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HomeMy WebLinkAboutResolution - 2022-R0281 - Contract 16488 with Aqua Rec, Inc 6.14.22Resolution No. 2022-RO281 Item No. 6.23 June 14, 2022 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. 16488, as per ITB 22-16488-YB, for the purchase of pool service and chemical systems, by and between the City of Lubbock and Aqua Rec, Inc., of Azle, 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 ATTEST: I 'JAAIZ--4 1.",/ Rebecca Garza, City Secretary APPROVED AS TO CONTENT: V`J Brooke Witcher, Assistant City Manager APPROVED AS TO FORM: Ryan Bro Assi tant City Attorney RES.Contract No. 16488-Aqua Rec, Inc. 5.2.22 June 14, 2022 V"-e' ;_ T A , MAYOR Resolution No. 2022-RO281 City of Lubbock Contract for Pool Service and Chemical Systems Contract 16488 THIS CONTRACT made and entered into this 14thday of June , 2022, by and between the City of Lubbock ("City"), and Aqua Rec, Inc. , ("Contractor"). WITNESSETH: WHEREAS, the City of Lubbock duly advertised for bids for Pool Service and Chemical Systems 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 Pool Service and Chemical Systems. 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, Pool Service and Chemical Systems and more specifically referred to as Item one (1) through Item three (3) on the bid submitted by the Contractor or in the specifications attached hereto. 2. The City promises and agrees to employ, and does employ, the Contractor to cause to be done the work provided for in this Contract and to complete and finish the same according to the attached specifications, offer, and terms and conditions contained herein. 3. The contract shall be for a term of one (1) year, with the option of four (4), one year extensions, 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. Prices quoted shall be set for a period for one (1) year, said date of term beginning upon City Council date of formal approval. The rate may be adjusted upward or downward at this time at a percentage not to exceed the effective change in Consumer Price Index (CPI) or Product Price Index (PPI), which ever is most appropriate for the specific contract for the previous 12-months at the City's discretion, the effective change rate shall be based on either the local or national index average rage for all items. If agreement cannot be reached, the contract is terminated at the end of the current contract period. 5. 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. 6. 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. 7. Insurance Requirements SECTION A. Prior to the approval of this contract by the City, the Contractor shall furnish a completed Insurance Certificate to the City, which shall be completed by an agent authorized to bind the named underwriter(s) to the coverages, limits, and termination provisions shown thereon, and which shall furnish and contain all required information referenced or indicated thereon. THE CITY SHALL HAVE NO DUTY TO PAY OR PERFORM UNDER THIS CONTRACT UNTIL SUCH CERTIFICATE SHALL HAVE BEEN DELIVERED TO THE CITY. SECTION B. The City reserves the right to review the insurance requirements of this section during the effective period of the contract and to require adjustment of insurance coverages and their limits when deemed necessary and prudent by the City based upon changes in statutory law, court decisions, or the claims history of the industry as well as the Contractor. SECTION C. Subject to the Contractor's right to maintain reasonable deductibles in such amounts as are approved by the City, the Contractor shall obtain and maintain in full force and effect for the duration of this contract, and any extension hereof, at Contractor's sole expense, insurance coverage written by companies approved by the State of Texas and acceptable to the City, in the following type(s) and amount(s): TYPE OF INSURANCE COMBINED SINGLE LIMIT GENERAL LIABILITY Commercial General Liability General Aggregate $2,000,000 Claims Made N Occurrence $1,000,000 Products-Comp/Op AGG X W/Heavy Equipment Personal & Adv. Injury X To Include Products of Complete Operation Endorsements Contractual Liability X Fire Damage (Any one Fire) X AUTOMOTIVE LIABILITY N Any Auto ❑ All Owned Autos Owned Autos Per Occurrence $1,000,000 Professional LIABILITY ® Each Occurrence $1,000,000 Aggregate $2,000.000 ® POLLUTION Each Occurrence $ 500,000 Aggregate $1,000,000 ® WORKERS COMPENSATION — STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY N EMPLOYERS' LIABILITY $1,000,000 OTHER: COPIES OF ENDOSEMENTS ARE REQUIRED N City of Lubbock named as additional insured on Auto/General Liability on a primary and non- contributory bases. N To include products of completed operations endorsement. N Waiver o subro ation infavor of the City o Lubbock on all coverages, except. IMPORTANT: POLICY ENDORSEMENTS The Contractor will provide copies of the policies without expense, to the City and all endorsements thereto and may make any reasonable request for deletion, revision, or modification of particular policy terms, conditions, limitations, or exclusions (except where policy provisions are established by law or regulation binding upon either of the parties hereto or the underwriter of any of such policies). Upon such request by the City, the Contractor shall exercise reasonable efforts to accomplish