HomeMy WebLinkAboutPR 18602: 1 YEAR CONTRACT WITH KNIFE RIVER CORPORATION FOR CONCRETE BUILDING MATERIALS PUBLIC WORKS DEPARTMENT
COUNCIL ACTION MEMO
TO: John A. Comeaux, P.E., Interim City Manager
FROM: Sue Polka, P. E., Director of Public Works
DATE: September 23, 2014
SUBJECT: P.R.18602—Concrete Building Materials
COMMENTS
RECOMMENDATION:
It is recommended that the City Council approve Proposed Resolution No. 18602, approving the
a one (1) year contract with Knife River Corporation of Beaumont, Texas, for concrete building
materials in the not to exceed amount of$500,000.
BACKGROUND:
This is an annual contract for the concrete building materials that will be used by the Streets
Division for maintenance and construction. These materials will be utilized by the Public Works
Department Streets Division for street maintenance, the City Streets Program, and streets funded
under the CDBG program.
Knife River Corporation of Beaumont, Texas, was the sole bidder and was found to be a
responsible bidder for this material.
BUDGETARY/FISCAL EFFECT:
Funding is available in 001-1203-531.36-00, 001-1203-531.86-00, and CDBG project accounts.
EMPLOYEE/STAFF EFFECT:
None.
SUMMARY:
It is recommended that the City Council approve Proposed Resolution No. 18602, approving a
one (1) year contract with Knife River Corporation of Beaumont, Texas, for concrete building
materials in the not to exceed amount of$500,000.
P.R. No. 18602
09/22/14 aw
RESOLUTION NO.
A RESOLUTION AUTHORIZING THE CITY MANAGER TO
EXECUTE A ONE (1) YEAR CONTRACT BETWEEN THE CITY
OF PORT ARTHUR AND KNIFE RIVER CORPORATION OF
BEAUMONT, TEXAS, FOR CONCRETE BUILDING
MATERIALS, IN A NOT-TO-EXCEED AMOUNT OF
$500,000.00. STREET ACCOUNT NOS. 001-1203-531.36-00 AND
001-1203-531.86-00,AND CDBG PROJECT ACCOUNTS.
WHEREAS, the City advertised for bids for concrete building materials; and,
WHEREAS, one bid was received and opened on September 3, 2014; and,
WHEREAS, Knife River Corporation of Beaumont, Texas, being the sole bid, was found
to be a responsible bidder as shown in attached Exhibit"A"; now therefore,
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PORT
ARTHUR, TEXAS:
THAT,the facts and opinions in the preamble are true and correct.
THAT, the City Manager is hereby authorized to execute a contract with Knife River
Corporation of Beaumont, Texas, for the purchase of concrete building materials, in the not-to-
exceed amount of$500,000, in substantially the same form as attached hereto as Exhibit"B".
THAT, funding is available in accounts 001-1203-531.36-00 and 001-1203-531.86-00,
and CDBG project accounts.
THAT, a copy of the caption of this Resolution be spread upon the Minutes of the City
Council.
READ,ADOPTED, AND APPROVED this the day of September, A.D. 2014 at
a meeting of the City of Port Arthur, Texas by the following vote: AYES:
Mayor:
Councilmembers:
Noes:
Mayor
ATTEST:
Sherri Bellard
City Secretary
APPROVED AS TO FORM:
Valecia • eno
City Attorney
APPROVED FOR ADMINISTRATION: APPROVED AS TO AVAILABILITY
OF FUNDS:
elfeL/6,41-e9t-ai
John A. Comeaux, P. E. Deborah Echols, CPA
Interim City Manager Director of Finance
cs ��
e Polka, P. E. Shawna Tubbs, CPPO
Director of Public Works Purchasing Manager
Exhibit A
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Exhibit "B"
(P.R. No. 18602)
MATERIALS SUPPLY AGREEMENT
Concrete Building Materials
THIS AGREEMENT, made this the of , 2014, 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 Knife River Corporation , hereinafter called
"CONTRACTOR". WITNESSED: 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 from to .
2. The CONTRACTOR will perform the work as delineated in the Scope of Work and
Specifications attached hereto.
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 supply the materials described in the specifications and
contract documents at the unit prices shown in the attached bid, in the not-to-exceed
amount of$500,000.
5. The term "Contract Documents"means and includes the following:
1) Agreement
2) Invitation to Bid
3) General Information
4) Specifications
5) Bid
6) 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 here to have executed, or caused to be executed by
their duly authorized officials, this Agreement in two (2) copies, each of which shall be
deemed an original of the date first written above.
Signed on the day of , 2014.
