HomeMy WebLinkAboutResolution - 2016-R0382 - Contract - Duininck Inc - Asphalt Materials - 10_27_2016Resolution No. 2016-R0382
Item No. 6.19
October 27, 2016
RESOLUTION
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. 13096 for Asphalt Materials, by and between
the City of Lubbock and Duininck, Inc., of Roanoke, 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 October 27., 2016
DANIEL M. POPE, MAYOR
ATTEST:
I-"+, a.
Rebecca Garza, City Secretary
OVED AS TO CONTENT:
in, P.E., Director —of Public Works
APPROVED AS TO FORM:
Kell Leisure, Assistant City Attorney
RES.Contract-Nbr-13096, Duininck, Inc
I0.7.16
Resolution No. 2016-R0382
CITY OF LUBBOCK, TX
CONTRACT FOR SERVICES
FOR ASPHALT MATERIALS
CONTRACT NO. 13096
THIS CONTRACT made and entered into this 27th day of October, 2016, by and between the City of
Lubbock ("City"), and Duininck, Inc., ("Contractor").
WITNESSETH:
WHEREAS, the City of Lubbock duly advertised for bids for Asphalt Materials and bids were received
and duly opened as required by law; and
WHEREAS, after careful consideration of the bid submitted by Contractor, the City of Lubbock has
heretofore adopted a resolution authorizing the acceptance of such bid, and the execution, in the name of the City
of Lubbock a contract with said Contractor covering the purchase and delivery of the said Asphalt Materials.
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 specifications and bid are
attached hereto and made part hereof, Contractor will deliver to the City, Asphalt Materials, and more
specifically referred to as Tertiary provider for items I thru 7 on the bid form 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. The rates may be adjusted upward or downward every six (6) months at
a percentage not to exceed the effective change in the Consumer Price Index (CPI) or Product Price Index
(PPI), whichever is most appropriate for the specific contract for the previous six (6) months. Written
consent from both parties is required for all price adjustments. At the City's discretion, the effective
change rate shall be based on either the local or national index average rate for all items. If agreement
cannot be reached, the contract is terminated at the end of the current contract period. 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.
4. This contract shall remain in effect until the expiration date, performance of services ordered, or
termination of by either party with a thirty (30) day written notice. Such written notice must state the
reason for cancellation. 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 old 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. At any time during the term of the contract, or thereafter, the City,
or a duly authorized audit representative of the City, 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 the
Contract. In the event such an audit by the City reveals any errors or overpayments by the City, Contractor
shall refund the City the full amount of such overpayments within thirty (30) days of such audit findings,
or the City, at its option, reserves the right to deduct such amounts owing the City from any payments due
Contractor.
INSURANCE 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.
INSURANCE COVERAGE REQUIRED
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. 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 ❑ Other
❑ Claims Made ® Occurrence
❑ W/Heavy Equipment
❑ To Include Products of Complete Operation Endorsements
PROFESSIONAL LIABILITY
11
AUTOMOTIVE LIABILITY
® Any Auto
❑ Scheduled Autos
❑ Non -Owned Autos
EXCESS LIABILITY
❑ Umbrella Form
GARAGE LIABILITY
❑ Any Auto
❑ BUILDER'S RISK
❑ INSTALLATION FLOATER
❑ POLLUTION
❑ CARGO
❑ 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 $
Combined Single Limit
Each Occurrence $1 00 0
Each Occurrence
Aggregate _
Auto Only - Each Accident
Each Accident Aggregate
❑ 100% of the Total Contract Price
❑ 100% of the Total Material Costs
® WORKERS COMPENSATION —STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY
® EMPLOYERS' LIABILITY $1 OQ. 0000
COPIES OF ENDOSEMENTS ARE REQUIRED
® City of Lubbock named as additional insured on Auto/General Liability on a primary and non-contributory basis.
® To include products of completed operations endorsement.
® Waiver of subrogation in favor of the City of Lubbock on all coverages, except
The City of Lubbock shall be named as an additional insured on a orimary and non-contributory basis and
shall include a waiver of subrogation in favor of the City on all liability coverage's except professional
liability. A waiver of subrogation will be required on workers comp coverages. All Copies of the
Certificates of Insurance and all applicable endorsements are required.
ADDITIONAL POLICY ENDORSEMENTS
The City shall be entitled, upon request, and without expense, to receive copies of the policies 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.
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 and Contract Management
City of Lubbock
1625 131h 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 anytime during the term of the contract, or thereafter, the City, or a duly authorized audit representative
of the City or the State of Texas, at its expense and at reasonable times, reserves the right to audit
Contractor's records and books relevant to all services provided to the City under this Contract.
In the event such an audit by the City reveals any errors or overpayments by the City, Contractor shall
refund the City, the full amount of such overpayments within thirty 30 days of such audit findings, or the
City, at its option, reserves the right to deduct such amounts owing the City from any payments due
Contractor.
