Issuing Agents for Building and/or Electrical Permits

1STATE OF TENNESSEE
DEPARTMENT OF COMMERCE AND INSURANCE
SOLICITATION # 33501-262514
FOR ISSUING AGENTS FOR BUILDING AND/OR ELECTRICAL PERMITS
1. INTRODUCTION
The State of Tennessee, Department of Commerce and Insurance, hereinafter referred to as “the State,”
has issued this Solicitation with the intent of awarding contracts to provide issuance of building and/or
electrical permits in accordance with Tenn. Comp. R. Regs. 0780-02-01 and 0780-02-23.
2. SCOPE OF SERVICE, CONTRACT PERIOD, TERMS AND CONDITIONS
The Contracts attached to this Solicitation (Attachments D and E) represent the contract document that
the contractor selected by the state must sign. It specifically details the State's required:
• Scope of Services and Deliverables (Section A);
• Contract Period (Section B);
• Payment Terms (Sections C);
• Standard Terms and Conditions (Section D); and
• Special Terms and Conditions (Section E).
3. PROCUREMENT SCHEDULE
The following schedule represents the State’s best estimates for this procurement, however, the State
reserves the right, at its sole discretion, to adjust the schedule at any time, or to cancel or reissue a
similar solicitation.
EVENT DATE
1. Solicitation Issued July 1, 2025
2. Response Deadline June 30, 2026
3. State Completion of Application EvaluationWithin 30 days receipt of the required
documentation
4. State sends contract to Contractor for
signatureOnce evaluated, approved, and
awarded
5. Contractor Signature Deadline Within 7 days receipt of the contract
6. Contract Start DateOnce approved by the Commissioner
and the Office of the Comptroller

24. RESPONSE REQUIREMENTS
4.1. An offer in response to this solicitation must respond only as required by this Solicitation
document.
The State may determine an offer to be non-responsive and ineligible for contract award if it fails
to address all items or is not organized to properly reference the Qualifications Evidence Guide.
4.2. Qualifications Evidence Guide - The Qualifications Evidence Guide (Attachment A) details
specific mandatory requirements for an offer in response to this Solicitation. Potential Contractor
must use the completed Qualifications Evidence Guide (Attachment A), as a table of contents to
organize and reference the supporting documentation for this portion of the Solicitation response.
4.3. Response Prohibitions. An offer in response to this Solicitation MUST NOT:

• Include the Potential Contractor's own contract terms and conditions;
• Restrict the rights of the State or otherwise qualify either the offer to deliver services as
required by this Solicitation; or
• Include, for consideration in this procurement process or subsequent contract
negotiations, incorrect information that the Potential Contractor knew or should have
known was materially incorrect.

4.4. Response Delivery. No later than the Response Deadline (refer to section 3, above), a Potential
Contractor must deliver to the State ALL documentation required in the Qualifications Evidence
Guide in response to this Solicitation. It must be delivered to:
Chad Butler, Assistant General Counsel
Department of Commerce and Insurance
Davy Crockett Tower, 12th Floor, Legal Division
500 James Robertson Parkway
Nashville, Tennessee 37243
Email: ci.procurement@tn.gov

5. EVALUATION & CONTRACT AWARD
An evaluation team of at least three (3) state employees will review the Qualifications Evidence
Guide and any supporting documentation timely submitted. For a response to be acceptable and
eligible for contract award, all evaluators must determine that the Qualifications Evidence Guide
documents that the Potential Contractor submits meet the minimum requirements specified by
this Solicitation and the Potential Contractor is, at least, minimally acceptable as a contractor for
the subject services.

6. GENERAL INFORMATION & REQUIREMENTS

6.1. Nondiscrimination . No person shall be excluded from participation in, be denied benefits of, or
be otherwise subjected to discrimination in the performance of a Contract pursuant to this
Solicitation or in the employment practices of the Contractor on the grounds of handicap or
disability, age, race, color, religion (subject to Tennessee Code Annotated, Sections 4-21-401
and 405), sex, national origin, or any other classification protected by federal, Tennessee state
constitutional, or statutory law. The Contractor pursuant to this Solicitation shall post in
conspicuous places, available to all employees and applicants, notices of nondiscrimination.
6.2. Communications . Reference Solicitation # 33501-262514, in all communications relating to this
Solicitation, and direct any such communications to the following person designated as the
Solicitation Coordinator.

3 Chad Butler, Assistant General Counsel
Department of Commerce and Insurance
Davy Crockett Tower, 12th Floor, Legal Division
500 James Robertson Parkway
Nashville, Tennessee 37243
Email: ci.procurement@tn.gov

Unauthorized contact about this solicitation with other employees or officials of the State of
Tennessee may result in disqualification from consideration as a contractor.
Notwithstanding the foregoing, potential responders may also contact the following as appropriate:
Staff of the Governor’s Office of Diversity Business Enterprise for assistance available to
minority-owned, women-owned, and small businesses as well as general, public information
relating to this solicitation; and
The following individual designated by the State to coordinate compliance with the
nondiscrimination requirements of the State of Tennessee, Title VI of the Civil Rights Act of
1964, the Americans with Disabilities Act of 1990, and associated federal regulations:
Maliaka Bass, Deputy General Counsel
Department of Commerce and Insurance
Davy Crocket Tower, Legal Division
500 James Robertson Parkway
Nashville, Tennessee 37243
Email: Maliaka.bass@tn.gov
Telephone: (615) 741-9594
Fax: (615) 741-4000

6.3. Conflict of Interest . The State shall not consider an offer from, and this Solicitation shall not result
in a contract with:
An individual who is, or within the past six (6) months has been, an employee of the State of
Tennessee or who is a volunteer member of a State board or commission that votes for, lets
out, overlooks, or in any manner superintends the services being procured in this Solicitation;
A company, corporation, or any other contracting entity in which an ownership of two percent
(2%) or more is held by an individual who is, or within the past six (6) months has been, an
employee of the State of Tennessee (this will not apply either to financial interests that have
been placed in a “blind trust” arrangement pursuant to which the employee does not have
knowledge of the retention or disposition of such interests or to the ownership of publicly traded
stocks or bonds where such ownership constitutes less than two percent (2%) of the total
outstanding amount of the stocks or bonds of the issuing entity);
A company, corporation, or any other contracting entity which employs an individual who is, or
within the past six (6) months has been, an employee of the State of Tennessee in a position
that would allow the direct or indirect use or disclosure of information, which as obtained
through or in connection with his or her employment and not made available to the general
public, for the purpose of furthering the private interest or personal profit of any person; or,
Any individual, company, or any other entity involved in assisting the State in the development,
formulation, or drafting of this Solicitation or its scope of services (such person or entity being
deemed by the State as having information that would afford an unfair advantage).
For these purposes, the state will deem an individual to be an employee of the State of Tennessee
until such time as all compensation for salary, termination pay, and annual leave has been paid.
6.4. Disclosure of Proposal Contents . All materials submitted to the State in response to this
Solicitation become the property of the State of Tennessee. Selection for award does not affect this
right. Upon completion of evaluations, indicated by the award notification (refer to Section 3, above),
the full contents and associated documents submitted in response to this solicitation will be open
for review by the public. By submitting an offer, a Potential Contractor acknowledges and accepts

4that the full contents and associated documents submitted in response to this solicitation will
become open to public inspection.
6.5. Before the Contract resulting from this Solicitation is signed, the apparent successful Potential
Contractor must be registered with the Department of Revenue for the collection of Tennessee
sales and use tax or exempt from such registration. The State shall not approve a contact unless
the Potential Contractor provides proof of such registration or proof of exemption. The foregoing is
a mandatory requirement of an award of a contract pursuant to this Solicitation.

