HomeMy WebLinkAboutResolution - 2021-R0475 - PO 31062979 with Sam Packs Five-Star Ford 12.7.21Resolution No. 2021-R0475
Item No. 7.16
December 7, 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. 31062979 in accordance with
BuyBoard Contract 601-19 for the purchase of police patrol SUVs, by and between the City of
Lubbock and Sam Pack's Five Star Ford of Carrollton, 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
December 7, 2021
�j \W/
DANIEL M. POPE, MAYOR
ATTEST:
Reb ca Garza, City Secre ary
�.)
APPROVED AS TO CONTENT:
Erik Rejino, Assistant City Manager
APPROVED AS TO FORM:
§&&-
kelli Leisure, Assistant City Attorney
ccdocs/RES.-PurchaseOrd 31062979 police patrol SUVs
11.15.21
F40. City of
Uibr)ocx
TEXAS
PURCHASE ORDER
TO: SAM PACK'S FIVE STAR FORD
PO BOX 110098
CARROLLTON TX 75011-0098
Page -
Date -
Order Number
Branch/Plant
1
11/11/2021
31062979 000 OP
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
Marta Alvarez, ct r of Purchasing & Contract Management
Ordered 11/11/2021 Freight
Requested 5/16/2022 Taken By
Delivery PER N DODSON REQ 58112
K MORGAN
Buy Board 601-19
If you have any questions, please contact Natalie Dodson at 806-775-2374 or via email at
NDodson@mylubbock.us
Description/Supplier Item Ordered Unit Cost UM Extension Request Date
Spec. 2022 AWD Mid Size SUV 41.000 37,664.0000 EA 1,544,224.00 5/16/2022
Equipment Options 41.000 710.0000 EA 29,110.00 5/16/2022
Total Order
Terms NET 30
1,573,334.00
This purchase order encumbers funds in the amount of $1,573,334.00 awarded to Sam Pack Five Star Ford of Carrollton, TX, on
December 7th , 2021. The following is incorporated into and made part of this purchase order by reference: ITB 22-16236-MA from
Sam Pack Five Star Ford of Carrollton, TX, dated on November 10, 2021.
Resolution # 2021-RO475
CITY OF LUBBO K ATTEST:
Daniel M. Pope, Mayor ReUecja Garza, City Secreta
Rev. 9/2021
Seller and Buyer agree as
follows:
PURCHASE ORDER
TERMS AND CONDITIONS
IMPORTANT: READ CAREFULLY
STANDARD TERMS AND CONDITIONS
CITY OF LUBBOC& 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
if applicable, (c) Container number and total number of containers, e g box 1 of 4 boxes, and (d) the number
of the container hearing the packing slip Seller shall bear cost ofpackaging unless otherwise provided Goods
shall be suitably packed to secure lowest transportation costs and to conform with requirements of common
tamers 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 nine but not aftenard
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 anached 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 Lability 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 recover or withhold the amount of the cost incurred by Seller in provuhngsuch 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 securing business For breach of
vitiation of this warranty the Buyer shall have the right in addition to any other right of rights to cancel this
contract without Lability and to deduct from die 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 limn 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 fumished 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 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
I 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 die specification will not give rise to such a clainm, 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
nonce 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 pan 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 of work under this order may be terminated in whole, or in pan by the
Buyer in accordance with this provision Termination of work hereunder shall be effected by the delivery
of the Seller of a "Nonce 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 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 ineffecnve 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 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 part 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 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 die Umfori 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 parry to this contract in good faith has reason to question
the other party'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 "thin five (5) days, the demanding
parry 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 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 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 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 enterpnses 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 remedy 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, the 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 maybe 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 Contractor's 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 the City, at its option, reserves the right to deduct such anmounts owing the City from any
payments due Contractor
27 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 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 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
httu 'wwwv.n lubhocF L..us+dei<artmental-websiies`deoanmralsrow h ,mgsnd9r-jnfom inn
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 website of
the Comptroller of the State of Texas concerning the listing of companies that are identified under Section
806 031, Section 807 051 or Section 2233 153 1 further certify that should the above -named company enter
into a contract that is on said listing of companies on the website of the Comptroller of the State of Texas, which
do business with Iran. Sudan or any Foreign Terrorist Organization, 1 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 or more full-time employees, and (2) has a value of
$100.000 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 regwrements of Subchapter J, Chapter 552, Govemment
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 J, 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 emarl address for which
public information requests may be made by an entailed request Please send this request to this email address
for at to be processed: orrm:mmwlubbock w
REV 9 2021
BID FORM
City of Lubbock, TX
Purchasing and Contract Management
In compliance with the Invitation to Bid 2246236-MA, the undersigned Bidder having examined the Invitation to Bid and
Specifications, and being familiar with the conditions to be met, hereby submits the following Bid for famishing the
material, equipment, labor and everything necessary for providing the items listed below and agrees to deliver said items at
the locations and for the prices set forth on this form. A bid will be subject to being considered irregular and maybe rejected
if it shows omissions, alterations of form, conditional alternate bids, additions or alternates in lieu of the items specified,
if the unit prices are obviously unbalanced (either in excess of or below reasonably expected values), or irregularities of any
kind. The Invitation to Bid 22-16236-MA by reference incorporated in this contract. The Bid Form must be completed in
blue or black ink or by typewriter.