10. All finds 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 nonappropriation 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 oil 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 proofof insurance from the Subcontractor that
complies with all contract insurance requirements
12. This Contract consists of the following documents set forth herein; Invitation to Bid 16-10310-KM 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:
DANIEL M. POP . Mayor
9TEST:
�*- -Ra
Rebecca Garza, City ecretary
APPROV 'D AS TO CONTEN
L. ood Fran li , .E ireetor of Public Works
APPROVED AS TO FORM:
lml�
Kelli L isure, Assistant City Attorney
CONTRACTOR:
By
:horli
Ad Representative's C;anature
_�.�a
Print Name ++
L& l%d ! w G)— `N C .
t-t 7 o t N. a I g, ,, t!,,_ 3 7"7
Address
F.710 n K-C— , 7)C 76 2 (cZ
City, State, Zip Code
Cfty of Lubbodc BW rrB 16-13010-KM
BID FORM
Asphalt Materials
City of Lubbock, Texas
ITB 16-13010-KM
In compliance with the Invitation to Bid 16-13010-KM, the undersigned Bidder having examined the invitation to Bid and
Specifications, and being familiar with the conditions to be met, hereby submits the following Bid for furnishing the
material, equipment, labor and everything necessary for providing the items listed below and agrees to deliver said items at
the locations and for the prices set forth on this form. A bid will be subject to being considered irregular and may be
rejected if it shows omissions, alterations of form, conditional alternate bids, additions or alternates in lieu of the items
specified, if the unit prices are obviously unbalanced (either in excess of or below reasonably expected values), or
irregularities of any kind. The Invitation to Bid 16-13010-KM is by reference incorporated in this contract. The Bid Form
must be completed in blue or black Ink or by typewriter.
QTY
UNIT OF
UNIT PRICE*
EXTENDED
Delivery
ITEM
(+/-)
MEASURE
DESCRIPTION
BID
(B)
COST
=(A X B)
Days
ARO**
A
1.
500
TN
Asphalt Stabilized Base
S gO ! ll
gO,OdO �'3
3
Black Base/TxDOT Item 292
2.
3,500
TN
TxDOT Hot Mix Type C
9O. J 11
3151006.E
3
3.
3,500
TN
g S. 4-'*
33a,Goo.°°
3
TxDOT Hot Mix Type D
4.
2,000
TN
TxDOT Hot Mix Type C (to include price
100. 007.001C:10
to deliver on -site
5.
2,000
TN
TxDOT Hot Mix Type D (to include price
0� °
210&W �°
'
3
to deliver on -site
6.
500
'IN
Cold Mix PM Type or Equal)
ao
l�� '
SZsaO re
3
7.
200
TN
110. c o
2 Z�Dode
3
Bull Mix
Certified MU 30 Prme Oil
'
TxDOT Certified CSS I-H Tack Oil'
****Note: All Hot Mix will be made with PG Grade Asphalt
G 64/22 or 64/28 ****
*PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed "Days After Receipt ofOrder (ARO)
Total $1,202,000
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 reserves the right to reject any or all bids, reject any particular item on a quote, and to waive
immaterial formalities.
PAYMENT TERMS AND DISCOUNTS -Bidder offers a prompt payment discount of NIA %, 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.
S: Purchase/Bid DocsUB 16-130I0-KM Asphalt Materials
4
8/17/2016 3:01 PM P. a
City of Lubbock Bid ITB 16-13010-KM
MOST FAVOURED PRICING: The Bidder certifies that the price quoted is not in excess of the lowest price charged
anyone else, including its most favoured customer, for like quality and quantity of the products/services; does not include an
element of profit on the sale in excess of that normally obtained by the Bidder on the sale of products/services of like quality
and quantity; and does not include any provision for discounts to selling agents. If at any time during the contract period, the
supplier should sell or offer for sale to any other customer, an equal or less quantity of similar contract products of like or
better quality, at a lower net price(s) than provided herein, supplier agrees to notify the City and sell same product(s) at the
lower price(s) on all deliveries made during the period in which such lowerprice(s) is effective.
INTERLOCAL PURCHASING (optional): The City desires to make available to other local governmental entities of the
State of Texas, by mutual agreement with the successful bidder,and properly authorized interlocal purchasing agreements as
provided for by the Interlocal Cooperation Act (Chapter 791, Government Code), the right to purchase the same services, at
the prices quoted, for the period of this contract. Each bidder shall indicate on the Bid Form in the space provided below if
he/she will honor Political Subdivision orders in addition to orders from the City of Lubbock. Should these other
governmental entities decide to participate in this contract, would you (the bidder) agree that all terms, conditions,
specifications, and pricing would apply?
