HomeMy WebLinkAboutResolution - 2021-R0134 - PO31058011 with Jim Bass Ford Inc. 4.13.2021Resolution No. 2021-R0134
Item No. 7.30
April 13, 2021
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute
for and on behalf of the City of Lubbock, Purchase Order No. 31058011 for the purchase of
mid -size SUV's for police patrol as per ITB 21-15742-CM, by and between the City of
Lubbock and Jim Bass Ford, Inc., of San Angelo, Texas, and related documents. Said Purchase
Order is attached hereto and incorporated in this resolution as if fully set forth herein and shall
be included in the minutes of the City Council.
Passed by the City Council on April 13, 2021
DANIEL M. POPE, MAYOR
ATTEST:
Reb ca Garza, City Se reta
APPROVED AS TO CONTENT:
W_'i:t�
Brooke Witcher, Assistant City Manager
APPROVED AS TO FORM:
K lli Leisure, Assistant City Attorney
ccdocs/RES.-PurchaseOrd 31058011 - Mid -Size SUV's for police patrol
March 11, 2021
Iyv1City of
Lubbock PURCHASE ORDER
TEXAS
TO: JIM BASS FORD, INC
4032 W HOUSTON HARTE EXPRESS
SAN ANGELO TX 76901
Page - I
Date - 3/3/2021
Order Number 31058011 000 OP
Branch/Plant 3526
SHIP TO: CITY OF LUBBOCK
FLEET SERVICES
206 MUNICIPAL DRIVE
LUBBOCK TX 79404
LN"VOICE TO: CITY OF LUBBOCK
ACCOU\TSPAYABLE
P.O. BOX 2000
LUBBOCK, TX 79457 BY:
Matta Ah-arez, Dvectory Purchasing & Contract Management
Ordered 3/3/2021 Freight
Requested 6/17/2021 Taken By R ROCHA
Delivery J LOERWALD REQ 57097 ITB 21-15742-CM PURI5742
Description/Supplier Item _ Ordered _ Unit Cost UM_ Extension Request Date
Mid -Size SUV's for 10.000 24,702.8000 EA 247,028.00 6/17/2021
Police Patrol
Mid -Size SUV's for 10.000 10,429.2000 EA 104,292.00 6/17/2021
Police Patrol
Total Order
Terms NET DUE ON RECEIPT 351,320.00
This purchase order encumbers funds in the amount of $351,320.00 awarded to Jim Bass Ford, Inc. of San Angelo, TX, on
April 13 , 2021. The following is incorporated into and made part of this purchase order by reference: ITB 21-15742-CM
from Jim Bass Ford, Inc. of San Angelo, TX, dated February 18, 2021.
Resolution # 2021-RO134
CITY OF LUBBOCK ATTEST:
Daniel M. Pope, Mayor Rebecc �Garza,City Secretary
Rev. 1/2020
Seller and Buyer agree as
follows:
PURCHASE ORDER
TERMS AND CONDITIONS
IMPORTANT: READ CAREFULLY
STANDARD TERMS AND CONDITIONS
CITY OF LUBBOCK, TX
1. SELLER TO PACKAGE GOODS Seller will package goods in accordance with good commercial practice.
Each shipping container shall be clearly and permanently marked as follows (a) Seller's name and address,
(b) Consignee s name, address and purchase order or purchase release number and the supply agreement number
ifapplicable, (c) Container number and total number of containers, e.g. box 1 of 4 boxes, and (d) the number
of the container bearing the packing slip. Seller shall bear cost of packaging unless otherwise provided. Goods
shall be suitably packed to secure lowest transportation costs and to conform with requirements of common
carriers and any applicable specifications. Buyer's count or weight shall be final and conclusive on shipments
not accompanied by packing lists.
2. SHIPMENT UNDER RESERVATION PROHIBITED. Seller is not authorized to ship the goods under
reservation and no tender of a bill of lading will operate as a tender of goods.
3. TITLE AND RISK OF LOSS. The title and risk of loss of the goods shall not pass to Buyer until Buyer
actually receives and takes possession of the goods at the point or points of delivery.
4. NO REPLACEMENT OF DEFECTIVE TENDER. Every tender of delivery of goods must fully comply
with all provisions of this contract as to time of delivery, quality and the like. If a tender is made which does
not fully conform, this shall constitute a breach and Seller shall not have the right to substitute a conforming
tender, provided, where the time for performance has not yet expired, the Seller may reasonably notify Buyer
of his intention to cure and nay then make a conforming tender within the contract time but not afterward.
5. INVOICES & PAYMENTS. a S e I 1 er shall submit separate invoices, in duplicate, one each purchase
order or purchase release after each delivery. Invoices shall indicate the purchase order or purchase release
number and the supply agreement number if applicable. Invoices shall be itemized and transportation charges,
if any, shall be listed separately. A copy of the bill of lading, and the freight waybill when applicable, should
be attached to the invoice. Mail To: Accounts Payable, City of Lubbock, P. 0. Box 2000, Lubbock, Texas
