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HomeMy WebLinkAboutResolution - 2021-R0460 - PO 31062734 with Romco Equipment Company 11.16.21Resolution No. 2021-R0460 Item No. 6.14 November 16, 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 and on behalf of the City of Lubbock, Purchase Order No. 31062734 in accordance v Sourcewell Contract 052417 for the purchase of a M30 concrete truck, by and between the ( of Lubbock and Romco Equipment Company of Dallas, TX and related documents. c Purchase Order is attached hereto and incorporated in this resolution as if fully set forth hei and shall be included in the minutes of the City Council. Passed by the City Council on November 16, 2021 �-A DANIEL M. POPE, MAYOR ATTEST: Rebe ca Garza, City Sett APPROVED AS TO CONTENT: Erik Rejino, Assistant City Manager APPROVED AS TO FORM: 1 elli Leisure, Assistant City Attorney ccdocs/RES.PurchaseOrd 31062734 concrete truck - Sourcewe11052417 11.04.21 City of Lubbock TEXAS PURCHASE ORDER TO: ROMCO EQUIPMENT CO PO BOX 841496 DALLAS TX 75284-1496 Page - 1 Date - 10/29/2021 Order Number 31062734 000 OP Branch/Plant 3526 SHIP TO: CITY OF LUBBOCK FLEET SERVICES 206 MUNICIPAL DRIVE LUBBOCK TX 79404 INVOICE TO: CITY OF LUBBOCK ACCOUNTSPAYABLE P.O. BOX 2000 LUBBOCK, TX 79457 JBY:-k Marta A arez, Director of Purchasing & Contract Management Ordered 10/29/2021 Freight Requested 11/30/2021 Taken By YBUSBY Delivery PER N DODSON REQ 58054 PUR 16254/SOURCEWELL CONTRACT 052417 If you have any questions contact Natalie Dodson:ndodson@mylubbock.us Phone 806-775-2374 Description/Supplier Item M30 Concrete Truck 6 Yard Package Accu-Printer II (AP2) 360' Swivel Chute Calibration Kit (1/4 Yard) Hydraulic Oil Cooler -Air Mixer Diaper Night Operating Lights (LED) Onsite Dealer Startup Sourcewell Purchase Strobe Lights Tarp - Black Mesh Transmission Integration - Aut Mounting - CTI Supplied Truck Purchase 40•6 Discount Freight Amount Terms NET DUE ON RECEIPT Ordered Unit Cost UM Extension Request Date 1.000 89,267.0000 EA 89,267.00 11/30/2021 1.000 2,095.0000 EA 2,095.00 11/30/2021 1.000 6,975.0000 EA 6,975.00 11/30/2021 1.000 1,421.0000 EA 1,421.00 11/30/2021 1.000 520.0000 EA 520.00 11/30/2021 1.000 2,715.0000 EA 2,715.00 11/30/2021 1.000 312.0000 EA 312.00 11/30/2021 1.000 1,526.0000 EA 1,526.00 11/30/2021 1.000 5,292.0000 EA 5,292.00 11/30/2021 1.000 EA 11/30/2021 1.000 917.0000 EA 917.00 11/30/2021 1.000 2,940.0000 EA 2,940.00 11/30/2021 1.000 1,431.0000 EA 1,431.00 11/30/2021 1.000 4,101.0000 EA 4,101.00 11/30/2021 1.000 88,257.0000 EA 88,257.00 11/30/2021 1.000 (4,616.4400) EA (4,616.44) 11/30/2021 1.000 5,000.0000 EA 5,000.00 11/30/2021 Total Order 208,152.56 This purchase order encumbers funds in the amount of $208,152.56 awarded to Romco Equipment Company Dallas, TX, on November 16th 2021 The following is incorporated into and made part of this purchase order by reference contract: 052417 from Romco Equipment Company Dallas, TX. Resolution# 2021-RO460 CITY OF LUBBOCK t-'_x Daniel M. Pope, Mayor ATTEST: Reb cca Garza, City Secretary Rev. 9/2021 Seller and Buyer agree as follows: PURCHASE ORDER TERMS AND CONDITIONS IMPORTANT: READ CAREFULLY STANDARD TERMS AND CONDITIONS CITY OF LUBBOCK, TX 1 commercial TO PACKAGE GOODS Seller will package goods in accordance with good conercial practice Each shipping contamer shall be clearly and permanently marked as follows (a) Seller's time and address, (b) Consignee's name, address and purchase order or purchase release number and the supply agreement number if applicable, (c) Container number and total number of containers, a & box 1 of 4 boxes, and (d) the number of the container hearing 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 carers 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 may then make a conforming tender within the contract time but not afterward 5 INVOICES & PAYMENTS a. S e I I e r 