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HomeMy WebLinkAboutPR 24077: RE-ROOFING OF THE PLEASURE ISLAND RV PARK OFFICE THROUGH SKR CONSTRUCTION, $33,500.00 �._ . ort rthu�^ www.PortArthurTx.gov INTEROFFICE MEMORANDUM Date: January 15, 2025 To: The Honorable Mayor and City Council Through: Ron Burton, City Manager From: George Davis, Director of Pleasure Island RE: P.R. 24077—Authorizing the re-roofing of the Pleasure Island RV Park office through SKR Construction at 540 South Spoil Levee Road. Introduction: The intent of this Agenda Item is to request the City Council's approval of P.R. No. 24077 authorizing the City Manager to re-roof the Pleasure Island RV Park office through SKR Construction of Port Arthur, Texas at 540 South Spoil Levee Road in the projected budgetary amount of$33,500.00. Background: Over the past decades, hurricanes and deterioration have severely damaged the roof of the Pleasure Island RV Park office. The roof of the Pleasure Island RV Park office has several leaks causing the entire roof to need repairing. Budget Impact: Funding in the projected budgetary amount of $33,500.00 is available for this purpose in Pleasure Island Building Maintenance Account Number 450-60-405-5312-00-00-000. Recommendation: It is recommended that the City Council approve P.R.No. 24077 authorizing the City Manager to re-roof the Pleasure Island office through SKR Construction of Port Arthur, Texas at 540 South Spoil Levee Road in the projected budgetary amount of$33,500.00. "Remember,we are here to serve the Citizens of Port Arthur" P.O.Box 1089 X Port Arthur,Texas 77641-1089 X 409.983.8182 X FAX 409.983.8294 P. R. No. 24077 1/15/2025 gd/TNR RESOLUTION NO. A RESOLUTION AUTHORIZING THE CITY MANAGER TO EXECUTE AN AGREEMENT WITH SKR CONSTRUCTION OF PORT ARTHUR, TEXAS, FOR THE RE-ROOFING OF THE PLEASURE ISLAND RV PARK OFFICE IN AN AMOUNT NOT TO EXCEED $33,500.00, WITH FUNDS ALLOCATED FROM PLEASURE ISLAND BUILDING MAINTENANCE ACCOUNT NUMBER 450-60- 405-5312-00-00-000. WHEREAS,the roof of the Pleasure Island RV Park office,located at 540 South Spoil Levee Road, has sustained significant damage over the years due to hurricanes and general wear,resulting in holes and water leaks that compromise the structural integrity and functionality of the building; and WHEREAS,on December 30,2024,the City's Purchasing Division, in accordance with the City's Purchasing Policy, solicited bids for the re-roofing project to restore the office's condition; and WHEREAS, SKR Construction of Port Arthur, Texas, submitted the lowest bid in the amount of$33,500.00, as evidenced by the bid tabulation attached hereto as Exhibit"A"; NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PORT ARTHUR,TEXAS: Section 1. That the facts and opinions in the preamble are true and correct. Section 2. The City Council hereby authorizes the City Manager to enter into a contract, substantially in the form attached hereto as Exhibit "B", with SKR Construction of Port Arthur, Texas, for the re-roofing of the Pleasure Island RV Park office. The project's total cost shall not exceed $33,500.00,with funds allocated from Account Number 450-60-405-5312-00-00-000. Section 3.A copy of the caption of this Resolution should be spread upon the Minutes of the City Council. READ, ADOPTED, AND APPROVED THIS day of January, A.D., 2025, at a Regular Meeting of the City Council of the City of Port Arthur by the following vote: P. R.No. 24077 1/15/2025 gd AYES:(Mayor) Councilmembers: NOES: Thurman"Bill" Bartie Mayor ATTEST: Sherri Bellard City Secretary APPROVED A 0 FOJW" Roxann Pais Cotroneo City Attorney APPROVED S TO ADMINISTRATION:`Calt7 Ron Burto► C City ager George D is Director of Pleasure Island P. R.No. 24077 1/15/2025 gd APPROVED AS TO AVAILABILITY OF FUNDS: Lynda :oswell, Director of Finance I 10 tiA4s Clifton Williams, CPPB Purchasing Manager P. R.No. 24077 1/15/2025 gd Exhibit "A" k - = H � � c) / 2 / r / 0 $ § q H / ? / \ ✓ � § 2 7r 2 k k k a. cl CA AM 4. k /• g ? i. o • k ? k o ■ � el U q H I = . 2 91- a. 2 10 .0 § - u tO n » / 2 3 : 2 1 § o H ■ ■ = 0 2 D 2 k 2 d t cd rlo § ta • = 7 w P O r4:2 E ° / - N / .0 o 91- o g a I = j _ § thp.,.4,-:,_--_ .-.-.-. u G t U \ 4 k k 2 0 2 . . § / 0 \ * 4 q < d P. R. No. 24077 1/15/2025 gd Exhibit "B" CONTRACT FOR ROOF REPAIR AT PLEASURE ISLAND RV PARK THIS AGREEMENT, made this day of , 2025, by and between the City of Port Arthur, a municipal corporation organized under the laws of the State of Texas, hereinafter called "OWNER" or "CITY" and SKR Construction hereinafter called "CONTRACTOR". WITNESSETH: That for and in consideration of the payment terms, conditions and agreements set forth herein, OWNER and CONTRACTOR agree as follows: 1. The term of this Contract shall be for six days from the date stated on the Notice to Proceed with an option to renew for two additional one-year terms,unless sooner terminated under the provision hereof. The City can terminate this contract at its convenience which includes, but is not limited to,funding not bring available in any budget cycle within fifteen(15)days written notice. 