HomeMy WebLinkAboutResolution - 2018-R0140 - Mythics Inc. - 04/26/2018Resolution No. 2018-RO140
Item No. 6.15
April 26, 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, Purchase Order No. 33000995 for the purchase of Oracle
Support Renewal as per DIR-TSO-2548, by and between the City of Lubbock and Mythics Inc.,
of Virginia Beach, Virginia, 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 April 26, 2018
DANIEL M. POPE, MAYOR
ATTEST:
Rebec a Garza, City Secretary
APPROVED AS TO CONTENT:
Mark Ye ood, A sistant City Manager
APPROVED AS TO FORM:
7,1, ';&�
Ka;,rooke, 6rssistant City Attorney
ccdocs/RES.Purchase Order 33000995.Oracle Support Renewal
03.21.2018
City of
Lubbock PURCHASE ORDER
TEXAS
TO: MYTHICS INC
4525 MAIN STREET
SUITE 1500
VIRGINIA BEACH VA 23462
Page - 1
Date - 3/21/2018
Order Number 33000995 000 OP
.aron.O1,A�h/Plant , 3410
SHIP TO: CITY OF LUBBOCK
INFORMATION TECHNOLOGY
1611 LOTH STREET
LUBBOCK TX 79401
INVOICE TO: CITY OF LUBBOCK
ACCOUNTSPAYABLE
P.O. BOX 2000
LUBBOCK, TX 79457 BY:
Marta A rez, Di ector of Purchasing & Contract Management
Ordered 3/21/2018
Freight
Requested 5/1/2018
Taken By
S SUMMERS
Delivery Per J Zhine / Req # 51910
Q#COL 6360535FY18/DIR-TSO-2548
Description/Supplier Item
Ordered
Unit Cost
UM
Extension
Request Date
OracleDB Enterpr EdtnProc Perp
1.000
47,103.5400
EA
47,103.54
5/1/2018
CSI 19444953 5/1/18-4/30/19
Oracle DiagnostPak-NamedUser
1.000
4,958.2500
EA
4,958.25
5/1/2018
CSI 19444953 5/1/18-4/30/19
Oracle Partitioning-ProcPerp
1.000
8,553.0300
EA
8,553.03
5/1/2018
CSI 19444953 5/1/18-4/30/19
Oracle Tuning Pak-ProcPerp
1.000
4,958,2500
EA
4,958.25
5/1/2018
CSI 19444953 5/1/18-4/30/19
Oracle WebLogic Srvr EntrpEdt
1.000
3,718.7300
EA
3,718.73
5/1/2018
Proc 19444953 5/1/18-4/30/19
Oracle WebLogic Srvr EntrpEdt
1.000
14,679.0400
EA
14,679.04
5/1/2018
User 19444953 5/1/18-4/30/19
Total Order
Terms NET 30 DAYS
83,970.84
ty of
� Lubb1o&
TEXAS
PURCHASE ORDER
Page -
Date -
3/21/2018
Order Number 33000995 000 OP
3410
TO: MYTHICS INC
4525 MAIN STREET
SUITE 1500
VIRGINIA BEACH VA 23462
SHIP TO: CITY OF LUBBOCK
INFORMATION TECHNOLOGY
1611 LOTH STREET
LUBBOCK TX 79401
INVOICE TO: CITY OF LUBBOCK
ACCOUNTSPAYABLE
P.O. BOX 2000
LUBBOCK, TX 79457 BY:A&
Marta Alvar Dir for of Purchasing & Contract Management
Ordered 3/21/2018 Freight
Requested 5/1/2018 Taken By S SUMMERS
Delivery Per J Zhine / Req # 51910 Q#COL 6360535FYI8/DIR-TSO-2548
This purchase order encumbers funds in the amount of $83,970.84 awarded to Mythics Inc. of Virginia Beach, VA. On
April 26 ,2018. The following is incorporated into and made part of this purchase order by reference: Quotation Number COL
6360535FY18 from Mythics Inc., of Virginia Beach, VA. and State of Texas Department of Information Resources (DIR) Contract
DIR-TSO-2548. Resolution # 2018-RO 140
CITY O LUBBOCK
L�
Daniel M. Pope, Mayor
ATTEST:
0 f VLO
Rebec a Garza, City Secretary
Seller and Buyer agree as
follows:
PURCHASE ORDER
TERMS AND CONDITIONS
IMPORTANT: READ CAREFUILLV
STANDARD TERMS AND CONDITIONS
CITY OF LUBBOCII , T\
L SELLER TO PACKAGE GOODS. Seller will package goods in accordance with good commavial practice.