OWNER:
CITY OF PORT ARTHUR
BY:
John A. Comeaux, P. E.
Interim City Manager
Signed on the day of , 2014.
CONTRACTOR:
KNIFE RIVER CORPORATION
BY:
Larry C. Rougeau
Special Projects
DELORIS"BOBBIE" PRINCE,MAYOR a+ '0°'44� JOHN A.COMEAUX,P.E.
DERRICK FREEMAN,MAYOR PRO TEM 3' INTERIM CITY MANAGER
City Of
COUNCIL MEMBERS: ✓' SHERRI BELLARD,TRMC
RAYMOND SCOTT,JR. CITY SECRETARY
TIFFANY HAMILTON o r t r
MORRIS ALBRIGHT VAL TIZENO
STEPHEN A.MOSELY / t<r, CITY ATTORNEY
WILLIE"BAE"LEWIS,JR.
ROBERT E.WILLIAMSON
KAPRINA RICHARDSON FRANK
AUGUST 18, 2014
INVITATION TO BID
CONCRETE BUILDING MATERIALS
4 V2 SK. READY-MIX GRAVEL CONCRETE
DEADLINE: Sealed Bid submittals must be received and time stamped by 3:00 p.m., Central Standard
Time, Wednesday, September 3, 2014. (The clock located in the City Secretary's office will be the official
time.) All bids received will be read aloud at 3:15 p.m. on Wednesday, September 3,2014in the City Council
Chambers, City Hall, 5`h Floor, Port Arthur, TX. You are invited to attend.
MARK ENVELOPE: Gravel
DELIVERY ADDRESS: Please submit one (1) original nd o (1) co_ of yo .id to:
CITY OF PORT ARTHUR CITY OF PORT ARTHUR
CITY SECRETARY or CITY SECRETARY
P.O. BOX 1089 444 4TH STREET, 4th Floor
PORT ARTHUR, TEXAS 77641 PORT ARTHUR, TEXAS 77640
POINTS OF CONTACT:
Questions concerning the Invitation to Bid should be directed in writing to:
City of Port Arthur, TX
Clifton Williams, Senior Purchasing Assistant
P.O. Box 1089
Port Arthur, TX 77641
cl ifton.wi l l iamsAportarthurtx.gov
Deadline for submission of questions is Wednesday,August 27,2014 by 5:00 p.m.
Purchasing Division/Finance Department I Purchasing Manager,Shawna Tubbs,CPPO,CPPB
P.O.Box 1089 1 444 4th Street 1 Port Arthur,Texas 77641 1 409.983.8160 1 Fax 409.983.8291
The enclosed INVITATION TO BID (ITB) and accompanying GENERAL INSTRUCTIONS, CONDITIONS
SPECIFICATIONS, are for your convenience in submitting bids for the enclosed referenced services for the
City of Port Arthur.
Bids must be signed by a person having authority to bind the firm in a contract. Bids shall be placed in a sealed
envelope, with the Vendor's name and address in the upper left-hand corner of the envelope.
ALL BIDS MUST BE RECEIVED IN THE CITY SECRETARY'S OFFICE BEFORE OPENING DATE
AND TIME. It is the sole responsibility of the firm to ensure that the sealed ITB submittal arrives at the above
location by specified deadline regardless of delivery method chosen by the firm. Faxed or electronically
transmitted ITB submittals will not be accepted.
Shawna Tubbs, CPPO, CPPB
Purchasing Manager
Page 2 of 13
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.
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: No public official shall have interest in this contract, in accordance with
Vernon's Texas Code Annotated, Local Government Code Title 5, Subtitle C, Chapter 171.
ETHICS: The bidder shall not offer or accept gifts or anything of value nor enter into any business
arrangement with any employee, official or agent of the City of Port Arthur.
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.
Page 9 of 13
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.: Public Works, 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
Page 10 of 13
•
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 determined.
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.
Page 11 of 13
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 Contract 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$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.
Page 12 of 13
•
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.
Page 13 of 13
SPECIFICATIONS FOR
CONCRETE BUILDING MATERIALS
4 'A SK. READY-MIX GRAVEL CONCRETE
ITEM NO. 1
Gravel Concrete: Per applicable sections of the Texas Highway Department Specifications,
Items 360, 420, 421, 520 and 522.
4 '/ sack per cubic yard minimum
Minimum compressive strength @ 28 days —2500 psi
Maximum water/cement ratio by weight: 0.70
Slump Range — 3" to 4"
Aggregate size— 3/4" to 1"
ITEM NO. 2
4 '/2 sack mix, is the base bid price. Each half sack of cement increment, whether additional or
less, will also be quoted.