2. The Contractor shall repair roof at Pleasure Island RV Park. 3. During the term of this Contract, the Contractor will furnish at his own expense all of the materials, supplies, tools, equipment, labor and other services necessary to connection therewith, excepting those supplies specifically not required of Contractor in the Specifications. 4. The CONTRACTOR agrees to perform all the work described in the specifications and contract documents and to comply with the terms in the amounts stated in the bid documents. 5. The term "Contract Documents" means and includes the following: 1) Agreement 2) General Information 3) Specification 4) Quote 5) Addendums 6) Notice of Award 7) Notice to Proceed 6. This Agreement shall be binding upon all parties hereto and their respective heirs, executors, administrators, successors and assigns. 7. IN WITNESS WHEREOF,the parties hereto have executed, or caused to be executed by their duly authorized officials, this Agreement in ( 2 copies) each of which shall be deemed an original on the date first written above. Signed on the day of 2025 ATTEST CITY OF PORT ARTHUR BY CITY SECRETARY Signed on the day of , 2025 ATTEST SKR Construction BY CITY SECRETARY PRINT NAME: TITLE: GENERAL INFORMATION: NOTE: It is extremely important that the Vendor, Bidder, and/or Contractor furnish the City of Port Arthur the required information specified in Bid or Proposal Specifications listed in this Bid Package. All bids meeting the intent of this request for bid will be considered for award. BIDDERS TAKING EXCEPTION TO THE SPECIFICATIONS, OR OFFERING SUBSTITUTIONS, SHALL STATE THESE EXCEPTIONS BY ATTACHMENT AS PART OF THE BID. The absence of such a list shall indicate that the bidder has not taken exceptions and the City shall hold the bidder responsible to perform in strict accordance with the specifications of the invitation. The City reserves the right to accept any and all or none of the exception(s)/substitutions(s) deemed to be in the best interest of the City of Port Arthur. ALTERING BIDS: Bids cannot be altered or amended after submission deadline. Any interlineations, alteration, or erasure made before opening time must be initialed by the signer of the bid, guaranteeing authenticity. BID AWARD: The City of Port Arthur will review all bids for responsiveness and compliance with these specifications. The award shall be made to the responsive, responsible bidder who submits the best value bid. The City reserves the right to: 1. Reject any and all bids and to make no award if it deems such action to be in its best interest. 2. Award bids on the lump sum or unit price basis, whichever is in the best interest of the City. 3. Reject any or all bids and to waive informalities or defects in bids or to accept such bids as it shall deem to be in the best interests of the City. 4. Award bids to bidders whose principal place of business is in the City of Port Arthur and whose bid is within 5% of the lowest bid price, as provided by Section 271.905 of the Texas Government Code. Excluding Federal Funds TERMINOLOGY: "Bid" vs. "Proposal"--For the purpose of this ITB, the terms "Bid" and Proposal" shall be equivalent. Bidders are cautioned to read the information contained in this ITB carefully and to submit a complete response to all requirements and questions as directed. CONFLICT OF INTEREST: Provide a completed copy of the Conflict of Interest Questionnaire (Form CIQ). The Texas legislature recently enacted House Bill 914 which added Chapter 176 to the Texas Local Government Code. Chapter 176 mandates the public disclosure of certain information concerning persons doing business or seeking to do business with the City of Port Arthur,including affiliations and business and financial relationships such persons may have with City of Port Arthur officers. The form can be can be located at the Texas Ethics Commission web site: https://www.ethics.state.tx.us/filinginfo/conflict forms.htm By doing business or seeking to do business with the City of Port Arthur including submitting a response to this RFP, you acknowledge that you have been notified of the requirements of Chapter 176 of the Texas Local Government Code and you are representing that you in compliance with them. Any information provided by the City of Port Arthur is for information purposes only.If you have concerns about whether