Each shipping container shall be clearly and permanently marked as follows (a) Sella's time and address.
(b) Consignee's aunts, address and purchase order or ptucbm release number and the supply agreement number
if applicable. (e) Container number and total number of coat ainers, e.g. box I of 4 boxes, and (d) the number
of the container bearing the packing slip. Sella shall bear cost oFpackaging unless athawise provided Goods
shall be sWrably packed to secure lowest transportation costs and to conform with requirements of common
carriers and any applicable specifications. Buyer's count or weight shall be final and conc(uxive on shipments
not accompanied by packing lists
2. SFIPNENT UNDER RFSF.RVATION PROHIBITED Seller is not autharized to ship the goods under
recreation and no tender ofa bill of lading will operate as a tender of goods
3. TITLE AND RISK OF LOSS. The title and risk of loss of the gods shall not pass to Buyer umd Buyer
actually receives and takes possession of the goods at the point or points of delivery.
4. NO REPLACEMENT OF DF.FFCTIVE 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 trader m made which does not
fully conform, this shall constitute a breach and Sella shall not have the right to substitutes conformine tender.
provided, where the time for performance has not yet expired. the Sella may reasonably notify Buyer of ins
intention to cure and may t}.an crake a conforming tender within the contract time but net afterward
5. INVOICES & PAYMF,NTS. a. S el ter shall submit separate inrnices. in duplicate, one each purchase
order or purchase release after each delivery Invoices shall indicate the purchase order or purchase release
number and the supply agreement number if applicable. Invoices shall be hemized and transportation charges,
if any. shall be listed separately. A copy of the bill of lading, and the freight waybill when applicah:e. should
be artarhed to the incoue Mail To: Accounts Payable. City of Lubbock. P O. Box 2000. Lubb irk. 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 Sella. cancel this contract wthout liability to
Sella if a is determined by Buyer that gratuities. in the fort- of enlenainmart. gt05 or otherwise. were offered
or given by the Seller, or any agent or representative of the Sella, to any officer or employee of the City of
Lubbock with a vim to securing a contract or securing favorable Ireatmeat with respect to the avvarding or
amending, or the making of any determinations with respect to the performing of such a contract. Ia the event
this contract is canceled by Buyer pursuant to this provision. Buyer shall be entitled, in addition to any other
rights and ranedies. to prover or withhold the amoutn of the cost incurred by Sella in providing sucb graruities
7. SPECIAL TOOLS & TEST EQUIPMENT If the price stated on the face bereof includes the coil of any
special tooling or special (at equipment fabricated or required by Sella for the purpose of filling this order.
such special tooling equipment and any process sheets related thereto shall became the property of the Buyer
and to the extent feasible shall be identified by the Seller as such
S. W'ARRANTY-PRICE. a The price to be paid by the Buyer shall be that omaincd in Seller's bid
which Seller warrants to be no higher than Sellkr's current process cu orders by others forproducts of the kind
and specification covered by this agreement for similar quantities under similar of lilac conditions and methods
of purchase In the event Sella breaches this warranty, the prices of the items shall be reduced to the
Seller's current price on orders by others. or in the alternative. Buyer may caucel this contract without
liability to Seller for breach or Seller's actual expense. b The Sella wananis that no person or selling agency
bas 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
vieimion of this warranty the Buyer shall have the right in addition to any other right of rights to c-cel this
comma without liability and to deduct from the contract price. or othawse recover without liability and to
deduct from the contract price, err otherwise recover the full amount of such commission, percentage. brokerage
or coatingcat fee.
9. WARRANTY -PRODUCT Sella shall not lima or exclude any impl:ed warranties and any altcmpt to do
so shall rends this contract voidable at the option of the Buyer Seller warrants that the goods famished will
goof irm to the specification. drawings, and descriptions listed in the bid invitation. and to the somple(s) furnished
by the Seller, if any. In &..a neat ofa conflict or betavoco the specifications, draw'mgs, and descriptions. the
specifications shall govern. Notwithstanding nay provisions contained in the contractual agreement the Sella
represents and warrants faun -free performance and fault -free result in the processing date and date related data
(including, but of limited to calculating. comparing and sequencing) of all hardware. software and firmware
products delivered and services pruvided under this Conran, individually or in combination. as the case may
be from the effective date of this Contract. The obligations contained herein apply to products and sin ices
provided by the Sella, its sub- Scala or any third parry involved in the creation or development of the products
and service to be delivered to the City of Lubbock under this Contract. Failure to comply w ah any of the
obligations contained herein. may result in the Cay of Lubbock availing itself of any of its rights under the
law and under this Comma including. but not Broiled to, its right pertaining to termination m defuih. 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, as 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 Buy" shall conform go 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 of conform to OSHA standards, Buyer my return the product for correction or
replacement at the Selle's expense. In the event Seller fails to make the appropriate correction within a
rMonable time, correction made by Buya will be at the Seller's expense.
