HomeMy WebLinkAboutResolution - 2017-R0421 - Chameleon Industries - 11/16/2017Resolution No. 2017-RO421
Item No. 6.8
November 16, 2017
RESOLUTIO
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, Contract No. 13668 for Aluminum Sulfate/Polymer Blend
for the North Water Treatment Plant as per ITB 18-13668-KW, by and between the City of
Lubbock and Chameleon Industries, Inc., of Mesquite, Texas, and related documents. Said
Contract 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 November 16, 2017
i
DANIEL M. POPE, MAYOR
ATTEST:
Rebe ca Garza, City Secreta y
APPROVED AS TO CONTENT:
L. Woo$ Franklin. Director of Public Works
11 APPROVED AS TO FORM:
vw:ccdocs/RES.Contract 13668.Aluminum Sulfate Polymer Blend for the North Water Treatment Plant
11.01.2017
Resolution No. 2017-RO421
Contract 13668
City of Lubbock, TX
Contract for
Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant
THIS CONTRACT, made and entered into this 16' day of November, 2017, pursuant to a resolution heretofore
adopted by the City of Lubbock, Texas, by and between the City of Lubbock ("City"), and Chameleon Industries
Inc. ("Contractor").
WITNESSETH:
WHEREAS, the City of Lubbock duly advertised for bids Aluminum Sulfate/Polymer Blend for the
North Water Treatment Plant and bids were received and duly opened as required by law; and
WHEREAS, after careful consideration of the bid submitted by Contractor, the City bid, and authorized
the execution, in the name of the City of Lubbock a primary contract with said Contractor covering the purchase
and delivery of the said Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant
NOW, THEREFORE, in consideration of the mutual agreement contained herein, as well as the financial
consideration hereinafter referred to, the parties hereby covenant and agree as follows:
1. In accordance with City's specifications and Contractor's bid, copies of which specifications and bid are
attached hereto and made part hereof, Contractor will provide to the City Aluminum Sulfate/Polymer
Blend for the North Water Treatment Plant, and more specifically referred to as Item four on the bid
submitted by the Contractor or in the specifications attached hereto.
2. The City promises and agrees to employ, and does employ, the Contractor to cause to be done the
work provided for in this Contract and to complete and finish the same according to the attached
specifications, offer, and terms and conditions contained herein.
3. The contract shall be for a term of three years, said date of term beginning upon formal approval. All
stated annual quantities are approximations of usage during the time period to be covered by pricing
established by this bid. Actual usage may be more or less. Order quantities will be determined by actual
need. The City of Lubbock does not guarantee any specific amount of compensation, volume, minimum,
or maximum amount of services under this bid and resulting contract. The Contractor must maintain the
insurance coverage required during the term of this contract including any extensions. It is the
responsibility of the Contractor to ensure that valid insurance is on file with the Purchasing and Contract
Management Department as required by contract or contract may be terminated for non-compliance.
4. This contract shall remain in effect until the first of the following occurs: (1) the expiration date, (2)
performance of services ordered, or (3) termination of by either party with a 30 day written notice. The
City of Lubbock reserves the right to award the canceled contract to the next lowest and best bidder as it
deems to be in the best interest of the city.
5. Contractor shall at all times be an independent contractor and not an agent or representative of the City
with regard to performance of the Services. Contractor shall not represent that it is, or
hold itself out as, an agent or representative of the City. In no event shall Contractor be authorized to enter
into any agreement or undertaking for or on behalf of the City.
6. The contractor shall obtain and maintain in full force and effect during the term of the contract,
commercial general liability coverage with insurance carriers admitted to do business in the State of
Texas. The insurance companies must carry a Best's Rating of A- VII or better. The policies will be
written on an occurrence basis, subject to the following minimum limits of liability:
7. INSURANCE COVERAGE REQUIRED
SECTION A. Prior to the approval of this contract by the City, the Contractor shall furnish a completed Insurance
Certificate to the City, which shall be completed by an agent authorized to bind the named underwriter(s) to the
coverages, limits, and termination provisions shown thereon, and which shall furnish and contain all required
information referenced or indicated thereon. THE CITY SHALL HAVE NO DUTY TO PAY OR PERFORM
UNDER THIS CONTRACT UNTIL SUCH CERTIFICATE SHALL HAVE BEEN DELIVERED TO THE
CITY.
SECTION B. The City reserves the right to review the insurance requirements of this section during the effective
period of the contract and to require adjustment of insurance coverages and their limits when deemed necessary
and prudent by the City based upon changes in statutory law, court decisions, or the claims history of the industry
as well as the Contractor.
