TIPPECANOE SCHOOL CORPORATION VENDOR APPLICATION

*Please provide a current W-9 with your application.

 

NOTE: Not providing a current year IRS W-9 form, could cause a delay in payment.

The undersigned principal or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, or any subcontractors are presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from entering into any agreements/contracts by any Federal agencies. The term “Principal” for purposes of this Affidavit means an officer, director, owner, partner, key employee, or other person with primary management or supervisory responsibilities, or a person who as a critical influence on or substantive control over the operations of the Vendor/Bidder. He further states that if he, a member, a representative, or agent of the firm, company, corporation or partnership represented by him or subcontractor certifies that it has verified the federal suspension and debarment status for all subcontractors receiving funds under this Affidavit and shall be solely responsible for any recoupment, penalties or costs that might arise from use of a suspended or debarred subcontractor. The Vendor/Bidder shall immediately notify the Tippecanoe School Corporation if any subcontractor for work to be performed under the relationships with Tippecanoe School Corporation.

The undersigned principal or agent, being duly sworn on oath, says that he has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, swears or affirms under the penalties of perjury that the Vendor/Bidder does not knowingly employ an unauthorized alien as required by IC 22-5-1.7. The Vendor/Bidder shall enroll in and verify the work eligibility status of all its newly hired employees through the E-Verify program as defined by IC 22-5-1.7-3. The Vendor/Bidder is not required to participate should the E-Verify program cease to exist. Additionally, the Vendor/Bidder is not required to participate if the Vendor/Bidder is selfemployed and does not employ any employees. The Vendor/Bidder shall not knowingly employ or contract with an unauthorized alien. The Vendor/Bidder shall not retain an employee or contract with a person that is also learned to subsequently be an unauthorized alien. The Vendor/Bidder shall require its subcontractors, who perform work under any relationship agreement with the Tippecanoe School Corporation, to certify to the Vendor/Bidder that the subcontractor does not knowingly employ to contract with an unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify program. The Vendor/Bidder agrees to maintain this certification throughout the duration of the term of the relationship with the subcontractor. The Tippecanoe School Corporation may terminate for default if the Vendor/Bidder fails to cure a breach of this provision no later than thirty (30) days after being notified by the Tippecanoe School Corporation.