79457. Payment shall not be due until the above instruments are submitted after delivery.
6. GRATUITIES. The Buyer may, by written notice to the Seller, cancel this contract without liability to
Seller if it is determined by Buyer that gratuities, in the form of entertainment. gifts or otherwise, were offered
or given by the Seller, or any agent or representative of the Seller. to any officer or employee of the City of
Lubbock with a view to securing a contract or securing favorable treatment with respect to the awarding or
amending, or the making of any determinations with respect to the performing of such a contract. In the event
this contract is canceled by Buyer pursuant to this provision, Buyer shall be entitled in addition to any other
rights and remedies, to recoveror withhold the amount of the cost incurred by Seller in pro%rding such gratuities
7. SPECIAL TOOLS & TEST EQUIPMENT If the price stated on the face hereof includes the cost of any
special tooling or special test equipment fabricated or required by Seller for the purpose of filling this order,
such special tooling equipment and any process sheets related thereto shall become the property of the Buyer
and to the extent feasible shall be identified by the Seller as such
S. WARRANTY -PRICE. a The price to be paid by the Buyer shall be that contained in Seller's bid
which Seller warrants to be no higher than Seller's current process on orders by others for products of the kind
and specification covered by this agreement for similar quantities under similar of like conditions and methods
of purchase In the went Seller breaches this warranty, the prices of the items shall be reduced to the
Seller's current prices on orders by others, or in the alternative Buyer may cancel this contract without
liability to Seller for breach or Seller's actual expense b. The Seller warrants that no person or selling agency
has been employed or retained to solicit or secure this contract upon an agreement or understanding for
commission, percentage, brokerage, or contingent fee excepting bona fide employees of bona fide established
commercial or selling agencies maintained by the Seller for the purpose of securing business. For breach of
viciation of this warranty the Buyer shall ha%e the right in addition to any other right of rights to cancel this
contract without liability and to deduct from the contract price, or otherwise recover without liability and to
deduct from the contract price, or otherwise recover the full amount ofsuch commission, percentage, brokerage
or contingent fee
9. WARRANTY -PRODUCT Seller shall not limit or exclude any implied warranties and any attempt to do
so shall render this contract voidable at the option of the Buyer. Seller nanants that the goods furnished w-ill
conform to the specification, drawings, and descriptions listed in the bid mvitation, and to the sample(s) furnished
by the Seller, if any In the event of a conflict or between the specifrcatwn:, drawings, and descriptions, the
specifications shall go%em Notwithstanding any provisions contained in the contractual agreement, the Seller
represents and warrants fault -free performance and fault -flee result in the processing date and date related data
(including, but not limited to calculating, comparing and sequencing) of all hardware, software and firmware
products delivered and services provided under this Contract, indn idually or in combination, as the case my
be from the effective date of this Contract The obligations contained herein apply to products and services
provided by the Seller, its sub- Seller or any third party tmol ed in the creation or development of the products
and services to be delivered to the City of Lubbock under this Contract. Failure to comply with any of the
obligations contained herein, may result in the City of Lubbock availing itself of any of its rights under the
law and under this Contract including, but not limited to, its right pertaining to termination or default. The
warranties contained herein are separate and discrete from any other warranties specified in this Contract,
and are not subject to any disclaimer of warranty, implied or expressed. or limitation of the Seller's liability
which may be specified in this Contract, its appendices. its schedules, its annexes or any document incorporated
in this Contract by reference.
10. SAFETY WARRANTY. Seller warrants that the product sold to the Buyer shall conform to the standards
promulgated by the U. S. Department of Labor under the Occupational Safety and Health Act of 1970. In the
event the product does not conform to OSHA standards, Buyer may return the product for correction or
replacement at the Seller's expense. In the event Seller fails to make the appropriate correction within a
reasonable time, correction made by Buyer will be at the Seller's expense.
11. NO WARRANTY BY BUYER AGAINST INFRINGEMENTS. As part of this contract for sale Seller
agrees to ascertain whethergoods manufactured in accordance w ith the specifications attached to this agreement
will give rise to the rightful claim of any third person by way of infringement of the like Buyer makes no
warranty that the production of goods according to the specification will not give rise to such a claim, and in no
event shall Buyer be liable to Seller for indemnification in the event that Seller is sued on the grounds of
infringement of the like. If Seller is of the opinion that an infringement or the like will result, he will notify the
Buyer to this effect in writing within two weeks after the signing ofthis agreement. If Buyer does not receive
notice and is subsequently held liable for the infringement or the like, Seller will save Buyer harmless. If
Seller in good faith ascertains the production of the goods in accordance with the specifications will result in
infringement or the like, the contract shall be null and void
12. NON APPROPRIATION. All funds for payment by the City under this contract are subject to the
availability of an annual appropriation for this purpose by the City. In the event of nonappropriation of funds
by the City Council of the City of Lubbock for the goods or services provided under the contract, the City will
terminate the contract, without termination charge or other liability, on the last day of the then -current fiscal
year or when the appropriation made for the then -current year for the goods or services covered by this contract
is spent, whichever event occurs first. If at any time funds are not appropriated for the continuance of this
contract, cancellation shall be accepted by the Seller on thirty (30) days prior written notice, but failure to give
such notice shall be of no effect and the City shall not be obligated under this contract beyond the date of
termination
13. RIGHT OF INSPECTION. Buyer shall have the right to inspect the goods at delivery before accepting
them
14. CANCELLATION. Buyer shall have the right to cancel for default all or any part of the undelivered
portion of this order if Seller breaches any of the terms hereof including warranties of Seller or if the Seller
becomes insolvent or commits acts of bankruptcy Such right of cancellation is in addition to and not in
lieu of any other remedies which Buyer may have in law or equity.
15. TERMINATION. The performance ofwork under this order may be terminated in whole, or in part by the
Buyer in accordance with this provision Termination of work hereunder shall be effected by the delivery
of the Seller of a "Notice of Termination" specifying the extent to which performance of work under the
order is terminated and the date upon which such termination becomes effective. Such right or termination is
in addition to and not in lieu of the rights of Buyer set forth in Clause 14, herein.
16. FORCE MAJEURE. Neither party shall be held responsible for losses, resulting if the fulfillment
of any terns of provisions of this contract is delayed or prevented by any cause not within the control of the
parry whose performance is interfered with, and which by the exercise of reasonable diligence said party is
unable to prevent.
17. ASSIGNMENT -DELEGATION. No right or interest in this contract shall be assigned or delegation of
any obligation made by Seller without the written permission of the Buyer. Any attempted assignment or
delegation by Seller shall be wholly void and totally ineffective for all purpose unless made in conformitywith
this paragraph.
18. WAIVER No claim or right arising out of a breach of this contract can be discharged in whole or in part
by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by
consideration and is in writing signed by the aggrieved party.
19. INTERPRETATION -PAROLE EVIDENCE. This writing, plus any specifications for bids and
performance provided by Buyer in its advertisement for bids, and any other documents provided by
Seller as pan of his bid, is intended by the parties as a final expression of their agreement and intended also
as a complete and exclusive statement of the terns of their agreement. Whenever a term defined by the
Uniform Commercial Code is used in this agreement, the definition contained in the Code is to control.
20. APPLICABLE LAW. This agreement shall be governed by the Uniform Commercial Code. Whereever
the term "Uniform Commercial Code-' is used, it shall be construed as meaning the Uniform Commercial
Code as adopted in the State of Texas as effective and in force on the date of this agreement.