SECTION C. Subject to the Contractor's right to maintain reasonable deductibles in such amounts as are
approved by the City, the Contractor shall obtain and maintain in full force and effect for the duration of this
contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by companies
approved by the State of Texas and acceptable to the City, in the following type(s) and amount(s):
TYPE OF INSURANCE COMBINED SINGLE LIMIT
GENERAL LIABILITY
® Commercial General Liability ❑ Other General Aggregate $1,000.000
❑ Claims Made ® Occurrence Products-Comp/Op AGG X
❑ W/Heavy Equipment Personal & Adv. Injury X
❑ To Include Products of Complete Operation Endorsements Contractual Liability X
Fire Damage (Any one Fire)
Med Exp (Any one Person)
PROFESSIONAL LIABILITY
❑ General Aggregate
AUTOMOTIVE LIABILITY
® Any Auto ❑ All Owned Autos Combined Single Limit
❑ Scheduled Autos ❑ Hired Autos Per Occurrence $1,000.000
❑ Non -Owned Autos
EXCESS LIABILITY
❑ Umbrella Form Each Occurrence
Aggregate
GARAGE LIABILITY
❑ Any Auto Auto Only - Each Accident
❑ Each Accident Aggregate
❑ BUILDER'S RISK ❑ 100% of the Total Contract Price
❑ INSTALLATION FLOATER ❑ 100% of the Total Material Costs
❑ POLLUTION
❑ CARGO
® WORKERS COMPENSATION —OR OCCUPATIONAL MEDICAL AND DISABILITY $1,000,000
® EMPLOYERS' LIABILITY
OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED
® City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis.
® To include products of completed operations endorsement.
❑ Waiver of subrogation in favor of the City of Lubbock on all coverages, except
IMPORTANT: POLICY ENDORSEMENTS
The Contractor will provide copies of the policies without expense, to the City and all endorsements thereto and may make
any reasonable request for deletion, revision, or modification of particular policy terms, conditions, limitations, or exclusions
(except where policy provisions are established by law or regulation binding upon either of the parties hereto or the
underwriter of any of such policies). Upon such request by the City, the Contractor shall exercise reasonable efforts to
accomplish such changes in policy coverages, and shall pay the cost thereof. Any costs will be paid by the Contractor.
REQUIRED PROVISIONS
The Contractor agrees that with respect to the above required insurance, all insurance contracts and certificate(s) of insurance
will contain and state, in writing, on the certificate or its attachment, the following required provisions:
a. Name the City of Lubbock and its officers, employees, and elected representatives as additional insureds, (as the
interest of each insured may appear) as to all applicable coverage;
b. Provide for 30 days notice to the City for cancellation, nonrenewal, or material change;
c. Provide for notice to the City at the address shown below by registered mail;
d. The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees, and elected
representatives for injuries, including death, property damage, or any other loss to the extent same may be covered
by the proceeds of insurance;
e. Provide that all provisions of this contract concerning liability, duty, and standard of care together with the
indemnification provision, shall be underwritten by contractual liability coverage sufficient to include such
obligations within applicable policies.
f. All copies of the Certificates of Insurance shall reference the proiect name or bid number for which the
insurance is beine supplied.
NOTICES
The Contractor shall notify the City in the event of any change in coverage and shall give such notices not less than 30 days
prior the change, which notice must be accompanied by a replacement CERTIFICATE OF INSURANCE.
All notices shall be given to the City at the following address:
Marta Alvarez, Director of Purchasing & Contract Management
City of Lubbock
1625 13t' Street, Room 204
Lubbock, Texas 79401
SECTION D. Approval, disapproval, or failure to act by the City regarding any insurance supplied by the Contractor shall
not relieve the Contractor of full responsibility or liability for damages and accidents as set forth in the contract documents.
Neither shall the bankruptcy, insolvency, or denial of liability by the insurance company exonerate the Contractor from
liability.
8. At any time during the term of the contract, or thereafter, the City, or a duly authorized audit
representative of the City, at its expense and at reasonable times, reserves the right to audit Contractor's
records and books relevant to all services provided to the City under the 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 any payments due Contractor.
9. The City reserves the right to exercise any right or remedy available 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 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.
10. 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 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.
11. The contractor shall not assign or 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 of insurance from the Subcontractor that
complies with all insurance requirements
12. Neither the City nor the Contractor shall assign, transfer or encumber any rights, duties or interests
accruing from this Contract without the written consent of the other.
13. The Contractor warrants that it complies with Chapter 2270, Subtitle F, Title 10 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 term of the Agreement.
