HomeMy WebLinkAboutResolution - 2016-R0430 - Contract For ITB - Advanced Stores Company - Automotive Batteries - 12_01_2016Resolution No. 2016-RO430
Item No. 5.16
December 1, 2016
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, ITB 16-13033-KM, Contract 13033 for
Automotive Batteries, by and between the City of Lubbock and Advanced Stores
Company, Inc. dba Advance Auto Parts, of Lubbock, Texas, and any 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 December 1 2016
L"-A�
DANIEL M. POFt, MAYOR
ATTEST:
Rebe ca Garza, City Secret ry
--)
APPROVED AS TO CONTENT:
Scott Snider, Assistant City Manager
APPROVED AS TO FORM:
elli Leisure, Assistant City Attorney
RES.Contract-Nbr 13033 Advance Stores Company Inc dba Advance Auto Parts
11.14.16
Resolution No. 2016-RO430 Contract 13033
City of Lubbock, TX
Automotive Batteries
ITB 16-13033-KM
THIS CONTRACT made and entered into this V day of December, 2016, by and between the City
of Lubbock ("City"), and Advance Stores Company, Inc. dba Advance Auto Parts ("Contractor").
WITNESSETH:
WHEREAS, the City of Lubbock duly advertised for bids for Automotive Batteries 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 Primary contract with said Contractor
covering the purchase and delivery of the said Automotive Batteries.
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 specifications and Contractor's bid, copies of which are attached hereto
and made part hereof, Contractor will deliver to the City, Automotive Batteries and more
specifically referred to as Items One thru Twenty -Two 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 Contractor shall perform the work according to the procedures outlined in the Bid Form
and Specifications attached hereto. The contract shall be for a term of one year, with the option
of two, one year extensions, said date of term beginning upon formal approval. The City does
not guarantee any specific amount of compensation, volume, minimum or maximum amount
of services under this contract.
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 cancelled
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 COVERAGE
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 COMBINED SINGLE LIMIT
GENERAL LIABILITY
® Commercial General Liability ❑ Other General Aggregate 9 5ob�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 Combined Single Limit
❑ Scheduled Autos ❑ Hired Autos Each Occurrence � 5�b4
❑ Non -Owned Autos
EXCESS LIABILITY
❑ Umbrella Form Each Occurrence
Aggregate
GARAGE LIABILITY
❑ Any Auto Auto Only - Each Accident
❑ Each Accident Aggregate
❑ BUILDER'S RISK ❑ 100% of the Total Contract Price
❑ INSTALLATION FLOATER ❑ 100% of the Total Material Costs
❑ POLLUTION
❑ CARGO
® WORKERS COMPENSATION — STATUTORY AMOUNTS OR OCCUPATIONAL MEDICAL AND DISABILITY
® EMPLOYERS' LIABILITY Sri&�ifa
OTHER: 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 primary 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 worker's
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 thirty 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 thirty (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 136' 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 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 b\ the Cite reveals any errors or overpayments
by the City, Contractor shall refund the City the (ull amount of such overpayments within
thirty days of such audit findings. or the City, at its option, reserves the right to deduct such
amounts o�yin�, the Cite from anN payments due Contractor.
10. All funds for pa}-ment h} the City under this contract are subject to the availability of an
annual appropriation for this purpose by the Cit,,. In the event of non -appropriation of funds
by the City Council of the City of Lubbock for 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 I ISC4d year or when the appropriation made for the then -current year
for the goods or services COvcred by this contract is spent, whichever event occurs first. If at
any time funds are nrn appropriated for the continuance of this contract, cancellation shall be
accepted by the Se110r on third (30) days prior n i-Mcn notice, but failure to give such notice
shall be of no effect and the C'it\ shall not be oblivatcd 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 froin the Director of lureltasin,acid Contract Management. Should consent
be given. the Contractor shall insure the Subcontractor or shall provide proof of insurance
from the Subcontractor that complies with all conu-act Insurance requirements.
12. This Contract consists ot'the 101loN ing documents sct li}rth herein, Invitation to Bid No. 16-
13033-KM. Specifications. and the Bid Form.
