO∞ mdele mav

resun in reieclion ofthe prooosal:

As denned by Texas House B‖ ! 602, a “nonresident vendor means a vendor whose p百 ncipal place of

business is not in Iexas, but excludes a contractor whose ullimate parent company or majority owner has its

principal plac ess in Texas. I certify that my company is a 'Tesident vendofl:

Signature Dao

lf you qualify as a "nonresident vendor," you must fumish the following information:

What is your resident state? (The state your principal place of business is located.)

Typed Name

Company Name Address

ZipStatecny

o Does your“ residence state"require vendors whose p百 ncipal place of business is in Texas lo under Proposal

vendors whose residence stale is the same as yours by a prescnbed amount or percentage lo receive a

comparable contract? “Residence stale・ means the stale in which the plncipal place of business is located

YES______ 0__事弊三二(B) What is the amount or percenlage?

I Ce面″|いメhe abOVe mforlna10nも

Pos i-tionComplete and return with progosal

Company NameTyped Name

BAKERY PRODUCTSI FRESH BREAD RFP#2044‐ 11 Page27 o'128

PROPOSAL ACKNOWLEDGMENT

BAKERY PRODUCTS: FRESH BREAD

IRFP# 1201e11I

TO: Education Service Center Region 10

l, or we, the duly authorized undersigned, having carefully read the lnstructions to Offerors, General

Conditions, Notice to Offerors, Contract Specifications, Responsibilities of Offerors, and Proposal Forms, do

hereby agree to enter into a mnlract with Region 10 by tendering this offer to perform the work required

and/or provide the product(s) specified in this solicitation. l, or we, will deliver the product(s) per specilications

found in this Proposal document for the prices indicated. l, or we, also certifo to the accuracy of the

certifications required (including, but not limited to, Felony Conviction Notice or Clean Air and Water Act)

which accompany this offer. l, or we, will follow all applicable state or federal laws.

The prices in this offer have been determined independently, without consultation, communication, or

agreement for the purpose of restricting competition, as lo any matter related to such prices, with any other

offeror or with any competitor. l, or we, are authorized to submit this offer and have not been a party to any

collusion among offer/offerors in restraint of freedom of competition by agreement to offer at a fixed price or to

refrain from offering; or with any Region 10 employee, Board Director, or consultant as lo quantity, quality, or

price in the prospective contract, or in any terms of the prospective contract except in any authorized

discussion(s) with Region '10's Business pemonnel; or in any discussions or actions between offer/ofierors

and any Region 10 employee, Board Director, or consultant mnceming exchange of money or other things of

value for special consideration in the award of this contract.

Daじ 陥med Rm:

Signature: 日rmヽ AddЮss 2%倦 Zあるご

NamdTⅢe:

Phone #:

Fax #: 77そ 多4P 531ス

ssorFed to*: 1? 240 lZot

PROPOSAL ENVELOPES SHOuLD BE PLA:NLY MARKED:

[RF耐 授01■111

Mu:ti‐ RegiOna:Co・ Op Purchasing GЮ up

“Requestfor ProposaL BAKERY PRODUCTS: FRESH BREAD"Attn:Mrs.Sue Hayes― Chief Financia:Omcer

400 East Spring Valley Rd.

Richardson,Texas 75081

DUE:Thursday,May 29,2014 at 4:30 pm

Complete and return with oЮ oosal

BAKERY PRODUCTSI FRESH BREAD RFP#2014‐ 11 Page 28 of 28