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Home My WebLink AboutResolution - 2018-R0125 - Farm And City Supply - 04/12/2018Resolution No. 2018-RO125 Item No. 6.15 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. 14028 and related documents for Automotive Filters for Citibus, by and between the City of Lubbock and Farm and City Supply LLC, of Des Moines, Iowa, as per ITB 18-13947-SS. 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: Reb ca Garza, City Secretar APPROVED AS TO CONTENT: 4� kl�' Bill Ho erton, Assistant City Manage APPROVED AS TO FORM: ccdocs/RES.Contract 14028.Automotive Filters for Citibus 2 03.20.2018 Resolution No. 2018-RO125 City of Lubbock, TX Contract for Automotive Filters for Citibus Contract 14028 THIS CONTRACT made and entered into this 12th day of April 2018, by and between the City of Lubbock ("City"), and Farm and City Supply LLC., ("Contractor"). WITNESSETH: WHEREAS, the City of Lubbock duly advertised for bids for Automotive Filters for Citibus 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 Automotive Filters for Citibus. 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, Automotive Filters for Citibus and more specifically referred to as Items 3, 5, 8, 10, 16-21, 23, 25, 28, 35, 36, 38, 40, 41, 44-47, 49, 53, 55-60, 62, 64-68, and 71-75 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. The Contractor shall perform the work according to the procedures outlined in the Bid Form and Specifications attached hereto. The contract shall be for a term of one year, with the option of two, one year extensions, said date of term beginning upon formal approval. The City does not guarantee any specific amount of compensation, volume, minimum or maximum amount of services under this contract. 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. 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. 7. 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. 8. 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 (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. 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. 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. 2. 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. 12. 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. 13. This Contract consists of the following documents set forth herein; Invitation to Bid No. 18- 13947-SS, Specifications, and the Bid Form. City of Lubbock, TX ITB 18-13947-SS Automotive Filters for Citibus SPECIFICATIONS I. SCOPE: This solicitation is an Invitation for Bid to establish an annual price contract for Automotive Filters. No guarantee of Volume. The City of Lubbock does not guarantee any specific amount of compensation volume, minimum or maximum. Amounts, quantities listed on the bid form are estimates only. No price Escalation: Bids are to be submitted on a firm fixed price basis. No escalation of price will be permitted during the term of this contract. I1. SCOPE OF SERVICES: • The successful vendor will keep stocking level at their warehouse in quantities enough as to not cause Citibus to buy automotive filters from any other source. • Delivery must be made with 24 hours after receipt of order. F.O.B to Citibus located at 801 Texas Ave, Lubbock, Texas 79401 III. REFERENCES: Supply a minimum of three references, which shall include the name and address of the company, contact