AWARD
1. The contract is for one year.
2. The City will award to multiple contractors.
3. The City will contact the lowest awarded contractor first. If the contractor is unable to
supply the materials in a timely manner, the City will contact the next lowest awarded
contractor.
Page 4 of 13
CITY OF PORT ARTHUR,TEXAS
BID SHEET
BID FOR: Concrete Building Materials-4 / SK Ready Mix Gravel
BID DUE DATE: September 3, 2014
ITEM # DESCRIPTION UNIT PRICE
. 4 '/2 sk. ready-mix gravel concrete(Base Bid) $ 91.00 /Cy
TX DOT 2500 PSI Concrete
2. a. '/2 sk. incremental increase to base bid S 2.00 /CY
500 PSI Increase
b. %z sk. incremental decrease to base bid $ 2.00--.ICy
500 PSI Decrease
Location of stockpile, plant or shipping pc', _. 7875 WPA Road Port Arthur,Texas 77640
Small Load Charge<6 cy $150.00/ea
Proper Washout Area or Receptacles must be furnished for concrete pours Environmental Fee applies if not provided. 5100.00/each load concrete
Knife River Corporation 4825 Romeda Road
COMPANY NAME STREET.ADDRESS
20257 Beaumont Texas 77720
SIGNATURE OF fOX
Larry C.Rougeau Beaumont, TX 77705
PRINT OR TYPE NAME CITY STATE ZIP
Special Projects (409)842-2100
AREA CODE TELEPHONE NO.
larry.rougeau @kniferiver.com (409)842-9393
EMAIL FAX NO.
Page 5 of 13
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 develo ent and submission of this bid proposal.
Signature:
Printed Name: Larry C. Rougeau
Title: Special Projects
Company: Knife River Corporation
Date:
8/31/2014
Larry C.Rougeau Special Projects Manager,Knife River Corp.
SUBSCRIBED and sworn to before me the undersigned authority by the of, on
behalf of said bidder 0011H11111/ cgiviitajoirac
poPNF GREENB� �i 'J�C GGl'et)
:•���PRYPU-</c").% Notary Public in and for the
State of Texas
•I. /\ __ 6/4/2017
1,q P5 i My commission expires:
OFTSi' .
••'•.�; PIRES../
"I,, 6-4 2011 1`1`t\�
Page 6 of 13
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:
X 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.
Knife River Corporation 8/31/14
Firn a ic• c Date
C....■ Special Projects
Authorize Signat 'l'iiic
Larry C.Rougeau Cell:(409)781-2244 Office:(409)842-2100
Name(please print) Telephone
Larry.Rougeau@kniferiver.com
Email
STATE: Texas
COUNTY: Jefferson
.................... .
SUBSCRIBED AND SWORN to before me by the above named Larry Rougeau
on this the 3rd day of September , 20 14
dviza
Notary Public \\\0\ANA GRFFti%ii
..OAliVp .9 ,
e/ 92'S
RETURN THIS AFFIDAVIT AS PART OF THE BID PI OPOSAL = • \-i., ••
TA •
E. •...Fp°FTE'K I
6•. REST••..• �
///// l�Ilnlll��∎�\\\\`
Page 7of13
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For Vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 1491,80`"Leg.,Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code by a person who has a business relationship
as defined by Section 176.001 (I-a)with a local governmental entity and the person meets requirements under Section 176.006(a).
By law this questionnaire must he filed with the records administrator of the local governmental entity not later than the 7'r'business
day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006,Local Government
Code.
A person commits an oltense if the person knowingly violates Section 176.006,Local Government Code.An offense under this
section is a Class C misdemeanor.
1. Name of person who has a business relationship with local governmental entity. N/A
2. X 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
7'h business day after the date the originally filed questionnaire becomes incomplete or inaccurate.)
3.Name of a local government officer with whom filer has employment or business relationship.
N/A
Name ofOtlicer
This section(item 3 including subparts A,B,C,&D)must be completed for each officer with whom the filer has an employment
or other business relationship as defined by Section 176.001 (I-a),Local Government Code.Attach additional pages to this Form
CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income,other than investment
income, from the filer of the questionnaire?
-1
Yes No
t i
B. Is the filer of the questionnaire receiving or likely to receive taxable income,other than investment income,from or at the
direction of the local government officer named in this section AND the taxable income is not received from the local
governmental entity?
l i
Li Yes No
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government
Officer serves as an officer or director,or holds an ownership of 10 percent or more?
Yes € No
D. De;dgayeach em _2_ nt or business relationship.with the local government officer named in this section.
•
• ° 8/31/14
4.
t Signature of person doing=smess with the governmental entity Date
Page 8 of 13