Representative of a prospective contractor means an officer or director of a corporation, a member or manager of a limited liability corporation, a partner of a partnership or a trustee of a trust of the prospective contractor.
Representative of a prospective contractor means an officer or director of a corporation, a member or manager of a limited liability corporation, a partner of a partnership or a trustee of a trust of the prospective contractor. Name(s) of Applicable Public Official(s) if any: _ (Completed by State Agency or Local Public Body) DISCLOSURE OF CONTRIBUTIONS BY PROSPECTIVE CONTRACTOR: Contribution Made by: Relation to Prospective Contractor: Date Contribution(s) Made: Amount(s) of Contribution(s) Nature of Contribution(s) Purpose of Contribution(s) (Attach extra pages if necessary) Signature Date Title (position) --OR— NO CONTRIBUTIONS IN THE AGGREGATE TOTAL OVER TWO HUNDRED FIFTYDOLLARS ($250) WERE MADE to an applicable public official by me, a family member or representative. Signature Date Title (Position)
Representative of a prospective contractor means an officer or director of a corporation, a member or manager of a limited liability corporation, a partner of a partnership or a trustee of a trust of the prospective contractor. Name(s) of Applicable Public Official(s) if any: _ (Completed by State Agency or Local Public Body) DISCLOSURE OF CONTRIBUTIONS BY PROSPECTIVE CONTRACTOR: Contribution Made By: Relation to Prospective Contractor: Date Contribution(s) Made: Amount(s) of Contribution(s) Nature of Contribution(s) Purpose of Contribution(s) (Attach extra pages if necessary) Signature Date Title (position) --OR— NO CONTRIBUTIONS IN THE AGGREGATE TOTAL OVER TWO HUNDRED FIFTYDOLLARS ($250) WERE MADE to an applicable public official by me, a family member or representative. Signature Date Title (Position)APPENDIX C Resident Veterans Preference Certification (NAME OF CONTRACTOR) hereby certifies the following in regard to application of the resident veterans’ preference to this procurement.
More Definitions of Representative of a prospective contractor
Representative of a prospective contractor means an officer or director of a corporation, a member or manager of a limited liability corporation, a partner of a partnership or a trustee of a trust of the prospective contractor. Name(s) of Applicable Public Official(s) if any: _ (Completed by State Agency or Local Public Body) DISCLOSURE OF CONTRIBUTIONS BY PROSPECTIVE CONTRACTOR: Contribution Made by:Relation to Prospective Contractor: Date Contribution(s) Made: Amount(s) of Contribution(s) Signature Date Title (position) --OR— NO CONTRIBUTIONS IN THE AGGREGATE TOTAL OVER TWO HUNDRED FIFTYDOLLARS ($250) WERE MADE to an applicable public official by me, a family member or representative. Signature Date Title (Position) APPENDIX CResident Veterans Preference Certification (NAME OF CONTRACTOR) hereby certifies the following in regard to application of the resident veterans’ preference to this procurement. Please check the box below: I declare under penalty of perjury that my business prior year revenue starting January 1 ending December 31 allows me the 10% preference discount on this solicitation. I understand that knowingly giving false or misleading information about this fact constitutes a crime.
Representative of a prospective contractor means an officer or director of a
Representative of a prospective contractor means an officer or director of a corporation, a member or manager of a limited liability corporation, a partner of a partnership or a trustee of a trust of the prospective contractor. Name(s) of Applicable Public Official(s) if any: (Completed by State Agency or Local Public Body) DISCLOSURE OF CONTRIBUTIONS BY PROSPECTIVE CONTRACTOR: Contribution Made By: Relation to Prospective Contractor: Date Contribution(s) Made: Amount(s) of Contribution(s) Nature of Contribution(s) Purpose of Contribution(s) (Attach extra pages if necessary) Signature Date Title (position) --OR— NO CONTRIBUTIONS IN THE AGGREGATE TOTAL OVER TWO HUNDRED FIFTYDOLLARS ($250) WERE MADE to an applicable public official by me, a family member or representative. Signature Date Title (Position)APPENDIX C DRAFT CONTRACTThe Agreement included in this Appendix C represents the contract the Agency intends to use to make an award. The State of New Mexico and the Agency reserve the right to modify the Agreement prior to, or during, the award process, as necessary.