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 entertamment, 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 recover or withhold the amount of the cost incurred by Seller in providing 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 8 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 dim 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 event 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 secunng business For breach of viciation of this warranty the Buyer shall have 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 of such 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 warrants that the goods furnished will conform to the specification, drawings, and descriptions listed in the bid invitation, and to the sample(s) furnished by the Seller. if any In the event of a conflict or between the specifications, drawings, and descriptions, the specifications shall govern Notwithstanding any provisions contained in the contractual agreement, the Seller represents and warrants fault -free performance and fault -free 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, individually or in combination, as the case may 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 involved 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 lunitation of the Seller's Inability 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 die product does not conform to OSHA standards, Buyer may return the product for correction or replacement at the Sellers 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 I 1 NO WARRANTY BY BUYER AGAINST INFRINGEMENTS As part of this contract for sale Seller agrees to ascertain whether goods manufactured in accordance with 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 nse 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 of this 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 nonappropriathon 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 Inability, 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 pan of the undelivered portion of this order if Seller breaches any of die terms hereof including warranties of Seller or of 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 of work 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 nght 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 parry shall be held responsible for losses, resulting if the fulfillment of any terms of provisions of this contract is delayed or prevented by any cause not within the control of the party 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 conformity with 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 wiring signed by the aggrieved party 19 INTERPRETATION -PAROLE EVIDENCE This writing, plus any specifications for bids and performance provided by Buyer in its adverusem m for bids, and any other documents provided by Seller as part of his bid is intended by the pares as a final expression of their agreement and intended also as a complete and exclusive statement of the terms 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 mitten 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 22 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 winch 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 Seller 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 nine 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 for an award 25 NON -ARBITRATION The City reserves the right to exercise any right or rented) to it by law, contract, equity, or otherwise, including without limitation, the right to seek any and all forms of relief in a court of competent jurisdiction Further, die City shall not be subject to any arbitration process prior to exercising 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 of any 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 term 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 die 