IN WITNESS WHEREOF, the parties hereto have caused this Contract to be executed the day and
year first above \�ritten. l SCCLIted in triplicate.
CITY OF LUBBOCK
Daniel M. Pope, ivl or
ATTEST:
�PtI4 - _)�K7
Rebe ca Garza, City Se reta y
APPROVED AS TO CONTENT
:��ft�kt5
CONTRACTOR
Authorized Representative
\J kee.Ae.4r-
Print Name
IiO,q avenue Q
Address
LLx bcnA, Tx 1g t401
City. State, Zip Code
Scott Snider, Assistant City Manager
APP- O V ED AS TO FORM:
Keill Leisure, Assistant City AttorneN
City cf Lubbock
BID FORM
Automotive Batteries
City of Lubbock, TX
ITB No. 16-13033-KM
Bid IrB 16-13033-KM
In compliance with the Invitation to Bid 16-13033-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 16-13033-KM is by reference incorporated in this contract. The Bid Form
must be completed in blue or black ink or by typewriter.
ITEM
QTY
(mareor less)
UNIT OF
MEASURE
DESCRIPTION
BCI GROUP NUMBER
UNIT PRICE•
BID
Extended
Cost
AGM
BID**
(if available)
Delivery
Days
ARO"•
1.
6
EA
Group U-1 Batteries
g, 9
ll 3 g
S'qm e
2.
2
EA
Group 22F Batteries
go -11
3.
2
EA
Group 22NF Batteries
ss.-�Lg
i Vs
4.
10
EA
Group 34 Batteries
q 3. 5 s
q 3 S. So
5.
2
EA
Group 34R Batteries
4 W. L17
qb.qq
6.
2
EA
Group 27 Batteries
565
1110
7.
2
EA
Group 58 Batteries
37.33
-
8.
23
EA
Group 78 Batteries
4 3 _ 5
11 a3 S
9.
12
EA
Group 65 Batteries
4 _f Q 7
5%? .19
10.
2
EA
Group 75 Batteries
3 Q ,
*79`?
it.
30 SAE
EA
Group 3 1 A Top Post
9 .
a 53.Y
12.
100
EA
Group 31 C Threaded Stud
r.
9 1,7
13.
2
EA
Group 8D Batteries
q7, 3
ae4.?$
14.
3
EA
Group 4DLT Batteries
3 I j . 5a
15.
10
EA
Group 4D Batteries
. a
!Ra•so
16.
6
EA
Group 3EH Batteries
5, 0
45'�•ab
17.
100
EA
Group H-6 Batteries
18.
20
EA
Group 35 Batteries
3 '7, $ 3
75L
19.
5o
EA
Group H-7/94R Batteries
/_ 0 , 6, 9
3, 03,5
20.
22
EA
Group 86 Batteries
4 I - [ 1 1
111
'
9=016 7:13 AM P. a
City of Lubbock
Bld ITS 16-13033-KM
QTY
UNIT OF
DESCRIPTION
UNIT PRICE•
Extended
AGM BID
Delivery
ITEM
(moreor less)
MEASURE
BCI GROUP NUMBER
BID
Cost
(ifavaiiabie)
Days
ARO••
21.
lb
EA
Group 31T Batteries
8'. 33
101, a
T t
d
22.
l0
EA
Group 48 Batteries
C p , I
sglwl
g av-,c
TOTAL (1-22)
3
*PRICE: F.O.B. Destination, Freight Pre -Paid and Allowed **AGM Absorbent Glass Mat
• • • Days After Receipt of Order (ARO) Total $28, 988.65
Unless otherwise specified herein, the City may award the bid either item-byAtem 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 Automotive Batteries 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 oZ %, neiLO 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 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 productslservices; 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 some
product(s) at the lower price(s) on all deliveries made during the period in which such lower price(s) is effective.
1NTERLOCAL 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
District, South Plains Association of Governments, City of Texarkana, Texas Tech University, West Texas
Municipal Power Agency, Lynn County, and City of WolRorth.