Other governmental entities that might have Interests in this contract are Frenship Independent School District, Lubbock Housing Authority,
Lubbock County, Lubbock County Hospital District. Lubbock Independent School Dlstrie4 South Plains Association of Governments, City of
Texarkaaa,Tesas Tech University, West Texas Municipal Power Agency, Lynn County, and City or Welifarlb.
YES f NO
• If you (the bidder) checked YES, the followirg will apply:
• Governmental entities utilizing Interlocal Agreements for Cooperative Purchasing with the City of Lubbock will be eligible, but not obligaled,
to purchase materials/services under the contract(s) awarded as a result of this solicitation. All purchases by governmental entities other than
the City of Lubbock will be billed directly to that governmental entity and paid by that governmental entity. City of Lubbock will not be
responsible for another govemmenud entity's debts. Each governmental entity will order their own materials/service as needed.
THIS BID IS SUBMITTED BY QUININCK, INC. a corporation organized under the laws of the State of
fA +,y %e jao*a. , or a partnership consisting of N �A or individual trading as
NIA of the City of N i A
Firm: %vI^*%4%Cy- r SnG-
Address: 4'101 13. 1A W v 3"7'1
City: State: 't"X Zip i6262..
Bidder acknowledges receipt of the following addenda:
Addenda No. Date
Addenda No. Date
M/WBE
By
Au
- must sign by hand
Officer Name and Title- RYAN DUININrx VICE PRESIDENT
Please Print
Business Telephone Number $1-1^ Lk%- 091I b FAX: IfT^ q9 k- 9 S 2.8
E-mail Address: C"C 6cji^;0L.K Q- dul^i,t.,LK. C 0V".,
S: PurchauBid DocMM 16-13010-KM Asphalt Materials
8/17/2016 3:01 PM p. 7
City of Lubbock, TX
Asphalt Materials
Bid Tabulation
October 27, 2016
ITB 16-13010-KM
Asphalt Materials
Item Qty U/M DescriptionNendor
Location
Unit Cost
Extended Cost
1 500 TN Asphalt Stabilized Base (Black Base/TxDOT Item 292)
West Texas Paving, Inc.
Lubbock, TX
S 76
38,000
Duininck, Inc.
Roanoke, TX
80
40,000
West Materials, LLC
Lubbock, TX
80
40,000
Lone Star Dirt & Paving, LTD
Lubbock, TX
85
42,500
Daley's Superior Asphalt Manufacturing, Inc.
Lubbock, TX
86
43,000
Heartland Asphalt Materials, Inc.
Lubbock, TX
No Bid
No Bid
2 3,500 TN TxDOT Hot Mix Type C
West Texas Paving, Inc.
Lubbock, TX
76
266,000
West Materials, LLC
Lubbock, TX
78
273,000
Duininck, Inc.
Roanoke, TX
90
315,000
Lone Star Dirt & Paving, LTD
Lubbock, TX
95
332,500
Daley's Superior Asphalt Manufacturing, Inc.
Lubbock, TX
96
336,000
Heartland Asphalt Materials, Inc.
Lubbock, TX
No Bid
No Bid
3,500 TN TxDOT Hot Mix Type D
West Texas Paving, Inc.
Lubbock, TX
76
266,000
West Materials, LLC
Lubbock, TX
78
273,000
Daley's Superior Asphalt Manufacturing, Inc.
Lubbock, TX
91
318,500
Duininck, Inc.
Roanoke, TX
95
332,500
Lone Star Dirt & Paving, LTD
Lubbock, TX
95
332,500
Heartland Asphalt Materials, Inc.
Lubbock, TX
No Bid
No Bid
2,000 TN TxDOT Hot Mix Type C (to include price to deliver on -site)
West Materials, LLC
Lubbock, TX
83
166,000
West Texas Paving, Inc.
Lubbock, TX
86
172,000
Duininck, Inc.
Roanoke, TX
100
200,000
Lone Star Dirt & Paving, LTD
Lubbock, TX
105
210,000
Heartland Asphalt Materials, Inc.
Lubbock, TX
No Bid
No Bid
Daley's Superior Asphalt Manufacturing, Inc.
Lubbock, TX
No Bid
No Bid
2,000 TN TxDOT Hot Mix Type D (to include price to deliver on -site)
West Materials, LLC
Lubbock, TX
83
166,000
West Texas Paving, Inc.
Lubbock, TX
86
172,000
Duininck, Inc.
Roanoke, TX
105
210,000
Lone Star Dirt & Paving, LTD
Lubbock, TX
105
210,000
Heartland Asphalt Materials, Inc.
Lubbock, TX
No Bid
No Bid
Daley's Superior Asphalt Manufacturing, Inc.
Lubbock, TX
No Bid
No Bid
500 TN Cold Mix (UPM Type or Equal)
West Texas Paving, Inc.