14. SB 252 prohibits the City from entering into a contract with a vendor that is identified by The
Comptroller as a company known to have contracts with or provide supplies or service with Iran, Sudan
or a foreign terrorist organization.
15. This Contract consists of the following documents set forth herein; Invitation to Bid No. 18-13668-KW,
Specifications, and the Bid Form.
[ Signatures on Next Page]
IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and year first
above written. Executed in triplicate.
CITY OF LUBBOCK:
Daniel M, Pope, Mayor
ATTEST:
Rebe t a Garza, City Secretary
APPWVED ASTO-CONTENT:
Aube ear, P.E.—,Director of Water Utilizes
APPROVED AS TO FORM:
A tms, uty Ci orn
CONTRACTOR:
BY o—
Auti zed RepreAntative's Signature
Jason L. Garza
Print Name
6252 Llano Ave
Address
Dallas, TX 75214 _
City, State, and Zip Code
City of Lubbock, TX
Bid 18-13668-KW
Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant
SPECIFICATIONS
L INTENT
It is the intent of these specifications to describe the aluminum sulfate/polymer blends to
be used as a coagulant at the City of Lubbock North Water Treatment Plant.
2. PRODUCT SPECIFICATION
The aluminum sulfate/polymer blend purchased for use at the City of Lubbock Water
Treatment Plant shall contain no soluble inorganic or organic substances capable of
producing deleterious or injurious effects upon the health of those consuming the water, or
that would otherwise render it unfit for public consumption. The aluminum
sulfate/polymer blend must have NSF/ANSI Certification for use in potable water
treatment plants. Bidder shall submit a certificate of analysis which will include the
specific gravity and pH. The City will require the product to have a pH in the range of
1.3 to 2.8 (slightly more stringent than AWWA Standard). The material safety data
sheets (MSDS) for the product shall also be submitted with the bid. Due to the fact that
successful aluminum sulfate/polymer blends are 90% or more aluminum sulfate by weight,
it is preferable that the bidders be a manufacturer of liquid aluminum sulfate. If the
successful bidder is not a manufacturer of aluminum sulfate, bidder must provide a copy
of a legal contract between the bidder and the aluminum sulfate manufacturer that will be
used to produce the blend. In any event, all products used must have NSF/ANSI
certification for use in drinking water treatment plants. The same aluminum sulfate
manufacturer must be used throughout the term of the contract. Throughout the term of
the contract, the successful bidder may not change the formulation of the aluminum
sulfate/polymer blend in any way without the express written consent of the Water
Production & Treatment Superintendent. No exceptions, an unauthorized change in
the formulation of the product will result in contract termination.
3. PRODUCT PERFORMANCE
Products to be considered for bid will be tested by the manufacturer using standard jar
testing methods at the City's site. The test results must include settled water and final water
turbidities, pH and temperature. A sample of the product being tested will be left at the
facility for additional jar testing by Operations personnel, if additional pilot plant testing is
necessary an additional amount of sample will be required. At the City's discretion full
plant testing will be required based on results of previous tests; the City will pay for a full
delivery (approximately 48,000 lbs.) at the price submitted in the bid document to conduct
full plant testing. Water Treatment Operations personnel will evaluate product
performance based on settled water quality, pH, filter effluent turbidities, and cost
effectiveness. Bidders must submit a list with a minimum of three (3) potable water
treatment plants with phone numbers and contact persons that are currently using the
product. References will be thoroughly checked and will figure prominently into the
selection of a successful bidder.
4. PRODUCT QUALITY PER LOAD
Upon delivery of each load of product, the transport driver must present a certificate of
analysis containing specific gravity and pH. As stated in the product specifications, the pH
must be within the range of 1.3 to 2.8. Plant operations staff will also perform specific
gravity and pH analyses on the product in the presence of the transport driver. A delivered
product that exhibits any unusual color or appearance compared to previous acceptable
deliveries will be refused, as will deliveries containing any form of foreign material. If the
product meets the required minimum standards, the product may then be off loaded into
the storage tanks. If desired, the vendor may provide their own hydrometer and perform
an additional specific gravity analysis in the presence of the plant operations staff. In the
event the product does not meet the required minimum standards, the load will be refused
and the vendor must provide another acceptable load within forty eight (48) hours. No
additional freight or shipping charges shall be assessed by vendor.