such changes in policy coverages, and shall pay the cost thereof. Any costs will be paid by the Contractor. REQUIRED PROVISIONS The Contractor agrees that with respect to the above required insurance, all insurance contracts and certificate(s) of insurance will contain and state, in writing, on the certificate or its attachment, the following required provisions: a. Name the City of Lubbock and its officers, employees, and elected representatives as additional insureds, (as the interest of each insured may appear) as to all applicable coverage; b. Provide for 30 days notice to the City for cancellation, nonrenewal, or material change; c. Provide for notice to the City at the address shown below by registered mail; d. The Contractor agrees to waive subrogation against the City of Lubbock, its officers, employees, and elected representatives for injuries, including death, property damage, or any other loss to the extent same may be covered by the proceeds of insurance; e. Provide that all provisions of this contract concerning liability, duty, and standard of care together with the indemnification provision, shall be underwritten by contractual liability coverage sufficient to include such obligations within applicable policies. NOTICES The Contractor shall notify the City in the event of any change in coverage and shall give such notices not less than 30 days prior the change, which notice must be accompanied by a replacement CERTIFICATE OF INSURANCE. All notices shall be given to the City at the following address: Marta Alvarez, Director of Purchasing & Contract Management City of Lubbock 1314 Avenue K, 9t' Floor 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 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 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. 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 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. 13. Contractor acknowledges by supplying any Goods or Services that the Contractor has read, fully understands, and will be in full compliance with all terms and conditions and the descriptive material contained herein and any additional associated documents and Amendments. The City disclaims any terms and conditions provided by the Contractor unless agreed upon in writing by the parties. In the event of conflict between these terms and conditions and any terms and conditions provided by the Contractor, the terms and conditions provided herein shall prevail. The terms and conditions provided herein are the final terms agreed upon by the parties, and any prior conflicting terms shall be of no force or effect. 14. The Contractor (i) does not engage in business with Iran, Sudan or any foreign terrorist organization and (ii) it is not listed by the Texas Comptroller under Section 2252.153, Texas Government Code, as a company known to have contracts with or provide supplies or services to a foreign terrorist organization. As used in the immediately preceding sentence, "foreign terrorist organization" shall have the meaning given such term in Section 2252.151, Texas Government Code. 15. The requirements of Subchapter J, Chapter 552, Government Code, may apply to this contract and the contractor or vendor agrees that the contract can be terminated if the contractor or vendor knowingly or intentionally fails to comply with a requirement of that subchapter. To the extent Subchapter J, Chapter 552, Government Code applies to this agreement, Contractor agrees to: (1) preserve all contracting information related to the contact as provided by the records retention requirements applicable to the governmental body for the duration of the contract; (2) promptly provide to the governmental body any contracting information related to the contract that is in the custody or possession of the entity on request of the governmental body; and (3) on completion of the contract, either: (A) provide at no cost to the governmental body all contracting information related to the contract that is in the custody or possession of the entity; or (B) preserve the contracting information related to the contract as provided by the records retention requirements applicable to the governmental body. 16. Pursuant to Section 2271.002 of the Texas Government Code, a) This section applies only to a contract that: (1) is between a governmental entity and a company with 10 or more full-time employees; and (2) has a value of $100,000 or more that is to be paid wholly or partly from public funds of the governmental entity. (b) A governmental entity may not enter into a contract with a company for goods or services unless the contract contains a written verification from the company that it: (1) does not boycott Israel; and (2) will not boycott Israel during the term of the contract. 17. Texas Government Code 2274. By entering into this Agreement, Contractor verifies that: (1) it does not, and will not for the duration of the contract, have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association or (2) the verification required by Section 2274.002 of the Texas Government Code does not apply to the contract. If Contractor is a company with 10 or more full-time employees and if this Agreement has a value of at least $100,000 or more, Contractor verifies that, pursuant to Texas Government Code Chapter 2274, it does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and will not discriminate during the term of the contract against a firearm entity or firearm trade association. 