name, telephone number and type of service provided. IV. DOCUMENTS: Bidder must submit the following forms with their bid. Failure to do so may deem the bid non -responsive: • Statement of Eligibility • Affidavit of Non -Collusion • List of Similar Contracts • Buy America Certificate V. The contract shall be for a term of one year, with the option of one, two year extension, said date of tern beginning upon formal approval and under the same terms and conditions upon written agreement from both parties. This agreement includes incorporation of Federal Transit Administration (FTA) Terms. The preceding provisions include, in part, certain Standard Terms and Conditions required by the Department of Transportation (DOT), whether or not expressly set forth in the preceding contract provisions. All contractual provisions required by DOT, as set forth in FTA Circular 4220.1F, are hereby incorporated by reference. Anything to the contrary herein notwithstanding, all FTA mandated terms shall be deemed to control in the event of a conflict with other provisions contained in this agreement. The Contractor shall not perform any act, fail to perform any act, or refuse to comply with any requests which would cause Citibus to be in violation of the FTA terms and conditions. City of Lubbock Bid ITB 18-13947-SS This agreement includes incorporation of Federal Transit Administration (FTA) Terms. The preceding provisions include, in part, certain Standard Terms and Conditions required by the Department of Transportation (DOT), whether or not expressly set forth in the preceding contract provisions. All contractual provisions required by DOT, as set forth in FTA Circular 4220.1F, are hereby incorporated by reference. Anything to the contrary herein notwithstanding, all FTA mandated terms shall be deemed to control in the event of a conflict with other provisions contained in this agreement. The Contractor shall not perform any act, fail to perform any act, or refuse to comply with any requests which would cause Citibus to be in violation of the FTA terms and conditions. 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 LUBBO Daniel M. Pope, Mayor ATTEST: �2' V, t -X '% 5K Re cca Garza, City ecreta y APPROVED AS TO CONTENT: Bill How on, A sistant City Ma ager APP S ED IS TO FORM: 7!\ Justi Prui , Assi tant City Attorney CONTRACTOR � BY Authorized Representative Jeff Lament Print Name 1825 E. Army Post Road Address Des Moines, IA 50320 City, State, Zip Code 2121 /2018 9:17 AM P. 50 City of Lubbock Bid ITB 18-13947-SS BID FORM Automotive Filters for Citibus City of Lubbock, TX ITB No. 18-13947-SS In compliance with the Invitation to Bid 18-13947-SS, 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 furnishing 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 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 below reasonably expected values), or irregularities of any kind. The Invitation to Bid 18-13947-SS is by reference incorporated in this contract. The Bid Form must be completed in blue or black ink or by typewriter. ITEM QTY UOM FILTER No. APPROVED EQUAL MANUFACTURER/ DESCRIPTION OF *UNIT PRICE BID EXTENDED "Delivery (+/) VENDOR PART No. PRODUUCTCT COST Days ARO 1. 50 EA R950011 Fleetguard Air Dryer Cartridge $ 22-- $ 13 -- ------------- Af27V7------WO-1-RTC------- ----------- ------50--- -�4- 2. 