HomeMy WebLinkAboutResolution - 2019-R0153 - Midwest Laboratories - 05/14/2019 Resolution No. 2019-RO153
Item No. 6.7
May 14, 2019
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, Service Contract No. 14545 for Analysis for Soil
Samples as per ITB 19-14545-JM, by and between the City of Lubbock and Midwest
Laboratories, of Omaha, Nebraska, 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 14, 2019
"P��
DANIEL M. POPE, MAYOR
ATTEST:
Reb cca Garza, City Secretar
APPROVED AS TO CONTENT:
C-.
Jesica McEachern, Assistant City Manager
APPROVED AS TO FORM:
Ry7n Br ke, A etstant City Attorney
ccdocs/RES.Service Contract 14545—Analysis for Soil Samples
April 1, 2019
Resolution No. 2019-RO 153 Contract 14545
City of Lubbock,TX
Contract for
Analysis for Soil Samples
THIS CONTRACT made and entered into this lgth day of May . 2019, by and between the
City of Lubbock ("City"), and Midwest Laboratories, ("Contractor").
WITNESSETH:
WHEREAS,the City of Lubbock duly advertised for bids for Analysis for Soil Samples 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 Analysis for Soil Samples.
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, Analysis for Soil Samples and more
specifically referred to as Items 1 through 15 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 year, with the option of four, 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. 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. 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 acce Mable to the City,in the following type(s)and amount(s):
TYPE OF INSURANCE COMBINED SINGLE LIMIT
GENERAL LIABILITY
® Commercial General Liability General Aggregate $1,000.000
❑ Claims Made ® Occurrence 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)
Med Exp(Any one Person)
PROFESSIONAL LIABILITY
® General Aggregate
AUTOMOTIVE LIABILITY
❑ Any Auto ❑ All Owned Autos
❑ Scheduled Autos ❑ Hired Autos
❑ Non-Owned Autos Per Occurrence
EXCESS LIABILITY
❑Umbrella Form Each Occurrence
Aggregate
GARAGE LIABILITY
❑ Any Auto Auto Only-Each Accident
❑ Other than Auto Only:
Each Accident
Aggregate
❑ BUILDER'S RISK ❑ 100%of the Total Contract Price
❑ INSTALLATION FLOATER ❑ 100%of the Total Material Costs
❑ CARGO
❑ WORKERS COMPENSATION—STATUTORY AMOUNTS OR
OCCUPATIONAL MEDICAL AND DISABILITY
❑ EMPLOYERS' LIABILITY
OTHER:COPIES OF ENDOSEMENTS ARE REQUIRED
® City ofLubbock named as additional insured on Atito/General Liability on a primary and non-contributory bases.
® To include products of completed operations endorsement.
® Waiver of subrogation in favor of the City of Larbbock 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, linutations, 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
1625 13"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.
7. 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.
8. 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.
9. At any time during the tenn 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.
10.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.
11.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.
12. 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 terns and conditions and any terns 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.
13. 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.
14.The Contractor warrants that it complies with Chapter 2270, Subtitle F,Title 10 of the Texas
Government Code by verifying that:
(1) The Contractor does not boycott Israel; and
(2) The Contractor will not boycott Israel during the term of the Agreement.
15. This Contract consists of the following documents set forth herein; Invitation to Bid No. 19-
145454M, Specifications, and the Bid Form.
-----INTENTIONALLY LEFT BLANK-----
IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and
year first above written. Executed in triplicate.
CITYOF LUB OCK CON CTOR
07
BY:
Daniel M. Pope, Mayor Authorized Representative
ATTEST: /wY u/` �,
Print Name
RRebccoGarza, City Secreta y
Address �.
APP ED AS TOC '�1TEN
-L City, State, Zip Code
Aubrey A Spear E.,Directo of Water
Utilities
APPROVED AS TO FORM
Ryan'loo ,Assistant City Attorn
City of Lubbock,TX
ITB 19-14545-JM
Analysis for Soil Samples
Specifications
The purpose of these specifications is to describe requirements for soil analyses to be performed on
soil and forage samples collected and composited by the City. Soil samples will be collected from the
Lubbock Land Application Site and the Hancock Land Application Site.
