HomeMy WebLinkAboutResolution - 2021-R0502 - PO 31063359 with Silsbee Ford 12.14.21Resolution No. 2021-R0502
Item No. 6.25
December 14, 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. 31063359 in accordance with
TIPS Contract No. 200206 for the purchase of three (3) one-half ton pick-up trucks, by and
between the City of Lubbock and Silsbee Ford of Silsbee, 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 14, 2021
STEVE _ A , YOR PRO TEM
ATTEST:
vj_��A
Reb+ca Garza, City Secr t
APPROVED AS TO CONTENT:
01 . .
Erik Rejino, Assistant City Manager
APPROVED AS TO FORM:
Yel&lflileisure�", Assistant City Attorney
ccdocs/RES.-PurchaseOrd 31063359 TIPS 200206 Silsbee Ford
12.08.21
City of PURCHASE ORDER
Lubbock
TEXAS
SILSBEE FORD INC
TO: 1211 N HIGHWAY 96 N
SILSBEE TX 77656
Page -
Date -
Order Number
Branch/Plant
1
12/6/2021
31063359 000 OP
3526
CITY OF LUBBOCK
SHIP TO: FLEET SERVICES
206 MUNICIPAL DRIVE
LUBBOCK TX 79404
INVOICE TO: CITY OF LUBBOCK
ACCOUNTSPAYABLE
P.O. BOX 2000
LUBBOCK, TX 79457 4BY:Y
Marta A arez, Director of Purchasing & Contract Management
Ordered 12/6/2021 Freight
Requested 6/6/2022 Taken By
Delivery PER N DODSON, REQ 58179
TIPS 200206/ PUR 16276
Description/Sup lier Item Ordered Unit Cost UM
CC# 5719 1.000 33,392.0000 EA
2022 F150 Supercab 4X4 6.5' be
CC# 5615 2.000 34,777.5000 EA
2022 F 150 Crew Cab 4X4 5.5; be
Terms NET 30
SBALLANCE
Extension Request Date
33,392.00 6/6/2022
Total Order
69,555.00 6/6/2022
102,947.00
This purchase order encumbers funds in the amount of $102,947.00 awarded to Silsbee Ford, Inc of Silsbee, TX, on
December 14 , 2021. The following is incorporated into and made part of this purchase order by reference: Quote dated
November 15, 2021, from Silsbee Ford, Inc of Silsbee, TX, and TIPS Contract 200206.
Resolution # 2021-RO502
CITY OF LUBBOCK ATTEST:
<��;A - � S)I'gof4� A
STEVEVASSff14GXTtJ, MAYOR PRO TEM Rebec a 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 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 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 suppl) 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 deterim ed 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 providingsuch 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 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 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 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 famished will
conform to the specification, drawings, and descriptions listed in the bid invitation, and to the sample(s) fumished
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 wider 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 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 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 oft is 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 of work under this order may beterminated inwhole, orinpart bythe
Buyer in accordance with this provision Termination of work herewider shall be effected by the delivery
of the Seller of a "Notice of Termination" specifying die 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 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 pan
by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by
consideration and as in writing signed by the aggrieved parry
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 pares as a final expression of their agreement and intended also
as a complete and exclusive statement of the term 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 w 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
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 anyjudgmenl
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 reqwred 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 w 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 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, die City shall not be subject to any arbitration process prior to exercising
itsunrestricted 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 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 the City, at its option, reserves the right to deduct such amounts owing the City from an)
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 1293 DISCLOSURE OF INTERESTED PARTIES House Bill 1295, adopted by the 84th
Legislature, created §2252 908, Texas Government Code Section 2252 909 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
Imp 1: ww,.•.n iabbo4.);_p�py_dcvanmema}-websues`deaanmemtsburchuina+vsndormformalimi
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 pares. In the event of conflict
between these terms and conditions and any term and conditions provided by the Contractor, the term 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 (18) 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
806 051, 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 companies 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 or more full-time employees, and (2) has a value of
SI00,000 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 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 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: rs .
