HomeMy WebLinkAboutResolution - 2018-R0175 - Brenntag Southwest - 05/24/2018Resolution No. 2018-RO175
Item No. 5.10
May 24, 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. 13939 for Hydrochloric Acid for the North
and South Water Treatment Plants as per ITB 18-13939-KW, by and between the City of Lubbock
and Brenntag Southwest, Inc., of Lancaster, 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 May 24, 2018
JEFF GRIFFITH, MAYOR PRO TEM
A TEST:
wl�ap�< b/"
Re ecca Garza, Cit Secretar
APPROVED AS TO CONTENT:
Woad FrayAlin, P.E., Division Director of Public Works
APPROVED AS TO FORM:
Amy L im , Deputy - ' rney
vw: ccdocs/RES. Contract 13939.Hydrochloric Acid for the North and South Water Treatment Plants
05.07.2018
Resolution No. 2018-R0175
Contract 13939
City of Lubbock, TX
Contract For
Hydrochloric Acid for North and South Water Treatment Plants
THIS CONTRACT made and entered into this 24' day of May, 2018 by and between the City of
Lubbock ("City"), and Brenntag Southwest, Inc., ("Contractor").
WITNESSETH:
WHEREAS, the City of Lubbock duly advertised for bids for Hydrochloric Acid for North and South
Water Treatment Plants 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 Hydrochloric Acid for North and South Water Treatment Plants.
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, Hydrochloric Acid for North and South
Water Treatment Plants 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.
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.
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 parry 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.
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 famish 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 CTI'Y.
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
GENERAL LIABILITY
® Commercial General Liability
❑ Claims Made ® Occurrence
❑ W/Heavy Equipment
❑ To Include Products of Complete Operation Endorsements
PROFESSIONAL LIABILITY
AUTOMOTIVE LIABILITY
® Any Auto
❑ Scheduled Autos
❑ Non -Owned Autos
❑ All Owned Autos
❑ Hired Autos
COMBINED SINGLE LIMIT
General Aggregate 1,000,000
Products-Comp/Op AGG X
Personal & Adv. Injury X
Contractual Liability X
Fire Damage (Any one Fire)
Med Exp (Any one Person)
General Aggregate
Each Occurrence I MOOMM)
EXCESS LIABILITY
❑ Umbrella Form Each Occurrence
Aggregate
GARAGE LIABILITY
❑ Any Auto
❑ BUILDER'S RISK
❑ INSTALLATION FLOATER
® POLLUTION
❑ CARGO
® WORKERS COMPENSATION — STATUTORY AMOUNTS
OR OCCUPATIONAL MEDICAL AND DISABILITY
® EMPLOYERS' LIABILITY
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
OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED
® City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory bases.
® To include products of completed operations endorsement.
® Waiver o subro ation infavor of the Cihy o Lubbock on all covers es, exce t
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 conies of the Certificates of Insurance shall reference the groiect name or bid number for which the
insurance is beine suanlied.
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 and Contract Management
City of Lubbock
1625 l3' 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. Further, the City shall not be subject to any arbitration process prior to
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 CONTRACTOR
BY (117
-
JEFF GRVFITH, MAYOR PRO YE Authorized Representativ
T ST:
4t-1,6/ F - ��
Rebecca Garza, Ci ecretary
AP ROVED O CONTENT:
Aubr ear, P.E., Director of Water Utilities
APPROVED -AS TO FORM:
Amy Sims, De uty i y Atte
W. Thomas Crain, Jr., President
Print Name
704 E. Wintergreen Road
Address
Lancaster, Texas 75134
City, State, Zip Code
City of Lubbock, TX
Bid 18-13939-KW
Hydrochloric Acid for North and South Water Treatment Plants
SPECIFICATIONS
INTENT
It is the intent of these specifications to describe the chemical hydrochloric acid 15.0% co -reactant to be used in
the water treatment process at the City of Lubbock North and South Water Treatment Plants.
PRODUCT SPECIFICATION
Treatment Chemical purchased for use at the City of Lubbock North and South Water Treatment Plants 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. All
treatment chemicals 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 material safety data sheets
(MSDS) for the product and NSF/ANSI certification shall also be submitted with the bid. In any event. all
products used must have NSF/ANSI certification for use in drinking water treatment plants, any product bid that
does not contain NSF/ANSI Certification will be determined unusable and not be considered.
PRODUCT PERFORMANCE
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(s). References will be thoroughly checked and will figure
prominently into the selection of a successful bidder.
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. 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. 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.
TECHNICAL SUPPORT
Vendor shall provide acceptable technical support and response time whenever problems are encountered
relating to product use and/or performance. 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.
QUANTITIES AND PRICING
The anticipated annual consumption of required treatment chemical is listed below. Prices quoted for product
shall be FOB City of Lubbock North Water Treatment Plant, 6001 North Quava Lubbock, Texas 79403, and
North and South Water Treatment Plants, 5114 East FM 1585 Lubbock, Texas 79404. Pricing shall be firm for
a period three (3) years with price being evaluated and adjusted annually. Written consent from both parties is
required for all price adjustments. Listed quantities are estimates only for pricing purposes. Actual usage may
vary.