There are two major soil sampling events per year. Samples are generally sent in groups (or-batches)
of approximately 12 to 15 samples. Forage samples are collected throughout the year and shipped in
groups of one to five samples. These dates and quantities are approximations only; they may or may
not be reflective of actual samples collected and/or shipped.
The laboratory must be accredited by the Texas Laboratory Accreditation Program (TLAP), methods,
and parameters of analysis. Preparation of soil samples must be in accordance with ASA, SSSA,NCR-
13, USDA Handbook 60 and/or USDA NRCS Soil Survey Laboratory Investigations Report No. 42,
Laboratory Methods Manual available at, http://soils.usda.c,ov/technical/lmni/or equivalent. Forage
samples will be prepared and analyzed in accordance with ASA, CSA, USDA, or equivalent methods.
NOTE: The City does not grind or dry soil and plant samples prior to shipment.
The below-listed methods of analyses are required for bid items 1 through 15, respectively. Any
request to use equivalent/alternative methods must be approved. Request for approval must be
submitted in accordance with paragraph 3.2 under Section 1. INSTRUCTIONS TO BIDDERS.
1. Analyze soil for TKN (ppm), determined by Kjedahl digestion or an equivalent accepted
procedure(Non-Mercury). Total Nitrogen=TKN +nitrate—nitrogen (same as, organic-
0 ammonium-nitrogen+nitrate-nitrogen) Nutritive parameters should be analyzed
in extractable or available form. Digested with sulfuric Acid for 1.5 hours at 420 degrees
C. It is then distilled into a Boric Acid receiving solution and titrated.
2. Analyze soil for Nitrate-Nitrogen (ppm) Extractable. From a 1 N_KCL soil extract. Mg/kg
(dry weight basis) Cadmium reduction followed by colorimetric analysis on a segmented
flow automated system. The nitrate is extracted using 2 normal potassium chloride extracts
on a 5:1 KCI:soil ratio.
3. Analyze soil for Ammonium-Nitrogen (ppm) Extractable. The ammonia is extracted using
2 normal potassium chloride extracts on a 5:1 KCI:soil ratio. Ammonia-nitrogen is analyzed
using a colorimetric analysis on a discrete automated system.
4. Analyze soil for Plant available: Phosphorus(ppm) Extractable Mehlich III with inductively
coupled plasma
5. Analyze soil for Potassium (ppm) Extractable Mehlich III with inductively coupled plasma
6. Analyze soil for Sodium (ppm) Extractable Mehlich III with inductively coupled plasma
7. Analyze soil for Magnesium (ppm) Extractable Mehlich III with inductively coupled plasma
8. Analyze soil for Calcium (ppm)Extractable Mehlich III with inductively coupled plasma .
9. Analyze soil (saturation paste) for Sodium Adsorption Ratio (SAR)
10. Analyze soil for EC (uS/cm); Electrical Conductivity(EC)determine from extract of 2:1
(v/v)water/soil mixture. Obtained from SAR water saturated paste extract. dS/m(same as
mmho/cm)
11. Analyze Soil Water pH (Standard Units),Analyzed by the electrometric method in "Test
methods for Evaluating Solid Waste,EPA SW 846,40 CFR 260.11. Method 9045 is
appropriate for determining pH. Soil pH method must use 2:1 (v/v)water to soil mixture.
12. Analyze forage samples for moisture,crude protein,Ca, P, K, Mg,Na, and nitrate-nitrogen
13. Water-soluble:Sodium,Calcium,and Magnesium: Obtained from SAR water saturated paste
extract. Reported in mg/L.
14. SAR = Na
(Ca+Mg
z
Express concentrations of Na, Ca, and Mg in the water saturated paste extract in
milliequivalents/liter(meq/L) to calculate the SAR. The SAR value is unitless.