Chapter 176 of the Texas Local Government Code applies to you or the manner in which you must comply,you should consult an attorney. ETHICS: Public employees must discharge their duties impartially so as to assure fair, competitive access to governmental procurement by responsible contractors. Moreover, they should conduct themselves in such a manner as to foster public confidence in the integrity of the City of Port Arthur's procurement organization. Any employee that makes purchases for the City is an agent of the City and is required to follow the City's Code of Ethics. MINIMUM STANDARDS FOR RESPONSIBLE PROSPECTIVE BIDDERS: A prospective bidder must affirmatively demonstrate bidder's responsibility. A prospective bidder must meet the following requirements: 1. Be able to comply with the required or proposed delivery schedule. 2. Have a satisfactory record of performance. 3. Have a satisfactory record of integrity and ethics. 4. Be otherwise qualified and eligible to receive an award. 5. Be engaged in a full time business and can assume liabilities for any performance or warranty service required. 6. The City Council shall not award a contract to a company that is in arrears in its obligations to the City. 7. No payments shall be made to any person of public monies under any contract by the City with such person until such person has paid all obligations and debts owed to the City, or has made satisfactory arrangements to pay the same. ADDENDA: Any interpretations, corrections or changes to the ITB and Specifications will be made by addenda. Sole issuing authority of addenda shall be vested in the City of Port Arthur Purchasing Manager. The City assumes no responsibility for the bidder's failure to obtain and/or properly submit any addendum. Failure to acknowledge and submit any addendum may be cause for the bid to be rejected. It is the vendor's responsibility to check for any addendums that might have been issued before bid closing date and time. PORT ARTHUR PRINCIPAL PLACE OF BUSINESS: Any bona fide business that claims the City of Port Arthur as its principal place of business must have an official business address (office location and office personnel) in Port Arthur, the principal storage place or facility for the equipment shall be in Port Arthur and/or the place of domicile for the principal business owner(s) shall be in Port Arthur or such other definition or interpretation as is provided by state law. Contractors outside the City of Port Arthur are allowed to bid. PRICES: The bidder should show in the proposal both the unit price and total amount, where required, of each item listed. In the event of error or discrepancy in the mathematics, the unit price shall prevail. PURCHASE ORDER:A purchase order(s)shall be generated by the City of Port Arthur to the successful bidder. The purchase order number must appear on all itemized invoices. INVOICES: All invoices shall be mailed directly to the City of Port Arthur, Attn.: Accounts Payable, P.O. Box 1089, Port Arthur, Texas 77641. PAYMENT: Payment will be made upon receipt of the original invoice and the acceptance of the goods or services by the City of Port Arthur, in accordance with the State of Texas Prompt Payment Act, Article 601f V.T.C.S. The City's standard payment terms are net 30, i.e. payment is due 30 days from the date of the invoice. SALES TAX: The City of Port Arthur is exempt by law from payment of Texas Sales Tax and Federal Excise Tax; therefore the proposal shall not include Sales Tax. VENUE: This agreement will be governed and construed according to the laws of the State of Texas. This agreement is performable in Port Arthur, Texas, Jefferson County. COMPLIANCE WITH LAWS: The Contractor shall comply with all applicable laws,ordinances,rules,orders, regulations and codes of the federal, state and local governments relating to performance of work herein. INTEREST OF MEMBERS OF CITY: No member of the governing body of the City, and no other officer, employee or agent of the City who exercises any functions or responsibilities in connection with the planning and carrying out of the program, shall have any personal financial interest, direct or indirect,in this Contract; and,the Contractor shall take appropriate steps to assure compliance. DELINQUENT PAYMENTS DUE CITY: The City of Port Arthur Code of Ordinances prohibits the City from granting any license, privilege or paying money to any-one owing delinquent taxes, paving assessments or any money to the City until such debts are paid or until satisfactory arrangements for payment has been made. Bidders must complete and sign the AFFIDAVIT included as part of this ITB. QUANTITIES: Quantities shown are estimated,based on projected use. It