5Issuing Agent
Solicitation 33501-262514 Solicitation Attachment A
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
QUALIFICATIONS EVIDENCE GUIDE
The response to this Solicitation must address all items detailed below and provide, in sequence, the
information and documentation as required (referenced with the associated item references).
In addition to the items below, the State will review each response for compliance with all solicitation
requirements, including but not limited to:
The response must be delivered to the State no later than the Response Deadline
The Qualifications Evidence must be submitted as required.
The response must NOT contain any qualification, limitation, or other restrictions.
POTENTIAL CONTRACTOR LEGAL ENTITY NAME
Reference Item Signature- By signing in this column,
Potential Contractor indicates
affirmatively to the respective item or
acknowledging that required information
has been attached or otherwise included.
A.1. Name: _____________________
Company Name: _____________________
E-mail Address: _____________________
Mailing Address: _____________________
_____________________
_____________________
_____________________
Telephone Number: __________________ Signature: _____________________

A.2. The Potential Contractor has included
Solicitation Attachment B, Statement of
Certifications and Assurances completed and
signed by an individual empowered to bind
Potential Contractor to the provisions of this
Solicitation and any resulting contract. The
document must be signed without exception or
qualification. Signature: _____________________
A.3. Neither the Potential Contractor nor any
individual who shall perform work under the
contract has a possible conflict of interest ( e.g.,
employment by the State of Tennessee;
relation by blood or marriage, financially
associated with any official of the Department
of Commerce and Insurance; or
operates/works at a commercial or residential
construction or electrician business ). If there is
a possible conflict of interest, an explanation
has been included below.
Any questions of conflict of interest shall be
solely within the discretion of the State, and the
State reserves the right to reject any response
or cancel any award. Signature: _____________________

6
Explanation:

A.4. Neither the Potential Contractor nor, to the
Potential Contractor’s knowledge, any of the
Potential Contractor’s employees, agents,
independent contractors, or subcontractors,
proposed to provide work on a contract
pursuant to this Solicitation, have been
convicted of, pled guilty to, or pled nolo
contendere to any felony. If there has been any
such conviction or plea, an explanation has
been included below.
Any issues relating to such a matter shall be
solely within the discretion of the State, and the
State reserves the right to reject any response
or cancel any award. Signature: _____________________

Explanation:

A.5. There is not any material, pending litigation
that the Potential Contractor should reasonably
believe could adversely affect its ability to meet
contract requirements pursuant to this
Solicitation or is likely to have a material
adverse effect on the Potential Contractor’s
financial condition.

If such exists, list each separately below,
explain the relevant details, and attach the
opinion of counsel addressing whether and to
what extent it would impair the Potential
Contractor’s performance in a contract
pursuant to this solicitation.
Any issues relating to such a matter shall be
solely within the discretion of the State, and the
State reserves the right to reject any response
or cancel any award. Signature: _____________________

Explanation:

A.6. The Potential Contractor’s place of business is
located in Tennessee or a state contiguous to
Tennessee so that services provided
hereunder are made available to citizens of the
State of Tennessee. Signature: _____________________

7A.7.The Potential Contractor and, to the Potential
Contractor’s knowledge, any of the Potential
Contractor’s employees, agents, independent
contractors, or subcontractors, proposed to
provide work on a contract pursuant to this
solicitation, are at least 18 years of age. Signature: _____________________
A.8. Upon receipt of the appropriate fee, the
Potential Contractor shall issue electrical
and/or building permits to qualified individuals
as set forth in Tenn. Comp. R. & Regs. 0780-
02-01 and 0780-02-23.Signature: _____________________
A.9. The Potential Contractor shall receive, make
proper disposition, and account for all monies
collected for electrical and/or building permits
issued as directed by the State. Signature: _____________________
A.10. The Potential Contractor acknowledges that all
cash fees collected from the sale of the
electrical and building permits are State funds
and, until remittance, shall be held in trust for
the State. Signature: _____________________
A.11. The Potential Contractor has, and will,
maintain a telephone with the capability for
voice mail, and an email for the purpose of data
transmission. Signature: _____________________
A.12. The Potential Contractor acknowledges by
signing the contract that the Potential
Contractor is not an electrical/building
inspector employed by Federal, State, Local
Government or private industry, or an
immediate family member of an
electrical/building inspector.Signature: _____________________
A.13. The Potential Contractor has included
Solicitation Attachment C completed and
signed by an individual empowered to bind
Potential Contractor to the provisions of this
Solicitation and any resulting contract.Signature: _____________________

8Issuing Agents
Solicitation 33501-262514 Solicitation Attachment B
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
STATEMENT OF CERTIFICATIONS AND ASSURANCES
An individual legally empowered to contractually bind the Potential Contractor must complete and sign the
Statement of Certifications and Assurances below as required, and this signed statement must be
included with the response as required by the Solicitation Attachment A.
____________________________________________________________________________________
The Potential Contractor does, hereby, expressly affirm, declare, confirm, certify, and assure ALL of the
following:
1. The Potential Contractor will comply with all provisions and requirements of the Solicitation.
2. The Potential Contractor will provide, for the total contract period, all services defined in the Scope
of Services specified by the Pro Forma Contract attached to the Solicitation.
3. The Potential Contractor accepts and agrees, without qualification, to all terms and conditions set
out by the Pro Forma Contract attached to the Solicitation.
4. The Potential Contractor acknowledges and agrees that a contract resulting from the Solicitation
shall incorporate, by reference, the offer in response to the solicitation as a part of the contract.
5. The Potential Contractor will comply, as applicable, with:
a) The laws of the State of Tennessee;
b) Title VI of the federal Civil Rights Act of 1972;
c) Title IX of the federal Education Amendments Act of 1972;
d) The Equal Employment Opportunity Act and the regulations issued there under by the federal
government.
6. To the knowledge of the undersigned, the information detailed within the response to the
Solicitation is accurate.
7. The response submitted to the Solicitation was independently prepared, without collusion, under
penalty of perjury.
8. No amount shall be paid directly or indirectly to an employee or official of the State of Tennessee
as wages, compensation, or gifts in exchange for acting as an officer, agent, employee,
subcontractor, or consultant to the Potential Contractor in connection with the Solicitation or any
resulting contract.

By signature below, the signatory certifies legal authority to bind the proposing entity to the provisions of
this solicitation and any contract awarded pursuant to it. The State may, at its sole discretion and at any
time, require evidence documenting the signatory’s authority to legally bind the proposing entity.
SIGNATURE & DATE: ________________________________________________________

PRINTED NAME & TITLE: ________________________________________________________

LEGAL ENTITY NAME: ________________________________________________________

FEIN or SSN: ________________________________________________________

DO NOT SIGN THIS DOCUMENT IF YOU ARE NOT LEGALLY AUTHORIZED TO BIND THE
INDIVIDUAL OR ENTITY MAKING AN OFFER IN RESPONSE TO THE SUBJECT SOLICITATION

9Issuing Agent
Solicitation 33501-262514 Solicitation Attachment C
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
ELECTRICALANDRESIDENTIALBUILDINGPERMITISSUEAGENTAPPLICATIONS
An individual legally empowered to contractually bind the Offeror must complete and sign the Electrical
Permit Issue Agent Application and/or the Residential Building Permit Issue Agent Application below as
required, and this signed statement must be included with the offer as required by the Qualifications
Evidence Guide, Attachment A.
Potential Contractor only needs to sign the application(s) for the type of permit it wants to sell.

10
STATE OF TENNESSEE
DEPARTMENT OF COMMERCE AND INSURANCE
DIVISION OF FIRE PREVENTION
CONTRACT INSPECTION SERVICES SECTION
500 JAMES ROBERTSON PARKWAY
NASHVILLE, TENNESSEE 37243
Phone (615) 741-7170
Fax (615) 253-4895

APPLICATION FOR
ELECTRICAL PERMIT ISSUE AGENT
Name: (Company/Organization Name if Applicable) _ _______________________________
Type of Business/Organization: _ ______________________________________
(if applicable)
Mail Address: ________________________________________________

Phone Number:

Business Address: ________________________________________________
(Address where Permits will be issued)
________________________________________________

Email Address: _____________________________________________
TN Sales Tax Number: ________________________________________________
Federal ID Number: ________________________________________________
Social Security Number: ________________________________________________
(Required if Individual)
The potential issue agent certifies by signing this application that:
the potential issue agent’s place of business is located in Tennessee or a state contiguous to
Tennessee in order to provide his or her services to the citizens of the state of Tennessee; and
the potential issue agent is not a convicted felon; and
the potential issue agent is not an electrical inspector approved by the state or employed by
federal, state, or local government, or private industry; and
the potential issue agent is at least eighteen (18) years of age; or
the potential issue agent is a governmental entity or an electrical cooperative.
I/We hereby make application to be appointed an Electrical Permit Issue Agent with the State of
Tennessee, Department of Commerce and Insurance.

