RECE:VED
MAY 29 20綺
BuS:NESS SERViCES
SPECIAL CONDIT10NS FOR DELiVERiES
‐
awarded venloS that mo鴨
Shoutt n be detemined by eilherthe Mu晰 Re9bnd CO‐ Op=KLLEEN lSDJo「
than once denVery a weekto any ofthe dЮ O Sites wimin the school Districts is necessary,please lst any
addllionalfees beloⅣ .Be specttc as to fOrrnulas′ iees,Or any othr chargesincu幅
,
Minimurn number ol cases or pounds to be delivered each
Additional iee if any forotherwarehouse districts:
Lead time for deliveries # of daY's
ノθ f
ofweeKs
below:
Please provide any other additional information
Vendor
Auhonzed ComPanY Official's Name:.
sicnature of COmpany OttCiali
Co m
雨
plels tlld-rgslr.:uith.-Prg
Page 16 of29
FELONY CONViCT10N NOTIFiCAT10N
蹴
‖
悩 Ⅷ躙 T朧:絣 悪
撃
掛
i欄
孵
聯
State of Texas Le9も
ねIve Senate Btt No.1,Secibn 4.034:Nottcation of Crimmal Hb10ry,Subseclon綺
),
notice rnustinclude a general descriplion ofthe conduく
f tte d螢 nd
ntract with a"mn tt bugness entlャ
lFl鵠冨富
嵩鴨
器甚:∞ 綿』
職 篤滉
寵:麒 鷺織ittu彙 ∬
胤懲 ::1縫
臨;薔淵 ri淵 騨 私
::麟 ::鼎
hecontact."
This Nolcels Nd Requk対 of a Publicly Held Corporalon
Vendors Name
Auhorized Company Official's Name (Pnnied):
A,Mylmも a puЫ Lv
hdd COrporalioni ttereb",hヽ
rep° ttng
requiement b not applcab燈
,
Signature of ComPanY Cfficiai:
B.
has been convicted of a felony'
My finn is not owned nor operated by anyone who
Signature of ComPanY
c.
fficial:
individual(s) who hadhave been convicted of a felony
My frnn is owned or operated by the following
Name of Felon(s):
Details of Conviction(s):
Signature of CcmPanY Oficiai:
Com● ete and return with ProposJ
FO生 しNE ёROCERヤ 雁
MSttREHOUSE,D面
勁 ip RFp髯
Page 17 of 29
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peЭ eld
seM
98)uolloes
UO'S!Щ qns
・spunコ
1glep33 Ul 000'001$
0Ufpmq qBluo3 pUB'Sluaujaaoy
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iluy(qqq Butpe6ag uoBB3$Ue3
Reque試 loF
pす
。
.。 sぷ
ATTACHMENtt A
Region 10 Education Service Center
lo:
From:
Organization Name
proposal in collusion with any other Vendors and tre contents of this Proposal
Vendorshali not prepare this
by this organization nor by an employee or agent
as to prices, lerms or conditions may not be communicated
persons engaEed in Uris type of business activity prior
of this oqanizatron io any other Vendor or lo any oher
agentor offrcer signing tris Proposal is not and has
to the official proposaloue oate. However, the authorized
to control the conditions and/ or
n,t been, for six months, direcuy or indirecrly concemed in any agreement
person to popose or not purpose thereon'
prices of services proposed, or fias not influenced any
FULL LINE GR0CERY ITEMS WAREHOUSE' DIRECT
I have rcad he complete Proposal RFP #2014-10
verify tlre accuracy of all informalion contained in the
sHtp for member districis in Muiti Region co-op and
Proposal.