Representative of a prospective contractor means an officer or director of a corporation, a member or manager of a limited liability corporation, a partner of a partnership or a trustee of a trust of the prospective contractor. Name(s) of Applicable Public Official(s) if any:_________________________(Completed by State Agency or Local Public Body) DISCLOSURE OF CONTRIBUTIONS BY PROSPECTIVE CONTRACTOR: Contribution Made By: __________________________________________ Relation to Prospective Contractor: __________________________________________ Date Contribution(s) Made: __________________________________________ __________________________________________Amount(s) of Contribution(s) __________________________________________ __________________________________________Nature of Contribution(s) __________________________________________ __________________________________________Purpose of Contribution(s) __________________________________________ __________________________________________(Attach extra pages if necessary)
Representative of a prospective contractor means an officer or director of a corporation, a member or manager of a limited liability corporation, a partner of a partnership or a trustee of a trust of the prospective contractor.DISCLOSURE OF CONTRIBUTIONS: Contribution Made By: Relation to Prospective Contractor: Name of Applicable Public Official: Date Contribution(s) Made: Amount(s) of Contribution(s): Nature of Contribution(s): Purpose of Contribution(s): (Attach extra pages if necessary) Signature Date Title (position) NO CONTRIBUTIONS IN THE AGGREGATE TOTAL OVER TWO HUNDRED FIFTY DOLLARS ($250) WERE MADE to an applicable publicofficial by me, a family member, or representative. Signature Date Title (position)BID FORMResident / Veterans Preference Certification (NAME OF CONTRACTOR) hereby certifies the following in regard to application of the resident veterans’ preference to this procurement: Please check one box only Veteran Resident Businesses:□ I declare under penalty of perjury that my business prior year revenue starting January 1 ending December 31 is less than$1M allowing me the 10% preference discount on this solicitation. I understand that knowingly giving false or misleading information about this fact constitutes a crime. □ I declare under penalty of perjury that my business prior year revenue starting January 1 ending December 31 is more than$1M but less than $5M allowing me the 8% preference discount on this bid or proposal. I understand that knowingly giving false or misleading information about this fact constitutes a crime. □ I declare under penalty of perjury that my business prior year revenue starting January 1 ending December 31 is more than$5M allowing me the 7% preference discount on this bid or proposal. I understand that knowingly giving false or misleading information about this fact constitutes a crime. Resident Businesses:□ I declare under penalty of perjury that my business is a New Mexico resident business allowing me the 5% preference discount on this bid or proposal. I understand that knowingly giving false or misleading information about this fact constitutes a crime.
Representative of a prospective contractor means an officer or director of a corporation, a member or manager of a limited liability corporation, a partner of a partnership or a trustee of a trust of the prospective contractor. Name(s) of Applicable Public Official(s) if any: Mayor Alan M Webber Councilor Signe Lindell, Pro-tem Councilor Renee Villarreal Councilor Michael Garcia Councilor Carol Romero-Wirth Councilor Lee GarciaCouncilor Christopher Rivera Councilor Amanda Chavez Councilor Jaime Cassutt DISCLOSURE OF CONTRIBUTIONS BY PROSPECTIVE CONTRACTOR: Contribution Made By: Relation to Prospective Contractor: Date Contribution(s) Made: Amount(s) of Contribution(s) Nature of Contribution(s) Purpose of Contribution(s) (Attach extra pages if necessary) Signature Date Title (position) --OR— NO CONTRIBUTIONS IN THE AGGREGATE TOTAL OVER TWO HUNDRED FIFTYDOLLARS ($250) WERE MADE to an applicable public official by me, a family member or representative. Signature Date Title (Position)
Representative of a prospective contractor means an officer or director of a corporation, a member or manager of a limited liability corporation, a partner of a partnership or a trustee of a trust of the Prospective Contractor. DISCLOSURE OF CONTRIBUTIONS: Contribution Made By:_ Relation to Prospective Contractor: Name of Applicable Public Official: Date Contribution(s) Made: Amount(s) of Contribution(s) Nature of Contribution(s) Purpose of Contribution(s) DateSignature SIGN WHERE APPLICABLETitle (position) – OR – NO CONTRIBUTIONS IN THE AGGREGATE TOTAL OVER TWO HUNDRED FIFTYDOLLARS ($250) WERE MADE to an applicable public official by me, a family member or representative. DateSignature Title (position) Offeror Business NameCONFLICT OF INTEREST, NON-COLLUSION AND DEBARMENT/SUSPENSION CERTIFICATION FORMCONFLICT OF INTERESTAs utilized herein, the term “Vendor” shall mean that entity submitting a proposal to Albuquerque Public Schools in response to the above referenced bids/request for proposals. The authorized Person, Firm and/or Corporation states that to the best of his/her belief and knowledge: No employee or board member of Albuquerque Public Schools (or close relative), with the exception of the person(s) identified below, has a direct or indirect financial interest in the Vendor or in the proposed transaction. Vendor neither employs, nor is negotiating to employ, any Albuquerque Public Schools employee, board member or close relative, with the exception of the person(s) identified below. Vendor did not participate, directly or indirectly, in the preparation of specifications upon which the quote or offer is made. If the Vendor is a New Mexico State Legislator or if a New Mexico State Legislator holds a controlling interest in Vendor, please identify the legislator: List below the name(s) of any Albuquerque Public Schools employee, board member or close relative who now or within the preceding 12 months (1) works for the Vendor; (2) has an ownership interest in the Vendor (other than as an owner of less than 1% of Vendor’s stock, if Vendor is a publicly traded corporation); (3) is a partner, officer, director, trustee or consultant to the Vendor; (4) has received grant, travel, honoraria or other similar support from Vendor; or(5) has a right to receive royalties from the vendor. CERTIFICATION OF NON-COLLUSION STATEMENTVendor certifies under penalty of perjury that its response to this procurement solicitation is in all respects bona fide, fair, and made without collusion or fraud with any pers...