Signature: ____________________________________________________ Date: ______________

11
STATE OF TENNESSEE
DEPARTMENT OF COMMERCE AND INSURANCE
DIVISION OF FIRE PREVENTION
CONTRACT INSPECTION SERVICES SECTION
500 JAMES ROBERTSON PARKWAY
NASHVILLE, TENNESSEE 37243
Phone (615) 741-7170
Fax (615) 253-4895

APPLICATION FOR
RESIDENTIAL BUILDING PERMIT ISSUE AGENT
Name: (Company/Organization Name if Applicable) _ _______________________________
Type of Business/Organization: _ ______________________________________
(if applicable)
Mail Address: ________________________________________________

Phone Number:

Business Address: ________________________________________________
(Address where Permits will be issued)
________________________________________________

Email Address: _____________________________________________
TN Sales Tax Number: ________________________________________________
Federal ID Number: ________________________________________________
Social Security Number: ________________________________________________
(Required if Individual)
The potential issue agent certifies by signing this application that:
the potential issue agent’s place of business is located in Tennessee or a state contiguous to
Tennessee in order to provide his or her services to the citizens of the state of Tennessee; and
the potential issue agent is not a convicted felon; and
the potential issue agent is not a building inspector approved by the state or employed by federal,
state, or local government, or private industry; and
the potential issue agent is at least eighteen (18) years of age; or
the potential issue agent is a governmental entity.
I/We hereby make application to be appointed a Residential Building Permit Issue Agent with the State of
Tennessee, Department of Commerce and Insurance.

Signature: ____________________________________________________ Date: ______________

12 Issuing Agent
Solicitation 33501-262514 Solicitation Attachment D

COMMERCIAL CONTRACTOR PRO FORMA CONTRACT
The Pro Forma contract detailed in the following pages of this attachment contains some “blanks,”
signified by red text, that will be filled in after the Solicitation has been evaluated and a contract
awarded.

10.31.24 FA
CONTRACT
(fee-for-goods or services contract with an individual, business, non-profit, or governmental entity of
another state)
Begin Date End Date Agency Tracking # Edison Record ID
June 30, 2030
Contractor Legal Entity Name Edison Vendor ID

Goods or Services Caption (one line only)
Issuance of State electrical and/or building permits
Contractor Assistance Listing Number#
Contractor
Funding —
FY State Federal Interdepartmental Other TOTAL Contract Amount
2026
2027
2028
2029
2030
TOTAL:

Contractor Ownership Characteristics:
Minority Business Enterprise (MBE):
African American Asian American Hispanic American Native American
Woman Business Enterprise (WBE)
Tennessee Service Disabled Veteran Enterprise (SDVBE)
Disabled Owned Business (DSBE)
Tennessee Small Business Enterprise (SBE): $10,000,000.00 averaged over a three (3) year period or
employs no more than ninety-nine (99) employees.
Government Non-Minority/Disadvantaged Other:
Selection Method & Process Summary (mark the correct response to confirm the associated summary)
Competitive Selection This contract resulted from a competitive procurement pursuant to authority
delegated by the Central Procurement Office in accordance with Tenn.
Comp. R. & Regs. Rule 0690-03-01-.04 and Rule 0690-03-01-05(4).
Other
Budget Officer Confirmation: There is a balance in the
appropriation from which obligations hereunder are
required to be paid that is not already encumbered to pay
other obligations.
Speed Chart (optional) Account Code (optional)

10.31.24 FA
1 CONTRACT
BETWEEN THE STATE OF TENNESSEE,
DEPARTMENT OF COMMERCE AND INSURANCE
AND
CONTRACTOR NAME

This Contract, by and between the State of Tennessee, Department of Commerce and Insurance
(“State”) and Contractor Legal Entity Name (“Contractor”), is for the issuance of State electrical and/or
building permits, as further defined in the "SCOPE." State and Contractor may be referred to individually
as a “Party” or collectively as the “Parties” to this Contract.

The Contractor is a/an Individual, For-Profit Corporation, Non-Profit Corporation, Special Purpose
Corporation Or Association, Partnership, Joint Venture, Or Limited Liability Company .
Contractor Place of Incorporation or Organization: Location
Contractor Edison Registration ID # Number

A. SCOPE:

A.1. The Contractor shall provide all goods or services and deliverables as required, described, and
detailed below and shall meet all service and delivery timelines as specified by this Contract.
A.2. Before issuing any electrical or building permits, the Contractor shall provide, on a declaration
form provided by the State, the amount the Contractor will charge for their issuing agent fee, as
permitted by Tenn. Comp. R. & Regs. 0780-02-01 and/or Tenn. Comp. R. & Regs. 0780-02-23.
Changes to the issuing agent fee shall be made in writing, on the appropriate form, submitted,
and approved by the State prior to the issuing agent fee change.
A.3. The Contractor shall collect a permit fee for each electrical and/or building permit issued, in
accordance with the amounts specified by Tenn. Comp. R. & Regs. 0780-02-01 and Tenn. Comp.
R. & Regs. 0780-02-23.
A.4. The Contractor acknowledges that all fees (both permit and issuing agent fees) collected from the
sale of electrical and/or building permits are State funds and shall be remitted in whole to the
State. The State shall reimburse the issuing agent fee to the Contractor once the State confirms
all monthly funds have been collected by the State. The Contractor shall receive, make proper
disposition, and account for all monies collected for electrical and/or building permits issued as
follows:
a. The Contractor shall manually enter the appropriate payment information (electronic check,
credit/debit card, or cash) directly into the online portal provided by the State.
If fees are paid in cash by the permit applicant, the State will send an invoice to the
Contractor at the end of the month noting the amount of funds that are due to the State.
Contractor shall send the invoiced State funds (both permit fee and issuing agent fee) to the
State. The State will reimburse the Contractor’s issuing agent fee.
b. If the Contractor does not have internet capabilities, the Contractor shall obtain written
approval from the Director of the Electrical, Residential, and Marina Section (hereinafter
referred to as “Director”) to issue electrical and/or building permits. Contractor shall be
responsible for collecting all State funds (both permit and issuing agent fee). The Contractor
shall send all collected State funds to the address listed on the State-provided monthly
invoice. Once all State funds are received, the State will reimburse the Contractor’s issuing
agent fee.
c. The Contractor shall not store, save, or keep a permit applicant’s payment information. All
payment information shall be immediately entered into the online portal. The Contractor
agrees and understands that storing, saving, or keeping a permit applicant’s payment
information shall constitute grounds for immediate termination of this Contract.
d. The Contractor shall not issue refunds on electrical and/or building permits. If a refund is
requested, the Contractor shall direct the permit applicant to contact the State directly.

10.31.24 FA
2 A.5. Upon receipt of the appropriate permit and issuing agent fees, the Contractor shall issue electrical
and/or building permits to qualified individuals as determined in Tenn. Comp. R. & Regs. 0780-
02-01 and Tenn. Comp. R. & Regs. 0780-02-23.
A.6. Upon termination of the Contract, or amendment to the Contract terminating a specific issuing
agent location (as provided under A.10.), the Contractor shall immediately return all State
materials entrusted to the location by the State, including but not limited to, any outstanding State
funds.
A.7. The Contractor agrees to maintain compliance with the following standards:
a. The Contractor’s place of business is located in Tennessee or a state contiguous to
Tennessee, so that services provided hereunder are made available to citizens of
Tennessee;
b. The Contractor, and its designated employee(s), shall not have any convictions for felony
offenses;
c. The Contractor, and its designated employee(s), are at least eighteen (18) years of age; and
d. In accordance with Tenn. Comp. R. & Regs. 0780-02-01 and Tenn. Comp. R. & Regs. 0780-
02-23, the Contractor, and its designated employee(s), are not immediate family of, or
financially associated with, any official of the Department of Commerce and Insurance.
A.8. For an Electrical Permit Issuing Agent, Contractor agrees by signing the Contract that the
Contractor is not an electrical inspector employed by Federal, State, or Local Government; is not
an immediate family member of a Federal, State, or Local Government electrical inspector; or
does not own or operate an electrician business.
A.9. For a Building Permit Issuing Agent, the Contractor agrees by signing the Contract that the
Contractor is not a State Deputy Building Inspector; is not an immediate family member of a State
Deputy Building Inspector; or does not own/operate a construction business.
A.10. Contractor may issue electrical and/or building permits from the following location(s):
Location Name
Location Point of Contact, Title
Location Address
Telephone #