5. TECHNICAL SUPPORT
Vendor shall provide acceptable technical support and response time whenever problems
are encountered relating to product use and/or performance. Acceptable technical support
will include routine site visits at least every three (3) months to perform jar testing and
consulting with operations staff on any questions or problems with the product. A
telephone response time of one (1) business day is required of vendor in cases of product
performance problems. A site visit by the vendor may be requested by the owner if owner
feels it is necessary to solve any significant problem related to product performance. If a
non -routine site visit is requested, the vendor will have five (5) business days to respond
and arrive on -site. If at any time during the duration of the contract a significant change in
the source water is experienced, including major changes related to the ground water to
surface water ratio of the owners blended raw water source, vendor will have five (5)
business days to respond and arrive on -site to test and evaluate current process and
recommend changes in the product if needed. All technical support will be at no cost to
the owner.
6. BID ACCEPTANCE
Product performance will be required to meet optimum quality results for settled and
effluent water. The evaluation of bids will include a set of water quality parameters that
must be met through the above outlined testing procedures. The bid will be awarded based
on water quality and overall visual plant performance, cost effectiveness, and reference
checks.
7. QUANTITIES AND PRICING
The anticipated annual consumption of an aluminum sulfate/polymer blend for coagulant
use is 949 tons more or less. Prices quoted for product shall be FOB North Lubbock Water
Plant, 6001 North Guava, Lubbock, Texas. Pricing shall be firm for a period of three years.
Written consent from both parties is required for all price adjustments. Listed quantities
are estimates only for pricing purposes. Actual usage may vary.
8. DELIVERY / SECURITY
Successful vendor shall be required to deliver the product to the Lubbock Water Treatment
Plant in bulk tank truck within five (5) days after order is placed. Unloading to plant
storage tanks is to be performed by the driver under the direction of operations personnel.
Successful vendor shall provide any and all special equipment necessary to perform
unloading at no cost to the City of Lubbock. All deliveries will be unloaded between the
hours of 8:00 A.M. and 4:00 P.M., Monday through Friday. No exceptions will be made
unless prior approval is agreed upon with the water treatment plant's operations personnel.
The transporter is required to furnish certified, dated, and stamped weight tickets with each
load of product, before and after unloading. All delivery people will display photo security
ID upon arrival at the site. All delivery vehicles shall meet OSHA and DOT regulations
and be operated in a safe manner while on site.
All delivery personnel will be identified by the vendor before arrival at the site; preferably
at the time an order is placed. Upon arrival at the Water Treatment Plant, delivery
personnel will check in at the main building before proceeding to the unloading site. The
driver will be met at the security gate by plant personnel and must present photo
identification. All shipments shall be sealed and the seal will be broken only in the
presence of the plant representative. If any of the security measures are violated, the
shipment will be refused.
9. SUPPLEMENTAL ADDITIVE SPECIFICATION
Buyer requests the option of having copper sulfate, containing at least 99% CuSO4.51-120,
added to the Aluminum Sulfate/Polymer blend. The copper sulfate must have NSF
Certification for use in potable water treatment plants. The copper sulfate would be added
per load at the buyer's request to control algae growth. Algae growth occurs when the
water reaches a temperature of 72°F. The yearly average of this temperature is between
the middle of April to the end of September. The amount of additive will be based on the
coagulant feed rate at the time the load was ordered and would be determined by the
operations staff, a 2.0% copper sulfate additive is to be expected.
10. TERM AND CONDITIONS
The contract shall be for a term of three years, said date of term beginning upon formal
approval. All stated annual quantities are approximations of usage during the time period
to be covered by pricing established by this bid. Actual usage may be more or less. Order
quantities will be determined by actual need. The City of Lubbock does not guarantee any
specific amount of compensation, volume, minimum, or maximum amount of services
under this bid and resulting contract. The Contractor must maintain the insurance coverage
required during the term of this contract including any extensions. It is the responsibility
of the Contractor to ensure that valid insurance is on file with the Purchasing and Contract
Management Department as required by contract or contract may be terminated for non-
compliance.
This contract shall remain in effect until the first of the following occurs: (1) the expiration
date, (2) performance of services ordered, or (3) termination of by either party with a 30
day written notice. The City of Lubbock reserves the right to award the canceled contract
to the next lowest and best bidder as it deems to be in the best interest of the city.
BID FORM
Aluminum Sulfate/Polymer Blend for the North Water Treatment Plant
City of Lubbock, TX
ITB 18-13668-KVN'
In compliance with the Invitation to Bid 18-13668-KNV, the undersigned Bidder having examined the Imitation to Bid and
Specifications, and being familiar with the conditions to be met. hereby submits the following Bid for furnishing the material
equipment. labor and everything necessary for providing the items listed below and a_rees 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 may be 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 belo« reasonably expected values), or irregularities of any kind. Tile
Imitation to Bid 18-13668-KW is by reference incorporated in this contract. The Bid Form must be completed in blue or
black ink or by typewriter.