YESNO
• If you (the bidder) checked YES, the following will apply:
• Governmental 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. 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.
9=016 7:13 AM p. 7
City of Lubbock
Bid ITB 16-13033-KM
THIS BID IS SUBMITTED BY AAV ID Ce 5"0«S a
Vfl, or a partnership consisting of
corporation organized under the laws of the State of
i of the City of
Firm: hc-I vati'G e- A-u+o Pn r4S
or individual trading as
Address: 110 a V e n U -e- Q City: G l A 6 o c wZ State: -TX zip 71
Y Q 1
Bidder acknowledges receipt of the following addenda:
Addenda No. Date %
Addenda No. Date sf 3t ao r c,
Addenda No. Date
Addenda No. Date
M/WBE Firm;
Woman I I Black American I I Native American
Hispanic American I I Asian Pacific Americj I Other (Specify)
Any entity or person that manufactures, distributes, converts new motor vehicles (or represents an entity that manufactures,
distributes, or converts new motor vehicles) or is in the business of buying, exchanging, or selling new motor vehicles is
required under the Tex. Occ. Code. Chapter 2301 to be licensed by Motor Vehicle Division of the Texas Department of
Transportation. In order for a bid to be in compliance with the Motor Vehicle Commission Code, the bidder must hold and
provide all applicable current valid licenses issued by the State of Texas:
1. Name and Manufacture's License No.
2. Name and Converter's License No.
3. Name and Representative's License No.
4. Name and Franchise Dealer's License No.
General Distin uishing No. N/� (Franchised TX dealer)
By Date: q _ j I_
Authorized Representative - must sign by hand
Officer Name and Title: Rn bet' . L ke-t e c- S U l Co YYl ng e rc t'a
Please Print �t / q
Business Telephone Number S (� �P q % 2I— V k� FAX: 91 / 3 0/ yQ
E-mail Address: 1 aurQ �/LJY12 CO- c dyanCe—Q,a O. C.01rV%
FOR CITY USE ONLY
Bid Form Item Number(s) Awarded to Above Named Firm/]ndividual:
Date of Award by City Council (for bids over $50,000): 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.
9/2/2016 7:13 AM P. 8
City of Lubbock
Bid ITB 16-13033-KM
City of Lubbock
Specifications
ITB 16-13033-KM
Automotive Batteries
It is the intent of these specifications, referenced documents, requirements and conditions section to
describe minimum specifications. The batteries shall meet or exceed the construction and performance
specifications described in the following minimum specifications. The seller shall be required to mark
compliance or non-compliance to each item of the specifications in the space provided. All items
furnished, as standard by the manufacturer to general public shall be included, even if it is not stated in
the written specifications. Any deviations from the written specifications shown in the invitation to bid
shall be noted on the attached exceptions to the specifications. In order to receive full consideration,
quotation must follow these specifications and the invitation to bid's terms and conditions.
No. Item
Minimum Requirements
Seller Compliance
Yes No
General These specifications describe the City of Lubbock's
1. Battery
1.1 Battery C.C.A.
1.2 Battery R.0
requirements for wet cell batteries. These batteries
will be used in light vehicles, trucks and heavy
specialized equipment. All quantities are based on
historical usage. Quantities order may vary for
each Battery Council International (BCI)
battery group number. Bid price quoted shall
include all special fees that apply to each battery.
Batteries will be fully charged with a minimum of
12.6 volts for 12 volt batteries. No reconditioned
or blemish batteries will be accepted.
All batteries must meet or exceed the cold
cranking amps (C.C.A.) Specification at zero
degrees F. The number of amps a battery
can deliver at zero degrees and not drop
below 7.2 volts for thirty seconds.
All battery must meet or exceed the reserve
capacity specification at eighty degrees F.
reserve capacity, the number of minutes a
fully charged battery can be discharged at
25 amps until the voltage falls below 10.5 volts.