A.11. Contractor shall possess and maintain internet service and a computer or tablet with internet
browser capabilities, or other similar technology approved by the State, which allows for
accessing the State’s online portal. Contractor shall also possess and maintain equipment and
materials to print permits or send permits via electronic mail.
If the Contractor does not have access to internet capabilities, they shall obtain the appropriate
approvals as set forth in Section A.4.b.
A.12. Contractor is responsible for providing its own legal representation in all legal matters. The State
does not represent the Contractor. If the Contractor becomes party to a suit, relative to the
services included in this Contract, Contractor shall notify the State within fourteen (14) calendar
days of notification of the suit.
A.13. The Contractor shall comply with and follow any applicable standard operating procedure(s)
issued by the State.
A.14. Warranty. Contractor represents and warrants that the term of the warranty (“Warranty Period”)
shall be the greater of the Term of this Contract or any other warranty generally offered by
Contractor, its suppliers, or manufacturers to customers of its services. The services provided
under this Contract shall conform to the terms and conditions of this Contract throughout the
Warranty Period. Any nonconformance of the services to the terms and conditions of this
Contract shall constitute a “Defect” and shall be considered “Defective.” If Contractor receives
notice of a Defect during the Warranty Period, then Contractor shall correct the Defect, at no
additional charge.

10.31.24 FA
3 Contractor represents and warrants that all services provided under this Contract shall be
provided in a timely and professional manner, by qualified and skilled individuals, and in
conformity with standards generally accepted in Contractor’s industry.

If Contractor fails to provide the services as warranted, then Contractor will re-provide the
services at no additional charge. If Contractor is unable or unwilling to re-provide the services as
warranted, then the State shall be entitled to recover the fees paid to Contractor for the Defective
services. Any exercise of the State’s rights under this Section shall not prejudice the State’s
rights to seek any other remedies available under this Contract or applicable law.

A.15. Inspection and Acceptance. The State shall have the right to inspect all services provided by
Contractor under this Contract. If, upon inspection, the State determines that the services are
Defective, the State shall notify Contractor, and Contractor shall provide the services at no
additional cost to the State. If after a period of thirty (30) days following performance of services
the State does not provide a notice of any Defects, the services shall be deemed to have been
accepted by the State.
B. TERM OF CONTRACT:
This Contract shall be effective for the period beginning on Date (“Effective Date”) and ending on
June 30, 2030, (“Term”). The State shall have no obligation for goods delivered or services
provided by the Contractor prior to the Effective Date.

C. PAYMENT TERMS AND CONDITIONS:

C.1. Maximum Liability. In no event shall the maximum liability of the State under this Contract
exceed Written Dollar Amount ($Number) (“Maximum Liability”). This Contract does not grant the
Contractor any exclusive rights. The State does not guarantee that it will buy any minimum
quantity of goods or services under this Contract. Subject to the terms and conditions of this
Contract, the Contractor will only be paid for goods or services provided under this Contract after
a purchase order is issued to Contractor by the State or as otherwise specified by this Contract.
C.2. Compensation Firm. The payment methodology in Section C.3. of this Contract shall constitute
the entire compensation due the Contractor for all goods or services provided under this Contract
regardless of the difficulty, materials or equipment required. The payment methodology includes
all applicable taxes, fees, overhead, and all other direct and indirect costs incurred or to be
incurred by the Contractor.
C.3. Payment Methodology. Upon receipt by the State of the permit fee(s) and issuing agent fee(s),
the State shall reimburse the Contractor’s issuing agent fee on a monthly basis. The issuing
agent fee is set by the declaratory form provided by the State to the Contractor, as set forth in
Section A.2. Issuing agent fees shall not exceed the amounts in the table below.
a. The Contractor’s compensation shall be contingent upon the satisfactory provision of goods
or services as set forth in Section A.

b. The Contractor shall be compensated based upon the following payment methodology:

Goods or Services Description Amount
(per compensable increment)
Issuing Agent Fee for Electrical Permits Up to $5.00 per permit
Issuing Agent Fee for Building Permits Up to $15.00 per permit

10.31.24 FA
4 C.4. Travel Compensation. The Contractor shall not be compensated or reimbursed for travel time,
travel expenses, meals, or lodging.
C.5. Invoice Requirements. The State shall invoice Contractor for permit and issuing agent fees paid
in cash to the Contractor and for the amount stipulated in Section C.3. above. Invoices shall be
presented monthly to:

Contractor Location Billing Address(es)
Contractor shall submit the State invoice and cash payments to the following address:

Department of Commerce and Insurance
Attention: Accounts Payable
500 James Robertson Parkway
Nashville, Tennessee 37243

C.6. Payment of Invoice. A payment by the State shall not prejudice the State's right to object to or
question any payment, invoice, or other matter. A payment by the State shall not be construed as
acceptance of goods delivered, any part of the services provided, or as approval of any amount
invoiced.
C.7. Retention of Reimbursement. The monthly reimbursement of issuing agent fees may be withheld
by the State until all State funds (permit and issuing agent fees) have been remitted under this
Contract. Once all State funds have been received by the State, the State shall release
reimbursement to the Contractor.
C.8. Prerequisite Documentation. The Contractor shall not invoice the State under this Contract until
the State has received the following, properly completed documentation.
a. The Contractor shall complete, sign, and present to the State the "Authorization
Agreement for Automatic Deposit Form" provided by the State. By doing so, the
Contractor acknowledges and agrees that, once this form is received by the State,
payments to the Contractor, under this or any other contract the Contractor has with the
State of Tennessee, may be made by ACH; and

b. The Contractor shall complete, sign, and return to the State the State-provided W-9 form.
The taxpayer identification number on the W-9 form must be the same as the
Contractor's Federal Employer Identification Number or Social Security Number
referenced in the Contractor’s Edison registration information.

D. MANDATORY TERMS AND CONDITIONS:

D.1. Required Approvals. The State is not bound by this Contract until it is duly approved by the
Parties and all appropriate State officials in accordance with applicable Tennessee laws and
regulations. Depending upon the specifics of this Contract, this may include approvals by the
Commissioner of Finance and Administration, the Commissioner of Human Resources, the
Comptroller of the Treasury, and the Chief Procurement Officer. Approvals shall be evidenced by
a signature or electronic approval.
D.2. Communications and Contacts. All instructions, notices, consents, demands, or other
communications required or contemplated by this Contract shall be in writing and shall be made
by certified, first class mail, return receipt requested and postage prepaid, by overnight courier
service with an asset tracking system, or by email or facsimile transmission with recipient
confirmation. All communications, regardless of method of transmission, shall be addressed to
the respective Party at the appropriate mailing address, facsimile number, or email address as
stated below or any other address provided in writing by a Party.

The State:

10.31.24 FA
5 State of Tennessee - Department of Commerce and Insurance
Division of Fire Prevention - Residential/Electrical Contract Inspections
500 James Robertson Parkway
Nashville, Tennessee 37243-0577
Phone: (615) 741-7170
Email: SFMO.permits-licensing@tn.gov
The Contractor:

Contractor Contact Name & Title
Contractor Name
Address
Email Address
Telephone # Number
FAX # Number

All instructions, notices, consents, demands, or other communications shall be considered
effective upon receipt or recipient confirmation as may be required.