ふ
爵 ￡ BJc
J鵬
幽
にご 協
肌
SuSAN MAMMARELLl
‖otary PubliC‐
Mソ
m腱
町 ∞ m輛 面 岬
塾
:鵬
State 01 Fiorida
::譜 I「
15
∬l後 ∬
」可0
'鵬
cOmJete and retum Witt ProoosJ
FULL
LINfffiERY
ITEMS WAREHOUSE,
D
ECI
'ShP
RTT* 201+10
Page
'19
of 29
ATTACHMENT B
朧
:∵
織鳳 乱i指
盤織ギ
t淵
b刷
i臨
1漑
訛
L器 脱
縞淵首
ヽ
9鷺
:緊
any Federaldepamento「 agency.
°myぴ he statemmお d
需繁:h鵠 :』 鶴恩 乳
∬
出:酬鬼
i∬
ttS醐
淵1鶴
∞
は
SuCh
is Proposal.
:%朧 ∬渕 慧菫駄蠍 黎 柵
Co―Op
may pursue any and a‖ ava‖ able remedies,including suspension and/ordebarment.
ぶ
ふ
肌
憚
鳳
紀
瀾 i捕猫鮮淵概勲贔卜
直
壻
塁
藤
機鱗 i榊聴
debarment
PotentialVenCor Name.
Tifle of Authorized Representative:
2_ゝ
Maiing ttidresst
Signature,
Complete and retum
FULL ttNEGROCERY「 EMSWAREHOUSEi DralShoRFP『 201410
PaEeZA of 29
ごと
sァ
untt sa11,Hl)and SeF責 博
LLC
PH:281151400
AttACHMENT C
FX:281‐ 2516507
CONFLiCT OF INTEREST QUES■
ONNAIRE
FORM CIQ
r vendor Or other person doing huslness wlth ioca`
questionnaire is being filed in accordance with chapter 176 of the Local
Code by a per:on doing business with the goYernmental enti\i-
OFF'CE US■
ONLY
)ate FiecivEd
with the records administrator of the locil
govemment not later than ihe 7th business day after the date the Person becomes
aware of iacts that require tlie statement tb be filed. Sce Section 176.0o6, Loeel
By law this questionnaire must be filed
Govemment Code.
person commits an offense if the pcrson violates Section 175.006, Local Gowrnrnent
Code. An offunse under this section is a Class C misdemqanot'
よ
5
Ct
".t
・
しし
/
this box if you a re filing an update to a
naire wttn the● ppnttnatt fllln3
口℃ laW観 uires thtat vou■ le ar updated∞ mpleted quesjぃ
al〈
la"rt鴨 n SeFtember l ofthe vearfOr wは ch an actM■ descrb2d in Sectlon 176.0061a),L∝
ttled
the
oriSirally
date
the
day
after
business
7th
code, is pending and not later *ran the
[;
rn
i]Ct
,■,e nt
recorn mendations
'rvith respct topxfinditures oi money
to a local g,overnment oFficer of ttre governmental entity
AND describe the affitiation or businesS reiatiorishlp'
L
s local 6overnment officers of the
describe the affiliation or business
AND
frted
is
questionnaire
snvernnrental entity for whj<d ttris
AdOPted 170η 2005
FULL LiNE GROCERソ IIMSWAREHOUSE,Direct ttlp ttP#2Cr14J0
?aEe21 ai?9
:LC
unibd Sales and Sewi嚇
PH:281・ 251・ 6500
F(281・ 251807
OFINTEREST QUEST10NNAIRE
Name of local govemnrcrrt
lCOrnplete this le00n on″「
Thお secto口 ,item
whom fil€r has affiliation or
昴ea― r toへ 町or c ISヤ E5),
5 hcbding subpaに
A,aC&D′
/
must be completed for eeChヴ 6Cer wth whom
。
the tter has am“ a● n Or other rdaOoい ship AttaCll addれ