21. RIGHT TO ASSURANCE. Whenever one party to this contract in good faith has reason to question
the other parry's intent to perform he may demand that the other party give written assurance of his intent to
perform. In the event that a demand is made and no assurance is given within five (5) days, the demanding
party may treat this failure as an anticipatory repudiation of the contract.
" INDEMNIFICATION. Seller shall indemnify, keep and save harmless the Buyer, its agents, officials and
employees, against all injuries, deaths, loss, damages, claims, patent claims, suits, liabilities, judgments, costs
and expenses, which may in anywise accrue against the Buyer in consequence of the granting of this Contract
or which may anywise result therefrom, whether or not it shall be alleged or determined that the act was
caused through negligence or omission of the Seller or its employees, or of the subSeller or assignee or its
employees, if any, and the Seller shall, at his own expense, appear, defend and pay all charges of attorneys
and all costs and other expenses arising therefrom of incurred in connection therewith, and, if any judgment
shall be rendered against the Buyer in any such action, the Seller shall, at its own expenses, satisfy and
discharge the same Seiler expressly understands and agrees that any bond required by this contract, or
otherwise provided by Seller, shall in no way limit the responsibility to indemnify, keep and save harmless
and defend the Buyer as herein provided.
23 TIME It is hereby expressly agreed and understood that time is of the essence for the performance of
this contract. and failure by contract to meet the time specifications of this agreement will cause Seller to
be in default of this agreement,
24 MBE The City of Lubbock hereby notifies all bidders that in regard to any contract entered into
pursuant to this request, minority and women business enterprises will be afforded equal opportunities to
submit bids in response to this invitation and will not be discriminated against on the grounds of race, color,
sex or natural origin in consideration form award.
25. NON -ARBITRATION. The City reserves the right to exercise any right or remedy to it by law, contract,
equity, or otherwise, including without limitation, the right to seek any and all fors of relief in a court of
competent jurisdiction. Further. the City shall not be subject to any arbitration process prior to exercming
its unrestricted right to seek judicial remedy. The remedies set forth herein are cumulative and not exclusive.
and may be exercised concurrently. To the extent ofany conflict between this provision and another provision
in, or related to, this document, this provision shall control.
26. RIGHT TO AUDIT. At any time during the ter of the contract, or thereafter, the City, or a duly
authorized audit representative of the City or the State of Texas, at its expense and at reasonable times.
reserves the right to audit Contractors records and books relevant to all services provided to the City under
this Contract. In the event such an audit by the City reveals any errors or overpayments by the City,
Contractor shall refund the City the full amount ofsuch overpayments within thirty (30) days of such
audit findings. or the City, at its option, resenes the right to deduct such amounts owing the City from any
payments due Contractor
27. HOUSE BILL 2015 House Bill 2015, signed by the Govemoron June 14. 2013 and effectwe on January
I, 2014, authorizes a penalty to be imposed on a person who contracts for certain services with a governmental
entity and who fails to properly classify their workers. This applies to subcontractors as well Contractors and
subcontractors who fail to properly classify individuals performing work under a governmental contract will be
pcmltzed $200 for each individual that has been misclassifred. (Texas Government Code Section 2155.001)
28. ASSIGNING OR SUBLETTING THE CONTRACT The Contractor shall not assignor sublet the contract,
or any portion of the contract, without written consent from the Director of Purchasing and Contract
Management Should consent be given, the Contractor shall insure the Subcontractor or shall pros ide proof on
insurance from the Subcontractor that complies with all contract Insurance requirements.
29. HOUSE BILL 1295 DISCLOSURE OF INTERESTED PARTIES. House Bill 1293. adopted by the 84th
Legislature, created §2252.908, Texas Government Code Section 2252.908 requires a business entity entering
into certain contracts with a governmental entity or state agency to file with the governmental entity or state
agency a disclosure of interested parties at the time the business entity submits the signed contract to the
governmental entity or state agency. Instructions for completing Form 1295 are available at
. %I�+�tx.u> deparn,enn!-uchsiiv,�Hep �.:....�,.rwh;firs %ertdor•inl:reatum
30. CONTRACTOR ACKNOWLEDGES, by supplying any Goods or Services that the Contractor has read,
fully understands, and will be in full compliance with all terms and conditions and the descriptive material
contained herein and any additional associated documents and Amendments. The City disclaims any terns and
conditions provided by the Contractor unless agreed upon in writing by the parties In the event of conflict
between these terms and conditions and any terms and conditions provided by the Contractor, the terms and
conditions provided herein shall prevail. The terms and conditions provided herein are the final terms agreed
upon by the parties, and any prior conflicting terns shall be of no force or effect
31. HB 89 The Contractor warrants that it complies with Chapter 2270.001 of the Texas Government Code by
verifying that: (1) The Contractor does not boycott Israel; and(2) The Contractor will not boycott Israel
during the ter of the Agreement.
32. The Contractor (i) does not engage in business with Iran, Sudan or any foreign terrorist organization and
(ii) it is not listed by the Texas Comptroller under Section 2252.153, Texas Government Code, as a
company known to have contracts with or provide supplies or services to a foreign terrorist organization
33. TEXAS PUBLIC INFORMATION ACT. The requirements of Subchapter 1, Chapter 552, Government
Code, may apply to this contract and the contractor or vendor agrees that the contract can be terminated if the
contractor or vendor knowingly or intentionally fails to comply with a requirement of that subchapter.
34. Pursuant to Section 552.234(c) of the Texas Government Code, the City of Lubbock has designated the
following email address for which public information requests may be made by an emailed request:
_ _ _ . Please send this request to this email address for it to be processed.