18. Contractor represents and warrants that: (1) it does not, and will not for the duration of the contract, boycott energy companies or (2) the verification required by Section 2274.002 of the Texas Government Code does not apply to the contract. If Contractor is a company with 10 or more full-time employees and if this Agreement has a value of at least $100,000 or more, Contractor verifies that, pursuant to Texas Government Code Chapter 2274, it does not boycott energy companies; and will not boycott energy companies during the term of the Agreement. This verification is not required for an agreement where a governmental entity determines that these requirements are inconsistent with the governmental entity's constitutional or statutory duties related to the issuance, incurrence, or management of debt obligations or the deposit, custody, management, borrowing, or investment of funds. 19. The Contractor shall retain all information received from or concerning the City and the City's business in strictest confidence and shall not reveal such information to third parties without prior written consent of the City, unless otherwise required by law. 20. The Contractor shall indemnify and save harmless the city of Lubbock and its elected officials, officers, agents, and employees from all suits, actions, losses, damages, claims, or liability of any kind, character, type, or description, including without limiting the generality of the foregoing, all expenses of litigation, court costs, and attorney's fees, for injury or death to any person, or injury to any property, received or sustained by any person or persons or property, to the extent arising out of, related to or occasioned by, the negligent acts of the Contractor, its agents, employees, and/or subcontractors, related to the performance, operations or omissions under this agreement and/or the use or occupation of city owned property. The indemnity obligation provided herein shall survive the expiration or termination of this agreement. 21. This Contract consists of the following documents set forth herein; Invitation to Bid No. 22- 16588-YB, Specifications, and the Bid Form. 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 ATT ST: I h A +4-�< 1�/ Reb ca Garza, tity Secretary APPROVE AS TO CONTENT: Colby VanGundy, Director of Parks and Recreation APPROVED AS TO F M: Ryan Br e, Xssistant Ci orney CONTRACTOR BY Authoriz Repre entative o Y iS-e/Y► Print Nalne 66 � pt-e4 Address 4Je 7X Acac� City, State, Zip Code City of Lubbock, TX ITB 22-16488-YB Pool Service and Chemical Systems Specifications INTENT: The City of Lubbock is soliciting bids to secure an annual contract to supply swimming pool chemicals. MSDS Information: Vendor shall provide with bid submittal any and all applicable MSDS information for materials supplied within this specification. DELIVERY: The Vendor shall supply and delivery all required chemicals needed at designated location(s) upon request from the Aquatics Supervisor within three (3) business days of the order, unless an emergency has occurred. We can only accept deliveries Tuesday -Sunday between the hours of 1:00 p.m. and 6:00 p.m. Clapp Pool — 4500 Avenue U, Lubbock, TX 79412 Maxey Pool — 4007 3Oth St, Lubbock, TX 79410 Montelongo Pool — 3200 Bates, Lubbock, TX 79415 Simmons Pool —1305 E 24t' St, Lubbock, TX 79404 CHEMICALS: The following is a breakdown of the necessary pool chemicals and the bid specifications for the 2022 pool season. 200 pails more or less of 60 lb Accu-Tab Blue SI tablets throughout the pool season 200 pails more or less of 45 lb Acid -Rite tablets throughout the pool season SERVICES: The Vendor must be able to provide miscellaneous services as needed including: • Annual cleaning of the both the Accu-Tab Chlorinator System and the Acid -Rite pH Adjustment System at each of our four pools if necessary. • Any required maintenance on broken parts the Accu-Tab Chlorinator System and the Acid -Rite pH Adjustment System at each of our four pools. • Replace parts that are beyond repair in either the Accu-Tab Chlorinator System and the Acid -Rite pH Adjustment System at each of our four pools. • Ensure both the Accu-Tab Chlorinator System and the Acid -Rite pH Adjustment System at each of our four pools are operating at an appropriate functioning level. • Other miscellaneous services that is deemed needed. Labor - Based on contracted hourly rate, time invoiced shall be for actual time worked subject to verification/documentation approved by the City Department. Contractor may not exceed contracted hourly rate. Should after hours/holiday hours be necessary or indicated, it shall be performed only after obtaining specific authorization from the respective City Department. Unauthorized after hours/holiday pay will not be paid. Materials — Materials are to be quoted on a cost-plus basis; percentage of markup to be based on net cost to Vendor, allowing for full credit for trade and/or cash discounts to the City. On any single item in which the cost equals or exceeds $100.00, a copy of the supplier's invoice — which must be dated and marked paid - shall be submitted as an attachment to the Vendors' invoice. City