'onalpags to ths ttm ctQaS necessary
ノ
ts
likely to re{Eive taxable
the lo.al government otficer n.med in this section
from the filer of the questionnaire? 口 V・ I □
L ttnけ
lyl.vla8 0F
rthe ques藪
。
“
“
ol the
CL・ e鮨
lGl
govemrnent officer
ざ 饉じqu蜀 ¨ 面
ニ
●no輸
"パ
3overRnent ofFlcer serV5基
mOに
'口
Y“
recrive taxable income flom orat the
thi5 seclion AND the taxable income is not from
面 衝 a∞ 7庶
cer or alrectoぅ
。
.therbuin6s m・ ヽ 市at he
OrhddSan ome`hp of 10 percent or
口 0/′
“′
′
″
´
齢 tlon or b崚 ―S rdatlonshi,
hcribe eacッ
/
/
/
1●
′
●
ししこ
″ノ
5-t包 ヾ
4●
●
"“
FULL LINE GRCCERY:TE■ lS IVAREHCuSE DFm Srわ RFP,即 1■ 10
=1/02′
Page 22 o129
。
。
'
Activities
,-"-?LJ*,E:xlx;rffi
Disclosure of Lobbying
l"rr,rJ[r,
j.?;Lti"ilIT*ro3ru.s.c.i-]5.-
Appiovcd c''
OME
・
・はbn
□
l鵠籍
『二
n a. C0lllrict
I I b. grrn,
c.post‐ ♂ward
c. cooperarive agrcefirenl
d. loan
e. loan guarantee
f. loan insurance
5. If Reportiog Entity in
and Addrcss of
4. Namg and Address trf Ruporting Cnrirr:
1号
ConsressiodDistrict, i I know
Congrc,sional Dist● ct,if k,oWn'
Agency:
Federal DePartment,r
xo' a is;gdfawardee,
r
Only:
Enter Name
Prime: '{
,/
,1
,1
｀
adelfknow.
□ ど
□Prme
6.
3. Report'l'YPe:
n a. initial filing
LI 6. mz1g1ixt 3hxnoe,
Fo( Material (:ha
2.Sutus oF Fcderal Actioni
l. 'type of Federat Aclior:
U.
.
t,!
,\-.'
n:
ncqrdt Program Name / Dcscription:
CFDr\ ){umber, if aPPlicable:
,ir
iion Number. il knolrB;
E. lndividuals Pedorming servrces
(inclurlirrg address if Ciffcrcnt tiom
firsr name, Ml):
ffil.r)bbvingEn(itY
{if inriividual, last llarne, first name' Mi):
.^t.**, ,f Pri..nr
(check ail thar
,
:
?
,-
? a. rer.ai$er
plenncd
? b. one-time lee
? c. commission
12. Form of Pay-mcnt (check all
? a. cash
? b. in-kind;
? d. contingsnt lbu
? c- deferred
sPecirY-: n
? i. otherr sPecifY:
■r,iccs P。「∴FFCd。「 be
ll::魔 IIIF:11 “
:鋪 鳳:ミ躙
10a)(lasl name'
p口 →
:(theck凛 ■饉■
applyf
rcrual
No
)OF Sert・ icc,incLIふ
perbrmed and Da
sheer(s)
(atrach Contin
ion Sh● Ct(ヽ )Sr― LLL― A
s
g。 面 cer(S),e■ 1'Oyec(s),Or MCmbc〈
I;-LLL-;\, if
S〕
necessary)
attachCd: ?Ycs =N。
ed by articie
16.infon■ atioll rcqucsted thFOugh thiS fOrrn is authO,I′
a
31 lr.S.c.seCtiCn 1352.ThiS diSC10Sure oFiobby'■ 3 activitiCS iS bv
upon which reriance was Praccd
This
*hen this ,runrr.,ion rvas made or enteted into'
―
*;;i;;;;;;;;;;;i;;',,i.-i;;r
iir"'i;"r
1352' This inforrnatir:n
and will be availabtre
scmianilually
congress
the
to
"u,i"*
disclosure is required pr,,u,nt lo 31 U'S'C'
*iti U. ,rrort..tl
i"l ruLri. inspection..Anv
よ
::￨:ざ :L::轟 it:I:こ
島
ncrson :Tl9-llli: P.