REV. 1 2020
BiD FORM
City of Lubbock, TX
Purchasing and Contract Management
Mid -Size SWs for Police Patrol
ITB No. 21-15742-CM
In compliance wish Ills Invitittion to [till 21-1>742-C11, (fie tn(tersinned Biddei having examiner! the Invitation it) laid lid Specifications, ali() being familialwilt the con(litions to be met, hciehy subrtti(s the li►Ilowirtg Ri(I li)r liunishing the material,
egnipmcnl, laburand everything nccessafy }i►I providing; the Rellis listed lhclow and aal-ecs to deliversaid items at the locations
cued fin• (he' prices set I')rdi on (his I'orm. A biri will he subiec( to heing conside.i-ed irregular and may be reiccled it, t1 shov,s omissions, alterations of form, con(liliouifl uhcrnafe bids, a(lditions oI alteniale.s in If",, of the ilcnis xpecilied, if lhr unit
Ill are obviously unbalanced (cithel in excess of or be•lmt, reasonably expcc(ed value~), ur ifWgulalilies ofany kind The
im'iteriolt If, Rid 21-15742-011 is by r•cterelic•e ineorpor'otcd In this corrrr•;r:l. The Rid Dorm must be eo►ttpltkd nT bifre nr
black ink or by Ivpewl Her,
QTI, — --
ITEM (+/-) UOM UNIT PRICE* EXTElVI3ED **Delivery
(cf) DESCRIPTION (b) COST
(a x b) days ARO
1 10 EA Mitt -Size SLTV for Police Patrol (Per
Specifications) 3r / 3 3 sl 72-a
Total (Items 1) S
*PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed "Days After Receipt of Order (ARO)
Unless otherwise specified herciu, the City may award the bid either item -by --item or on an all -or -none basis for any
item ar g;rroltp of items shown oil the bid.
The C'ily of Lubbock is seelihig a coutrsict Ibr with one or more contractors. In order to assure a(legttate eon eragv, tilt• ('it%. ula mats• urfflti}rfc alvarrls, seleeting; multiple vefiduts to Provide (fie prodffs•ts devir-rd, if ►nrrffi}►lc• :►liar (Is life }fir
[lilt I)cvt interest of the City. A decision to make• a nntltipfe .mai d (if- thij flid, howt•ver, is all option I ceervcd by the
City, based o►r the needs of file City.
I'AYMEN-1 T RMS AND DISCOUNTS - Hid(lef oilers ,i prompt p;tyntent discount of _ '�net ralc'ndal days
i)iscuulft; will nut be cult,itlefetl in drtrimining low hid. Millers., ollierwise indicated tin file. laid I Dina, p;tymenl lean, \aril!
be NI:I 111110 V f )AYS. 'I he C'ifv will pity the successfill hu1(ter %vithin thirty days afic•! (he receipt of a convel invoice of
after the date of acceptance, tvhichevel event occurs later. Discounts lin prompt paynicnl requiring payment by the City
Wallin a slipulaled nuniher of,day, will he interpreted a, applying vvitllin the stipulated nunibca o1•caleodai' days aficr the date
ufreceipt by tlfe C•ily ol'a cou-ccf invoice or alter the (lade (11accrptancc that tiler[, contract reynirements, n•hichck-of event
oceut s later. Uiscotuil, for I,:tymcot ui 1""' Iran tin days will not be considered.
tMOS 1 I;AVORIih PRWIN(;: The Bidder cciiilies that 111r price (}toted is not in excess of the lowest price cha►gcd aifyone
c•Ist-, Including its mast fitvored t;ustxnncf, fiir like quality and quarltily of fhc pruduets/ser'viccs: does nol inchide an elrntrnt
of profit on fiir side iu est•ess of,tlaaf, normally obtained by file Bidder tin the sale uf'pi'u(Ittefs,'scrvicrs of like yual;ly and
quantity; aucf clues nut include any provision lair (list aunts to selling at,euls if at any lints (furinr the ronlract period, flit!
mpplier should ..<cll or offer "of sale to any uthcr customer, :fit equal of Icx.s quantity of simil;u cunnacl product~ of like or
hc(tel duality, al a 1mver net piirc(s) th to provided herein, ;tippli(•r agrees to nobly the City and -cell sanic product(,:) !u the lower paice(s) on all (Icliveries made timing the ptlriod in which such luvvcd pfiec:(s) is eficrtivc
INTIJRL.(WAL i URCHASIN(i (optional). 'I'hc City desires to fnake :available to other local govcinmenf it enlilics of fhr State I)['fexa;, by ntutudl dg;reenient Willi (he surc•essful hiddrr, and prupclly autholiza l inlcrlocal purchasing agraaneftts ds provided fiir by (hc• lnic•Ilocal (•oupcialiun Act !Fli;lpfer 791, (iuvennnetit ('ode). the right to pluchase the v;nue services, al
the prices (paolcd, for the period of' contract Mach bidder .shall intlicafe on file I}id i•orro in Ilse space providedI below it belsbe will h000f Political Suhdivi,ioo order:; in a(Itlition to order. from the C'ily of I ubbock. Slicitild lhc,e other
90ver-nmcntal entities decide to participate in this conta'act, would you (the bidder) agree that all terms, conditions,
SI)wlicalionr, and pricing would apply?
Other ;;overnmcntal entities ilea( alight have interest- in this contract are Frenship Independent Sclwol 1)istr•iet,
Lubbock Housing Aulhorily, Lubbock County, Lubbock County Hospital Uistr'icl, l,ubhock Indepcadcnt School
District, South Plains Association o1'Govcrnrucnts, City uf'1'cxarkaua, Tevns'{`cch University, \rest rc,as M1lunicipJtl
1'o►err AI,'`�=, I,yun (�nunt}•, :sod City of �1'olfforth.
r;s_ — No
+ If you ('the bidder) checked YES, the following will apply:
► (iovernmentiil entities utilising Interlocal Agreements lua cooperative I'urchuzing with the ('sty oCl.ubboa k will be
eligible, but not ublig;ucd, to purchase matcrials!sen aes under the Collrtrct(s) a arded as :a Jesuit of Ilia solicitation.
:UI purchases by govcannacnl;al entities ()titer than the City off ubhock will be hilla:tl dircclly to Haut govcannicu4al
enuly and paid by that guveminenual cntily. City of I.ubbocl< will not bt: responsible for miolhc+t govemntcntal
entity', debts. Each governmcnl,•tl entity will otdra IheiJ own materinIs/set vice us needed,
THIS BID IS SUNMITTED By yK 64il corporation organised under the laws of the State of
or a partnership consisting of or individual trading ar;
— _ of the City of
Address:
---
Bidder acknowledges receipt of the following addenda:
Addenda No I Ad&nd;a No, Z _ Addenda No. Addenda No.