Department representative when requested for any reason, within ten calendar days of the request. TRAVEL EXPENSES: Out of town travel, if applicable shall be reimbursed to Vendor in accordance to the City of Lubbock Travel policy. Travel in the City to pool locations will not be reimbursed. City of Lubbock, TX Purchasing and Contract Management VENDOR ACKNOWLEDGEMENT FORM The City of Lubbock reserves the right to accept or reject any and all proposals in whole or in part and waive any informality in the competitive proposal process. Further, the city reserves the right to enter into any contract deemed to be in the best interest of the city. It is the intent and purpose of the City of Lubbock that this request permits competitive proposals. It is the offeror's responsibility to advise the City of Lubbock Director of Purchasing and Contract Management if any language, requirements, etc., or any combinations thereof, inadvertently restricts or limits the requirements stated in this RFP to a single source. Such notification must be submitted in writing and must be received by the director of purchasing and contract management no later than five (5) business days prior to the above submittal deadline. The City of Lubbock Charter states that no officer or employee of the City can benefit from any contract, job, work or service for the municipality or be interested in the sale to the City of any supplies, equipment, material or articles purchased. Will any officer or employee of the City, or member of their immediate family, benefit from the award of this proposal to the above firm? YES VINO THE OFFEROR HEREBY ACKNOWLEDGES RECEIPT OF AND AGREES ITS PROPOSAL IS BASED ON ANY ADDENDA POSTED. INSURANCE REQUIREMENTS I, the undersigned Bidder certify that the insurance requirements contained in this bid document have been reviewed by me and my Insurance Agent/Broker. If I am awarded this contract by the City of Lubbock, I will be able to, within ten (10) business days after being notified of such award by the City of Lubbock, furnish a valid insurance certificate to the City meeting all of the requirements defined in this bid. If the time requirement specified above is not met, the City has the right to reject this proposal and award the contract to another contractor. If you have any questions concerning these requirements, please contact the Director of Purchasing & Contract Management for the City of Lubbock at (806) 775-2572. SUSPENSION AND DEBARMENT CERTIFICATION Federal Law (A-102 Common Rule and OMB Circular A-110) prohibits non -Federal entities from contracting with or making sub -awards under covered transactions to parties that are suspended or debarr.-d or whose principals are suspended or debarred. Covered transactions include procurement contracts for City of Lubbock ITB 22-16488-YB Pool Service and Chemical Systems Bid Form Numeric #0-1 Acid -Rite Tabs, 45 lbs (per 200 EA $ 96.50 $ 19,300.00 pail). Includes delivery. IAccu-Tab Blue SI, 60 Ibs #0-2 (per pail). Includes delivery 200 EA $ 156.50 $ 31,300.00 #0-3 Service Call for Repairs 11 HR $ 125.00 $ 1,375.00 #04 Travel & Fuel Charge 11 TVL $ 75.00 $ 825.00 #05 Partks Mark Up Pecentage I % 10% goods or services equal to or in excess of $25,000 and all non -procurement transactions (e.g., sub -awards to sub -recipients). Contractors receiving individual awards of $25,000 or more and all sub -recipients must certify that their organization and its principals are not suspended or debarred by a Federal agency. Before an award of $25,000 or more can be made to your firm, you must certify that your organization and its principals are not suspended or debarred by a Federal agency. I, the undersigned agent for the firm named below, certify that neither this firm nor its principals are suspended or debarred by a Federal agency. TEXAS GOVERNMENT CODE SECTION 2252.152 The undersigned representative of the undersigned company or business, being an adult over the age of eighteen (18) years of age, pursuant to Texas Government Code, Chapter 2252, Section 2252.152, certify that the company named above is not listed on the website of the Comptroller of the State of Texas concerning the listing of companies that are identified under Section 806.051, Section 807.051 or Section 2253.153. I further certify that should the above -named company enter into a contract that is on said listing of companies on the website of the Comptroller of the State of Texas, which do business with Iran, Sudan or any Foreign Terrorist Organization, I will immediately notify the City of Lubbock Purchasing and Contract Department. TEXAS GOVERNMENT CODE SECTION 2271.002 Company hereby certifies the following: 1. Company does not boycott Israel; and 2. Company will not boycott Israel during the term of the contract. The following definitions apply to this state statute: (1) 'Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel, or with a person or entity doing business in Israel or in an Israeli -controlled territory, but does not include an action made for ordinary business purposes; and (2) "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, or limited liability company, including a wholly owned subsidiary, majority -owned subsidiary, parent company, or affiliate of those entities or business associations that exists to make a profit. TEXAS