is specifically understood and agreed that these quantities are approximate and any additional quantities will be paid for at the quoted price. It is further understood that the contractor shall not have any claim against the City of Port Arthur for quantities less than the estimated amount. SHIPPING INFORMATION: All bids are to be F.O.B., City of Port Arthur, Port Arthur,TX 77640 INCORPORATION OF PROVISIONS REQUIRED BY LAW: Each provision and clause required by law to be inserted into the Contract shall be deemed to be enacted herein and the Contract shall be read and enforced as though each were included herein. If, through mistake or otherwise, any such provision is not inserted or is not correctly inserted the Contract shall be amended to make such insertion on application by either party. CONTRACTOR'S OBLIGATIONS: The Contractor shall and will, in good workmanlike manner,perform all work and furnish all supplies and materials, machinery, equipment, facilities and means, except as herein otherwise expressly specified,necessary or proper to perform and complete all the work required by this Contract, in accordance with the provisions of this Contract and said specifications. The apparent silence of these specifications as to any detail or to the apparent omission from it of a detailed description concerning any point shall be regarded as meaning that only the best commercial practices are to prevail. While the purpose of the specifications is to indicate minimum requirements in the way of capability, performance, construction, and other details, its use is not intended to deprive the City of Port Arthur the option of selecting goods which may be considered more suitable for the purpose involved. In the event of conflicts between the written bid proposal and information obtained verbally, the vendor is specifically advised that the written bid proposal will prevail in the determination of the successful bidder. Under the Title VI of the Civil Rights Act of 1964, no person shall, on the grounds of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. TERMINATION FOR CAUSE: If, through any cause, the Contractor shall fail to fulfill in a timely and proper manner his obligations under this contract, or if the Contractor shall violate any of the covenants, agreements or stipulations of this contract, the City shall thereupon have the right to terminate this contract by giving written notice to the Contractor of such termination and specifying the effective date thereof,at least fifteen (15) days before the effective date of such termination. Notwithstanding the above, the Contractor shall not be relieved of liability to the City for damages sustained by the City by virtue of any breach of the contract by the Contractor, and the City may withhold any payments to the Contractor for the purpose of set-off until such time as the exact amount of damages due the City from the Contractor is deteimined. TERMINATION FOR CONVENIENCE: The City may terminate this contract at any time giving at least thirty (30) days notice in writing to the Contractor. If the Contract is terminated by the City as provided herein, the Contractor will be paid for the service that it has performed up to the termination date. If this contract is terminated due to fault of the Contractor, the previous paragraph hereof relative to termination shall apply. RELEASES AND RECEIPTS: The City of Port Arthur before making payments may require the Contractor to furnish releases or receipts for any or all persons performing work and supplying material or service to the Contractor, or any sub-contractors for work under this contract,if this is deemed necessary to protect its interests. CARE OF WORK: The Contractor shall be responsible for all damages to person or property that occurs as a result of his fault or negligence in connection with the work performed until completion and final acceptance by the City. SUB-CONTRACTS: The Contractor shall not execute an agreement with any sub-contractor or permit any sub- contractor to perform any work included in this Contract until he has received from the City of Port Arthur written approval of such agreement. INSURANCE: All insurance must be written by an insurer licensed to conduct business in the State of Texas, unless otherwise permitted by Owner. The Contractor shall, at his own expense, purchase, maintain and keep in force insurance that will protect against injury and/or damages which may arise out of or result from operations under this contract, whether the operations be by himself or by any subcontractor or by anyone directly or indirectly employed by any of them, or by anyone for whose acts any of them may be liable, of the following types and limits 