Datcl-,Z1' -- D att. 24 -LI Date Date -
M/'ArBE Firm:
Black American
Asian Pacific At
Native American
Uthcr (5 �c•rify)
(rrtbe 'Led Il-In-eV rtrft =e — must sign by hand
cr ad Tillc :
Plea Fktl
Please Print
'
Business Telephone Number �!..`� � � -- FAX:_.?-7 7 y�
E-mail Address: , �'i ►{'L �/• Ce i t�`(J <J
FOR CITY USE ONLY
Bid Form Item Number(s) Awarded to Above Named Firm/Individual:
Date of Award by City Council (/nr bider over 350,0(10l: bate P.O./Contract Tsstted:
RETURN COMPLETED & SIGNED BiD FORM ALONG WITH CITY OF LUBBOCK SPECIFICATIONS.
LABEL THE OUTSIDE OF YOUR SEALED BID WITH THE ITB NUMBER, TILE CLOSING DATE AND
TIME, AND YOUR COMPANY NAhIE AND ADDRESS.
Revised 10/01/20
CITY OF LUBBOCK
MINIMUM SPECIFICATIONS FOR THE PURCHASE OF (10)
FOUR DOOR, ALL WHEEI, DRIVE, SPORT UTII,ITY SPECIAL. SERVICES UNITIWITH CARGO AREA
SPEC # 2020 SUV PATROL
It i, the e, or a -ce 111c on tilrnu, ce or need dneunu ots, rrquireurenls:unl ennditions sections [u dcxcuhe mnvnwm pet linnrant c rapnrenlrniti. I Itc vehiclrlcgniputcnl
mull meet nr c�eced the petti,nnauce nr consltuclinrt tfe;enhcd "Clem I he vendor .Ir,tll be ruluired w mark nunpbance nr nnnconryslr.utre to each ecru deecriptipn rn
the space pmvrded. All cquipmcnt furnished as standard to lhs: geucIA public un the product by tb,• nl,nlufacit rer shall b,: atclttdcd, cycn when nol speofically Idrntilicd
in lhis •:pccific,nion And deyr;dinm hom 111C cvrrtisat specificalirm. u•ilh date as shown in the luvl.mmt In mill (I Ill) dmil be uolvif un the attached Fxeylti+ors I„ lire
tipn'tticthon lu t,tder to recvrvc 11111 cuujsrdcrnuuRn. ITT response rpwla4an Itn1St tulluw' Ihtr' spccifn Gunn ,Ind Ilse 1-1 ft's tams .[.mCdrw,ndrhon:;.
— —
�'f'.ixii)[,li NAME:J' r1 4 + JU-NO. ITEkf �,.C_1..��_ _ ----- ��.�� L• a---k--"� .
1vtiNIMUM REQUIREMENTS
_- -•-- ---- - - -- --- --SELLER COMPLIANCE
— This is for (10) all -wheel drive, Mid -size SUV, police
GENERAL
package, Special Services Unit, four door, sport utility
vehicle with cargo area.
I
ENGINE
3.3 liter V6, 285 Horsepower (� 6,500 RPM and 260 ft, lb.
--
torque (i; 4,000 RPM
—
2
TRANSMISSION
OEM AUTOMATIC with overdrive.
/ —
3.
GVWR —..
.._ 6,3001bs.
4.
PAYLOAD
1,600 lbs. -- — --
— —
5•
FRAME W —
-
Full perimeter steel, modular with hydro fonned rails
-
A. Wheelbase 119 inches
—
B. Overall length 198 inches
6
EXTERIOR
MEASUREMENTS
C. Overall width: 78 inches without mirrors
extended and 89 inches with mirrors extended
U, Overall height 69 inches
E. Ground clearance 7.5 inches
7
REAR AXLE —
Heavy duty locking differential
-- --
S'
STEERING
Electric Power Steering, OEM power assisted, tilt -wheel
--
- --
with coliunn mounted gear shift lever.
V
y
ABS, HEAVY DiJTY AIvTl-LOCK BRAKi S;
BRAKES
anti -lock front and rew- disc with vaeutlnt boost power
assist.
t0.
Front suspension to be independent, single, coil -over -
SUSPENSION
shock with stabilizer bar, Real- suspension to be multi -link
with coil springs with stabilizer bar.
11
COOLTNG SYSTEM
i OEM heavy-duty hi -
vy- ty high capacity radiator, with electric
— —
__
fans.
12. IRF.ATING/AIR
CONDTTTONING
13. ALTERNATOR
14, I BATTERIES
M AUXILLIARY POWER
FRONT
16. AUXILIARY POWER
REAR
17 I SPOTLIGHTS
is . GROUND STUDS
19' POWER OUTLETS
20. LOCKOUT PROTECTION
2 STABILITY CONTROL
227 -- —
AUDIO
23. CRUISE CONTROL
FUEL TANK CAPACITY
25, WINDSHIELD WIPERS
26. WHEELS- --�- �-
27 TIRES
28. DEFLECTOR PLATES
29. FRONT COMPARTMENT
�0' I REAR COMPARTMENT
OEM dual -zone manual climate control with individual
climate settings for driver and front passenger; includes
auxiliary rear air
Conditioning and heat. Rear operated from front control
orrly,
200 AMP I r-
Maintenance free, cranking, 750 CCA �� I✓
50-AMP ignition and main power supply wiring at lower
center of instrument panel. Two (2) 50-amp battery ground
circuits Power distribution junction block,
50-AMP auxiliary power in cargo area,
POST MOUNT LED SPOT LArV1PS ON DRIVER AND
PASSENGER SIDE -
Two studs located in rear compartment near bottom of life
gate.
Two located on front instrument panel and one in rear
cargo area,
Prevents the power door locks from locking the driver's
door if the keys are left in the ignition. Manually lockable
with cuiic
OEM Traction/Stability control
OEM AM/FM stereo, with blue -tooth capabilities.
Electronic with scrlrcratitlacrcicrrrc,4'esurnr speed --
functions.
OEM Maximwu capacity I w---
Intermittent, wet-arnt with flat blade and pulse washers. I
OF,M 18" Wheels, 5 spoke—1 ai"Iell i lad steel wheels with
center caps
Ail (4) four rires. Good Year, all season, P255/60R) 8 Frith
speed rating (H), (includes TPMS).