ldiド Ic・ Ittf:lliliボ
*
i」
and Ccnt rno10こ han S100,000 FoF e`
ll:"t:;q"'ltiln
l:ll贔
nu,
p‖ :281‐ 251-3500
l'cdcrrrl tisrr OnlY:
rAREHOl」
FULL LiNE GROCERYITEMS A・
SE.01面 Sn,RFP r 2111■
10
Autburrizrd for I.ocal Re!roductioit
Standartl Frcm -
LLL
Page 23
ol29
PROPOSAL FORM
for
CERTIFiCAT10N RECARDING TEXAS FAMiLY CODE
by Sa鉾 !Acts,F晦 iぬuQ RS 1990:醐
the following andavL
悧l職sd“
l器淵闇鰤
置齋盤刷慧
l緞
l誌 詰
乱靡
Ю耗
轟葛Ⅲ 議も
編 二高品語
119ible lo Proposal or rece市
e a State
contract.
ADDRESS
■ 罵
ぃ
PRINTED N
Vや s
S^
ずハL
AND TITLE OF AUTHORiZED REPRESENTATiVE
ダ′
′ブ
COFndett and return with PЮ
3 VVAREHOUSE,DOa Shい RF'j201410
DOSd
P鴫 o25 of29
Food Wholesaler License
lolesate lood manutactures and′
FimS that manufacture andわ r dislributt f00d fOr Sale to schools are lけ
distributors"and must acquire he approplate ttCense with the Texas Depa」
bbn、
Food and Drug Safety,Manuhctured Foods D市
購:曇
翻 憑撼感品蓮
1盤
o「
hlenl o「 Health,Bureau●
l
鵬 躙樵淵鮮財
精
leparmenl of Health(TDH):
Texas DepOmentof H“ 識h
Manufactured Food D市 islon
l100 West 49JI Street
Austin ttX 78756・ 3199
(388)963・ 7111
A∞ py
of he F∞ d WhOlesaier License must be included With Proposal.
ごm
ヾ?
cOpy d Food Whdesaler Ll∝
nse配 鮨d“ 面 血 PropOSま YeS Or間 二
疑
F三
一
一
一
一
一
Comdete and durn哺 衝 PЮ noSJ
FULL LINEGROCERYITEMIミ REHOUI,Dttd飾 わRP μ2014‐ 10
Pη e26 of四
Clen Air andWabr Act
pursuant to
r. the Vendor, am in compliance with alt applicable standards, orders or regutaticns issued
amended (33
Act,
as
ol the cban water
ctean Air Act of 1g70, as Arnended (42 U.S.C. 1857(h)), section 508
Agency Regulation.40 CFR Part 15 as
u.S.C. 136g), Executive Order 1173'Bg and EnvironmmtatProtection
required under OMB Circular A-102,
the
violations to the grantor agency and to the United States
Attachment 0, paragraph 14 (1) regarding reporting
for the Enforcement'
Environment Protection Agency Assistant Administrator
Polental VendOr
Title of Authorized Representative:
〕 20■
Ma面 ng Address:
signaturei
薇FP#η 1410
Page 27 of西
CERTIFiCAT10N OF PROPOSAL SPECiFlCAT10NSRRMS&CONOIT10NS
RFP″ 014o10
腱
朧融 暉
椰
“
糠露驀脳撚彙
coMpANy
clwi?で
fir::ts
Nnur: flornn 44,;
address:
餞 r61c
ptt h輔
,
lT-nc-
:た
Sね ね
‐ 力ttt,■ ―
,
乙多
「
W―
…
・
…
…
…
L5 9t´
…
RESIDENT VENDOR CERTIFICAIION
informatbn must be provided. Failure to comoleie may
rn order for proposar to be considered, the fo[owing
result in reJection of the oroposal:
As defined by Texas
a vendor whose principal clace of
rioil*ari 002, a "nonresident vendor' frleans
parent company or majonty owner has its
+rtrose ultimate
business is not in Texas, but excludes a coniractor
my
cgmpany is a'Tesident vendor':
prirripri place of business in Texas, I certify that
Date:
Signature
lf you