11. NO WARRANTY BY BUYER AGAINST IINTRINGEMEMS. As part of this contract for We Seller
agrees to ascagr tm whetha goods manufacturod in accordance with the specifications attached to this agreement
wwll give rise to the rightful claim of any third person by way Of infringement of the like. Buya makes no
warranty that the production of goods according to the specification will of gw•e rise to such a claim. and in no
a:vanr shall Buyer be liable to Sella for indemnification in the event that Sella is sued on the grounds of
infringement of the like. If Seller is a f the opinion that an infringement or the like will result, he will notify the
Buyer to this effect in writing within two weeks ohm the signing ofths agreement. If Buy" does not rmcike
notice and is subsequently held liable for the infringement or the like. Sella will save Buyer harmless. If
Seller in good faith ascertains the production of the goods in accordance with the specifications w-at result in
infringement or the like, the comma shau 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 Cav la the nem of onappropriminn of fonds
by the Cry Council of the Cory of Lubbock for the goads 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 a any time funds we not appropriated go, the continuance of thus
contract, cancellation shall be accepted by the Sella on thirty (30) days prior written actice. bur failure to give
such notice si:a't I" of r:e rK-d zm' rlv: Car stall not 1'" �C:•: ,n:,l a:a.i i'-? : ,i.: a, : I.— 'J ihr .f.i•c a;
13. RIGHT OF INSPECTION. Buyer shall have the right to inspect the goods at delivery before accepting
them
14. CANCELLATION Buya sWl bs.c the right to i;—cl Sr. default all or mg pan of the undd—ed
panion of this order if 5ella Ixeachcs any of the tiros haeuf includiag warranties of Sella or if the Sella
hecnmev invnlvenr rr crin ins Arm of hanknmtcv Such riulit of rancellatinn is in addnirn to and MY in
lieu of say other remedies which Buyer may have as law or equity.
15 TERMINATION. The perfntmaace of work under this order maybe terminated in whole, or in part by the
Buyer in accordance with this pmvisioa Termination of work hereunder shall he effected by the delivery
of the Seger of a "Notice of TermeatiOIC specifying the Mail 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 lice of the rights of Buyer sm forth in Clause 14. herein.
16. FORCF XWEURE. Neither party shall be held responsible for losses, resulting if the fulfilhxel,
of any terms of pravis:om of Qs contract is delayed or presented by any cause not within the control of the
party whose perfertaance is interfaed with, and which by the exorcise of reasonable diligence said party s
unable to prevent.
1 %.ASSIGNMENT -DELEGATION. No right at at tied in this contract shall be assigned or delegation of
any Obligation made M Sella is ithout the written permission of the Buyer. Any arempted assignment or
delegation by Seller shall be wholly void and nla0y meffecrive for all purpose unless made in conformity with
this paragraph.
18 OJAIVFR No claim or right arising out ofa breach of the contract can be discharged in whole or in part
by a waiver or renunciation of the claim or right unless the waiver or renunciation is supported by
corutderation and is in writing signed by the aggrieved party.
19. INTERPRETATION -PAROLE EVIDENCE. This writing, plus any specifications for bids and
performance provided by Buyer in its advertisement for bids. and nay other d0cumrnl3provided by
Sella as pan of his hid is inteadext by the parties as a final expression or theiragreemetm and int nod atso
as a complete and exclusive statement of the terns of their agreement. Whenevera term defined by the
Uniform Commercial Code is used in this agreement, the defuution coatained in the Code is to control.
20. APPLICABI.F LAW. This a(?ecmeat shall be governed by the Uniform Commercial Cade Whacesa
the term "Uniform Commemial Code' is used. it shall be construed as meaning the Uniform Commercial
Code as adopted in the State of Texas w effective and in force on the date of this agreement
21. RIGHT TO ASSURANCE. 1henever One party 10 this roolract in good faith has reason to question
the other party s intent to perform he may demand that the other party give written assurance of his imatt to
perform. In the evert 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 o f the contract.