1. Standard Worker's Compensation Insurance: 2. Commercial General Liability occurrence type insurance City of Port Arthur, its officers, agents, and employees must be named as an additional insured): a. Bodily injury $500,000 single limit per occurrence or$500,000 each person/$500,000 per occurrence for contracts of$100,000 or less; or Bodily injury$1,000,000 single limit per occurrence or$500,000 each person/$1,000,000 per occurrence for contracts in excess of$100,000; and, b. Property Damage$100,000 per occurrence regardless of contract amount; and, c. Minimum aggregate policy year limit of$1,000,000 for contracts of $100,000 or less; or, Minimum aggregate policy year limit of$2,000,000 for contracts in excess of$100,000. 3. Commercial Automobile Liability Insurance (Including owned, non-owned and hired vehicles coverage's). a. Minimum combined single limit of$500,000 per occurrence, for bodily injury and property damage. b. If individual limits are provided, minimum limits are $300,000 per person, $500,000 per occurrence for bodily injury and $100,000 per occurrence for property damage. Contractor shall cause Contractor's insurance company or insurance agent to fill in all information required (including names of insurance agency, contractor and insurance companies, and policy numbers, effective dates and expiration dates) and to date and sign and do all other things necessary to complete and make into valid certificates of insurance and pertaining to the above listed items, and before commencing any of the work and within the time otherwise specified, Contractor shall file completed certificates of insurance with the Owner. None of the provisions in said certificate of insurance should be altered or modified in any respect except as herein expressly authorized. Said CERTIFICATE OF INSURANCE Form should contain a provision that coverage afforded under the policies will not be altered, modified or canceled unless at least fifteen (15) days prior written notice has been given to the City of Port Arthur. Contractor shall also file with the City of Port Arthur valid CERTIFICATE OF INSURANCE on like form from or for all Subcontractors and showing the Subcontractor(s) as the Insured. Said completed CERTIFICATE OF INSURANCE Form (s) shall in any event be filed with the City of Port Arthur not more than ten(10) days after execution of this Contract. NOTICE TO PROCEED: Notice to Proceed shall be issued within ten(10)days of the execution of the Contract by OWNER. Should there be any reasons why Notice to Proceed cannot be issued within such period, the time may be extended by mutual agreement between OWNER and CONTRACTOR. CELL PHONE OR PAGER: The Contractor must have a working cell phone or pager available Monday through Friday from 8:00 a.m. to 5:00 p.m. so that the City will be able to contact the contractor. -CITY OF PORT ARTHUR,TEXAS )1 ��rr rrh�t�/ ADDENDUM NO.TWO (2) JANAURY 9, 2025 QUOTE FOR: ROOF REPAIR AT PLEASURE ISLAND RV PARK QUOTE#Q25-002 . The following clarifications, amendments, deletions, additions, revision andlor modifications are made a part of the contract documents and change the original documents only in the manner and to the extent hereinafter stated and shall be incorporated in the contract documents. Provisions of this addendum shall take precedence over requirements of the original contract documents and all BIDDERS ARE REQUESTED TO ACKNOWLEDGE SAID PROVISIONS IN THE SUBMISSION OF THEIR QUOTE. Addendum as follows Below is the revised specifications 1. Remove existing gutters and downspouts. 2. Remove existing shingle roof and underlayment. 3. Install Synthetic Underlayment over existing decking. 4. Install 1" x 4"YP laths over underlayment. 2' OC at eave and ridge, approximately 4' OC in field. 5. Install 2" x 4" prefinished aluminum eave metal on eaves. 6. Conventional Rake Trim on rakes. 7. Install 26 ga,color finished PBR Panel roof wl long life fasteners and foam closures. 8. Install new ,24 ga, roof to wall trim at gables. 9. Install new rubber vent boots at PVC penetrations and weather head. 10. Install new slant back vent jacks and flashing. 11. Install 24 ga. flashing at 2 exhaust vents. 12. Install new Gutters and Downspouts. 13. Apply for WPI-8. 14. Return Quote by 1:00 pm. Monday, January 13, 2025. If you have any questions,please contact the Purchasing Division at 409-983-8160. NOTE: ALL PAGES OF ADDENDA MUST BE SIGNED AND SUBMITTED WITH YOUR BID DOCUMENTS. Clifton Williams Pun asing Manager i66(44 Ot - 13 — d-oa%."-- Signature of Proposer Date ice-lL1 CZ ik,S h VC 11—(O1/1.. 1!