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 of such overpayments within thirty (30) days of such audit findings, or die City, at its option, reserves the right to deduct such amounts owing the City from an) payments due Contractor 27 ASSIGNINGOR 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 provide proof on insurance from the Subcontractor that complies with all contract Insurance requirements 29 HOUSE BILL 1295 DISCLOSURE OF INTERESTED PARTIES House Bill 1295, adopted by the 84th Legislature, created §2252 909, 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 govemmental entity or state agency Instructions for completing Form 1295 are available at h� ciI Lbba�k Jx ii�c'ilcpzrtmvnn, 4.w�§Bite ¢spar�ih�ry(slvurchasmcivendoe-information 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 terms 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 terms shall be of no force or effect 31 TEXAS GOVERNMENT CODE, CHAPTER 2252 The undersigned representative of the undersigned company or business, being an adult over the age of eighteen (I8) years of age, pursuant to Texas Government Code, Chapter 2252, Section 2252 152, certify that the company named above is not listed on the webshte of the Comptroller of the State of Texas concerning the listing of companies that are identified under Section 806 051, Section 807 051 or Section 2253 153 1 further certify that should the above -named company enter into a contract that is on said listing of compames on the website of the Comptroller of the State of Texas, which do business with Iran. Sudan or any Foreign Terrorist Organization, I will immediately notify the City of Lubbock Purchasing and Contract Department. 32 TEXAS GOVERNMENT CODE, CHAPTER 2270 This section applies only to a contract that (1) is between a governmental entity and a company with 10 of more full-time employees, and (2) has a value of f100,000 or more that is to be paid wholly or partly from public funds of the governmental entity (b) A governmental entity may not enter into a contract with a company for goods or services unless the contract contains a written verification from the company that it (1) does not boycott Israel. and (2) will not boycott Israel during the term of the contract 33 TEXAS PUBLIC INFORMATION ACT The requirements of Subchapter J, 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 To the extent Subchapter 1, Chapter 552, Government Code applies to this agreement, Pursuant to Section 552 301(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 entailed request Please send this request to this email address for it to be processed Or r• iA niv I ubboc k us REV 91021 SOLD TO: Company: Contact: Address: Cell No: Phone No.: Date: Sales Person: CITY OF LUBBOCK TEXAS BRIAN BEARDEN 402 MUNICIPAL DRIVE LUBBOCK, TX 79457 806-775-2996 11-1-2021 ROMCO PAVING EQUIPMENT PURCHASE ORDER 14343 SHIP TO: CITY OF LUBBOCK TEXAS 402 MUNICIPAL DRIVE LUBBOCK, TX 79457 Ship Method: CUSTOMER TO ARRANGE E.X.W Factory -Indianola, Iowa TERMS: 20% with Order, Balance on or before Delivery MODEL DESCRIPTION BASE PRICE M30 PRODUCE UP TO 30 CUBIC YARDS OF CONCRETE PER HOUR 89,267 OPTIONS INCLUDE: Qty 6 YARD PACKAGE 1 2,095 ■ INCLUDES 6 YARD BIN, 65 CUBIC FOOT CEMENT BIN AND 430 GALLON WATER TANK ACCU-PRINTER II (AP2) 1 6,975 ■ ADVANCED SECOND GENERATION ELECTRONIC TICKET PRINTER THAT EXPANDS THE CAPABILITIES OF THE ORIGINAL ACCUPRINTER. TOUCHSCREEN DISPLAY ALONG WITH THE ABILITY TO STORE MORE MIX DESIGNS AS WELL AS UPLOAD MIX DESIGNS AND DOWN LOAD MIX DATA THROUGH USB PORT INCLUDES WATER RECORDING METER AND TICKET PRINTER FOR USE IN TRUCK CAB 360° SWIVEL CHUTE 1 1,421 ■ 360" SWIVEL CHUTE WITH 24" SHORT CHUTE. ACCEPTS STANDARD MIDDLE AND END CHUTES. CALIBRATION KIT (1/4 YARD) 1 520 ■ 1/4 YARD ALUMINUM, COLLAPSIBLE YIELD BOX WITH DIGITAL SCALE AND MEASURING CUPS TO AID IN CALIBRATION OF THE UNIT. HYDRAULIC OIL COOLER -AIR 1 2,715 ■ FAN