D.3. Modification and Amendment. This Contract may be modified only by a written amendment
signed by all Parties and approved by all applicable State officials.
D.4. Subject to Funds Availability. The Contract is subject to the appropriation and availability of State
or federal funds. In the event that the funds are not appropriated or are otherwise unavailable,
the State reserves the right to terminate this Contract upon written notice to the Contractor. The
State’s exercise of its right to terminate this Contract shall not constitute a breach of Contract by
the State. Upon receipt of the written notice, the Contractor shall cease all work associated with
the Contract. If the State terminates this Contract due to lack of funds availability, the Contractor
shall be entitled to compensation for all conforming goods requested and accepted by the State
and for all satisfactory and authorized services completed as of the termination date. Should the
State exercise its right to terminate this Contract due to unavailability of funds, the Contractor
shall have no right to recover from the State any actual, general, special, incidental,
consequential, or any other damages of any description or amount.
D.5. Termination for Convenience. The State may terminate this Contract for convenience without
cause and for any reason. The State shall give the Contractor at least thirty (30) days written
notice before the termination date. The Contractor shall be entitled to compensation for all
conforming goods delivered and accepted by the State or for satisfactory, authorized services
completed as of the termination date. In no event shall the State be liable to the Contractor for
compensation for any goods neither requested nor accepted by the State or for any services
neither requested by the State nor satisfactorily performed by the Contractor. In no event shall
the State’s exercise of its right to terminate this Contract for convenience relieve the Contractor of
any liability to the State for any damages or claims arising under this Contract.
D.6. Termination for Cause. If the Contractor fails to properly perform its obligations under this
Contract in a timely or proper manner, or if the Contractor materially violates any terms of this
Contract (“Breach Condition”), the State shall have the right to immediately terminate the Contract
and withhold payments in excess of compensation for completed services or provided goods.
Notwithstanding the above, the Contractor shall not be relieved of liability to the State for
damages sustained by virtue of any Breach Condition and the State may seek other remedies
allowed at law or in equity for breach of this Contract.
D.7. Assignment and Subcontracting. The Contractor shall not assign this Contract or enter into a
subcontract for any of the goods or services provided under this Contract without the prior written
approval of the State. Notwithstanding any use of the approved subcontractors, the Contractor
shall be the prime contractor and responsible for compliance with all terms and conditions of this
Contract. The State reserves the right to request additional information or impose additional
terms and conditions before approving an assignment of this Contract in whole or in part or the
use of subcontractors in fulfilling the Contractor’s obligations under this Contract.

10.31.24 FA
6 D.8. Conflicts of Interest. The Contractor warrants that no part of the Contractor’s compensation shall
be paid directly or indirectly to an employee or official of the State of Tennessee as wages,
compensation, or gifts in exchange for acting as an officer, agent, employee, subcontractor, or
consultant to the Contractor in connection with any work contemplated or performed under this
Contract.

The Contractor acknowledges, understands, and agrees that this Contract shall be null and void if
the Contractor is, or within the past six (6) months has been, an employee of the State of
Tennessee or if the Contractor is an entity in which a controlling interest is held by an individual
who is, or within the past six (6) months has been, an employee of the State of Tennessee.
D.9. Nondiscrimination. The Contractor hereby agrees, warrants, and assures that no person shall be
excluded from participation in, be denied benefits of, or be otherwise subjected to discrimination
in the performance of this Contract or in the employment practices of the Contractor on the
grounds of handicap or disability, age, race, creed, color, religion, sex, national origin, or any
other classification protected by federal or state law. The Contractor shall, upon request, show
proof of nondiscrimination and shall post in conspicuous places, available to all employees and
applicants, notices of nondiscrimination.
D.10. Prohibition of Illegal Immigrants. The requirements of Tenn. Code Ann. § 12-3-309 addressing
the use of illegal immigrants in the performance of any contract to supply goods or services to the
state of Tennessee, shall be a material provision of this Contract, a breach of which shall be
grounds for monetary and other penalties, up to and including termination of this Contract.
a. The Contractor agrees that the Contractor shall not knowingly utilize the services of an
illegal immigrant in the performance of this Contract and shall not knowingly utilize the
services of any subcontractor who will utilize the services of an illegal immigrant in the
performance of this Contract. The Contractor shall reaffirm this attestation by submitting
to the State a completed Attestation (accessible through the Edison Supplier Portal) and
included at Attachment A, semi-annually during the Term. If the Contractor is a party to
more than one contract with the State, the Contractor may submit one attestation that
applies to all contracts with the State. All Contractor attestations shall be maintained by
the Contractor and made available to State officials upon request.

b. Prior to the use of any subcontractor in the performance of this Contract, and semi-
annually thereafter, during the Term, the Contractor shall obtain and retain a current,
written attestation that the subcontractor shall not knowingly utilize the services of an
illegal immigrant to perform work under this Contract and shall not knowingly utilize the
services of any subcontractor who will utilize the services of an illegal immigrant to
perform work under this Contract. Attestations obtained from subcontractors shall be
maintained by the Contractor and made available to State officials upon request.

c. The Contractor shall maintain records for all personnel used in the performance of this
Contract. Contractor’s records shall be subject to review and random inspection at any
reasonable time upon reasonable notice by the State.

d. The Contractor understands and agrees that failure to comply with this section will be
subject to the sanctions of Tenn. Code Ann. § 12-3-309 for acts or omissions occurring
after its effective date.

e. For purposes of this Contract, "illegal immigrant" shall be defined as any person who is
not: (i) a United States citizen; (ii) a Lawful Permanent Resident; (iii) a person whose
physical presence in the United States is authorized; (iv) allowed by the federal
Department of Homeland Security and who, under federal immigration laws or
regulations, is authorized to be employed in the U.S.; or (v) is otherwise authorized to
provide services under the Contract.

D.11. Records. The Contractor shall maintain documentation for all charges under this Contract. The
books, records, and documents of the Contractor, for work performed or money received under

10.31.24 FA
7 this Contract, shall be maintained for a period of five (5) full years from the date of the final
payment and shall be subject to audit at any reasonable time and upon reasonable notice by the
State, the Comptroller of the Treasury, or their duly appointed representatives. The financial
statements shall be prepared in accordance with generally accepted accounting principles.

D.12. Monitoring. The Contractor’s activities conducted and records maintained pursuant to this
Contract shall be subject to monitoring and evaluation by the State, the Comptroller of the
Treasury, or their duly appointed representatives.
D.13. Progress Reports. The Contractor shall submit brief, periodic, progress reports to the State as
requested.
D.14. Strict Performance. Failure by any Party to this Contract to require, in any one or more cases,
the strict performance of any of the terms, covenants, conditions, or provisions of this Contract
shall not be construed as a waiver or relinquishment of any term, covenant, condition, or
provision. No term or condition of this Contract shall be held to be waived, modified, or deleted
except by a written amendment signed by the Parties.
D.15. Independent Contractor. The Parties shall not act as employees, partners, joint venturers, or
associates of one another. The Parties are independent contracting entities. Nothing in this
Contract shall be construed to create an employer/employee relationship or to allow either Party
to exercise control or direction over the manner or method by which the other transacts its
business affairs or provides its usual services. The employees or agents of one Party are not
employees or agents of the other Party.
D.16 Patient Protection and Affordable Care Act. The Contractor agrees that it will be responsible for
compliance with the Patient Protection and Affordable Care Act (“PPACA”) with respect to itself
and its employees, including any obligation to report health insurance coverage, provide health
insurance coverage, or pay any financial assessment, tax, or penalty for not providing health
insurance. The Contractor shall indemnify the State and hold it harmless from any costs to the
State arising from Contractor’s failure to fulfill its PPACA responsibilities for itself or its
employees.
D.17. Limitation of State’s Liability. The State shall have no liability except as specifically provided in
this Contract. In no event will the State be liable to the Contractor or any other party for any lost
revenues, lost profits, loss of business, decrease in the value of any securities or cash position,
time, goodwill, or any indirect, special, incidental, punitive, exemplary or consequential damages
of any nature, whether based on warranty, contract, statute, regulation, tort (including but not
limited to negligence), or any other legal theory that may arise under this Contract or otherwise.
The State’s total liability under this Contract (including any exhibits, schedules, amendments or
other attachments to the Contract) or otherwise shall under no circumstances exceed the
Maximum Liability. This limitation of liability is cumulative and not per incident.
D.18. Limitation of Contractor’s Liability. In accordance with Tenn. Code Ann. § 12-3-701, the
Contractor’s liability for all claims arising under this Contract shall be limited to an amount equal
to two (2) times the Maximum Liability amount detailed in Section C.1. and as may be amended,
PROVIDED THAT in no event shall this Section limit the liability of the Contractor for: (i)
intellectual property or any Contractor indemnity obligations for infringement for third-party
intellectual property rights; (ii) any claims covered by any specific provision in the Contract
providing for liquidated damages; or (iii) any claims for intentional torts, criminal acts, fraudulent
conduct, or acts or omissions that result in personal injuries or death. For clarity, except as
otherwise expressly set forth in this Section, Contractor’s indemnification obligations and other
remedies available under this Contract are subject to the limitations on liability set forth in this
Section.
D.19. Hold Harmless. The Contractor agrees to indemnify and hold harmless the State of Tennessee
as well as its officers, agents, and employees from and against any and all claims, liabilities,
losses, and causes of action which may arise, accrue, or result to any person, firm, corporation,
or other entity which may be injured or damaged as a result of acts, omissions, or negligence on

10.31.24 FA
8 the part of the Contractor, its employees, or any person acting for or on its or their behalf relating
to this Contract. The Contractor further agrees it shall be liable for the reasonable cost of
attorneys’ fees, court costs, expert witness fees, and other litigation expenses for the State to
enforce the terms of this Contract.

