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HomeMy WebLinkAboutResolution - 2018-R0120 - Chameleon Industries - 04/12/2018Resolution No. 2018-RO 120 Item No. 6.8 April 12, 2018 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, Contract No. 13923 for Aluminum Sulfate for the Northwest Water Reclamation Plant as per ITB 18-13923-KW, by and between the City of Lubbock and Chameleon Industries, Inc., 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 April 12, 2018 DANIEL M. POPE, MAYOR ATTEST: APP>OVED AS TOXONTENT: P.E., Director of Public Works APPROVED AS TO FORM: &' A4W-e-'� elli Leisure, Assistant City Attorney ccdocs/RES.Contract 13923.Aluminum Sulfate for the Northwest Water Reclamation Plant 03.13.2018 Resolution No. 2018-RO120 Contract 13923 Cite of Lubbock, TX Contract For Aluminum Sulfate for the Northwest 'Water Reclamation Plant THIS CONTRACT made and entered into this 12thday of sprit , 2018 by and between the City of Lubbock ("City"), and Chameleon Industries, Inc.. ("Contractor"). WITNESSETH: WHEREAS, the City of Lubbock duly advertised for bids for Aluminum Sulfate for the Northwest Water Reclamation 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 authorized the execution, in the name of the City of Lubbock a contract with said Contractor covering the purchase and delivery of the said Aluminum Sulfate for the Northwest Water Reclamation 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 are attached hereto and made part hereof, Contractor will deliver to the City, Aluminum Sulfate for the Northwest Water Reclamation Plant and more specifically referred to as Item one 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 tern of one year with the option of two, one-year renewals, 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 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 City. In no event shall Contractor be authorized to enter into any agreement or undertaking for or on behalf of 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 ,is the Contractor. SECTION C. Subject to the Contractors 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 cuntntct, 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 follow in--! t} 1)1:111 and amount(s): TYPE OF INSURANCE GENERAL LIABILITY ® Commercial General Liability ❑ Claims Made ® Occurrence ❑ w/Heavy Equipment ❑ To Include Products of Complete Operation Endorsements COMBINED SINGLE LIMIT General Aggregate 1,000.000 Products -Comp Op AGG X Personal & Adv. Injury X Contractual Liability X Fire Damx-,c (Any one Fire) _ Med I xl) (Any one Person) PROFESSIONAL LIABILITY ❑ General Aggregate _ AUTOMOTIVE LIABILITY ® Any Auto ❑ Scheduled Autos ❑ Non -Owned Autos EXCESS LIABILITY ❑ Umbrella Form GARAGE LIABILITY ❑ Any Auto ❑ All Owned Autos ❑ Hired Autos ❑ BUILDER'S RISK ❑ INSTALLATION FLOATER ❑ CARGO ® WORKERS COMPENSATION — STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY 0 EMPLOYERS' LIABILITY Each Occurrence 1,000,000 Each Occurrence _ Aggregate T Auto Only - Each Accident Other than Auto Only: Each Accident Aggregate _ ❑ 100% of the Total Contract Price ❑ 100% of the Total Material Costs 1,000.000 110111 ER:COPIES OF LNI)OSENIENTS AR L REQUIRED —11 0 City of Lubbock named as additional insured on AutolGcoi� i al Liability, an a primary and non-contributory bases. Z T,;iiic:hideproducts ofcompleted operations etidorser?icnt. EJ if Oil -el- of-�llbr(�iwtion infityor of the City q1'Lubbock on all coverages. swept 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 prolect name or bid number for which the insurance is being 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: C7 Marta Alvarez, Director of Purchasing and Contract Management City of Lubbock 1625 13s' 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. 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. 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 Fuii]Wl, 111C City' S11,111 not IV subject to any arlv'pry 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. 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 the City under this Contract. In the event such an audit by the City reveals any errors or overpayments by the City, Contractor shall refund the City the full amount of such overpayments within thirty 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. 11. 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 non -appropriation 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. 12. 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. 13. 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 on insurance from the Subcontractor that complies with all contract Insurance requirements. 