29
t
y
9/2/2016 7:13 AM p. 31
City of Lubbock
Bid ITB 16-13033-KM
City of Lubbock
Specifications
ITB 16-13033-KM
Automotive Batteries
No. Item Minimum Requirements Seller Compliance
Yes No
1.3 Battery Label Supplier shall date mark each battery when
delivered to the City of Lubbock.
All batteries shall have a punch out
date label. All batteries shall have
date of manufacturer imprinted on
battery case.
1.4 Battery Stock Supplier shall check freshness of batteries
in stock once a week and stock levels.
Supplier shall rotate battery stock,
when making deliveries of new batteries.
1.5 Battery Freshness To maintain a fresh battery stock, supplier shall
1.6 Battery Warranty
replace batteries not sold after 90 days of
delivery. V
Batteries shall have a minimum of 18 month
100% free replacement warranty, from date of
installation. All defective batteries after
18 month warranty period, shall be prorated
for the remaining warranty months and a credit
invoice shall be issued to the City of Lubbock. All
battery warranty claims shall be handle weekly by
local supplier. Defective batteries returned for
warranty, may be verified by supplier.
any battery that is considered good, by supplier, shall
be returned to the City of Lubbock Part's
Department at no cost.
30
9/2/2016 7:13 AM p. 32
City of Lubbock
Bid frB 16-13033-KM
Item
City of Lubbock
Specifications
ITB 16-13033-KM
Automotive Batteries
Minimum Requirements
1.7 Battery Order Supplier shall accept purchase order numbers,
or credit cards, for battery purchases.
Battery orders placed by phone shall be delivered
within one hour after order has been placed.
All batteries shall be delivered to the City of
Lubbock, Parts Department, 204 Municipal Drive.
All battery cores shall be picked -up at the same
time new batteries are delivered. Supplier shall
not charge any core charge on batteries. Supplier
shall pick up and disposed of all used battery cores,
located in the Parts Department.
1.8 Battery Invoicing An invoice or delivery ticket shall be included
with any battery purchased. The invoice or delivery
ticket shall include; battery part number, unit price,
total price, and the city's purchase order number.
For purchases using a purchase order number,
supplier shall send an original invoice to;
City of Lubbock,
Accounting Department
P.O. Box 2000
Lubbock, TX 79457
for payment.
Seller Compliance
Yes No
1.9. Battery Credit A separate credit invoice shall be issued for
any battery credits. No invoice will be accepted
with credits and debits on the same invoice.
31
9/2/2016 7:13 AM p. 33
City of Lubbock
Bid ITB 16-13033-KM
City of Lubbock
Specifications
ITB 16-13033-KM
Automotive Batteries
No. Item Minimum Requirements Seller Compliance
Yes No
2.0 Battery Not Listed Supplier shall apply other
battery purchases not listed on bid.
List shall meet the same requirements and
specifications as above. Supplier shall apply
the same discount and warranty to these /
purchases.
2.1 Catalog Supplier shall furnish a battery application
guide and battery specification with bid.
32
9/2/2016 7:13 AM p. 34
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 0f 1
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:
2016-113088
Date Filed:
09/16/2016
Date Acknowledged:
11/03/2016
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Advance Stores Company Inc.
Roanoke, VA 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 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.
ITB 16-13033-KM
Automotive batteries
4
Name of Interested Party
City, State, Country (place of business)
Nature of interest
(check applicable)
Controlling
I Intermediary
5
Check only if there is NO Interested Parry.
X
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 I 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 V1.0.2, t
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
l of l
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.
2016-113088
Advance Stores Company Inc.
Roanoke, VA United States
Date Filed:
0911612016
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.
ITB 16-13033-KM
Automotive batteries
4
Nature of interest
Name of Interested Party
City, State, Country (place of business)
(check applicable)
Controlling
I intermediary
5 Check only if there is NO Interested Party. ❑
X
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
ZBECKO'''%
AFFIX NOTARY S,fi 7 SEAL ABOZJ -',
Sworn to and sribed�efOore me", 4�xthe did !� �'��� 7 k i�e���' this the ul day of t
20 , toViceertify which, witness my hat@ snd seal of office.
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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