Front underbody shield starting behind front bumper and
running to 2nd cross -member protecting front underbody
and,ril
A. Head Room 40 inches
B. Leg Room (Maximum) 40 inches,
C. Head room 40 inches
D. Leg room (Mininj*n) 40 inches
M
31 �S.ATS
32
CARGO AREA
33,
INTERIOR LIGHTS
EXTERIOR LIGHTS
35.
EXTERIOR MIRRORS
36. POWER WINDOWS AND
POWER DOOR LOCKS
37 REAR LIFTGATE/I.IFT
GLASS
REAR DEFOGGER
WINDOW GLAZING
-- 40.
KEYS
41
KEYLESS ENTRY
42.
REARVIEW CAMERA
__l
4.t SPEEDOMETER/
CLUSTER
A. OHM - 40/20l40 front cloth falrrt� -
B. Color. Black
C. Rcar standard cloth 60/40 split folding bench
A. Cargo volume behind second row 52 cubic feet
B. Cargo area height 31 inches
A. Console overhead -snap lights
B. Dome Lamps, cargo lamp with delayed entry
feature and map lamps
F
Daytime running lamps and automatic headlamp delete
OI',M nurror.s Shall be below cyc level, both sides
—_—
cqurplred with temute t nntruls. outside heated power -
adjustable, manual -folding, and color to hi matte black.
OEM power windows and power door locks, door locks:
powct, non-progo,oniniahle with lockout protection and
automatic dent locking and urdncking- Child .salety luck.
un Ittded in rear doots ;Ind hidden dun' lurk plungc•'.s and
nroperahle h;uull'
Glass with washer and wiper.
Equipped with electric, rear window defogger
c�
Deep tinted all windows except light -tinted glass on
windshield, driver and front passenger side glass.
(4) four keys to be provided at time of delivery and (4)-
four key fobs for keyless entry.
Keyless entry remote fleet package to include (4) four
remotes to be provided at time of delivery With non-
functional panic button. Stealth mode feature includes
li
exterior lamps and horn disable, du' int; remote start
feature running lamps will remain illuminated.
Rearview camera with display in rearview mirror
A. 131 mph certified analog speedometer and (1)
F --f
one mph increments
CONTA I NG
STANDARD WAR14iANTy
STANDARD DRIVETRAIN
WARRANTY
COLOR
ADbITIONAL i�iODIFICA'i ON
EXTENUEll WARRANTY
B. Digital trip odometer
C. Oil pressure D. Volt meter ✓ --
E. Tachometer
F. Engine temperature gauge-
-G. Hour meter
II. Driver information center
Black vinyl floor and load floor behind second row seats.
Bidder shall fifinish a written detailed explanation orilw
standard warranty. Shall include a listing of all covered
components and a complete listing of exclusions in
Willr'anty with their bids. Warranty shall have a zero
deductible.
A. Nfileagc ,� 000
B. Months 1(
Bidder shall furnish a written detailed explanation of the
standard drive train warranty. Shall include a listing of
all covered components and a complete listing of
exclusions in warranty with their bids. Warranty shall
[rave it zero deductible-
A.
Nfilcagc 4
B. Months 60
(Please see attached paint scheme)
OPTIONS
Pre -wiring for grif[e [amp, siren, and speaker -Option 60-a
Headlamp Housing -Option 86-p
Tail amp Housing -Option 86-T
Police front/tail housing Eliminates the need to drill or
modify
Housing assemblies; with incremental hole for side
marker klNs. _
1- S year / 100,000 mile Bumper to Bumper
with Zero deductible
V-
8 U
3 qS
PILO�'IDf HUILU I) %TLS IN SPACE BELOW
BUILD DATE: -
MUST BE DELIVERED WITHIN 120-240 DAYS AFTER
PURCHASE.
— RISO AND Pr11't?I2 WORK
Vehicle/equipment will not be accepted by the City of 1_ubhock without
the MSO, all keys, wan;uu , an_ d al� I ierwnrk
(iliNlatFii. Ill;( ltl�ljl��fliNl' �\N�) INFOR(YtA'I'(ON �----`-- [Bidder shall submit with each hid, current printed literature and specification sheets ott the unit offered in the re., roll.
--- __-- ..-- ! t0 -solicitation,,
EXC.•I'.1' 17OVS '1'0'1'IIE SPECIFICATIONS of any items stated herein shall be fully described in writing by the bidding
vendor in the Space provided hclmv. isist itemS by item numbers.
A
[i'
E
F
LUBBOCK POLICE DEPARTMENT
SUV PPV
PAINT SCHEME
.._ ..A
I ■
DOORS 7
WHITE
FY18-19 SUV PPV
L/R Front Quarter
Panels, Front/Rear Black
bumpers
Metal areas on all 4
passenger doors White
All passenger door
handles
Rear Quarter Panels Black
Hood and Roof White
Rear Lift Gate and
spoiler Black
Paint on quarter panel to extend
upward stopping at the point
where the A -pillar seam begins.
Paintable surfaces only.
If paintable, white. If not, black.
Color to extend up to roof line on C
Pillar and across to top of A pillar.
(Paintable surfaces only)
Roof, white only between roof
channels.
8/7/2018
governmental entities decide to participate in this contract, would you (the bidder) agree that all terms, conditions,
specifications, and pricing would apply?
Other governmental entities that might have Interests in this contract are Frenship Independent School District,
Lubbock Housing Authority, Lubbock County, Lubbock County Hospital District, Lubbock Independent School
District, South Plains Association of Gavernments, City of Texarkana, Texas Tech University, West Texas Municipal
Power Agc�ey, Lynn County, and City of Wolfforth.
YFS i/ � NO
• If you (the bidder) checked YES, the following will apply:
• Governmental entities utilizing Interlocal Agreements for Cooperative Purchasing with the City of Lubbock will be
eligible, but not obligated, to purchase materials/services under the contract(s) awarded as a result of this solicitation.
All purchases by governmental entities other than the City of Lubbock will be billed directly to that governmental
entity and paid by that governmental entity. City of Lubbock will not be responsible for another governmental
entity's debts. Each governmental entity will order their own materials/service as needed.