Lubbock, TX
95
47,500
West Materials, LLC
Lubbock, TX
110
55,000
Duininck, Inc.
Roanoke, TX
165
82,500
Heartland Asphalt Materials, Inc.
Lubbock, TX
No Bid
No Bid
Daley's Superior Asphalt Manufacturing, Inc.
Lubbock, TX
No Bid
No Bid
Lone Star Dirt & Paving, LTD
Lubbock, TX
No Bid
No Bid
City of Lubbock, TX
Asphalt Materials
Bid Tabulation
October 27, 2016
Item Qty UIM DescriptionNendor Location Unit Cost Extended Cost
200 TN Bull Mix
Daley's Superior Asphalt Manufacturing, Inc.
Lubbock, TX
85
17,000
West Materials, LLC
Lubbock, TX
85
17,000
West Texas Paving, Inc.
Lubbock, TX
100
20,000
Duininck, Inc.
Roanoke, TX
110
22,000
Heartland Asphalt Materials, Inc.
Lubbock, TX
No Bid
No Bid
Lone Star Dirt & Paving, LTD
Lubbock, TX
No Bid
No Bid
3,000 GAL TxDOT Certified MC 30 Prime Oil
West Texas Paving, Inc.
Lubbock, TX
6
18,000
West Materials, LLC
Lubbock, TX
6
18,000
Lone Star Dirt & Paving, LTD
Lubbock, TX
7
20,250
Duininck, Inc.
Roanoke, TX
No Bid
No Bid
Heartland Asphalt Materials, Inc.
Lubbock, TX
No Bid
No Bid
Daley's Superior Asphalt Manufacturing, Inc.
Lubbock, TX
No Bid
No Bid
3,000 GAL TxDOT Certified CSS 1-H Tack Oil
Heartland Asphalt Materials, Inc.
Lubbock, TX
1.45
4,350
Daley's Superior Asphalt Manufacturing, Inc.
Lubbock, TX
4.25
12,750
West Materials, LLC
Lubbock, TX
4.50
13,500
Lone Star Dirt & Paving, LTD
Lubbock, TX
6.75
20,250
Duininck, Inc.
Roanoke, TX
No Bid
No Bid
West Texas Paving, Inc.
Lubbock, TX
No Bid
No Bid
Item by Item
Heartland Asphalt Materials, Inc. (Item 9 - Primary)
Lubbock, TX
$
4,350
West Texas Paving, Inc. (Items 1-3, 6 and 8 - Primary,
Items 4-5 - Secondary)
Lubbock, TX
979,500
West Materials, LLC (Items 4-5 and 7 - Primary, Items
1-3, 6 and 8 - Secondary)
Lubbock, TX
1,008,000
Duininck, Inc. (Items 1-8 - Tiertary)
Roanoke, TX
1,202,000
Daley's Superior Asphalt Manufacturing, Inc.
Lubbock, TX
727,250
Lone Star Dirt & Paving, LTD
Lubbock, TX
1,168,000
CERTIFICATE OF INTERESTED PARTIES
FORM 1.295
loll
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.
2016-106426
Duininck, Inc.
Roanoke, TX United States
Date Filed:
08/30/2016
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 identity the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
Solicitation ITB 16-13010-KM
Asphalt Stabilized Base, Various Hot Mix Grades, Cold Mix, and other Roadway Construction Products
4
Nature of interest
Name of Interested Party
City, State, Country (place of business)
(check applicable)
Controlling
Fintermediary
5 Check only if there is NO Interested Party. 1771
X
6 AFFIDAVfT \\\���L. � H U/? I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
Y PVe�7''
'Z
n _
�n CO c
�91F OF +� Signature of authorized agent of contracting business entity
AFFIX NOTA'1 A;W� % j0E
\00VE
���/lllllllll\I���
Swom to and subscribed before me, by the said �`�a'� ��`"`^ C.k , this the i SV day of 5C %!W «,
20(o , to certify which, witness my hand and seal of office.
13.--11 1 � Z= BARRY HUIZENGA CONTRACT MANAGER
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277
CERTIFICATE OF INTERESTED PARTIES
FORM 1.295
loll
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:
2016-106426
Date Filed:
08/30/2016
Date Acknowledged:
11/01/2016
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Duininck, Inc.
Roanoke, TX United States
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
3 Provide the identification number used by the govemmental entity or state agency to track or identity the contract, and provide a
description of the services, goods, or other property to be provided under the contract.
Solicitation ITB 16-13010-KM
Asphalt Stabilized Base, Various Hot Mix Grades, Cold Mix, and other Roadway Construction Products
Party
4 Name of Interested Pa
City, State, Count lace of business
ty, Country (p )
Nature of interest
(check applicable)
Controlling
I Intermediary
5 Check only if there is NO Interested Party. a
6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said this the day of
20 , to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.277