QTl
UNIT OF
UNIT PRICE*
EXTENDED
DELIVERY
ITEM
DESCRIPTION
(+/-)
MEASURE
B
COST
DAYS
A
AxB=
ARO**
1.
Hydrate Aluminum
S
specifications.
2.
Hydrate Aluminum
949
TON
Sulfate/Polymer Blend with I%
223.10
2i1 721.90
48hrs
specifications.
3.
Hydrate Aluminum
949
TON
Sulfate/Polymer Blend with 2%
Copper Sulfate AdditlVe, as per
specifications.
4.
Hydrate Aluminum
949
TON
Sulfate/Polymer Blend with 3%
263.10
249,681.90
48hrs
Copper Sulfate Additive, as per
specifications.
5.
Bauxite Aluminum
949
TON
Sulfate/Polymer Blend, as per
NB
specifications.
6.
Bauxite Aluminum
949
TON
Sul fate/PolymerB lend with I%
Copper Sulfate Additive, as per
NB
specifications.
7.
Bauxite Aluminum
949
TON
Sulfate/Polymer Blend with 2%
Copper Sulfate Additive, as per
NB
specifications.
8.
Bauxite Aluminum
949
TON
Sulfate;`Polymer Blend with 3%
NB
Copper Sulfate Additive, as per
specifications.
Total 1-8
Total $249,681.90
*PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed **Days After Receipt of Order (ARO)
The City of Lubbock is seeking an agreement for aluminum sulfate/polymer blend 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.
1113 18-13668-KNV Almninum Sullaie'Pohmcr Blend for NWTP
PAYMENT TERMS AND DISCOUNTS - Bidder offers a prompt payment discount of 0 %, net 30calendar days.
Discounts will not be considered in determining low bid. Unless otherwise indicated on the Bid Form, payment terms will
be NET THIRTY DAYS. The City will pay the successful bidder within thirty days after the 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 correct invoice or after the date of acceptance that meets agremment requirements, whichever event
occurs later. Discounts for payment in less than ten days will not be considered.
MOST FAVOURED PRICING: The Bidder certifies that the price quoted is not in excess of the lowest price charged anyone
else, including its most favoured customer, for like quality and quantity of the 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 agreement period, the
supplier should sell or offer for sale to any other customer, an equal or less quantity of similar agreement 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 agreement. 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 agreement, would you (the bidder) agree that all terms, conditions,
specifications, and pricing would apply?
Other governmental entities that night have interests in this agreement are Frenship Independent School District,
Lubbock Housing Authority, Lubbock County, Lubbock County Hospital District, Lubbock Independent School
District, South Plains Association of Governments, City of Texarkana, Texas Tech University, West Texas Municipal
Power Agency, Lynn County, and City of Wolfforth.
YES X 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 agreement(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 BYChameleon Industries a corporation organized under the laws of the State of
Texas , or a partnership consisting of
of the City of
Chameleon Industries Inc.
PO Box 853027
or individual trading as
City: Mesquite State: TX Zip 75185
Bidder acknowledges receipt of the follo-%+ing addenda:
Addenda No. Date _ Addenda No. Date
Addenda No. Date Addenda No. Date
MIWBE Firm:1 Woman I [ Black American I INative
I X Hispanic American I I Asian Pacific Americi I Other I
ITB 18-13668-KW Aluminum Sulfate/Polymer Blend for NWTP
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos. 1- 4 and 6 if there are interested parties.
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
OFFICE USE ONLY
CERTIFICATION OF FILING
Certificate Number:
2017-276927
Date Filed:
10/26/2017
Date Acknowledged:
11/01/2017
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Chameleon Industries Inc.
Mesquite, TX United States
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
g 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.
18-13668-KW
Aluminum Sulfate / Polymer Blend
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
Garza, Jared
Maineville, OH United States
X
Garza, Jason
Dallas, TX United States
X
5 Check only if there is NO Interested Party. ❑
6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said this the day of
20 , to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337
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.
2017-276927
Chameleon Industries Inc.
Mesquite, TX United States
Date Filed:
10/26/2017
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:
11/01/2017
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.
17-13668-KW
Aluminum Sulfate / Polymer Blend
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling I
Intermediary
Garza, Jared
Maineville, OH United States
X
Garza, Jason
Dallas, TX United States
X
5
Check only if there is NO Interested Party. ❑
6
AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said this the
day of
20 , to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.3337