ITEM
QTY
(+�-)
UOM
DESCRIPTION
UNIT
PRICE*
EXTENDED
PRICE
**Delivery
days ARO
1
41
EA
SPEC. 2022 All Wheel drive, Mid -Size
SUV, Police Package, Special Service(,
17"?:
Unit, four door sport utility vehicle with
Y71
P ORi �•
cargo area, asspecified herein
Model Year, Brand Name, and Model Number:
Item 1 Overall Total: $
Factory installed overlay wiring harness
that will allow customer supplied siren
speaker and lighting in the engine
t�l
compartment, terminating in the rear
cargo area. This harness include
shall
ignition and battery blunt cut wires, as
D
'
Opt. 1
41
EA
h
��
well as wiring for various vehicle
functions. (e.g: headlight/ taillight flasher
control, VSS). This cabling shall also
include wiring in the rear hatch for
customer supplied lighting, terminating in
the rear car o area.
Rear door handles/ window controls and
L (tc 0
D
r
Opt. 2
41
EA
locks shall be rendered inoperable from
D77
the inside of the vehicle.
The vehicle shall come equipped with
3
Opt. 3
41
EA
either a customer controlled switch or be
programmed such that the cabin, parking,
K
and puddle lights shall not turn on
ID
whenever you enter/exit the vehicle.
The vehicle shall be equipped such that
l
interconnection into the OBD-2 or vehicle
CANBUS Gateway be
Of•f
"
Opt.
41
EA
can accomplished
by the upfitter, and in a manner that will
allow the customer installed controller to
l
access the signaling for control of various
• =�` _ ' "-
vehicle functions.
a ;
Total $1,573,334.00
*PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed **Days After Receipt of Order (ARO)
Unless otherwise specified herein, the City may award the bid either item -by —item or on an all -or -none basis for
any item or group of items shown on the bid.
The City of Lubbock Is seeking a contract for with one or more contractors. In order to assure adequate coverage,
the City may make multiple awards, selecting multiple vendors to provide the products desired, if multiple awards
are in the best interest of the City. A decision to make a multiple award of this Bid, however, is an option reserved
by the City, based on the needs of the City.
PAYMENT TERMS AND DISCOUNTS - Bidder offers a prompt payment discount of o, net _ calendar
days. Discounts will not be considered in determining low bid. Unless otherwise indicated on id Form, payment terms
will be NET THIRTY DAYS. The City will pay the successful bidder within thirty days after th receipt of a correct invoice
or after the date of acceptance, whichever event occurs later. Discounts for prompt payment requiring payment by the City
within a stipulated number of days will be interpreted as applying within the stipulated number of calendar days after the
date of receipt by the City of a correct invoice or after the date of acceptance that meets contract requirements, whichever
event occurs later. Discounts for payment in less than ten days will not be considered.
MOST FAVORED PRICING: The Bidder certifies that the price quoted is not in excess of the lowest price charged anyone
else, including its most favored customer, for like quality and quantity ofthe products/services; does not include an element
of profit on the sale in excess of that normally obtained by the Bidder on the sale of products/services of like quality and
quantity; and does not include any provision for discounts to selling agents. If at any time during the contract period, the
supplier should sell or offer for sale to any other customer, an equal or less quantity of similar contract products of like or
better quality, at a lower net price(s) than provided herein, supplier agrees to notify the City and sell same product(s) at the
lower price(s) on all deliveries made during the period in which such lower price(s) is effective.
INTERLOCAL PURCHASING (optional): The City desires to make available to other local governmental entities of the
State of Texas, by mutual agreement with the successful bidder, and properly authorized interlocal purchasing agreements
as provided for by the Interlocal Cooperation Act (Chapter 791, Government Code), the right to purchase the same services,
at the prices quoted, for the period of this contract. Each bidder shall indicate on the Bid Form in the space provided below
if he/she will honor Political Subdivision orders in addition to orders from the City of Lubbock. Should these other
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 PlOns Association of Governments, City of Texarkana, Texas Tech University, West Texas Municipal
Power Agenc ynn County, and City of Wolfforth.
YES 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 B IS SUBMITTED BYj!! . .YLt,�L "l��°.YAI k'cotporation organized under the laws of the State of
7e rd 5 or a partnership consisting of
or individual trading as
��^^— of the City of
Firm: W. �S V OV/"e- lr�r_d
Address: G ?�� W
City: P, A_C` s a ll`TO v` State - Zip l SO o L¢
Bidder acknowledges receipt of the following addenda:
Addenda No. _
Date
Addenda No. _
Date
Addenda No. _
Date
Addenda No. _
Date
M/WBE Firm:
Woman I I Black American I Native American
Hispanic American I I Asian Pacific Americ4 I Other (Specify)
I / /Z-/..?-
Representative - must sign by hand
Officer Name and Title: !K k o k -js M'1, wy L,..— I V 1 Qf
Please Print
Business Telephone Number o?%`t " aqi-" 641 S FAX:
E-mail
FOR CITY USE ONLY
Bid Form Item Number(s) Awarded to Above Named Firm/Individual:
Date of Award by City Council (for bids over $50, 000): Date P.O./Contract
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 TEVIE
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.
2022-952543
SAM PACK'S FIVE STAR FORD
CARROLLTON, TX United States
Date Filed:
11/07/2022
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 PO 31062979 ]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.
601-19
VEHICLES
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5 Check only if there is NO Interested Party. ❑X
6 UNSWORN DECLARATION
.� ,and my date of birth is My name i
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
/
Executed in s a� County, State of e S on the day of Nthy 20dR'�
(month) (year)
Sign ture of authorized agent of contracting business entity
(Declarant)
Fnrms nrovided by Texas Ethics Commission www.ethics.state.tx.us Version V3.5.1.d1b92728
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.
2022-952543
SAM PACK'S FIVE STAR FORD
CARROLLTON, TX United States
Date Filed:
11/07/2022
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:
11/10/2022
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.
601-19
VEHICLES
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.dlb92728