14. 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. 15. 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. 16. This Contract consists of the following documents set forth herein; Invitation to Bid No. 18-13923- KW, Specifications, and the Bid Form. IN NN ITNESS WHEREOF. the pat -ties hereto have caused this Contract to be executed the day and year first abovc written. Executed in triplicate. CITY OF LUB OCK Daniel NI. Pope. Wiwi YFFFS] S 0 Rc-hkmc�i Garza, City Secrewry AP VED AST N1. Aubrey Spear,,7., Dieector of Water Utilities APPROVED AS TO FORM: CONTRACTOR. B - ' Aut/ln,',red Jared W. Garza Ili -lilt Nanic PO Box 853027 Mesquite, TX 75 185 i�.. `,tale. Zip Code City of Lubbock, TX Bid 18-13923-KW Aluminum Sulfate for the Northwest Water Reclamation Plant SPECIFICATIONS 1. INTENT It is the intent of these specifications to describe the Aluminum Sulfate (Alum, Al2(SO4)3 14 H2O) to be ordered and delivered to existing alum storage tank on an "as needed" basis to the Water Reclamation Plant (WRP). The alum will be used in the wastewater treatment processes to assist in the reduction of phosphorus. 2. PRODUCT SPECIFICATION Alum shall meet the requirements of AWWA B403 and conform to the following physical and chemical properties: Chemical Formula: Al2(SO4)3-14H2O. Appearance: Specific Gravity: Baume: pH (neat): Freezing Point: A1203: Basicity: Dry 17% Alum: Clear to amber or light green liquid. 1.32 — 1.34 @ 60°F. 35.15 — 36.80 @ 60°F. 1.8 2.4. 3 .- 25°F. 8.0 — 8.4 %. 0 — 0.4 %. 48.2%. Impurities: Alum shall contain no soluble material or organic substances in quantities capable of producing deleterious or injurious effects to the health of those consuming a water that has been treated property with aluminum sulfate. Total water-soluble iron: 0.35% on a basis of 8.0% A1203 (9% as Al). Verification - Sampling and testing of product for compliance with physical and chemical property requirements shall be as outlined in AWWA B403. Existing Alum Tank Specifications - The City owns and utilizes the following alum tank for storage: No. of tanks 1. Tank volume 6,000 gallons. Tank fill connection 1.5" with 1.5" quick connect. Max. allowable fill pressure atmospheric tank. Certification: Aluminum sulfate can be used a direct additive used in the treatment of potable water and/or wastewater. This material should be certified as suitable for contact with, or treatment of. drinking water by an accredited certification organization in accordance with NSF/ANSI 60. Evaluation shall be accomplished in accordance with requirements that are not less restrictive than those listed in NSF/ANSI 60. Certification shall be accomplished by a certification organization accredited by the American National Standards Institute. Upon request by the City, Vendor shall be required to submit an affidavit of compliance with AWWA B304 and the Vendor's Drinking Water Treatment Chemical Certification (NSF Standard Number 60). 3. PRODUCT OUALITY 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 1.8 to 2.4. 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. 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. 4. 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 tivlll include routine site visits 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. All technical support will be at no cost to the owner. 5. BID ACCEPTANCE The bid will be awarded based on time of delivery, cost per gallon, and reference checks. 6. QUANTITIES AND PRICING The anticipated annual consumption of an aluminum sulfate use is 247,000 gallons more or less. Prices quoted for product shall be FOB Water Reclamation Plant, 4107 N County Road 1900,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. 7. DELIVERY / SECURITY Successful vendor shall be required to deliver the product to the City of Lubbock Water Reclamation Plant in bulk tank truck within three (3) days after order is placed. Unloading to plant storage tank 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 3:00 P.M., Munday through Fnd,ay. No (-a,c ptions Nvill be made unless prim approval its agreed upon with the water reclamation 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 Reclamation Plant, delivery personnel will check in at the security gate 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. 