THIS BID IS SUBMITTED BY_..Yr �, a corporation organized under the laws of the State of
or a partnership consisting of or individual trading as
of the City of
Fir•n: r -A J:4 L
Address: O T Lt/ vj1d_l
City:_State:- TL-`- zip
Bidder acknowledges receipt of the following addenda:
Addenda No, I Addenda No- 2, Addenda No. Addenda No.
DateIVIA Date Z--j 1 _2,1 Date - -
Date
M/WBE Firm:—�His
Black American Native American
American I I Asian Pacrfir Amerir� nil.....
By
An
Off icer• Name and Title:
Please Print
- must sign by hand
Y&/- 0 L-7
Business Telephone Number 3_- 11f-f Z--� ^`
E-mail Address: j #" *4*t-V- VC .1 b
CITY USE ONLY
Bid Form Item Number(s) Awarded to Above Named Firm individual:
Date of Award by City Council (Jh►• bids over $50,
FAX: ?V-9N 7 9
0 V--r
Date P.O./Contract Issued:
RETURN COMPLETED & SIGNED BID FORM ALONG WITH CITY OF LUBBOCK SPECIFICATIONS.
LABEL THE OUTSIDE OF YOUR SEALED BID WITH THE ITB NUMBER, THE CLOSING DATE AND
TIME, AND YOUR COMPANY NAME AND ADDRESS.
Revised 10/01/20
CITY OF LUBBOCK
MINIMUM SPECIFICATIONS FOR THE PURCHASE OF (10)
FOUR DOOR, ALL WHEEL DRIVE, SPORT UTILITY SPECIAL SERVICES UNIT/WITH CARGO AREA
SPEC # 2020 SUV PATROL
MAKE _ i7)�Ci, MODEL trj'✓ ��
P� EAR
It is the intent of'this specification, rcterenced documcnis, rcquircmenLs and eonditinns sections to dcsct tbu minimum perfomtauce rctluiremcnts. The vehicle/equipmut
nnatl meet air exceed the pct liormance or constuclioo described herein. The vendor shall be rquired to mark compliance or non-compliance to etch dcm description in
the space provided. All equipment furnished as standard to the general public on the product by the manufacturer shall be included, even when not specifically idcntified
in (his specification Any deviations from [lie wriucn specification, with date as shown ill the Invitation to Bid (MI) shall be noted on the auucliLd Exceptions to the
tiPecilicatroii. In ntder to receive filll ennsidutntion. ITB response quotation must follow this spcLiffcation aid tho ITB's terms and conthtions-
VENDOR NAME: V' t/✓� �CL f PHONE:
f-
NO. ITEM MINIMUM REQUIREMENTS -
SELLER COMPLIANCE
rti NO
GENERAL
This is for (10) all -wheel drive, Mid -size SUV, police
package, Special Services Unit, four door, sport utility
vehicle with cargo area.
3.3 liter V6, 285 Horsepower @ 6,500 RPM and 260 ft. lb.
torque @ 4,000 RPM
1
ENGINE
2.
TRANSMISSION
OEM AUTOMATIC with overdrive.
,
✓�
3•
GVWR
6,300lbs.
4.
PAYLOAD
1,600lbs.
5.
FRAME
Full perimeter steel, modular with hydro formed rails
6
EXTERIOR
MEASUREMENTS
A. Wheelbase 119 inches
B. Overall length 198 inches
C. Overall width: 78 inches without mirrors
extended and 89 inches with mirrors extended
D. Overall height 69 inches
E. Ground clearance 7.5 inches
7
REAR AXLE
Heavy duty locking differential.
Eleetric Power SteerMing, OEpower assisted, tilt -wheel
with colwrur mounted gear shift lever.
8'
STEERING
9
BRAKES
ABS, HEAVY DUTY ANTI -LOCK BRAKES; 4-wheel
anti -lock front and rear disc with vacuum boost power
assist.
Front suspension to be independent, single, coil -over -
shock with stabilizer bar. Real- suspension to be multi -link
with coil springs with stabilizer bar.
10.
SUSPENSION
11.
COOLING SYSTEM
OEM [tea du
vy- ty high capacity radiator, with electric
fans.
OEM dual -zone manual climate control with individual
12. HF,ATTNG/ATR climate settings for driver and front passenger; includes /
CONDITIONING auxiliary rear air t/
Conditioning and heat. Rear operated from front control
only,
13. ALTERNATOR 200 AMP /
14. I BATTERIES
15. AUXILLIARY POWER
FRONT
16. AUXILIARY POWER
REAR
1 7' SPOTLIGHTS
I" I GROUND STUDS
Maintenance free, cranking, 750 CCA
50-AMP ignition and main power supply wiring at lower
center of instrument panel. Two (2) 50-amp battery ground
circuits Power distribution junction block.
50-AMP auxiliary power in cargo area
POST MOUNT LED SPOT LAMPS ON DRIVER AND
PASSENGER SIDE.
Two studs located in rear compartment near bottom of lit1
gate.
19.
POWER OUTLETS
Two located on front instrument panel and one in rear
cargo area.
20.
LOCKOUT PROTECTION
Prevents the power door locks from locking the driver's
door if the keys are left in the ignition. Manually lockable
with engine running.
21'
STABILITY CONTROL
OEM Traction/Stability control
22.
AUDIO
OEM AM/FM stereo, with blue -tooth capabilities.
23.
CRUISE CONTROL
Electronic with sel/coasllaccelerate/resurne speed
functions.
24.
FUEL TANK CAPACITY
OEM Maximum capacity
25.
WINDSHIELD WIPERS
Intermittent, wet -arm with flat blade and pulse washers.
26•
WHEELS
OEM 18" Wheels, 5 spoke painted black steel wheels with
center caps
27'
TIRES
All (4) four tires, Good Year, all season, P255/60R18 with
speed rating (H). (Includes TPMS).
28.
DEFLECTOR PLATES
Front underbody shield starting behind front bumper and
running to 2nd cross -member protecting front underbody
and oil pan.
29.
FRONT COMPARTMENT
A. Head Room 40 ruches
B. Leg Room (Maximum) 40 inches
30.