50 EA R950048 No Bid Air Dryer Cartridge 04, No Bid No Bid 14 - --- -- ------- ---------- I ----- ----------- ---------------- 3. 10 EA P550965 Fleetguard Oil Filter for 1997 Ford 2.65 26.50 LF3681 Crown Victoria 14 4. _10_ EA _ 21516Y'legtgu4rd___ 30060ilFilter ___-_ -2.82_-__-__ __2.$.20-----___t4-_ LF3339 5. 10 EA P550371 Fleetguard Oil Filter 1999 Ford 6.55 65.50 14 LF3630 F250 Super Duty 6. -- 50 ------ EA 82-54477- -------- � - - - - Air Dryer Cartridge -- -No-Bid -- - - ---- 000 11/13 Gillig No-Bid 7. -- 20 - - - EA - -- P610561 - - - - -- Flectguard Air Filter for Dodge 9.12 182.40 --- AF4177 ---------- Ram 2005- 783 8. 10 EA 3585 Fleetguard Fuel Filter for Dodge 7.14 71.40 FS19855 Ram 2005-783 14 9. 10 EA P551772 Fleetguard Fuel Filter Ford Crown 5.00 50.00 -- -- - - -- --1�- 10. 10 EA 3818 Fleetguard Fuel Filter 1999 Ford 12.90 129.00 14 FF5418 F250 Super Duty -11._ 10. .EA_ - P528228_ _F4eetgtlard- _ Air EilterFotd_Crowu - - - - 4.55- - - - - - _ -4S5-0 - - - - - _ _ �4 AF4619 Victoria a2.-_10. EA -P60b281_ -Fleetguar-d-- AirEilter-Chev-y--------5:69H--------56.99------ AF25754 Uplander 14 13, _50_ EA _47 L7896.4- -No-13id- - - - 'r- Dry er_Cartridge- - - +,p-Byd - - - - - --No-Sid - - - - - - - Nova LF 14 14. _LO_ EA _ -7620 - - Fleetguard _ _ o-dge 250 Oil Filters_ _ _3 q5_ _ _ _ _ _ _ _ _ 39, 50_ _ _ _ _ _ --14-- LF3972 15 - 5 _ EA - 208114 _ _M6 Bid- - - _ rrr-Unline ALC Eilter _ -No-aid - - - - - - -No Bid- - - - - �4 Screen Internationals 16. 10 EA 1-5923 Carquest Trails Gasket and Filter 15.55 155.50 14 96049 F350 ,;TL11CIwsQ/la1d Dorn/I'TB l "n-13947-SS Automotive 1:11tcrs fol Olibu,e 2/21/2018 9:17 AM P. 6 City of Lubbock Bid ITB 18-13947-SS ITEM Q.I.},APPROVED UOM FILTER No. EQUAL MANUFACTURER/ DESCRIPTION OF "UNIT PRICE BID EXTENDED -Delivery t+/ 1 VENDOR PART No. PRODUCT COST Days ARO 17. 10 EA 1-5924 Carquest A/Trans Filter Kit Unit 13.27 132.70 96050L 3006 14 18. 10 EA 1-5927 Carquest Trans Filter and Gasket 10.43 96015L Kit for Chevy Uplander 104.30 14 19. 50 EA 1-5931 Carquest Gasket and Filter Kit 96022 Transmission - Chevy 12.82 641.00 14 20. 10 EA 1-5937 Carquest Trans Filter and Gasket 96033L Kit Unit 783 8.95 89.50 14 21. 60 EA 1-5950 Carquest Transmission Filter and 85976 Gasket Kit, 16/17 23.53 1,411.80 14 Chevy Arboc 22. 10 EA 10322538 Carquest Cabin Air filter Chevy 9002°7ff--- tanda EAeff- ---119}8----- --149.84----- - 14- UN1T TAKF,S 2-** 23. 25 EA 23516489 Coolant Need Release Fleetguard Additive w/Filter, 29.47 736.75 14 WF2131 ALLISON 24. 10 EA 29538846 Transmission Filter -- - -- -- - - - - - -- -4,lo4-id--- Assentb4y-Gq-Gil-lig-----No Bid --------j%10-B-id---- - - - - - Hybrid, ALLISON 14 25. 50 EA 29539579 Trans Spin on Filter for Fleetguard Internationals and 7.83 391.50 HF35296 Hybrids, ALLISON 14 26. 10 EA 29544785 No Bid NOVA Trans Valve __ ___ __ _________________ Filter-Kit,Ai.iISMi_ No Bid - No_Bid 27. 10 EA 29545785 Carquest E.V. Drive Trans Filter 84742 Internal Kit, 09 and __ --- --- - - - - - -- _ - - - _ - 20iifiiliigs-vitlr--- __26.23 ___-- -262.30___-- 14 ----- Gasket and O-Rings, ALLISON 28. 