15. Estimated shipping cost per box, as delivered from the COL to the lab(UPS ARS for
example), each box weighs less than 50 pounds. Box size is I' x I' x I' or less. Each
shipping box size is one cubic foot or less. All Shipping containers to be returned to the
Southeast Water Reclamation Plant,3606 Guava Avenue, Lubbock,TX 79403. Analysis
results returned in 30(thirty) days to Sampling and Monitoring Department.
NOTE: NCR-13 is available from University of Missouri Extension Publication Service at 1-
800-882-7216 and requesting SB 1001, Recommended Chemical Soil Test Procedures, at a cost
of$6.00 (does not include shipping). It may also be accessed on-line, in downloadable PDF at:
httn://muextension.missouri.edu/xplor/specialb/sb i 001.htm#getpdf.
SSSA(Soil Science Society of America, Inc). Book Series 5 Methods of Soil Analysis Part 3:
Chemical Methods(1996)
USDA Agriculture Handbook 60 http://www.ars.usda.�,,ov/pwa/riverside/ussl
Quality Assurance and Quality Control (QA/QC) must be performed in accordance with Texas
Commission on Environmental Quality(TCEQ) and EPA guidelines. It is also recommended that
NCR- 13, Chapter 15 Laboratory Quality Assurance Program guidelines are incorporated into the labs
QA/QC program.
A copy of the Chain of Custody, furnished with each sample shipment, must be completed(signed
with an annotation of date&time received) and returned to Craig Henderson, Wastewater Treatment,
PO Box 2000, Lubbock,TX, 79457 within 30 days of sample receipt. An electronic copy of the
signed Chain of Custody is preferable, i.e., a scanned copy sent by e-mail.
Results of individual shipments must be returned within three weeks after sample receipt. Results
must be furnished in both hard copy and in an acceptable form of electronic media compatible with
Microsoft Excel or Access. Acceptable media forms are CD-ROM or downloadable from a secure
website. The following are also required to be returned to the City of Lubbock with results:
A. Copy of each analysis method used (you need provide only one hard copy of each method,
unless method changes during subsequent analysis events)
B. Annotation of method used for analyses
C. Laboratory QA/QC
D. Dates and Times of each analysis or analysis group
E. A copy of the Chain of Custody(s)—see item 5 above
F. Sodium Adsorption Ratio(SAR)results must show both analysis results and calculations
City of Lubbock Bid ITB 19-14545-JM
BID FORM
City of Lubbock, TX
Purchasing and Contract Management
Analysis for Soil Samples
ITB No. 19-14545-JM
In compliance with the Invitation to Bid 19-14545-JM, 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 fon-n. 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 19-14545-JM is by
reference incorporated in this contract. The Bid Form must be completed in blue or black ink or by typewriter.
UNIT OF EXTENDED Delivery
ITEM QTY MEASURE DESCRIPTION UNIT PRICE* BID COST Days
{+/-) ARO**
]. 345 Each Analyze soil for TKN (ppm), as $ ��
specified herein.
Analyze soil for Nitrate-
2. 345 Each Nitrogen (ppm) Extractable, as $ . ��C I , Vi •SZ
specified herein.
Analyze soil for Ammonium-
3. 345 Each Nitrogen(ppm) Extractable, as $ '.; 6-b
specified herein.
Analyze soil for Plant available:
4. 345 Each Phosphorus(ppm) Extractable, $ r�. ( -1 Gf,• l�Z y
asspecified herein.
Analyze soil for Potassium
5. 345 Each (ppm) Extractable, as specified $ �I�(I V&e d —
herein. 1 h t.*-
Analyze
Analyze soil for Sodium (ppm) � -ed
6. 345 Each Extractable, as specified herein. $ ; ►� l ►) e A r
Analyze soil for Magnesium
7. 345 Each (ppm) Extractable, as specified $ l�eto i+ d
r _
herein. u', e A`I
8. 345 Each Analyze soil for Calcium (ppm) $ Ivlc k o A e d
Extractable, as specified herein. ,, L-', v>e #
Analyze soil (saturation paste)
9. 345 Each for Sodium Adsorption Ratio $ L 1, cI vC ,i
(SAR), asspecified herein.