In the event of any suit or claim, the Parties shall give each other immediate notice and provide
all necessary assistance to respond. The failure of the State to give notice shall only relieve the
Contractor of its obligations under this Section to the extent that the Contractor can demonstrate
actual prejudice arising from the failure to give notice. This Section shall not grant the Contractor,
through its attorneys, the right to represent the State in any legal matter, as the right to represent
the State is governed by Tenn. Code Ann. § 8-6-106.

D.20. HIPAA Compliance. As applicable, the State and Contractor shall comply with obligations under
the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), Health Information
Technology for Economic and Clinical Health (“HITECH”) Act and any other relevant laws and
regulations regarding privacy (collectively the “Privacy Rules”). The obligations set forth in this
Section shall survive the termination of this Contract.
a. Contractor warrants to the State that it is familiar with the requirements of the Privacy
Rules, and will comply with all applicable requirements in the course of this Contract.

b. Contractor warrants that it will cooperate with the State, including cooperation and
coordination with State privacy officials and other compliance officers required by the
Privacy Rules, in the course of performance of the Contract so that both parties will be in
compliance with the Privacy Rules.

c. The State and the Contractor will sign documents, including but not limited to business
associate agreements, as required by the Privacy Rules and that are reasonably
necessary to keep the State and Contractor in compliance with the Privacy Rules. This
provision shall not apply if information received or delivered by the parties under this
Contract is NOT “protected health information” as defined by the Privacy Rules, or if the
Privacy Rules permit the parties to receive or deliver the information without entering into
a business associate agreement or signing another document.

d. The Contractor will indemnify the State and hold it harmless for any violation by the
Contractor or its subcontractors of the Privacy Rules. This includes the costs of
responding to a breach of protected health information, the costs of responding to a
government enforcement action related to the breach, and any fines, penalties, or
damages paid by the State because of the violation.

D.21. Tennessee Consolidated Retirement System. Subject to statutory exceptions contained in Tenn.
Code Ann. §§ 8-36-801, et seq., the law governing the Tennessee Consolidated Retirement
System (“TCRS”), provides that if a retired member of TCRS, or of any superseded system
administered by TCRS, or of any local retirement fund established under Tenn. Code Ann. §§ 8-
35-101, et seq., accepts State employment, the member's retirement allowance is suspended
during the period of the employment. Accordingly and notwithstanding any provision of this
Contract to the contrary, the Contractor agrees that if it is later determined that the true nature of
the working relationship between the Contractor and the State under this Contract is that of
“employee/employer” and not that of an independent contractor, the Contractor, if a retired
member of TCRS, may be required to repay to TCRS the amount of retirement benefits the
Contractor received from TCRS during the Term.
D.22. Tennessee Department of Revenue Registration. The Contractor shall comply with all applicable
registration requirements contained in Tenn. Code Ann. §§ 67-6-601 – 608. Compliance with
applicable registration requirements is a material requirement of this Contract.
D.23. Debarment and Suspension. The Contractor certifies, to the best of its knowledge and belief, that
it, its current and future principals, its current and future subcontractors and their principals:

10.31.24 FA
9 a. are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any federal or state department or
agency;

b. have not within a three (3) year period preceding this Contract been convicted of, or had
a civil judgment rendered against them from commission of fraud, or a criminal offense in
connection with obtaining, attempting to obtain, or performing a public (federal, state, or
local) transaction or grant under a public transaction; violation of federal or state antitrust
statutes or commission of embezzlement, theft, forgery, bribery, falsification, or
destruction of records, making false statements, or receiving stolen property;

c. are not presently indicted or otherwise criminally or civilly charged by a government entity
(federal, state, or local) with commission of any of the offenses detailed in section b. of
this certification; and

d. have not within a three (3) year period preceding this Contract had one or more public
transactions (federal, state, or local) terminated for cause or default.

The Contractor shall provide immediate written notice to the State if at any time it learns that
there was an earlier failure to disclose information or that due to changed circumstances, its
principals or the principals of its subcontractors are excluded, disqualified, or presently fall under
any of the prohibitions of sections a-d.

D.24. Force Majeure. “Force Majeure Event” means fire, flood, earthquake, elements of nature or acts
of God, wars, riots, civil disorders, rebellions or revolutions, acts of terrorism or any other similar
cause beyond the reasonable control of the Party except to the extent that the non-performing
Party is at fault in failing to prevent or causing the default or delay, and provided that the default
or delay cannot reasonably be circumvented by the non-performing Party through the use of
alternate sources, workaround plans or other means. A strike, lockout or labor dispute shall not
excuse either Party from its obligations under this Contract. Except as set forth in this Section,
any failure or delay by a Party in the performance of its obligations under this Contract arising
from a Force Majeure Event is not a default under this Contract or grounds for termination. The
non-performing Party will be excused from performing those obligations directly affected by the
Force Majeure Event, and only for as long as the Force Majeure Event continues, provided that
the Party continues to use diligent, good faith efforts to resume performance without delay. The
occurrence of a Force Majeure Event affecting Contractor’s representatives, suppliers,
subcontractors, customers or business apart from this Contract is not a Force Majeure Event
under this Contract. Contractor will promptly notify the State of any delay caused by a Force
Majeure Event (to be confirmed in a written notice to the State within one (1) day of the inception
of the delay) that a Force Majeure Event has occurred, and will describe in reasonable detail the
nature of the Force Majeure Event. If any Force Majeure Event results in a delay in Contractor’s
performance longer than forty-eight (48) hours, the State may, upon notice to Contractor: (a)
cease payment of the fees for the affected obligations until Contractor resumes performance of
the affected obligations; or (b) immediately terminate this Contract or any purchase order, in
whole or in part, without further payment except for fees then due and payable. Contractor will
not increase its charges under this Contract or charge the State any fees other than those
provided for in this Contract as the result of a Force Majeure Event.
D.25. State and Federal Compliance. The Contractor shall comply with all State and federal laws and
regulations applicable to Contractor in the Contractor’s performance of this Contract.
D.26. Governing Law. This Contract shall be governed by and construed in accordance with the laws
of the State of Tennessee, without regard to its conflict or choice of law rules. The Tennessee
Claims Commission or the state or federal courts in Tennessee shall be the venue for all claims,
disputes, or disagreements arising under this Contract. The Contractor acknowledges and
agrees that any rights, claims, or remedies against the State of Tennessee or its employees
arising under this Contract shall be subject to and limited to those rights and remedies available
under Tenn. Code Ann. §§ 9-8-101 - 408.

10.31.24 FA
10 D.27. Entire Agreement. This Contract is complete and contains the entire understanding between the
Parties relating to its subject matter, including all the terms and conditions of the Parties’
agreement. This Contract supersedes any and all prior understandings, representations,
negotiations, and agreements between the Parties, whether written or oral.
D.28. Severability. If any terms and conditions of this Contract are held to be invalid or unenforceable
as a matter of law, the other terms and conditions of this Contract shall not be affected and shall
remain in full force and effect. The terms and conditions of this Contract are severable.
D.29. Headings. Section headings of this Contract are for reference purposes only and shall not be
construed as part of this Contract.
D.30. Incorporation of Additional Documents. Each of the following documents is included as a part of
this Contract by reference. In the event of a discrepancy or ambiguity regarding the Contractor’s
duties, responsibilities, and performance under this Contract, these items shall govern in order of
precedence below:
a. any amendment to this Contract, with the latter in time controlling over any earlier
amendments;
b. this Contract with any attachments or exhibits (excluding the items listed at subsections
c. through f., below), which includes Attachment A;
c. any clarifications of or addenda to the Contractor’s proposal seeking this Contract;
d. the State solicitation, as may be amended, requesting responses in competition for this
Contract;
e. any technical specifications provided to proposers during the procurement process to
award this Contract; and
f. the Contractor’s response seeking this Contract.

