Fillable Variance Request (Form III.D.2.) Please complete this form (Lone Star College System)

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Variance Request (Form III.D.2.) Please complete this form (Lone Star College System)

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Variance Request (Form III.D.2.)
Please complete this form to request a one-time member reduction
in the Submission Review Committee (SRC) or Interview Review
Committee (IRC) because of a vacancy or approved leave.
Submit to the Chancellor’s Office once complete.
Requestor:
RFQ Number:
Review Committee: The Review Committee presently consists of
members. The mandatory number of Review Committee
members is seven (7) for the Submission Review Committee (SRC)
and five (5) for the Interview Review Committee (IRC).
Request: Explain the reason the SRC or IRC is requesting a Variance (e.g., a vacancy
exists at the Project Director level):
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OFFICE OF THE CHANCELLOR
Approved
Not Approved
Stephen C. Head
Chancellor
Date
SectionIII.D.2.PurchasingofConstructionManager‐At‐RiskServicesProcedures
EVALUATIONCOMMITTEENON‐DISCLOSURESTATEMENT
REQUESTFORPROPOSALNUMBER_____________
FORCONSTRUCTIONMANAGER‐AT‐RISKSERVICES
FORMIII.D.2.3.
Toprotecttheintegrity,propriety,andfairplayofprocurementprocessesofLoneStarCollege(“College”)
andtoobtainthebestvaluefortheCollege—
I, ,theundersigned,amemberoftheEvaluationCommitteefor the
competitivesolicitationreferencedabove(“Solicitation”),certifytotheCollegethatthefollowingstatements
aretrueandcorrectandthatIunderstandandagreetobeboundbythecommitmentscontainedherein.
Iamnotcurrentlyemployedby,noramIreceivinganycompensationfromanyproposer,offeror,bidder,or
vendorinvolvedwiththisSolicitation(each,a“Proposer”),withanydisclosedoridentifiedsubcontractoror
suppliertoanyProposer(each,a“Subcontractor”),withanyparententity,subsidiary,orotheraffiliateofany
ProposerorSubcontractor(each,a“Affiliate”),orwithanyagent, broker, officer, director, shareholder,
manager, member, partner, executive, owner, or other person or entity acting in conjunction with any
Proposer,Subcontractor,orAffiliate(each,a“ProposerParty”).Ihavenotreceivednorbeenpromisedany
present or future economic opportunity, employment, gift, loan, trip, favor, special discount, special
treatment,specialservice,oranyothergratuityorbenefitin return for favorable consideration of any
proposal,response,orbidofanyProposerinconnectionwiththisSolicitation(each,a“Proposal”).Iamnot
closelyrelatedbybloodormarriagetoanyProposer,Subcontractor,Affiliate,orProposerParty.
UntiltheSolicitationends—throughanexecutedcontractortheCollege’sdecisionnottoprocurethesolicited
goodsorservices—Iagreetokeepconfidential,andtonottodiscloseorotherwisedivulge,anyinformation
ormaterialspertainingtothecontents,costorpriceinformation,or statusor rankingof anyProposal to
anyone except the Evaluation Committee leader, other EvaluationCommitteemembers,theExecutive
DirectorofProcurement,anyCollege‐retainedconsultantforthisSolicitation,orCollegelegalcounsel,unless
otherwise directed by the Board of Trustees as a whole, the Chancellor, the Executive Director of
Procurement,orCollegelegalcounsel.Iagreetocomplywithallpresentandfuturenon‐disclosureagreements
applyingtotheCollege.
Iunderstandthatloss,misplacement,ormishandlingofanyportion of a Proposal provided to me as an
EvaluationCommitteemembermayfallwithinthephrase“discloseorotherwisedivulge”.
I agree to comply with all applicable laws and College policies and procedures onconflicts of interest in
connectionwiththisSolicitation.Iunderstandthatviolatingapplicablelaws,policies,orproceduresmaybea
breachofethical standardsunderBoardPolicyManualSection IV.D.3.01.,whichmaysubjectviolator(s)to
immediateemploymentterminationunderBoardPolicyManualSectionIV.F.13.03.
Iagree toimmediatelyandfullyinformtheExecutiveDirectorof ProcurementifIwitnessor learn of any
communication orconductrelating tothisSolicitation byanyProposer, Subcontractor,Affiliate,Proposer
Party, Collegeemployee,or third party that reasonably appears to violatethis Non‐Disclosure Statement,
applicable laws, policies, procedures, or any non‐contact provision under the Solicitation, even if the
communicationorconductonlycreatesanappearanceofimpropriety.Iagreethatthisdutyremainsineffect
duringtheSolicitationandforuptofouryearsafterthecontractisawarded.
IhavenopreconceivedpositiononanyProposal’srelativemerits.IagreetoevaluateallProposalswithout
bias,tothebestofmyability,andwiththeCollege’sbestinterestsparamountinalldecisions.
Signature Date
SectionIII.D.2.PurchasingofConstructionManager‐At‐RiskServicesProcedures
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Variance Request (Form III.D.2.) Please complete this form (Lone Star College System)

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Completed 6 October 2020

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