REAR COMPARTMENT
C. Head room 40 inches
D. Leg room (Minimum) 40 inches
J
31.
A. OEM - 40/20/40 front cloth fabn
SEATS
B. Color: Black
C. Rear standard cloth 60/40 split folding bench
32.
CARGO AREA
A. Cargo volume behind second row 52 cubic feet
B. Cargo area height 31 inches
�-
33.
INTERIOR LIGHTS
A. Console overhead -map lights
B. Dome lamps, cargo lamp with delayed entry
feature and map lamps
34.
EXTERIOR LIGHTS
Daytime
/
✓
running lamps and automatic headlamp delete
35.
EXTERIOR MIRRORS
OEM mirrors shall be below eye level, both sides
equipped with remote controls, outside heated
power -
adjustable, manual-lblding, and color to be matte black.
36.
OEM power windows and power door locks, door locks:
POWER WINDOWS AND
POWER DOOR LOCKS
power, non -programmable with lockout protection and
automatic door locking and unlocking. Child safety locks
/
included in rear doors and hidden dour lock plungers and
inoperable handles.
37. REAR LIFTGATE/LIFT
GLASS
Glass with washer and wiper.
38.
REAR DEFOGGER
Equipped with electric, rear window defogger
39.
WINDOW GLAZING
Deep tinted all windows except light -tinted glass on
windshield, driver and front passenger side glass.
40.
KEYS
(4) four keys to be provided at tune of delivery and (4)
four key fobs for keyless entry.
Keyless entry remote fleet package to include (4) four
41.
KEYLESS ENTRY
remotes to be provided at time of delivery. With non -
tirnctional panic button. Stealth mode feature includes
exterior lamps and horn disable, during remote start
feature running lamps will remain illuminated.
42.
REARVIEW CAMERA
Rearview camera with display in rearview mirror
SPEEDOMETER/
A. 131 mph certified analog speedometer and (1)
CLUSTER
one nrph increments
`'
STANDARD WARRANTY
STANDARD DRIVETRAIN
WARRANTY
COLOR
B. Digital trip odometer
C. Oil pressure
D. Volt meter
E. Tachometer
F. Engine temperature gauge
G. Hour meter
H. Driver information center
Block vinyl floor and load floor behind second row seats.
Bidder shall furnish a written detailed explanation of the
standard warranty. Shall include a listing of all covered
components and a complete listing of exclusions in
wan•,mty with their bids. Warranty shall have a zero
deductible.
A. Mileage V, 00o
B. Months
Bidder halfFumish a written detailed explanation of the
standard drive train warranty. Shall include a listing of
all covered components and a complete listing of
exclusions in warranty with their bids. Warranty shall
have a zero deductible.
A. MilcageLc)o 00 0
B. Months__
(Please see attached paint scheme)
OPTIONS
ADDITIONAL MODIFICATION Pre -wiring for grille lamp, siren, and speaker -Option 60-a
Headlamp Housing —Option 86-p
Tail amp Housing —option 86-T
Police front/tail housing Eliminates the need to drill or
modify
Housing assemblies; with incremental hole for side
<1 O
EXTENDED WARRANTY 1. 5 year / 100,000 mile Bumper to Bumper f 33 , � `�
—j with Zero deductible 1 �
PROVIDE BUILD DATES IN SPACE BELOW
BUILD DATE:
MUST BE DELIVERED WITHIN 120-240 DAYS AFTER
PURCHASE. i
MSO AND YAPEI2WORK
Vehicle/equipment will not be accepted by the City of Lubbock without
the MSO, all kc s, warranty. and all nr reiwork
GENERAL Rf IJiRI? IiNT ANI� 1 OR ATI(>N
Bidder shall submit with each bid, current printed literature andspecification ication sheets on the unit offered in the response to solicitation.
EXCEPTIONS TO THE SPECIFICATIONS of any items stated herein shall be fully described in writing by the bidding
vendor in the space provided below. List items by item numbers.
LUBBOCK POLICE DEPARTMENT
SUV PPV
PAINT SCHEME
�I
CV1 4_10 cl 1\l nnu
LOCATION
COLORITEM
INFORMATION
L/R Front Quarter
Paint on quarter panel to extend
A
Panels, Front/Rear
Black
upward stopping at the point
bumpers
where the A -pillar seam begins.
e
Metal areas on all 4
passenger doors
White
Paintable surfaces only.
C
All passenger door
handles
If paintable, white. If not, black.
Color to extend up to roof line on C
D
Rear Quarter Panels
Black
Pillar and across to top of A pillar.
(Paintable surfaces only)
E
Hood and Roof
white
Roof, white only between roof
channels.
F
Rear Lift Gate and
spoiler
Black
s/7/2ols
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
10111
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, S. and 6 If there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2021.726633
Date Filed:
03112120-21
Date Acknowledged:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Jim Bass Ford, Inc
SAN ANGELO, TX United States
2 Name of governmental entity or state agency that is a party tot the contract for which e form is
being filed.
City of Lubbock, Texas
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
ITB-21-15742-CM
Mid size SUVS for Police Patrol
4
Name of Interested Party
Bass, John
City, State, Country (place of business)
San Angelo, TX United States
Nature of interest
(check applicable)
Controlling
X
Intermediary
5 Check only If there Is NO Interested Party-
6 UNSWORN DECLARATION
My name is (, I, &—b V
My address is
(sheet) (may) (state) 1
(zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed insr�-_County. State of on the ILay of &4-4. 20V
(month) (year)
Signatur of a orize gent of contra business entity
Brent)
:arms nrn%Afiprt by Tovae Ffhlrc r•.,....,,1 1....
""".cunw.arw.txya v- Version ..ce a
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos. 1- 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
1
Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2021-726633
Jim Bass Ford, Inc
SAN ANGELO, TX United States
Date Filed:
03/12/2021
2
Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Lubbock, Texas
Date Acknowledged:
03/12/2021
3
Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
ITB-21-15742-CM
Mid size SUVS for Police Patrol
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
Bass, John
San Angelo, TX United States
X
5
Check only if there is NO Interested Party. ❑
6
UNSWORN DECLARATION
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of on the day of , 20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by texas Ethics Commission www.ethics.state.tx.us Version V1.1.ceffd9ft
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