D.31. Iran Divestment Act. The requirements of Tenn. Code Ann. § 12-12-101, et seq., addressing
contracting with persons as defined at Tenn. Code Ann. §12-12-103(5) that engage in investment
activities in Iran, shall be a material provision of this Contract. The Contractor certifies, under
penalty of perjury, that to the best of its knowledge and belief that it is not on the list created
pursuant to Tenn. Code Ann. § 12-12-106.
D.32. Insurance. Contractor shall maintain insurance coverage as specified in this Section. The State
reserves the right to amend or require additional insurance coverage, coverage amounts, and
endorsements required under this Contract. The State reserves the right to require complete
copies of all required insurance policies, including endorsements required by these specifications,
at any time. If Contractor loses insurance coverage, fails to renew coverage, or for any reason
becomes uninsured during the Term, Contractor shall immediately notify the State.
The insurance obligations under this Contract shall be: 1—all the insurance coverage and
policy limits carried by or available to the Contractor; or 2—the minimum insurance
coverage requirements and policy limits shown in this Contract; whichever is greater. Any
insurance proceeds or policies in excess of or broader than the minimum required
coverage and minimum required policy limits, which are applicable to a given loss, shall
be available to the State. No representation is made that the minimum insurance
requirements of the Contract are sufficient to cover the obligations of the Contractor
under this Contract. The Contractor shall obtain and maintain, at a minimum, the
following insurance coverage(s) and policy limits.
a. Automobile Liability Insurance
1) In the event that the Contractor (1) owns, leases, or otherwise operates an automotive vehicle
and (2) intends to use such vehicle in furtherance of their Contractual duties or for regular or
periodic transportation onto State property for the purposes of performing the Contractor’s duties
under the Terms of this Contract, then the Contractor shall provide to the State proof of the
Contractor’s automobile liability insurance policy. Such automobile liability insurance policy shall
maintain limits not less than the minimum liability limits established by the relevant authority

10.31.24 FA
11 under which said vehicle is licensed. Such verification is required whether or not the State
intends to reimburse the Contractor for mileage.
2) If the Contractor DOES NOT (1) own, lease, or otherwise operate an automotive vehicle or (2)
WILL NOT operate or otherwise employ a personal vehicle in furtherance of their contractual
duties or for regular or periodic transportation onto State property for the purposes of performing
the Contractor’s duties under the Terms of this Contract, then the Contractor shall provide to the
State a letter signed by the Contractor certifying as to the above. In the event that such situation
changes over the course of the Term of this Contract as described in provision 1) above, the
Contractor shall inform the State and provide proof of automobile liability insurance before such
time as the Contractor shall use such vehicle in furtherance of their Contractual duties or for
regular or periodic transportation onto State property for the purposes of performing the
Contractor’s duties under the Terms of this Contract.

b. Workers’ Compensation and Employer Liability Insurance

1) For Contractors statutorily required to carry workers’ compensation and employer
liability insurance, the Contractor shall maintain:
i. Workers’ compensation and employer liability insurance in the amounts
required by appropriate state statutes.

2) If the Contractor certifies that it is exempt from the requirements of Tenn. Code
Ann. §§ 50-6-101 – 103, then the Contractor shall furnish written proof of such
exemption for one or more of the following reasons:
i. The Contractor employs fewer than five (5) employees;
ii. The Contractor is a sole proprietor;
iii. The Contractor is in the construction business or trades with no
employees;
iv. The Contractor is in the coal mining industry with no employees;
v. The Contractor is a state or local government; or
vi. The Contractor self-insures its workers’ compensation and is in
compliance with the TDCI rules and Tenn. Code Ann. § 50-6-405.
D.33. Major Procurement Contract Sales and Use Tax. Pursuant to Tenn. Code Ann. § 4-39-102 and
to the extent applicable, the Contractor and the Contractor’s subcontractors shall remit sales and
use taxes on the sales of goods or services that are made by the Contractor or the Contractor’s
subcontractors and that are subject to tax.
D.34. Confidentiality of Records. Strict standards of confidentiality of records and information shall be
maintained in accordance with applicable state and federal law. All material and information,
regardless of form, medium or method of communication, provided to the Contractor by the State
or acquired by the Contractor on behalf of the State that is regarded as confidential under state or
federal law shall be regarded as “Confidential Information.” Nothing in this Section shall permit
Contractor to disclose any Confidential Information, regardless of whether it has been disclosed
or made available to the Contractor due to intentional or negligent actions or inactions of agents
of the State or third parties. Confidential Information shall not be disclosed except as required or
permitted under state or federal law. Contractor shall take all necessary steps to safeguard the

10.31.24 FA
12 confidentiality of such material or information in conformance with applicable state and federal
law.

The obligations set forth in this Section shall survive the termination of this Contract.

D.35. Boycott of Israel. The Contractor certifies that it is not currently engaged in, and covenants that it
will not, for the duration of the Contract, engage in a Boycott of Israel, as that term is defined in
Tenn. Code Ann. § 12-4-119.
D.36. Prohibited Contract Terms. The prohibited contract terms and conditions enumerated in Tenn.
Code Ann. § 12-3-515, shall be a material provision of this Contract. The Contractor acknowledges,
understands, and agrees that the inclusion of a term or condition prohibited by Tenn. Code Ann. §
12-3-515, shall be null and void and the Contract shall be enforceable as if the Contract did not
contain such term or condition.
E. SPECIAL TERMS AND CONDITIONS:

E.1. Conflicting Terms and Conditions. Should any of these special terms and conditions conflict with
any other terms and conditions of this Contract, the special terms and conditions shall be
subordinate to the Contract’s other terms and conditions.
E.2. Contractor Commitment to Diversity. The Contractor shall comply with and make reasonable
business efforts to exceed the commitment to diversity represented by the Contractor’s Response
to Solicitation # 33501-262514 and resulting in this Contract.

The Contractor shall assist the State in monitoring the Contractor’s performance of this
commitment by providing, as requested, a monthly report of participation in the performance of
this Contract by small business enterprises and businesses owned by minorities, women, service-
disabled veterans, and persons with disabilities. Such reports shall be provided to the State of
Tennessee Governor's Office of Diversity Business Enterprise in the TN Diversity Software
available online at:
https://tn.diversitysoftware.com/FrontEnd/StartCertification.asp?TN=tn&XID=9810 .
E.3. State Furnished Property. The Contractor shall be responsible for the correct use, maintenance,
and protection of all articles of nonexpendable, tangible personal property furnished by the State
for the Contractor’s use under this Contract. Upon termination of this Contract, all property
furnished by the State shall be returned to the State in the same condition as when received, less
ordinary wear and tear. Should the property be destroyed, lost, or stolen, the Contractor shall be
responsible to the State for the fair market value of the property at the time of loss.
E.4. Prohibited Advertising or Marketing. The Contractor shall not suggest or imply in advertising or
marketing materials that Contractor's goods or services are endorsed by the State. The
restrictions on Contractor advertising or marketing materials under this Section shall survive the
termination of this Contract.

10.31.24 FA
13 IN WITNESS WHEREOF,
CONTRACTOR LEGAL ENTITY NAME :
CONTRACTOR SIGNATURE DATE
PRINTED NAME AND TITLE OF CONTRACTOR SIGNATORY (above)
DEPARTMENT OF COMMERCE AND INSURANCE:
CARTER LAWRENCE, COMMISSIONER DATE

10.31.24 FA
ATTACHMENT A
ATTESTATION RE PERSONNEL USED IN CONTRACT PERFORMANCE
SUBJECT CONTRACT NUMBER:
CONTRACTOR LEGAL ENTITY NAME:
EDISON VENDOR IDENTIFICATION NUMBER:
The Contractor, identified above, does hereby attest, certify, warrant, and
assure that the Contractor shall not knowingly utilize the services of an illegal
immigrant in the performance of this Contract and shall not knowingly utilize
the services of any subcontractor who will utilize the services of an illegal
immigrant in the performance of this Contract.
CONTRACTOR SIGNATURE
NOTICE: This attestation MUST be signed by an individual empowered to contractually bind the Contractor. Attach evidence
documenting the individual’s authority to contractually bind the Contractor, unless the signatory is the Contractor’s chief
executive or president.
PRINTED NAME AND TITLE OF SIGNATORY
DATE OF ATTESTATION

13 Issuing Agent
Solicitation 33501-262514 Solicitation Attachment E

GOVERNMENT CONTRACTOR PRO FORMA CONTRACT

The Pro Forma contract detailed in the following pages of this attachment contains some “blanks,”
signified by red text, that will be filled in after the solicitation has been evaluated and a contract
awarded.