GOVERNMENT CODE 2274 By entering into this Agreement, Contractor verifies that: (1) it does not, and will not for the duration of the contract, have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association or (2) the verification required by Section 2274.002 of the Texas Government Code does not apply to the contract. If Contractor is a company with 10 or more full-time employees and if this Agreement has a value of at least $100,000 or more, Contractor verifies that, pursuant to Texas Government Code Chapter 2274, it does not have a practice, policy, guidance, or directive that discriminates against a firearm entity or firearm trade association; and will not discriminate during the term of the contract against a firearm entity or firearm trade association. Contractor represents and warrants that: (1) it does not, and will not for the duration of the contract, boycott energy companies or (2) the verification required by Section 2274.002 of the Texas Government Code does not apply to the contract. If Contractor is a company with 10 or more full-time employees and if this Agreement has a value of at least $100,000 or more, Contractor verifies that, pursuant to Texas Government Code Chapter 2274, it does not boycott energy companies; and will not boycott energy companies during the term of the Agreement. This verification is not required for an agreement where a governmental entity determines that these requirements are inconsistent with the governmental entity's constitutional or statutory duties related to the issuance, incurrence, or management of debt obligations or the deposit, custody, management, borrowing, or investment of fiends. FEDERAL AND STATE SAFETY REGULATIONS Contractor shall comply with all federal and state safety regulation including but not limited to Occupational, Safety and Health Administration (OSHA) and the Department of Workforce Development (DWD) regulations. 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, asset 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 Bus to be in violation of the FTA terms and conditions. All Environmental Protection Agency (EPA) rules and regulations must be followed by the Contractor. MASTER AGREEMENT For Federal Transit Administration Agreements authorized by 49 U.S.C. chapter 53, Title 23, United States Code (Highways), the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users, as amended by the SAFETEA-LU Technical Corrections Act of 2008, the Transportation Equity Act for the 21 st Century, as amended, the National Capital Transportation Act of 1969, as amended, the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5, February 17, 2009, or other Federal laws that FTA administers. https:llwww.transit.dot.gov/fundinj;i �,7antee-resourceslsample-fta-agi,eementsi fta-grant-agreements The Master Agreement can be found in its entirety on the City of Lubbock website www.ci.lubbock.tx.us VENDOR ACKNOWLEDGEMENT In compliance with this solicitation, the undersigned offeror having examined the request for proposal/invitation for bid instructions to offerors/bidder, documents associated with the request for proposals, and being familiar with the conditions to be met, has reviewed the information regarding: • Insurance Requirements • Suspension and Debarment Certification • Texas Government Code Section 2252.152 • Texas Government Code Section 2271.002 • Texas Government Code 2274 • Federal and State Regulations • Master Agreement An individual authorized to bind the company must sign the following section. Failure to execute this portion may result in propo�spl rejection. pQuo'- " 2 et_ 10c Company Name OLX---�QOSM Title S. ZZ Date Address _k'uT -I6oz0 City, State Zip Code CERTIFICATE OF INTERESTED PARTIES FORM 1295 10f 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: i Name of business entity filing form, and the city, state and country of the business entity's place of business. 2022-878384 Aqua-Rec, Inc. AzleAzle, TX United States Date Filed: 04/26/2022 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: 04/27/2022 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 16488 Pool Chemicals 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. M X 6 UNSWORN DECLARATION My name is and my date of birth is My address is (street) (City) (state) (zlp 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 V1.1.191b5cdc CERTIFICATE OF INTERESTED PARTIES FORM 1295 lofl Complete Nos. 1.4 and 6 if there are interested parties. Complete Nos.1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING Certificate Number: 2022-878384 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Aqua-Rec, Inc. AzleAzle, TX United States Date Filed: 04/26/2022 2 Name of governmental entity or state agency that is a party tot 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. 16488 Pool Chemicals 4 Name of Interested Parry City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. a X 6 UNSWORN DECLARATION My name is Rnal2.Y LSley,� and my date of birth is My address is �� r lQ J `' ej a�Z"� e �16 ky'� y (str t) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed inLL\L1:0 County, State of ,y C f► J , on thez�of 20Z� ' W TRACY BM My NOWY @ # 13015WM0 (month) (year) IL Signature if a orized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission www.ethics.state.tx.us----J Version V1.1.191b5cdc