REV. 9.•2021
PRODUCT PRICING SUMMARY
TIPS USA 200206 TRANSPORTATION VEHICLES
VENDOR- Silsbee Ford, 1211 Hwy 96 N., Silsbee TX 77656
End User: CITY OF LUBBOCK (TIPS MEMBER TX998244) Prepared by: RICHARD HYDER
Contact: MARTA ALVAREZ 806 775 2572 Phone: 409.300.1385
Email: MALVAREZ(a)MAIL.CI.LUBBOCK.TX.US Email: RHYDER.COWBOYFLEEI@ MAIL.COM
Product Description: FORD FI50 CREW CAB Date: November 15, 2021
A. Bid Item: 32 A. Base Price: $ 26,123.00
B. Factory Options
Code
Description
Bid Price
Code
Description
Bid Price
WIC/W1I
2022 F150 CREW CAB 4X4 5 5' BED
$ 5,195 00
BLUETOOTH
$ -
995
5 OL V8 GAS
$ 1,995 00
REAR VIEW CAMERA
$ -
1S
EXTERIOR SILVER
$ -
CS
40/20/40 CLOTH SEATING
$ -
101 A
XL HIGH PKG
$ 92000
POWER EQUIPMENT GORUP
$ -
CRUISE
$ -
SPEC 5615 SILVER
REVERSE SENSING
$ -
Total of B. Published Options:1 $ 8,110.00
Published Option Discount (5%) $ (405.50)
C_ IInnnhlished Ontions
Description
Bid Price
Options
Bid Price
4 KEYS/FOBS
$ 200 00
OPTIONAL EQUIPMENT
53A TRAILER TOWING PKG $1090
FACTORY ORDER TO DELIVERY—150-180 DAYS
D. Floor Plan Interest (for in -stock and/or equipped vehicles):
E. Lot Insurance (for in -stock and/or equipped vehicles):
F. Contract Price Adjustment:
G.
H.
I
J.
K.
Additional Delivery Charge: 607 miles
Subtotal:
Quantity Ordered
Trade in:
Total Purchase Price
I xH=
Total of C. Unpublished Options: I $ 200.00
Is -
Is -
Is -
$ 750.00
$ 34,777.50
IS 34,777.50
5 -
$ 34,777.50
PRODUCT PRICING SUMMARY
TIPS USA 200206 TRANSPORTATION VEHICLES
VENDOR- Silsbee Ford, 1211 Hwy 96 N., Silsbee TX 77656
End User: CITY OF LUBBOCK (TIPS MEMBER TX998244) Prepared by: RICHARD HYDER
Contact: MARTA ALVAREZ 806.7752572 Phone: 409.300.1385
Email: MALVAREZ()MAIL.CI.LUBBOCK.TX.US Email: RHYDER.COWBOYFLEETCa.GMAIL.COM
Product Description: FORD F150 SUPERCAB Date: November 15, 2021
A. Bid Item: 31 A. Base Price: $ 24,158.00
B. Factory Ontions
Code
Description
Bid Price
Code
Description
Bid Price
XIC/XI E
2022 F150 SUPERCAB 4X4 6 5' BED
$ 5,195 00
BLUETOOTH
$
YZ
EXTERIOR WHITE
$ -
REVERSE SENSING
$
CS
40/20/40 CLOTH SEATING
$ -
REAR VIEW CAMERA
$ -
REAR VIEW CAMERA
$ -
995
5 OL V8 GAS
$ 1,99500
101 A
101 A PKG
$ 1,53000
POWER EQUIPMENT GROUP
$ -
SPEC 5719
CRUISE
$ -
Total of B. Published Options:1 $ 8,720.00
Published Option Discount (5%) S (436.00)
C. Unnublished Options
Description
Bid Price
Options
Bid Price
4 KEYS/FOBS
$ 200 00
OPTIONAL EQUIPMENT
53A TRAILER TOWING PKG $1090
FACTORY ORDER TO DELIVERY-150-180 DAYS
D. Floor Plan Interest (for in -stock and/or equipped vehicles):
E. Lot Insurance (for in -stock and/or equipped vehicles):
F. Contract Price Adjustment:
G. Additional Delivery Charge:
H. Subtotal:
I. Quantity Ordered
J. Trade in:
K. Total Purchase Price
607 miles
I xH=
Total of C. Unpublished Options: I $ 200.00 J
Is -
Is -
Is -
$ 750.00
$ 33,392.00
$ 33,392.00
$ 33,392.00
12
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
loft
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.
2021-833332
Silsbee Ford
Silsbee, TX United States
Date Filed:
12/15/2021
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
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.
31063359
Trucks
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Donalson, Drew
Silsbee, TX United States
X
5
Check only if there is NO Interested Party. ❑
6
UNSWORN DECLARATION Z
,j I ?
My name is �'�." ` `� t/��✓ and my date of birth is
My address is 7% -7 &3-41 , A ` a- 77 �� Z- `d
(street) (city) islate) (zip code) (country)
I declare under penalty perjury that the foregoing is true and correct.
%of
Executed ut I ar��'• County, State of on the Jr .day of I/ , 20 Z
(month) (year)
Signature of n thon I nt rac . witness entity
io�=s
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.191b5cdc
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.
2021-833332
Silsbee Ford
Silsbee, TX United States
Date Filed:
12/15/2021
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
Date Acknowledged:
12/16/2021
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.
31063359
Trucks
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Donalson, Drew
Silsbee, 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 V1.1.191b5cdc