DELIVERY / SECURITY
Successful vendor shall be required to deliver the product to the City of Lubbock North and North and South
Water Treatment Plants 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 9:00 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 rickets with each load of bulk product delivered 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 City of Lubbock North and North and South Water Treatment Plants, delivery
personnel will check in with plant representative, present photo identification, and then be directed to the
unloading site. 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.
Delivery Method: Bulk
Unloading Method: The fill pipe connection is located near ground level.
The connection is a 2" male camlock fitting.
The supplier shall pump the material to the top of the tank, approximately 15' above
ground level.
Storage Capacity: 5,000 gallons tanks
Typical Delivery: 3,300 gallons each tank
Delivery Frequency: estimated every 2-3 months
There is no storage or chemical feed equipment required to be furnished for this bid.
Individual Chemical Specifications
15.0% Hvdrochloric Acid
Annual usage of 15.0% Hydrochloric Acid is estimated to be 623,000 +/- pounds. Product will be off loaded
into one 5,000 gallon bulk storage tank at the South Water Treatment Plants and a 7,000 gallon bulk storage
tank at the North Water Treatment Plant. Product must be NSF/ANSI Certified for use in public water treatment.
Specific gravity of 15.01/o Hydrochloric Acid shall be 1.075 at 25 C (77F) with a pH of 1.0 at 1.0 wt/wt%.
Hydrochloric Acid, HCI, shall be furnished as an aqueous solution of 15.0% by weight.
The Hydrochloric Acid will be used in conjunction with Sodium Chlorite (NaC1O2) and Sodium Hypochlorite
(NaOCI) to generate Chlorine Dioxide for Potable Water Treatment.
The Hydrochloric Acid shall be reasonably clear liquid and be free from visible foreign matter and sediment.
The Hydrochloric Acid shall contain no inorganic or organic substances in quantities capable of producing
delirious or injurious effects on health of those consuming water that has been properly treated with
Hydrochloric Acid.
This material shall be certified as suitable for contact with, or treatment of, drinking water by an accredited
certification organization in accordance with ANSI NSF Standard 60, Drinking Water Treatment Chemicals —
Health Effects.
The bid price, per pound, shall be based on the actual pounds of solution.
TERMS 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.
110
City of Lubbock
BID FORM
Hydrochloric Acid for North and South Water Treatment Plants
City of Lubbock, TX
1TB 18-13939-KNN'
Bid ITS 18-13939.KW
In cornl?liance with the Invitation to Bid 18-13939-KW`. file ucldersfaned itukler ha%nig examirled the In nation tii III in I
Specifications, trncl being taniib:n' w ith the conditions to he stet, heicbt ,uh"i's the fi,lliM Ole Bid list lin-ins inu the material-
eyuipnxnt, labor and eeci tithm_l ,e,: „s ry for profiling the items hs(ed belo%c and agree, to dell%cr ,iud hest, itt the location,
and liar the prices set forth tin tilt, ion, A hid will be uhiect to heiov considered inegulai and ma) he rejected 11 If shoos omissions. alterations of form. conditional altematc bids. addition, ()t alternate, it) lieu of the items specified. if the unit
prices are oliviousl-y unbalanced (either in exec„ (If, Or helow reasouabh expected values), or irregularities ofam kind. file
Invitation to i3id 18-13939-KW" is by reference incorporated in this contract I he 13id Form must he completed in little or
black ink or by rite,
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*PRICE: F.O.B. Destination, Freight Pre -Paid and ,',lbws<I *"Days After Receipt ufOrder(ARO I 306.00
The Cit3 tut Lubbock is seek- ing an agreement fill' aluniimoil, sulfate i,itIf one or more contractors. In order to assure
adequate col craze, the City maare in the y make multiple awards, selectin<g multiple vendors to prop ide the products desired, if
multiple
sh) the City' b aset onthe needs cst of theoity.f the City. deckn it) make a multiple award of this Bid, hortic� cr, is an
(optionrescr. ed
PAYMF\ 1 I R\tti :\Nl) O(�Cl>t'N7 l - Bidder olTers it prompt pavnicnt discount of 0 'i*, net30 calendar day,
Discounts w fll not he :on,ulered in determtninc low hid 1 isle" ()therw ise indicated On the Bid Form, payment terms will
he NFI -I IIIR I N' DAYS the Cnv will pad the successful hidtici w iihin fblirty days alter the receipt of a coinoice of
alter the date of acceptance, whichever scent occurs later Discount, for prompt pa-inent requiring payment by the Cltti
within a stipulated number ufdays will he interpreted as applying w iihm the stipulated number ofcalendar days after the date
of receipt by the Cnv, ofa correct inoice or alter the date ofacceplance that meets agreement requirements, whichever event
Occurs later Discounts fire Payment in le„ than ten days will not he considered.
