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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 (PR18602) n o A 00 N N m 5. .. Cr n °� o � o � , � d bc O O CI � 0 O x -.5 - : 3 '- -! [ co E. C C D C C A. = ` 1 CAD CD CD CD O`C O 1 to to CD n n i OQ CD Z < 0 VCD CD CD 0 -. c VI O O6 CD O �r CD N 0 CZ E. CA to a2 ''.Q CD En aria 4 to b • C7 � a 0 ¢. r: �. m -4. 1.... y < � x = d a Q. R, 4, Pe CA CN a Pro; co to td 0 'b N N ►s c o a ° ° ° b o o o o a o. rn .p O 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