OIL COOLER TO LOWER HYDRAULIC OIL TEMPERATURE FOR OPERATION IN HIGH AMBIENT HEAT CONDITIONS, EXTENDED OPERATION, OR WHEN MIX WATER CAN NOT BE USED. MIXER DIAPER 1 312 ■ MIXER DIAPER UNDER MIXING THROAT TO CATCH MATERIALS AND PREVENT THEM FROM SPILLING. STANDARD COLOR IS YELLOW. NIGHT OPERATING LIGHTS (LED) - QTY 5 1 1,526 ■ NIGHT OPERATING LIGHTS ALLOW SAFE OPERATION OF THE UNIT AFTER DARK INCLUDES 5 LED TYPE FLOOD LIGHTS. ON/OFF SWITCH WILL BE LOCATED IN THE CONTROL PANEL. ONSITE DEALER STARTUP 1 5,292 ■ ONSITE CUSTOMER STARTUP PERFORMED BY CEMEN TECH DEALER SOURCEWELL PURCHASE 1 0 ■ GOVERNMENT ENTITIES CAN PURCHASE CEMEN TECH EQUIPMENT DIRECTLY THROUGH SOURCEWELL, A COOPERATIVE PURCHASING AGENCY, ELIMINATING THE REQUIREMENT OF SOLICITING A BID. CEMEN TECH CONTRACT #052417-CMT. 4% DISCOUNT APPLIED TO TOTAL PURCHASE PRICE. STROBE LIGHTS - ONE FRONT & ONE REAR 1 917 ■ ONE FRONT AND ONE REAR MOUNTED STROBE CAUTION LIGHT. STROBE WILL BE MOUNTED ON THE BACK OF THE UNIT ON THE DRIVER'S SIDE, AND ON THE FRONT WATER TANK CAGE. SWITCH LOCATION WILL BE LOCATED IN THE CAB IF THE UNIT IS MOUNTED ON A TRUCK CHASSIS. THE SWITCH WILL BE LOCATED IN THE MIXER CONTROL PANEL IF THE UNIT IS MOUNTED ON A TRAILER. Romco Equipment Co LLC' 1519 W Bell Line Dr, ' Carrollton 75006 USA' Ph +1 214 819 4108 PURCHASE ORDER 14343 TARP - BLACK MESH 1 2,940 ■ ELECTRIC MOTOR OPERATED MESH TARP TO HELP SECURE YOUR AGGREGATES DURING TRANSIT. SWITCH WILL BE MOUNTED ON THE BIN SUPPORT. TRANSMISSION INTEGRATION -AUTOMATIC (INCLUDES ROLL AND POUR 1 1,431 CAPABILITY) ■ TRANSMISSION INTEGRATION - AUTOMATIC (INCLUDES ROLL AND POUR CAPABILITY) TRUCK Sr TRAILER SECTION: 0 Price MOUNTING - CTI SUPPLIED 1 4101.00 CEMEN TECH PROVIDED CHASSIS OR TRAILER. PROVIDE QUALITY WORKMANSHIP AND PROPERLY MOUNT UNIT TO APPROPRIATE CHASSIS. TRUCK PURCHASE 1 88257.00 DUE TO DELIVERY AND PREPARATION, NEW TRUCK PURCHASES MAY HAVE UP TO 1.500 MILES ON THE ODOMETER. NOTE: Standard unit color is white 4 % DISCOUNT ON MIXER ADDED FOR PURCHASING THROUGH SOURCEWELL, CEMEN TECH SOURCEWELL NUMBER 052417-CMT Base Unit Price: Unit Options Total: Less Discount: 89,267 26,144 4,616.44 Unit Total Price: 110,794.56 Truck I Trailer Section Total: 92,358,00 Est. Freight Amount: 5,000.00 Total Per Unit: $208,152.56 Quantity: 1 TOTAL: $208,152.56 Any applicable taxes are the responsibility of the customer . Currency - USD Changes to the order after acceptance will incur additional charges . Romco Equipment Co. LLC • 1519 W Belt Line Dr, • Carrollton, 75006 USA • Ph: +1 214.819.4108 CERTIFICATE OF INTERESTED PARTIES FORM 1295 1of1 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. 2022-957627 ROMCO Equipment Co., LLC Carrollton, TX United States Date Filed: 11/21/2022 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 Date Acknowledged: 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. Sourcewell Contract 052417 Cemen Tech unit purchase Nature of interest 4 Name of Interested Party City, State, Country (Place of business)(check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. x 6 UNSWORN UECL�RATION r 2 name is f l and my date of birth is My address isLl LG� r' • �� (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. n� Executed in �'L S County, State of [ on l the 2� d q of 40rr t-L�— (month) (year) Sig ure a► a of contracting business entity (D a t) Forms provided by Texas Ellucs Commission www.ethics.state.txversion v3.5.i.eb8 rer42 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. 2022-957627 ROMCO Equipment Co., LLC Carrollton, TX United States Date Filed: 11/21/2022 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 Date Acknowledged: 11/21/2022 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. Sourcewell Contract 052417 Cemen Tech unit purchase 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. ❑ X 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 V3.5.1.eb87ef42