h1Cts i I AVa )1 `RI 1) PRICING. I he Bidder certifies that the price quoted is not m excess of the lowest price charged anvunc
else, including it, most favoured customer, fist like quality and grwntitc of the products services. dues not include an clement
Of prolo on the sale in exec„ of that not ohfauted bV the Bidder on the sale ()f pf,xluctsservice, oflike quality ;and
quantity . and does not nichuie am Ill Isom Ilse discounts to selling agent, If at any tittle during the aereen)e if period. the
Supplfef should sell of offer list sale to ant ()tile' cnfsion)er. an equal ur le„ gnantlt% of snntilar .igreenlenl products of like of
letter guahtt, at a lower list price(s) thin, provided herein, supplier agree, t+, nonfv the Gilt Mid sell same product(s) a1 the
lower pr)ee(,) on all deliveries shade ).luring the periodin which such lower piwoNii 1, e&ctivc•
PtIRC'IIASIM. (optional) t he L M desires it, make acitlli)hlc it, other local guvcnuucmal entities of the
,State tit' I es,I,. by mutual agrecitivill ,v ith the suecessfld bidder. and properly authorised unerlocal puichasutg agreements as
provided ti,r by tite Interlocal C om (C
ullcratn-Act hapter 791. tioxernnent ( ode), the right to purchase the sane scrz icc,. illRite price; quoted. lot the period of 1111, a_reeniciii I ach hidder shall Indicate on the Rid form Ill the ,pare provided below
It' he the will honor Political �uhdi+,',ion orders fit addition lit order, lions the C In tit' I ubboc•k Should these Other
_uscrtlnental entities decide tit participate in this agreement. would you (the hi.ldcr) agree that all terms, conditions.
spec•ilieations, and pricing would apph"
Other governmental entities that might have interests in this agreement are Frenship Independent School District.
Lubbock Housing Authority, Lubbock Counh, Luhbock County Hospital District, Lubbock Independent School
District, South Plaint Association of Go%urnments, City (of Texarkana, Texas Tech University, ki est Texas Municipal
Power Agency. L} no County, and City of W olfforth.
YI NI) X
* if you (the bidder) checked ) S, the lollowing will apply
if It I8-13939-Kw ! (•.dnxhf<si. Newt for Nordi and "nub wutcr I aratntcnt Wjunts
2:23.201$ 222 PM
P 6
City of Lubbock
Bid ITB 18-13939-KW
• Governmental entities utilizing Interlocal Agreements for Cooperative Purchasing with the City of Lubbock will be
eligible, but not obligated, to purchase materiaWservices 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 BY Brenntag Southwest, Inc. a corporation organized under the laws of the State of
Texas , or a partnership consisting of or individual trading as
------ of the City of
Firm: Brenntag Southwest. Inc.
.Address: 704 E. Wintergreen Rd.
City: Lancaster State: Texas Zip 75134
Bidder acknowledges receipt of the following addenda:
Addenda No. Date Addenda No. _ Date
Addenda No. Date Addenda No. Date
M/WBE Firm:1 I Woman Black AmericanT=Nati%e American _
hispanic American T Asian Pacific Americi I tither iSpecif,) j
By
,4uthoriaed Representath" -
h,v hand
Officer Name and Title: W. Thomas Crain. Jr. President
Please Print
March 19, 2018
Business Telephone Number (972) 218-3500 FAX: (972) 218-3501
F-mail Address: gtollefsen@brenntag.com
FOR CITY USE ONLY
Bid Form Item Number(s) Awarded to Above Named Firm/individual:
Date of Award by City Council (for hide over S50.000): Date P.O./Contract Issued:
RETURN COMPLETED & SIGNED BID FORM ALONG WITH CITY OF LUBBOCK SPECIFICATIONS.
LABEL THE OUTSIDE OF YOUR SEALED BID WITH THE ITB NUMBER, THE CLOSING DATE AND
TIME. AND YOUR COMPANY NAME AND ADDRESS.
" 18-13939-KW Hydrochloric Acid for North and South Water 1'reatmeni Plaits
2123i2018 2:22 PM P• 7
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:
2018-347493
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Brenntag Southwest, Inc.
Longview, TX United States
Date Filed:
05/02/2018
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.
13939
Hydrochloric Acid for North and South Water Treatment Plants
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Brenntag North America, Inc.
Reading, PA United States
X
5
Check only if there is NO Interested Party. ❑
6
UNSWORN DECLARATION
My name is (AEI I�CI� �11�— f�� and my date of birth is
My address is
(street) (city)
(state) (zip code) (country)
I declare underpenaltyof perjury that the foregoing is true and correct.
Executed in `' ) Q County, State of / ,[ F-fil on
I
the —day of 20J.
(mo th) (year)
LJ
Signature of authorized ag_ nt of contracting business entity
(Declarant)
Forms Drovided by Texas Ethics Commission www_ethics.statP.tx_iis
\/arcinn \/1 n rs,)q
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.
2018-347493
Brenntag Southwest, Inc.
Longview, TX United States
Date Filed:
05/02/2018
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:
05/09/2018
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.
13939
Hydrochloric Acid for North and South Water Treatment Plants
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
Intermediary
Brenntag North America, Inc.
Reading, PA 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