22 INDE-vLNIFTCATION. Sella shall indemnify, keep and save harmless the Buyer, its agents. officials and
employees. against all injuries, deaths, loss, damages, claims, patent claims, suits. liabilities, judgrOents, cons
and expenses. which may in aaywse acme 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 Me act was
caused through aegligence or omission of the Seller or as eaployea, or of the wb,Seller or assignee or its
employees. if any, and the Sella shall. at his own expense, appear, defend and pay all charges of attorneys
and all costs and other expenses wising therefrom of mcurred in connection tbarevvah. and, if any judgment
shall be rendered against the Buyer in am• such action, the Sella shaLL at its own expeasm satisfy and
discharge the same Seller expressly understands and agrees that any bond required by this contract, or
otherwise provided by Sella, shall in no way lour the responsibility to indettmify, keep and save harmless
and defend the Buyer as herein provided.
23. n%T- It is haehy expressly agreed and understood that time is of the essence for the performance of
this comcact, and failure by contract to meet the time specifications of this agreement will cause Scuff 10
be in default of this agreement.
24. MRE 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 *01 be afforded equal opportunities to
submit bids in response to this invitation and will 001 be discriminated against on the grounds of race. colon
sex or natural origin in consideration for an award
25. NON -ARBITRATION. The City rescrva the right to exercise any right Or remedy to it by law, contract
equity, or otherwise. including without funitatlon. 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 sm forth herein are cumulative and not exclusive,
and may be exaciscd 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 gait of the contract, or thereafter, the City, or a duly
authorized audit representative of the City or the State of Texas, at is expense and at reasonable motes,
reserves the right to audit Conttatior's records and books relevant W all services provided to the City under
this Contract. In the vent such an audit by the City reveals any arrrs or ovapaytacnts by the City,
Contractor shall refund the City the full amount of such overpayments within shim (30) days of such
audit findings. or the City, at is option. reserves the right to deduct such amuunts owing the City from any
Payments due Contractor
17. HOUSE BILL 2015. House Bill 2015, sigaed by the Governor on Jurr W, 2013 and effective on Janumv
1, 2014. authorizes a penalty to be imposed on a person who contracts for certain services with a governmental
emery and who fails to properly classify their workers. This applies to subcontractors as well. Contractors and
subcontractors wbo fail to properly classify individuals performing work under a governmental contract will be
penalized 5200 for each individual that bar beet misclassdiied. (Texas Govattmem Code Section 2155.001)
28. ASSIGNING OR SUBLETMG THE CONTRACT The Cmtractorshalimiacgignorwblathccomraa,
or any portion Of the contract, without Written consent from the Director of Purchasing and Contract
Management Should corset be given, the Contractor shall msurc the Subcontractor" shall provide proof on
insurance Goo the Subcontractor that complies with all contract fasurance requirements.
29. HOUSE BILL 1295 DISCLOSIUM OF INTERESTED PARTIES. House Bill 1295, adopted by the 84th
Legislature. created §2252.908. Texas Government Code. Section 2152.908 requires a business entity entering
into certain contracts with a governmental entity or state agency to file with the governmental entity or state
agency a disclosure of interested parties at the time the business entity submits the signed contract to the
gov'eramrntal entity or state agency instructions for omplaing Form 1295 are available at
htip "'w r Ciem�I-websites'drnarnrmmte, k wend 'RLS,sS+*�_. _., vV-iaformmi0a
30. CONTRACTOR ACIGNOW LETXIES, by supplying any Goods or Savxa that the Contractor has read,
fully understands, and will be in full compliance with all tams and conditions and the descriptive material
contained berem and anv addaioral associated documents and Amendments Thr City dixtaims any terms zed
eandrtmres pmcidcd by rho Contractor unless agreed upon in writing by the parties. In the event of conflict
between these terms and conditions gad any terms and conditions provided by the Contactor, the tarts and
conditions pro,ided herein shall prevail. The terms and conditions pnnvided herein are the final tams agreed
upon by the parries. and my prior onfliring terms shall be of o force or effect -
31 By acceplinr this pnnhase order, the Vendor verifies that it ones ring livvvtnm Israel. and agrees that durine
ICv true rl tl::; A_accment i('oalr •.i a.. • :,mLr _!dr'i .sell a:' Iirr Ice..., •Lot is ,. ds•11nel in Te'•.ety