01-19-23 GU
CONTRACT
(fee-for-service contract with a federal or Tennessee local or quasi-governmental entity)
Begin Date End Date Agency Tracking # Edison Record ID
June 30, 2030 -
Contractor Legal Entity Name Edison Vendor ID

Subrecipient or Vendor Assistance Listing Number
Subrecipient Vendor
Service Caption (one line only)
Issuance of State electrical and/or building permits
Funding —
FY State Federal Interdepartmental Other TOTAL Contract Amount
2026
2027
2028
2029
2030
TOTAL:
American Recovery and Reinvestment Act (ARRA) Funding: YES NO
Budget Officer Confirmation: There is a balance in the
appropriation from which obligations hereunder are required to
be paid that is not already encumbered to pay other
obligations. CPO USE - GU
Speed Chart (optional) Account Code (optional)

01-19-23 GU
2 CONTRACT
BETWEEN THE STATE OF TENNESSEE,
DEPARTMENT OF COMMERCE AND INSURANCE
AND
CONTRACTOR NAME

This Contract, by and between the State of Tennessee, Department of Commerce and Insurance,
hereinafter referred to as the “State” and Contractor Legal Entity Name , hereinafter referred to as the
“Contractor,” is for the issuance of State electrical and/or building permits, as further defined in the
"SCOPE OF SERVICES."

Contractor Edison Registration ID # Number

A. SCOPE OF SERVICES:
A.1. The Contractor shall provide all service and deliverables as required, described, and detailed
herein and shall meet all service and delivery timelines as specified by this Contract.
A.2. Before issuing any electrical or building permits, the Contractor shall provide, on a declaration
form provided by the State, the amount the Contractor will charge for its issuing agent fee, as
permitted by Tenn. Comp. R. & Regs. 0780-02-01 and/or Tenn. Comp. R. & Regs. 0780-02-23.
Changes to the issuing agent fee shall be made in writing, on the appropriate form, submitted,
and approved by the State prior to the issuing agent fee change.
A.3. The Contractor shall collect a permit fee for each electrical and/or building permit issued, in
accordance with the amounts specified by Tenn. Comp. R. & Regs. 0780-02-01 and Tenn. Comp.
R. & Regs. 0780-02-23.
A.4. The Contractor acknowledges that all fees (both permit and issuing agent fees) collected from the
sale of electrical and/or building permits are State funds and shall be remitted in whole to the
State. The State shall reimburse the issuing agent fee to the Contractor once the State confirms
all monthly funds have been collected by the State. The Contractor shall receive, make proper
disposition, and account for all monies collected for electrical and/or building permits issued as
follows:
a. The Contractor shall manually enter the appropriate payment information (electronic check,
credit/debit card, or cash) directly into the online portal provided by the State.
If fees are paid in cash by the permit applicant, the State will send an invoice to the
Contractor at the end of the month noting the amount of funds that are due to the State.
Contractor shall send the invoiced State funds (both permit fee and issuing agent fee) to the
State. The State will reimburse the Contractor’s issuing agent fee.
b. If the Contractor does not have internet capabilities, the Contractor shall obtain written
approval from the Director of the Electrical, Residential, and Marina Section (hereinafter
referred to as “Director”) to issue electrical and/or building permits. Contractor shall be
responsible for collecting all State funds (both permit and issuing agent fee). The Contractor
shall send all collected State funds to the address listed on the State-provided monthly
invoice. Once all State funds are received, the State will reimburse the Contractor’s issuing
agent fee.
c. The Contractor shall not store, save, or keep a permit applicant’s payment information. All
payment information shall be immediately entered into the online portal. The Contractor
agrees and understands that storing, saving, or keeping a permit applicant’s payment
information shall constitute grounds for immediate termination of this Contract.
d. The Contractor shall not issue refunds on electrical and/or building permits. If a refund is
requested, the Contractor shall direct the permit applicant to contact the State directly.
A.5. Upon receipt of the appropriate permit and issuing agent fees, the Contractor shall issue electrical
and/or building permits to qualified individuals as determined in Tenn. Comp. R. & Regs. 0780-
02-01 and Tenn. Comp. R. & Regs. 0780-02-23.

01-19-23 GU
3 A.6. Upon termination of the Contract, or amendment to the Contract terminating a specific issuing
agent location (as provided under A.10.), the Contractor shall immediately return all State
materials entrusted to the location by the State, including but not limited to, any outstanding State
funds.
A.7. The Contractor agrees to maintain compliance with the following standards:
a. The Contractor’s place of business is located in Tennessee or a state contiguous to
Tennessee, so that services provided hereunder are made available to citizens of
Tennessee;
b. The Contractor, and its designated employee(s), shall not have any convictions for felony
offenses;
c. The Contractor, and its designated employee(s), are at least eighteen (18) years of age; and
d. In accordance with Tenn. Comp. R. & Regs. 0780-02-01 and Tenn. Comp. R. & Regs. 0780-
02-23, the Contractor, and its designated employee(s), are not immediate family of, or
financially associated with, any official of the Department of Commerce and Insurance.
A.8. For an Electrical Permit Issuing Agent, Contractor agrees by signing the Contract that the
Contractor is not an electrical inspector employed by Federal, State, or Local Government; is not
an immediate family member of a Federal, State, or Local Government electrical inspector; or
does not own or operate an electrician business.
A.9. For a Building Permit Issuing Agent, the Contractor agrees by signing the Contract that the
Contractor is not a State Deputy Building Inspector; is not an immediate family member of a State
Deputy Building Inspector; or does not own/operate a construction business.
A.10. Contractor may issue electrical and/or building permits from the following location(s):
Location Name
Location Point of Contact, Title
Location Address
Telephone #
A.11. Contractor shall possess and maintain internet service and a computer or tablet with internet
browser capabilities, or other similar technology approved by the State, which allows for
accessing the State’s online portal. Contractor shall also possess and maintain equipment and
materials to print permits or send permits via electronic mail.
If the Contractor does not have access to internet capabilities, it shall obtain the appropriate
approvals as set forth in Section A.4.b.
A.12. Contractor is responsible for providing its own legal representation in all legal matters. The State
does not represent the Contractor. If the Contractor becomes party to a suit, relative to the
services included in this Contract, Contractor shall notify the State within fourteen (14) calendar
days of notification of the suit.
A.13. The Contractor shall comply with and follow any applicable standard operating procedure(s)
issued by the State.
B. TERM OF CONTRACT:

This Contract shall be effective on DATE (“Effective Date”), and ending on June 30, 2030,
(“Term”). The State shall have no obligation for goods or services provided by the Contractor
prior to the Effective Date.

C. PAYMENT TERMS AND CONDITIONS:

C.1. Maximum Liability. In no event shall the maximum liability of the State under this Contract
exceed Written Dollar Amount ($Number). The payment rates in section C.3 shall constitute the
entire compensation due the Contractor for all service and Contractor obligations hereunder
regardless of the difficulty, materials or equipment required. The payment rates include, but are
not limited to, all applicable taxes, fees, overheads, and all other direct and indirect costs incurred
or to be incurred by the Contractor.

01-19-23 GU
4
The Contractor is not entitled to be paid the maximum liability for any period under the Contract or
any extensions of the Contract for work not requested by the State. The maximum liability
represents available funds for payment to the Contractor and does not guarantee payment of any
such funds to the Contractor under this Contract unless the State requests work and the
Contractor performs said work. In which case, the Contractor shall be paid in accordance with
the payment rates detailed in section C.3. The State is under no obligation to request work from
the Contractor in any specific dollar amounts or to request any work at all from the Contractor
during any period of this Contract.