q
・
訂計 僣赫
蕊
vendor,' vou ry st.!T:,l
uali! as a "nonresident
'ま
lit^l1P:Y:t:Hl:l'
plndpd口 a∝ dbuSnesb bCatedl
i3品
L`高
恐
1高 品爵
σ
″
04
Company
Name
Cty
°ldに
01緞ぽ薦∬鮒ξ鱚
oompambb con戯_“ Reslde∝ e
(B)
Addre“
撚f津 :穏t∬ 警[朧 1
譜躍憾h慇
聖滉
he plndpJが
・ means he sね 撻 h Whに
tta鯰
ace of bujness t 10CaOd
ge?2≧ %
m am話轟 高ね
試
瀧‖
しい
Cotrpany
赫
面 画 面 面 IAREHOUSE.馴 m Shlp RFP#富
嘉赦
Name
Page 28 o129
"0
PROPO SAL ACKNOWLEDGI{ENT
FULL LINE GROCERY ITEMSWAREHOUSE, DIRECT SHIP
lRrPf
T0:
#2014"101
Education Service Center Region 10
i, or we, the duly authorized undensigned, having carefully red the
lnstructions to Offerors, General
Conditions, Notice to Cfferors, Contract Specifications, Responsibilities of Offerors, and Proposal Forms, do
hereby agree to enter into a contract wrth Region 10 by tendering tu's offer to perform the work reouired
per specifications
and/oi provide the product(s) specified in this solicitation. l, or we, willdeliverthe product(s)
the
found in this proposal documeni for the prices indicated. l, 0r we, also certify to the accuracy of
Water
Acti
certifications requrred (including, but not limited to, Felony Conviction Notic,e or Clean Air and
which accompany this offer. l, or we, will follow all applicable state or federal laws'
or
The prices in this offer have been determined independently, without consuftation, mrnmunication,
prices, with any other
agreement tor ihe purpose of restricting competition, as to any matter related to such
have not been a party to any
orhror or with any competitor. l, or we. are aulhorized to submil this offer and
offer at a fixed price or to
coilusion am6ng offer/offerors in restraint of freedom of competition by agreement to
consultant as to quantity, quality, or
refrain from ofriring; or rvith any Region 10 employee, Board Drector, or
any authcrized
pnce in the prosjmtive contrmt, or in any terms of the prospective conbact except in
offer/offerors
between
or
actions
discussion(s) with Region 10's Business perscnnel; or in any discussions
things of
other
or
rnoney
of
exchange
and any negion 10 employee. Board Diredor or consultant conceming
value for soecial consideration in the award of this contraci'
Date.
Firrn's Address
0こ ら丁
´
ち と 2'´
Namefr「 Ile:
Phone #:
r"^*, tss-444- t/7{'/ss or Fed lD#:
PROPOSAL ENVELOPES SHOULD BE PLAINLY MARKED:
IRF諄 燿 014・ 101
MJ轟・Regbnd C●
RequestfOrPropllal'稚
“
鍵謂
I嵩調
鳳 乳 usE,回 旺 CT SHP'
111::1:lil:IchiefFinancialCttncer
400 East Spring Va‖ ey Rd,
RIchardson,Texas 75081
DUE:Thursday,May 29:2014 at 4:30 pm
Comdeわ and
FULi_日 NE
GROCERYITEMSヽ
ヽ証
retum with口 ЮoOSd
HOuSE,Diゐ 歓 Ship RFP#2014‐ 10
Ptte 29 of29
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