iimrrnnwnl C'eJ: 5_clion 5Ci OJ1, a; e,;ncufe.:
MYTH I C S`" Platinum
Partner
410�
Chad McPhatter
Direct: 757.955.8069
Fax: 757.965.9486
Email: cmcphatter@mythics.com
Mythics, Inc
4525 Main Street Suite 1500
Company Name: City of Lubbock
Contact: Jay Zhine
Phone: (806) 775-2366
Email: izhine(a)mail.ci.lubbock.tx.us
ORACLE SUPPORT RENEWAL
Software Update License & Support
Quote Number: COL 6360535 FY18
Valid Through: May 1, 2018
Line
Item
CSI
Oracle
Product Description
Term
License Type
Number of
Licenses
License Level
Extended
Price
1
19444953
Oracle Database Enterprise Edition
May 1, 2018 - April 30, 2019
Processor Perpetual
400
Full Use
$47,103.54
2
19444953
Oracle Diagnostics Pack
May 1, 2018 - April 30, 2019
Named User Plus Perpetual
400
Full Use
$4,958.25
3
19444963
Oracle Partitioning
May 1, 2018 - April 30, 2019
Processor Perpetual
300
Full Use
$8,663.03
4
19444953
Oracle Tuning Pack
May 1, 2018 -April 30, 2019
Processor Perpetual
400
Full Use
$4,958.25
5
19444963
Oracle WebLogic Server Enterprise Edition
May 1, 2018 -April 30, 2019
Processor Perpetual
60
Full Use
$3,718.73
6
19444958
Oracle WebLogic Server Enterprise Edition
May 1, 2018 - April 30, 2019
Named User Plus Perpetual
6
Full Use
$14,679.04
SUPPORT:
$83,970.84
NEW LICENSE & SUPPORT:
UPON REQUEST
TRAINING:
UPON REQUEST
SERVICES:
UPON REQUEST
TOTAL $83,970.84
"'Please reference Mythics Quote Number on your purchase order. COL 6360535 FY18 Apllicable state and local sales tax will apply unless an exemption has been provided.
Additional Information:
This quotation is an estimate and is an invitation for you to offer to purchase products and services from Mythics. Your order is subject to Mythics' acceptance and to software licensing
terms and conditions per reference to an existing license/contract or a newly executed license accompanying your order.
Mythics Fed Tax ID# 54-1987871
Support services are provided under Oracle's then current technical support policies located at: http://www.oracle.com/support/policies.html
You agree that Mythics has the right to cancel your support due to non-payment.
Media is available for download at no additional cost at http://edelivery.oracle.com/
In reliance on your order, Mythics will issue a non -cancellable order with its supplier for software or hardware products ordered. Therefore all orders are non -cancellable. By confirming,
referencing or placing an order based on this quote, you are agreeing that the software products being purchased are for electronic delivery only and there is no transfer of tangible
property.
Purchasing Instructions:
Please include the following statements in your order:
1. This order is placed pursuant to the terms and conditions of Texas DIR-TSO-2548.
2. Payment terms are: Quarterly in Arrears
3. Mythics Quote Number COL 6360535 FY18 .
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.
2018-328667
Mythics, Inc.
Virginia Beach, VA 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.
City of Lubbock, TX
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.
#14029
Information Technology
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
LaRose, Scott
Virginia Beach, VA United States
X
Hillier, Michael
Virginia Beach, VA United States
X
Wergley, Albert
Savannah, GA United States
X
Sirh, Peter
Virginia Beach, VA United States
X
Welborn, Richard
Virginia Beach, VA United States
X
Newman, Gary
Virginia Beach, VA 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 T exas Ethics uommisslon www.ethics.state.tx.us Version V1.0.5523
CERTIFICATE OF INTERESTED PARTIES FORM 1295
lofl
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.
2018-328667
Mythics, Inc.
Virginia Beach, VA 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.
City of Lubbock, TX
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.
#14029
Information Technology
Nature of interest
4
Name of Interested Party
City, State, Country (place of business)
(check applicable)
Controlling
Intermediary
LaRose, Scott
Virginia Beach, VA United States
X
Hillier, Michael
Virginia Beach, VA United States
X
Wergley, Albert
Savannah, GA United States
X
Sirh, Peter
Virginia Beach, VA United States
X
Welborn, Richard
Virginia Beach, VA United States
X
Newman, Gary
Virginia Beach, VA United States
X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is 1�{1�,,/�IZ and my date of birth is
My address is m Al ;/? j <<�1+rfe f S6(]
(street) 61 (city (state) (zip code) (country)
I declare under penalty of perju r th�>i t�e foregoing is true and correct.
f
u 1
11 ,e
S H j/' �/
Executed in !� 9 ��� County, State of ✓ on th�� day of 20 J a .
(month) (year)
S
q
RATION NO' ; <
= w ' 7726145 m
=
m :MY Comm EkP � =
01RES
5•31.2021; .�` X
o �� Signa of thorized agent of contracting business entity
��'�� FY�RGtT��t,•
��
�� ��: • .• � `�� (Declarant)
Forms provided by Texas Etlrft&/PPMM0Wn www.ethics.state.tx.us Version V1.0.5523