10. 345 Each Analyze soil for EC (uS/cm), as $ 1 �0 tJ�.� 2v LA
specified herein.
Analyze soil Water Ph (standard I tL t o Lk ��1
l 1. 345 Each Units), as specified herein. $
Analyze forage samples for
12. 345 Each moisture, crude protein, Ca, P, $
K, Mg,Na and nitrate-nitrogen,
asspecified herein
3/8/2019 3:38 PM P.6
City of Lubbock Bid ITB 19-14545-JM
Water-soluble: Sodium,
Calcium, and Magnesium:
13. 345 Each Obtained from SAR Water
saturated paste extract, as
specified herein.
14. 345 Each SAR, as specified herein $
�ti�1l►ti;�+_ ��
15. 100 Each Estimated shipping cost per $ ` C
box, as specified herein. y
Total Cost(Items 1-15) $ 1- 6C
*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 Analysis for Soil Samples 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 %,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 FAVORED PRICING: The Bidder certifies that the price quoted is not in excess of the lowest price charged anyone
else, including its most favored 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 tenns, 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 I/ NO
• If you(the bidder)checked YES,the following will apply:
• Govemmental 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.
3/8/2019 3:38 PM p. 7
City of Lubbock Bid ITB 19-14545-JM
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 M 1:A\4 C-S� LAl=V 4tu,na corporation organized under the laws of the State of
!15 1-1 ,or a partnership consisting of or individual trading as
of the City of
Firm:
Address:
City: �, 11f1/1 I'1 State: �ti Zip to !�
Bidder acknowledges receipt of the following addenda:
Addenda No. Addenda No. Addenda No. Addenda No.
Date Date Date Date
M/WBE Firm: --,I Woman Black American Native American
His anic American J. Asian Pacific Americi Other(Specify)
i
BY �� —�`�_ Date: •J - �� C
Autho epresentative-must sign by hand
Officer Name and Title: )
Please Print
Business Telephone Number; IL-. ! J 54 ' 17 7/; FAX: L4 C
E-mail Address: �NP,t r"�J
FOR CITY USE ONLY
Bid Form Item Number(s)Awarded to Above Named Firm/Individual:
Date of Award by City Council (for bids over 550,000): 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.
3/8/2019 3:38 PM
P.8
CERTIFICATE OF INTERESTED PARTIES FORM 3.295
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
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2019-467216
Midwest Laboratories
Omaha, NE United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 03/22/2019
being filed.
City of Lubbock Date Acknowledged:
03/27/2019
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.
19-14545-JM
Analytical testing services for the City of Lubbock,TX.
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
Pohlman, Ken Omaha, NE United States X
Pohlman, Brent Omaha, NE 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 V1.1.39f8039c
i
CERTIFICATE OF INTERESTED PARTIES
FORM 1.295
101`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
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2019-467216
Midwest Laboratories
Omaha, NE United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 03/22/2019
being filed.
City of Lubbock Date Acknowledged:
r
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.
19-14545-JM
Analytical testing services for the City of Lubbock,TX.
4
Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
Pohlman, Ken Omaha, NE United States X
Pohlman, Brent Omaha, NE United States X
r
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is ` \�� �1,�� r�land my date of birth is
My a1,ddress is I L J. 1 . t1`• Ll i Y1 r,'` 11 i �J �, (��.Sfq
(street) (city) (state) (zip code) (country)
y I declare under penalty of perjury that the foregoing is true and correct.
Executed in t \;�;i l.l�ii County, Stat of��+�1 I day of rr 1/,U-1= j r�
}
��=-1 ,on the � ,20
ti (month) (year)
a /
r
Signature of authorized agent of contracting-busi ess entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.39f8039c