50 EA P560972 Fleetguard Transmission Filter Kit, HF35153 Filter 2" Sump 30.41 1,520.50 ALLISON Internal 14 Filter B40OR 2000 Nova 10 EA - No�id AirFilter_I-- Bid -- -- --- -- - - ------- - - -- - - - -- -No ___-_ _ No -Bid---_____-_ 000 Gillig 30--10- EA 25.0322-1C4 -F4eetgtlard-- JS.Ffilters=---------4t.4 ---------- - - -- T4-- HF 3 5476 International 114.40 31, 200 EA 53-22412- Carquest Power Steering 84317 - - -1�- Element- Gillig S.1'vichasc/Rid DOS N'I I I 13-139-17-SS Automotive PiItery for C'itihus 5 2/21/2018 9:17 AM p. 7 City of Lubbock Bid ITB 18-13947-SS ITEM Q"1'1' UOM FILTER No. APPROVED EQUAL MANUFACTURER/ DESCRIPTION OF *UNIT PRICE BID EXTENDED **Delivery t+/ 1 VENDOR PART No. PRODUCT COST Days ARO 32. EA 82-60186= P/SElementFilterl__ _50 000 No Bid 2011 & 2013 Hybrids _ _____ No Bia __ _____ IJoBid -- -- 33. 5 EA P546597 Fleetguard Filter, Air filter #3006, -- --- -- - - - - - -- -A-1735-5-96--- 20al-F-ord-E✓ 50m--- ---7-92------ ---39_60------14-- 34. 20 EA FS19764G Fuel Filter Gillig -- --- -- ------- No Bid **Special filter only on No Bid No Bid --------- ------------- certain units: not the ----------- ----------- ---- same as P550774** 35. 100 EA LF3970 LF3970 Oil Filter- New Hybrid 5.18 518.00 14 36. 10 EA LF634 LF634 Filter Trolley Power Steering (P/S) 3.50 35.00 14 37. 50 EA P129472 Fleetguard Air Filter- 04' Gillig -- --- --- - - - - - -- --AF9"31Nt---------------- ---3-3-9-9----- --1,69950--- --14--- 38. 10 EA P133701 Fleetguard Air Filter 1992 & 2000 19.57 195.70 14 AF376 Trolley 39. 10 EA P167829 Fleetguard Hydraulic Spin On 42 304.20 -- - - ---- ' 566-92(i---HF6603---F'tt:=r---------- ----------- ---------- _l4_ _ 40. 50 EA P522293 Fleetguard Air Filter For 06' Gillig 36.28 1,814.00 14 AF4588M 41. 100 EA P527484 Fleetguard Air Filter Novas AF4878 13.62 1,362.00 14 42. -- 10 --- EA -- P537452 _ _ _ Fleetguard _ Air Cleaner Filter ------------- - _ 3�2� 14_ AH 1192 Trolley New - - _ _ _ _ _ 3-6-2-2fl------ _ 43. 10 EA P550104 Fleetguard Wabasto Fuel Filter 14 -- -- ---------- _ _ FF104 Fly-brids--------- ----2.74---- - �7-40--- 44. 10 EA P550428 eetguar Oil Filter -Trolley 5.18 51.80 14 LF3970 45. 10 EA P550430 Fleetguard Fuel Filter - Trolley 14 FS19855 7.14 71.40 46. 10 EA P550437 Fleetguard Filter Fuel International 12.90 14 129.00 FS5418 47. 20 EA P550528 Fleetguard Oil Filter - International LF 16166 8.43 168.60 14 48. 25 EA P550698 Fleetguard P/S Reservoir Element, 14 -- --- - - - _ _ - - _ _ -�i1T623i�-- Hydraulic yrl ----- 49. 200 EA P550774 Fleetguard Fuel Filter - 04, 06, 09 14 FF5488 Gillig 6.02 1,204.00 50. 175 EA P550794 Fleetguard g Oil Filter- Chevy 2.33 407.75 14 ----- -- ------- -I.FT62-4Z-- E-xPress-`fan- ------------------------- 51. 50 EA P550880 Fleetguard Fuel Filter- Hybrid 429.00 14 -- --- ---------F-F56g2---- 'lli 58 52. 25 P550881 Fleetguard Fuel Filter Gillig 14 -- --- �EA -- ----------FFS424--- lybrid-f+lter-1-1-0- AW2 I___-_9.87 246.75 ti:Punic:_,Mlid Docs/1113 I8-13947-SS Automotive Filters for Citi bus G 2/21/2018 9:17 AM P. 8 City of Lubbock Bid ITB 18-13947-SS ITEM QTt UOM FILTER No. APPROVED EQUAL MANUFACTURER/ DESCRIPTION OF *UNIT PRICE BID EXTENDED "Delivery VENDOR PART No. PRODUCT COST Days ARO 53. 120 EA P551103 Fleetguard Fuel Filter -Gillig 14 FS 1003 14.74 1,768.80 54. 100 EA P551 122 Fleetguard Fuel Filter NOVA -- -- ---------- -Tsrm------- ------- - - - - -- ----14.38---- -----43-Fr.00-- -14 - 55. 80 EA P552071 Fleetguard Coolant Filter - Gillig WF2071 4.78 382.40 14 56. 80 EA P552100 Fleetguard Oil Filter, RTS 14 6.70 536.00 LF3620 57. 200 EA P553000 Fleetguard Oil Filter, Bypass 15.26 3,052.00 14 LF3000 58. 15 EA P554685 Fleetguard Coolant Filter- 63.90 14 WF2077 international - (4070) - 4.26 59. 