8. TERM AND CONDITIONS The contract shall be for a term of one year with the option of two, one-year renewals, 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 for the Northwest Water Reclamation Plant City of Lubbock, TX iTB 18-13923-KW In compliance with the Invitation to Bid 18-13923-KW, 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 fumishing the material, equipment, labor and ever)4hing 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 may be rejected if it shows omissions, alterations of form, conditional altemate 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 18-13923-K%1' is by reference incorporated in this contract. The Bid Form must be completed in blue or black ink or by typewriter. QTY t1;�l-1 Or UN IT PRICE" IXTE:NDEI) DELIVERY ITEh't DESCRIPTION (y,) MEASURE B COST DAYS AYS A A x A 1' 48% Aluminum Sulfate, as per 5 specifications. 217•t1G© Gallon 0,t35B S 211,9268 hr 'PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed "Days After Receipt of Order (ARO) The City or Lubbock is seeking an agreement for aluminum sulfate with one or more contractors. In order to assure adequate coverage, the City may, make multiple uvsards, 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 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 a correct invoice or after the date of acceptance that meets agreement 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 product&1services; does not include an element of profit on the sale in excess of that normally obtained by the Bidder on the sale of pmductsJserviccs 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 tower price(s) is effective. INTERLOCAL PURCHASING (optional): The City desires to make available to other local governmental entities of the State of'rexas, 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 bctow 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 temis, conditions, specifications, and pricing would apply? Other governmental entities that might 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, or Wolfrorth. YES X NO • If you (the bidder) checked YES, the following will apply: irB 18.13923-KW Aluminum Suit= fur the Nunhµcst water Rcclamation Plant Governmental entities utilizing Interlocal Agreements for Cooperative Purchasing with the City of Lubbock will be eligible, but not obligated, to purchase materialslsery ices 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 govemmental 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 SUBMIT -FED 13Y Chameleon Ind ustrieskr—corporat ion organized under the laws of the State of Texas , or a partnership consisting of or individual trading as or (lie City of Firm: Chameleon Industries Inc, Address:— PO Box 863027 State: TX Zip 75185 Bidder acknowledges receipt of the following addenda: Addenda No. I Daie_ALA_1f5 Addenda No. Addenda No. DateAddenda No, MIWHE Fina: EX A By' — , 117 4 ho,w_d roc esc�rtl� Officer Name and Tit) Please Print Woman Hispanic American e'tirust sign bj, hanil Date Dwe Black, American Nativ, Asian Pacific Arrieric Other Jason L. Garza, Vice President Business Telephone Number 972.880.1493 E-mail Address: into@Chameleonindustriesinc.com 20 February 2016 FAX: 972.692.8642 FOR CITY USE ONLY Bid Form Item Number(s) Awarded to Above Named FirmAndividual-, Date of Award by City Council (for bids over S30,0001: — Dan: P.O./Contract Issued - RETURN COMPLETED & SIGNED BID FORM ALONG WITH CITY OF LUBBOCK SPECIFICATIONS. LADEL THE OUTSIDE OF YOUR SEALED BID WITH THE ITB NUMBER, THE CLOSING DATE AND TIME, AND YOUR COMPANY NAME AND ADDRESS, VTB 18-13923-KW Aluminuat Sulfate for the Nordi%estWater RcclamationPlanet 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. 2018-324646 Chameleon Industries Inc. Mesquite, TX United States Date Filed: 03/10/2018 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: 03/12/2018 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. 18-13923-KW Aluminum Sulfate Nature of interest 4 Name of Interested Party City, State, Country (place of business) (check applicable) Controlling 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 UNSWORN DECLARATION My name is and my date of birth is My address is I , (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 V1.0.5523 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. 2018-324646 Chameleon Industries Inc. Mesquite, TX United States Date Filed: 03/10/2018 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. 18-13923-KW Aluminum Sulfate 4 Name of Interested Parry 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 UNSWORN DECLARATION My name is Jason L. Garza and my date of birth is My address is PO Box 853027 Mesquite TX 75185 USA (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in Dallas County, State of Texas on the 10th day of March 2018 (month) (year) Signatur of uthorized ag t of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.5523