`-C- . Company Vendor Name -CITY OF PORT ARTHUR,TEXAS ,,, ��i,�,�'� ADDENDUM NO.ONE (1) JANAURY 7, 2025 QUOTE FOR: ROOF REPAIR AT PLEASURE ISLAND RV PARK QUOTE#Q25-002 The following clarifications, amendments, deletions, additions, revision and/or modifications are made a part of the contract documents and change the original documents only in the manner and to the extent hereinafter stated and shall be incorporated in the contract documents. Provisions of this addendum shall take precedence over requirements of the original contract documents and all BIDDERS ARE REQUESTED TO ACKNOWLEDGE SAID PROVISIONS IN THE SUBMISSION OF THEIR QUOTE. Addendum as follows 1. Attached is the revised quote sheet showing the department as Pleasure Island. 2. The shingle should be replaced with synthetic If you have any questions, please contact the Purchasing Division at 409-983-8160. NOTE: ALL PAGES OF ADDENDA MUST BE SIGNED AND SUBMITTED WITH YOUR BID DOCUMENTS. Clifton Williams Purchasing Manager Signature of Proposer Date 7 K 2— CO Ka r vc-{-1 C/ti . Company Vendor Name CITY OF PORT ARTHUR QUOTE SHEET- REVISED (Specifications are attached) ort Tun Date of Request: December 30, 2024 Department Requesting Quote: Pleasure Island Bid Number: Q25-002 Services Needed: Roof Repair at Pleasure Island RV Park Quote Due Date& Time: Friday.January 10, 2025 by 10:00 A.M. Delivery: Quotes are to be faxed to (409)983-8291, E-mailed to Clifton.williams?aportarthurtx.gov Delivered to the Purchasing Div.. 2" floor. City Hall. Non Mandatory Pre-Bid: Monday, January 6. 2025 by 11:00 A.M Questions, Please contact: Clifton Williams. Purchasing Manager. DAPS TO ITEM # DESCRIPTION COMPLETE COST Roof Repair at Pleasure Island l I RV Park �p , $ '3 3 . 5 0 Cov,,s_ Company Name Signature 40q - 2_--GoCe3 Printed Name Phone 1(C,Q 1, __._... .e J A u v ko(1 - t V 2—o 4 3 D Add ress Fax Tcrr+___ l _Ir�t/►.- 1 t�.1��ois s I(1���l t�v� YL�.�G�1'�A �. cr r.-� City.State,Zip E-mail d t Clif Williams,Purchasing:Manager Date CITY OF PORT ARTHUR, TEXAS NON-COLLUSION AFFIDAVIT CITY OF PORT ARTHUR § § STATE OF TEXAS § By the signature below, the signatory for the bidder certifies that neither he nor the firm, corporation, partnership or institution represented by the signatory or anyone acting for the firm bidding this project has violated the antitrust laws of this State, codified at Section 15.01, et seq., Texas Business and Commerce Code, or the Federal antitrust laws, nor communicated directly or indirectly the bid made to any competitor or any other person engaged in the same line of business, nor has the signatory or anyone acting for the firm, corporation or institution submitting a bid committed any other act of collusion related to the development and submission of this bid proposal. Signature: Printed Name: Title: Company: Date: SUBSCRIBED and sworn to before me by the above named on this the day of , 20 Notary Public in and for the State of Texas My commission expires: AFFIDAVIT All pages in Offeror's Responses containing statements, letters, etc., shall be signed by a duly authorized officer of the company whose signature is binding. The undersigned offers and agrees to one of the following: I hereby certify that I do not have outstanding debts with the City of Port Arthur. I further agree to pay succeeding debts as they become due. I hereby certify that I do have outstanding debts with the City of Port Arthur and agree to pay said debts prior to execution of this agreement. I further agree to pay succeeding debts as they become due. I hereby certify that I do have outstanding debts with the City of Port Arthur and agree to enter into an agreement for the payment of said debts. I further agree to pay succeeding debts as they become due. Firm Name Date Authorized Signature Title Name (please print) Telephone Email STATE: COUNTY: SUBSCRIBED AND SWORN to before me by the above named on this the day of , 20 Notary Public RETURN THIS AFFIDAVIT AS PART OF THE BID PROPOSAL CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code.An offense under this section is a misdemeanor. I Name of vendor who has a business relationship with local governmental entity. J Check this box if you are filing an update to a previously filed questionnaire.(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) Name of local government officer about whom the information is being disclosed. Name of Officer J Describe each employment or other business relationship with the local government officer, or a family member of the officer,as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? Yes nNo B. Is the vendor receiving or likely to receive taxable income, other than investment income,from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity? Yes nNo Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more. Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). Signature of vendor doing business with the governmental entity Date Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 CONFLICT OF INTEREST QUESTIONNAIRE For vendor doing business with local governmental entity A complete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176,htm,For easy reference,below are some of the sections cited on this form. Local Government Code§176.001(1-a):"Business relationship"means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on: (A) a transaction that is subject to rate or fee regulation by a federal,state,or local governmental entity or an agency of a federal,state,or local governmental entity; (B) a transaction conducted at a price and subject to terms available to the public;or (C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by,and reporting to,that agency. Local Government Code§176.003(a)(2)(A)and(B): (a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if: (2) the vendor: (A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds$2,500 during the 12-month period preceding the date that the officer becomes aware that (i) a contract between the local governmental entity and vendor has been executed; or (ii) the local governmental entity is considering entering into a contract with the vendor; (B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than$100 in the 12-month period preceding the date the officer becomes aware that: (i) a contract between the local governmental entity and vendor has been executed;or (ii) the local governmental entity is considering entering into a contract with the vendor. Local Government Code§176.006(a)and(a-1) (a)A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and: (1) has an employment or other business relationship with a local government officer of that local governmental entity,or a family member of the officer,described by Section 176.003(a)(2)(A); (2) has given a local government officer of that local governmental entity,or a family member of the officer,one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B),excluding any gift described by Section 176.003(a-1);or (3) has a family relationship with a local government officer of that local governmental entity. (a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of: (1) the date that the vendor: (A) begins discussions or negotiations to enter into a contract with the local governmental entity;or (B) submits to the local governmental entity an application,response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity;or (2) the date the vendor becomes aware: (A) of an employment or other business relationship with a local government officer,or a family member of the officer,described by Subsection(a); (B) that the vendor has given one or more gifts described by Subsection(a);or (C) of a family relationship with a local government officer. Form provided by Texas Ethics Commission www.ethics state.tx.us Revised 11/30/2015 House Bill 89 Verification I, (Person name), the undersigned representative (hereafter referred to as "Representative") of (company or business name, hereafter referred to as "Business Entity"), being an adult over the age of eighteen (18) years of age, after being duly sworn by the undersigned notary, do hereby depose and affirm the following: 1 . That Representative is authorized to execute this verification on behalf of Business Entity; 2. That Business Entity does not boycott Israel and will not boycott Israel during the term of any contract that will be entered into between Business Entity and the City of Port Arthur; and 3. That Representative understands that the term "boycott Israel" is defined by Texas Government Code Section 2270.001 to mean refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business purposes. SIGNATURE OF REPRESENTATIVE SUBSCRIBED AND SWORN TO BEFORE ME, the undersigned authority, on this day of , 20 Notary Public SB 252 CHAPTER 2252 CERTIFICATION I, , the undersigned n representative of (Company or Business Name) being an adult over the age of eighteen (18) years of age, pursuant to Texas Government Code, Chapter 2252, Section 2252.152 and Section 2252.153, certify that the company named above is not listed on the website of the Comptroller of the State of Texas concerning the listing of companies that are identified under Section 806.051, Section 807.051 or Section 2253.153. I further certify that should the above-named company enter into a contract that is on said listing of companies on the website of the Comptroller of the State of Texas which do business with Iran, Sudan or any Foreign Terrorist Organization, I will immediately notify the City of Port Arthur Purchasing Department. Name of Company Representative (Print) Signature of Company Representative Date