25 EA P556915 Fleetguard Fuel Filter 14 3.37 84.25 FF5207 60. 25 EA P556916 Fleetguard Fuel Filter 3.39 84,75 14 FF5206 61. -- -10- - EA -- - P558615 ------- EI_QQ_tguard_ Oil Filter, Trolley 14- _ _ - _ _ - ---- 26---- - -- 32.fi6------ - LF3349 62. 80 EA P559000 Fleetguard Oil Filter, DART 19.91 1,592.80 14 LF 14000NN 63. 75 EA P600501 - -Fleetguard _ - _ Air Filter, Chevy Arboc - - _549Z5 64. 10 EA P606503 Fleetguard Air Filter, International 28.71 287.10 14 AF25707 65, 10 EA P608666 Fleetguard Air Filter, Gillig Hybrid 33.44 334.40 14 AF27876 66. 20 EA P614221 Fleetguard Cabin Air Filter, 8.41 168.20 14 AF26430 International 67, 50 EA P762756 Fleetguard Trans. Filter, 21.34 1,067.00 14 HF7999 RTS/DART 68. 20 EA P776157 Iectguard AF4586 Air Filter, RTS/DART 37.11 742.20 14 69. 10 EA 73CZ-9601- No Bid Air Filter, MV1 -- --- -- -- --------------------------- -L`1QBIS1------ No Bid------- 14-- A 70. -- 10- ----- EA F l AZ-6731- -- - - - Carquest - - - - - Oil Filter, MV 1 - _ - - 4.25 42.50 L4_ BD 85372 _ - - _ _ - _ _ _ - _ _ _ _ _ _ _ 71. 50 EA FF63009 FF63009 Fuel Filter, 17 Gillig 27.65 1,382.50 14 72, 100 EA 5303604 Fleetguard UF101 Def Urea Filter 37.03 3,703.00 14 73. 25 EA BF1259 Fleetguard Fuel Filter, DART FS1000 7.14 178.50 14 74. 25 EA CV50628 Fleetguard Crankcase Filter, 17 75.58 1,889.50 14 CV50628 Gillig S:Purc1wse/13id Docs/I1'B I8-13947-SS Automotive Fillers fnr Cit:I)L;S 7 2/21/2018 9:17 AM P. 9 City of Lubbock Bid ITB 18-13947-SS ITEM QTAPPROVED W-) UOM FILTER No. EQUAL MANUFACTURER/ VENDOR PART No. DESCRIPTION OF PRODUCT `UNIT PRICE: BID EXTENDED COST "Delivery Days ARO 75. 25 EA CV52001 Fleetguard Crankcase Filter 11/13 56.80 1,420.00 14 CV52001 Gillig TOTAL $ 39,43.4.00- -$ 2 9, 7 6 2. 7 5 *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 Automotive Filters for Citibus 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 NA %, net _ calendar 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 contract 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 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 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 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. S:Purchase/Rid Docs/ITB 18-13947-SS Automotive Filters for Citibus 8 2/21 /2018 9:17 AM P. 10 CERTIFICATE OF INTERESTED PARTIES FORM ZZ9rJ 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. 2018-328586 Farm and City Supply LLC Des Moines, TX United States Date Filed: 03/21/2018 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Farm and City Supply LLC Date Acknowledged: 03/21/2018 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. RFP 18-13947-SS Automotive Filters 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary City Of Lubbock Lubbock, 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) corms proviaea Dy i exas Etnics commission www.ethics.state.tx.us Version V1.0.5523 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. 2018-328586 Farm and City Supply LLC Des Moines, TX United States Date Filed: 03/21/2018 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Farm and City Supply LLC 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. RFP 18-13947-SS Automotive Filters 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary City Of Lubbock Lubbock, 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 V1.0.5523